Conversion disorder refers to a mental health condition that has symptoms that indicate neurological signs such as speech impairment, numbness, paralysis, blindness, and tremors but without any neurological cause, substance abuse or physical disease. These symptoms are preceded by psychological stress or conflicts in life. This disorder is caused by psychological reactions from a highly stressful condition or event. Other psychological disorder and depression are common in patients experiencing conversion disorder (Voon et al, 2010). The condition may take a long period to develop and thus it is crucial for therapists to understand the client’s past life in relation to the contributing factors. People with medical illness, dissociative and personality disorder are at a greater risk of developing this condition.
Conversion disorder is also referred to as hysterical neurosis. The conditions are considered as unfortunate because symptoms are much more common to unsophisticated and uneducated people (Kanaan et al, 2007). The real conversion symptoms are generally an extension or reflection of symptoms seen or experienced bypatient. In most cases, when the symptoms of the disorder arise, a reduction on anxiety level is realized. Close inspection confirms that symptoms are not premeditated but simply happens. Although the observers may have a feeling that there is a purpose behind the symptoms, the patient is usually unaware of any of such things.
Clinical Signs and Symptoms
Although pathophysiologic relevance is not clear, PET scanning has indicated that patients with conversion hemianesthesia or hemiplegia have reduced activation of thalamus and contralateral basal ganglia. This is likely to represent premorbid vulnerability to the advancement of conversion symptoms. On the other hand, it may be unrelated and epiphenomenal to the underlying causes.Most people experience their initial symptoms during early adult or adolescent years. The actual beginning of symptoms is suIDen and usually follows a major stressful event in the patient’s life. Patients with this disorder experience only one symptom at a time.
Signs and symptoms that are inconsistent with information provided by pathophysiology and anatomy characterize the disorder. For instance, a patient may suffer blindness, yet his cortical visual isnormal. Inspection of the symptomatology case corresponds with patient’s conception of the way that illness manifests itself. A patient, who complains of unsteadiness and walking problem, could be having a malady conception though he does not have symptomatology evident upon bedsit examination expected by the physicians (Karin et al, 2005). This means that although the patient may lurch and stumble in an effort to cross from the bed to the chair, no truncal ataxia or deficiency on heel-to-knee-to-shin and finger-to-nose testing. Patients experiencing conversion disorder do not intentionally feign the symptoms as noted with malingerers, but experience themselves as genuine.
Conversion anesthesia can occur in any place though it is more common on the extremities. A typical distribution of “glove and stocking” may appear in a polyneuropathy. Areas for conversion anesthesia tend to have a very sharp and precise boundary, usually located at a joint. Similar sharp boundary for nonphysiologic may appear in conversionhemianesthesia where the boundary precisely and accurately bisects the body along the sagittal plane (Karin et al, 2005). Other anomalies may also appear upon examination. For instance, patients who complain about entire lack of sensory modalities, vibratory sense included, in the foot or hand may nevertheless comprise intact position sense at the toe or index finger. Similarly, patients with similar lack of feelings in the legs are nonetheless indicates a negative Romberg test and are not able to walk normally. This means that when some patients with this disorder are requested to close their eyes and mention the word ‘light’ when they feel something and ‘dark’ when they feel nothing, will reliably say ‘dark’ anytime that the anesthetic areas are touched. The test on deep tendon reflex did not present the expected hyporeflexia.
In uncertain cases, evoked potentials for somatosensory may be helpful. Anesthesia may also appear on the palate and cornea. In conversion paralysis, similar anomalous boundary may be experienced as in conversion anesthesia. For instance, the weakness may spread to the elbow and then end there precisely. Other abnormalities such as ‘a hand that has been weak for many months may limp at the side instead of displaying the expected physiologic flexion posture’seen in conversion hemiplegia. Patients suffering from conversion hemiplegia may experience “wrong-way tongue” sign but have a protruded tongue rather than deviating to the hemiplegic side expected in true hemiplegia (Voon et al, 2010). On observation of gaits, it was found that the weakened leg is not circumducted but it is instead dragged.
Upon formal muscle strength testing in the lower extremities, an effort to bring out Hoover’s sign may be beneficial. When a patient tries to his best to raise an affected leg out of the bed, the examiner feels significant pressure upon the hand below the unaffected leg, in case of weakness that is secondary to a stroke. In case the patient suffers from conversion paralysis, Hoover;s sign is present where the examiner does not realize any pressure on the hand below the affected leg. In aIDition,Babinski sign is absent, in case of conversion paralysis and thus, deep tendon reflexes do not increase. In conversion paraplegia, normal instead of raised deep tendon reflexes are realizedwhere Babinski sign are absent. However, in uncertain cases, the problem may be resolved through demonstrating the potentials of normal motor.
In conversion ataxia, the patient exhibits some unique characteristics. For instance, when such a patient attempts to walk or stand, he staggers and lurches forward, trunk swaying and arms flinging, rushing to the safety of a chair or bed. Conversion tremor is irregular, coarse and most of the time disappears upon distracting the patient. Unlike other forms of conversion, grand mal seizures present multiple anomalies. Their initiation is gradual but suIDen. In case the patient cries out during the onset, intelligible screaming instead of an inarticulate cry may be realized. The period between the conversion seizures varies widely but is generally purposeful. The patient may strike the wall, thrash about, and break furniture in contrast to the simple, rhythmic tonic-clonic activity realized in most grand mal seizures (Voon et al, 2010). During the conversion period, most patients do not develop the behavior of biting their tongue, and the only patients who pass urine are those with considerable medical sophistication. It is notable that most conversion seizures disappear gradually instead of abrupt and later the patient does not indicate signs of somnolence and confusion.
The complex partial type of conversion seizures is difficult to diagnose. One method of differentiating is that true complex partial seizures start with automatisms or motionless stare before development of complex behaviors. Other methods of identifying conversion seizures include post-ictal Babinski sign, post-ictal EEG or positive ictal.In conversion deafness, unexpected loud sound is heard when the reflex blink, therefore demonstrating brain stem intactness (Kanaan et al, 2007). Bilateral conversion blindness is likely to be present in case the patient complaining of blindness has not sustained any form of injury and does not indicate any signs of scrapes or bruises. Monocular conversion blindness is much easier to detect. If in the unaffected eye, the peripheral is full and both eyes have normal papillary response then, this offers a confirmatory signs of this disorder.
Effective treatment and diagnosis of conversion disorder demand a range of clinical skills and assessments in order to understand the patient’s condition and history. The psychologist should create favorable conditions for the patients to explain his immediate circumstances, which includes emotional state, symptoms onset, and family history. To achieve a comprehensive treatment intervention, the five axes of DSM-IV are used (Kanaan et al, 2007). To formulate and conceptualize a treatment for every patient, the three P’s” which means precipitating stressors; predisposition and perpetuating factors are used. Predisposition entails considerations such as experiences and personal factors that create a tendency to somatise. Other crucial considerations include impaired communicative ability such as social inhibitors and underlying neurological and psychiatric disorders. Precipitating stressors includes psychological conflicts such as separation and sexuality issues arising from impending marriage or traumatic events such as sexual abuse and combat. Perpetuating factors refers to the availability of secondary gain as well as the extent to which the symptoms changes to the original problem. Secondary and primary gains turn blurred when the symptoms are multidetermined or achieve a need. Conversion should be considered as a symptom and therefore the aim of an effective treatment should aIDress both the symptoms and causes. The precipitating stressor must be identified to determine the best treatment method.
A systematic theory approach to the treatment of conversion disorder is recommended because it creates room for multidetermined symptoms etiologies and conceptualizes patients in a comprehensive biopsychosocial model. In aIDition, symptom theory promotes multiple coordinated therapeutic activities that aIDress the social, psychological and biological aspect of the patients’ lives. As a clinician, one is expected to choose a modality that is effective to a specific patient based on the most appropriate formulation. The choice for the treatment intervention of a specific patient with a conversion disorder depends on the comprehensive diagnostic formulation.
Role of Nursing in the Treatment of Conversion Disorder
Nurses have a key role to play in the management of this disorder. Before the condition is determined, physical causes should be excluded prior to classifying it as a psychiatric illness. The observations made by nurses are very crucial in evaluating whether the conversion symptoms and signs are part of the mental and physical illness. For instance, if a patient has fits, does it mean he has the disorder or not?Nurses must understand that patients are not aware of the reason behind the prevailing conditions in their body. This means that nurses should have sympathy to the patients and help them recover from the condition. The symptoms disappear in Nacro analysis or Hypnosis, but it is important to deal with the causes as well (Anthony et al, 2005). These patients are in need of strong support from the health care providers in order to regain their insight and develop crucial coping mechanisms.
Before the patients leave the hospital, nurses must ensure their attitude and feeling towards what had caused the disorder has changed. This means that nurses must apply their skills in helping these people change their reasoning and perceptions towards crucial aspects of life. Patients should be trained on the best methods to handle emotional stress and what needs to be done to gain positively from such events. Quality services from the nurses would provide a reassurance and support to patient and thus a significant reduction on the hospital stay.
Nurses have a role in counseling and mentoring the patients with this disorder. The roles that nurses need to play are relevant to the Canadian context, which emphasizes on the relationship between moral distress frequency and intensity with ethical work environment. According to Canadian context, nurses must adhere to the specified nurse ethics, policies and procedures. These interventions may be helpful and relevant to many mental health facilities such as Community Mental Health Teams (CMHT) operating in the United Kingdom (Anthony et al, 2005). This facility treats and support people suffering from mental disorders such as mental health difficulties and illness.
Given a chance, I believe that I would implement these ideas immediately. I would ensure that nurses provide the best health care services to the patients and therefore quick recovery from conversion disorder and other related ailments. In aIDition, I would create favorable environment that would encourage productivity and enhance nurses’ morale in order to deliver the best services. To function at such a managerial post, one must be determined, hardworking and focused towards success in terms of services offered to the patients and nurses’ job satisfaction. One must have considerable managerial and leadership skills to deliver the services effectively. The community agencies, advocacy and government legislation could improve the patients’ life through development of rules, policies, and requirement regulating working ethics. This could ensure that patients receive the best services from the hospital staffs.
Anthony, E. et al. (2005). Antidepressant Treatment Outcomes of Psychogenic Movement Disorder. Journal of Clinical Psychiatry, Vol 66(12), Dec 2005, 1529-1534. Retrieved from doi: 10.4088/JCP.v66n1206
Kanaan, R. et al. (2007). Imaging Repressed Memories in Motor Conversion Disorder.
Journal of Biobehavioral Science.Retrieved from doi: 10.1097/PSY.0b013e31802e4297
Voon, V. et al. (2010). The involuntary nature of conversion disorder. Journal of Neurology. Retrieved fromdoi:10.1212/WNL.0b013e3181ca00e9
Voon, et al. (2010). Emotional stimuli and motor conversion disorder. A journal of Neurological.Retrieved from doi: 10.1093/brain/awq054
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