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n_conversion

Conversion disorder

see neurology

Suspected conversion disorder or malingering:

  • the diagnosis of a psychogenic disorder is always a diagnosis of exclusion

conversion disorders:

  • pt is not aware of the lack of organic basis
  • symptoms may be brought on or altered by suggestion
  • history is often vague
  • symptoms may be bizarre & unexplainable by specific anatomic lesions
  • pt's attitude & affect may be inappropriate for the given symptoms

malingering:

  • a conscious & deliberate feigning of an illness or symptom
  • symptoms often fail to fit an organic pattern
  • if involves pain, it may be very difficult to distinguish from the true sufferer:
    • pain may correlate with proximity of staff
    • Mannkopf's sign:
      • examiner induced pressure over a painful area increases HR by 10-30bpm
      • not completely reliable but usually occurs if organic or psychogenic pain but not in malingerers.
  • if involves weakness:
    • Hoover's sign helps verify unilateral muscle weakness:
      • pt lying supine is asked to raise affected leg while the examiner places a hand under the pt's contralateral heel.
      • the pt with organic weakness will exert downward pressure on contralat. heel in attempt to raise the leg.
    • palpate antagonist muscles as contraction strongly suggests malingering
  • try manoeuvres which attempt to confuse the patient, see elsewhere.
n_conversion.txt · Last modified: 2008/11/05 00:29 (external edit)