Research Article
BibTex RIS Cite

Demographics and Clinical Features of Children with Functional Neurological Symptom Disorder/Conversion Disorder: A retrospective cross-sectional study

Year 2021, Volume: 54 Issue: 3, 360 - 365, 01.01.2022
https://doi.org/10.20492/aeahtd.848081

Abstract

Objective: Functional Neurological Symptom Disorder (FNSD) known as conversion disorder is physical manifestation of psychological stress. This study aimed to investigate demographics and clinical features of conversion disorder in children through data obtained by examining records of patients diagnosed with conversion disorder.

Material and Methods: Forty-four patients, aged with 4-17 years, who were followed up from Atatürk University Medical Faculty Hospital pediatric neurology and child and adolescent psychiatry outpatient clinics were included in study. Clinical data of the sample including sociodemographic characteristics, clinical conditions, and treatment responses obtained from file records of cases in pediatric neurology and child and adolescent psychiatry clinics were retrospectively examined.

Results: Of cases, 29 were female (65.9%), and 61.8% (n = 21) lived in rural areas. Factors that triggered conversion in 41.2% were school/ learning stressors, in 23.5%, they were loss/divorce /death. Rate of a visit to doctor in first attack was 88.4%. 61.4% (n=27) of patients who visited doctor presented to emergency department in their first attack and hospitalized at pediatric clinic. 40.9% of cases had conversion type with accompanying attacks or convulsions. Comorbid psychiatric disorders were found in 50% of cases. The time until diagnosis was significantly shorter in patients who had been taken to doctor in first attack, compared to those who had not. While 85.7% of conversion cases lasting for more than 6 months persisted, 90% of conversions that lasted less than 6 months recovered.

Conclusions: Conversion disorder is mostly manifested by neurological symptoms and signs. Chronicity can be prevented by early diagnosis and treatment of these patients.

Supporting Institution

-

Project Number

-

Thanks

None

References

  • REFERENCES 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013.
  • 2. Mink JW. Conversion disorder and mass psychogenic illness in child neurology. Ann N Y Acad Sci. 2013 Nov;1304:40-4. doi: 10.1111/nyas.12298. Epub 2013 Oct 18. PMID: 24138153.
  • 3. Carson AJ, Brown R, David AS, Duncan R, Edwards MJ, Goldstein LH, et al. Functional (conversion) neurological symptoms: research since the millennium. Journal of neurology, neurosurgery, and psychiatry 2012;83:842-50.
  • 4. Kerimoğlu E, Yalın A (1992) Obsessive-compulsive disorder and hysteria (conversion reaction) in children. Journal of Ankara Medical School, 14(1): 11-18.
  • 5. Avcı A, Aslan H (1995) Çocuklarda obsesif kompulsif bozukluk ve konversiyon bozukluğu: Karşılaştırmalı bir klinik çalışma. Türk Psikiyatri Dergisi, 6(1): 49-53
  • 6. Kozlowska K, Nunn KP, Rose D, Morris A, Ouvrier RA, Varghese J. Conversion disorder in Australian pediatric practice. Journal of the American Academy of Child and Adolescent Psychiatry 2007;46:68-75.
  • 7. Kala S. Konversiyon Bozukluğu Tanısı Konan Ergenlerde Yüz İfadelerinin, Duygu Tanımlama Becerilerin ve İlişkili Etmenlerin Değerlendirilmesi. Hacettepe Üniversitesi Tıp Fakültesi, Çocuk Psikiyatri Departmanı. Yayımlanmamış Uzmanlık Tezi, Ankara. 2015.
  • 8. Pehlivantürk B, Unal F. Conversion disorder in children and adolescents: a 4-year follow-up study. Journal of psychosomatic research 2002;52:187-91.
  • 9. Özen Ş, Özbulut Ö, Altındağ A, Arıcıoğulları Z. Acil serviste konversiyon bozukluğu tanısı konan hastaların sosyodemografik özellikleri, stres faktörleri, I. ve II. eksen eştanıları. Türkiye’de Psikiyatri 2000;2:87-96.
  • 10. Srinath S, Bharat S, Girimaji S, Seshadri S. Characteristics of a child inpatient population with hysteria in India. Journal of the American Academy of Child & Adolescent Psychiatry 1993;32:822-5.
  • 11. Uguz S, Toros F. [Sociodemographic and clinical characteristics of patients with conversion disorder]. Turk psikiyatri dergisi = Turkish journal of psychiatry 2003;14:51-8.
  • 12. Şar V, Akyüz G, Kundakçı T, Kızıltan E, Doğan O. Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry 2004;161:2271-6.
  • 13. Pehlivantürk B, Unal F. Conversion disorder in children and adolescents: clinical features and comorbidity with depressive and anxiety disorders. The Turkish journal of pediatrics 2000;42:132-7.
  • 14. Elliott BJ, Huppert FA. In sickness and in health: associations between physical and mental well-being, employment and parental status in a British nationwide sample of married women. Psychol Med 1991;21:515-24.
  • 15. Williams B, Jalilianhasanpour R, Matin N, Fricchione GL, Sepulcre J, Keshavan MS, et al. Individual differences in corticolimbic structural profiles linked to insecure attachment and coping styles in motor functional neurological disorders. J Psychiatr Res 2018;102:230-7.
  • 16. Campo JV, Fritsch SL. Somatization in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry 1994;33:1223-35.
  • 17. Bakvis P, Roelofs K, Kuyk J, Edelbroek PM, Swinkels WA, Spinhoven P. Trauma, stress, and preconscious threat processing in patients with psychogenic nonepileptic seizures. Epilepsia 2009;50:1001-11.
  • 18. Wyllie E, Glazer JP, Benbadis S, Kotagal P, Wolgamuth B. Psychiatric features of children and adolescents with pseudoseizures. Arch Pediatr Adolesc Med 1999;153:244-8.
  • 19. Dickson JM, Peacock M, Grünewald RA, Howlett S, Bissell P, Reuber M. Non-epileptic attack disorder: the importance of diagnosis and treatment. BMJ Case Rep 2017;2017:bcr2016218278.
  • 20. Gelauff J, Stone J. Chapter 43 - Prognosis of functional neurologic disorders. In: Hallett M, Stone J, Carson A, editors. Handb Clin Neurol 139: Elsevier; 2016. p. 523-41.
  • 21. Duncan R, Razvi S, Mulhern S. Newly presenting psychogenic nonepileptic seizures: Incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav 2011;20:308-11.
  • 22. Häfner H, Nowotny B. Epidemiology of early-onset schizophrenia. Eur Arch Psychiatry Clin Neurosci 1995;245:80-92.
  • 23. Rosebush PI, Mazurek MF. Treatment of conversion disorder in the 21st century: have we moved beyond the couch? Current treatment options in neurology 2011;13:255-66.
  • 24. Watson C, Sivaswamy L, Agarwal R, Du W, Agarwal R. Functional Neurologic Symptom Disorder in Children: Clinical Features, Diagnostic Investigations, and Outcomes at a Tertiary Care Children's Hospital. J Child Neurol 2019;34:325-31.

İşlevsel Nörolojik Semptom Bozukluğu/Konversiyon Bozukluğu Tanılı Çocukların Demografik ve Klinik Özellikleri: Geriye-dönük kesitsel bir çalışma

Year 2021, Volume: 54 Issue: 3, 360 - 365, 01.01.2022
https://doi.org/10.20492/aeahtd.848081

Abstract

Amaç: Konversiyon bozukluğu, psikolojik stresin fiziksel yollarla kendini ortaya koymasıdır. Bu çalışmanın amacı, konversiyon bozukluğu tanılı hastaların kayıtlarının incelenmesiyle elde edilen demografik ve klinik veriler aracılığıyla çocuklarda konversiyon bozukluğunun özelliklerini araştırmaktır.

Gereç ve Yöntemler: Yaşları 4-17 arasında değişen, Atatürk Üniversitesi Tıp Fakültesi Hastanesi Çocuk Nöroloji ve Çocuk Psikiyatri polikliniğinden konversiyon bozukluğu tanısı ile takipli olan 44 olgu çalışmaya alınmıştır. Olguların çocuk nöroloji ve çocuk psikiyatri kliniklerindeki dosya kayıtları geriye dönük incelenerek elde edilen sosyodemografik özellikleri, klinik durumları ve tedavi yanıtları gibi klinik veriler irdelenmiştir.

Bulgular: Olguların %65,9’u (n=29) kız olmakla birlikte %61,8’i (n=21) kırsal alanda yaşamaktadır. %41,2’sinin konversiyonu tetikleyen faktörleri okul/öğrenme stresörleri iken, %23,5’inin ise kayıp/boşanma/ölümdür. İlk atakta doktora başvuru oranı %88,4’tür. Doktora başvuran olguların %61,4’ü (n=27) ilk atağında acile başvururken, olguların aynı oranda da pediyatri kliniğine yatışları yapılmıştır. Konversiyon alt tipleri açısından olguların %40,9’u ataklarla veya katılmalarla giden tiptir. Olguların %50’sinde komorbid psikiyatrik rahatsızlık saptanmıştır. Tanı alana kadar geçen süre ilk atakta doktora götürülen olgularda, doktora götürülmeyen olgulara kıyasla anlamlı olarak daha kısadır. 6 aydan uzun süren konversiyon vakalarının %85,7’si sebat ediyorken, 6 aydan kısa süren konversiyonların %90’ı düzelmiştir.

Sonuç: Konversiyon bozukluğu daha çok nörolojik semptom ve bulgularla kendini göstermektedir. Bu hastaların erken tanı ve tedavisi ile kronikleşmenin önüne geçilebilir.

Project Number

-

References

  • REFERENCES 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013.
  • 2. Mink JW. Conversion disorder and mass psychogenic illness in child neurology. Ann N Y Acad Sci. 2013 Nov;1304:40-4. doi: 10.1111/nyas.12298. Epub 2013 Oct 18. PMID: 24138153.
  • 3. Carson AJ, Brown R, David AS, Duncan R, Edwards MJ, Goldstein LH, et al. Functional (conversion) neurological symptoms: research since the millennium. Journal of neurology, neurosurgery, and psychiatry 2012;83:842-50.
  • 4. Kerimoğlu E, Yalın A (1992) Obsessive-compulsive disorder and hysteria (conversion reaction) in children. Journal of Ankara Medical School, 14(1): 11-18.
  • 5. Avcı A, Aslan H (1995) Çocuklarda obsesif kompulsif bozukluk ve konversiyon bozukluğu: Karşılaştırmalı bir klinik çalışma. Türk Psikiyatri Dergisi, 6(1): 49-53
  • 6. Kozlowska K, Nunn KP, Rose D, Morris A, Ouvrier RA, Varghese J. Conversion disorder in Australian pediatric practice. Journal of the American Academy of Child and Adolescent Psychiatry 2007;46:68-75.
  • 7. Kala S. Konversiyon Bozukluğu Tanısı Konan Ergenlerde Yüz İfadelerinin, Duygu Tanımlama Becerilerin ve İlişkili Etmenlerin Değerlendirilmesi. Hacettepe Üniversitesi Tıp Fakültesi, Çocuk Psikiyatri Departmanı. Yayımlanmamış Uzmanlık Tezi, Ankara. 2015.
  • 8. Pehlivantürk B, Unal F. Conversion disorder in children and adolescents: a 4-year follow-up study. Journal of psychosomatic research 2002;52:187-91.
  • 9. Özen Ş, Özbulut Ö, Altındağ A, Arıcıoğulları Z. Acil serviste konversiyon bozukluğu tanısı konan hastaların sosyodemografik özellikleri, stres faktörleri, I. ve II. eksen eştanıları. Türkiye’de Psikiyatri 2000;2:87-96.
  • 10. Srinath S, Bharat S, Girimaji S, Seshadri S. Characteristics of a child inpatient population with hysteria in India. Journal of the American Academy of Child & Adolescent Psychiatry 1993;32:822-5.
  • 11. Uguz S, Toros F. [Sociodemographic and clinical characteristics of patients with conversion disorder]. Turk psikiyatri dergisi = Turkish journal of psychiatry 2003;14:51-8.
  • 12. Şar V, Akyüz G, Kundakçı T, Kızıltan E, Doğan O. Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry 2004;161:2271-6.
  • 13. Pehlivantürk B, Unal F. Conversion disorder in children and adolescents: clinical features and comorbidity with depressive and anxiety disorders. The Turkish journal of pediatrics 2000;42:132-7.
  • 14. Elliott BJ, Huppert FA. In sickness and in health: associations between physical and mental well-being, employment and parental status in a British nationwide sample of married women. Psychol Med 1991;21:515-24.
  • 15. Williams B, Jalilianhasanpour R, Matin N, Fricchione GL, Sepulcre J, Keshavan MS, et al. Individual differences in corticolimbic structural profiles linked to insecure attachment and coping styles in motor functional neurological disorders. J Psychiatr Res 2018;102:230-7.
  • 16. Campo JV, Fritsch SL. Somatization in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry 1994;33:1223-35.
  • 17. Bakvis P, Roelofs K, Kuyk J, Edelbroek PM, Swinkels WA, Spinhoven P. Trauma, stress, and preconscious threat processing in patients with psychogenic nonepileptic seizures. Epilepsia 2009;50:1001-11.
  • 18. Wyllie E, Glazer JP, Benbadis S, Kotagal P, Wolgamuth B. Psychiatric features of children and adolescents with pseudoseizures. Arch Pediatr Adolesc Med 1999;153:244-8.
  • 19. Dickson JM, Peacock M, Grünewald RA, Howlett S, Bissell P, Reuber M. Non-epileptic attack disorder: the importance of diagnosis and treatment. BMJ Case Rep 2017;2017:bcr2016218278.
  • 20. Gelauff J, Stone J. Chapter 43 - Prognosis of functional neurologic disorders. In: Hallett M, Stone J, Carson A, editors. Handb Clin Neurol 139: Elsevier; 2016. p. 523-41.
  • 21. Duncan R, Razvi S, Mulhern S. Newly presenting psychogenic nonepileptic seizures: Incidence, population characteristics, and early outcome from a prospective audit of a first seizure clinic. Epilepsy Behav 2011;20:308-11.
  • 22. Häfner H, Nowotny B. Epidemiology of early-onset schizophrenia. Eur Arch Psychiatry Clin Neurosci 1995;245:80-92.
  • 23. Rosebush PI, Mazurek MF. Treatment of conversion disorder in the 21st century: have we moved beyond the couch? Current treatment options in neurology 2011;13:255-66.
  • 24. Watson C, Sivaswamy L, Agarwal R, Du W, Agarwal R. Functional Neurologic Symptom Disorder in Children: Clinical Features, Diagnostic Investigations, and Outcomes at a Tertiary Care Children's Hospital. J Child Neurol 2019;34:325-31.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original research article
Authors

Hüseyin Tan 0000-0003-3331-1828

Hakan Öğütlü 0000-0002-1325-446X

Esen Yıldırım Demirdöğen 0000-0002-4650-1164

Handan Alp 0000-0003-4047-0472

Project Number -
Publication Date January 1, 2022
Submission Date December 28, 2020
Published in Issue Year 2021 Volume: 54 Issue: 3

Cite

AMA Tan H, Öğütlü H, Yıldırım Demirdöğen E, Alp H. İşlevsel Nörolojik Semptom Bozukluğu/Konversiyon Bozukluğu Tanılı Çocukların Demografik ve Klinik Özellikleri: Geriye-dönük kesitsel bir çalışma. Ankara Eğitim ve Araştırma Hastanesi Tıp Dergisi. January 2022;54(3):360-365. doi:10.20492/aeahtd.848081