Received: 20.02.2020; Revision: 09.03.2020; Accepted: 18. 03.2021; Published: 20.03.2021
Dr. Priyadarshini N.C1, Dr. Lovedeep Saini2 and Dr. Satnam Singh3
1Senior Resident, Department of Psychiatry, Gian Sagar Medical College and Hospital, Rmanagar, Rajpura, Punjab, India
2Assistant Professor, Department of Psychiatry, Gian Sagar Medical College and Hospital, Rmanagar, Rajpura, Punjab, India
3Clinical Psychologist, Department of Psychiatry, Gian Sagar Medical College and Hospital, Rmanagar, Rajpura, Punjab, India
Conversion disorders generally affect and are more prevalent in females than males. It is associated with a stressor which is perceived as unmanageable, and the symptoms are generally reflected as means to avoid the stressor. This case report presents a successful intervention with antidepressants and counselling.
Keywords: male conversion, antidepressants, counselling.
As per classification by DSM-IV and ICD-10, the term Hysteria was replaced Conversion Disorder. The typical features consist of neurological deficits, generalised medical condition without any organ city (American Psychiatric Association, A. P. 1994; & World Health Organisation. 2006). It can cause a deficit in the motor/sensory system (such as hemiparesis, loss of vision, and difficulty in swallowing). At times it can present as seizures or be of a mixed kind. It may also present as weakness, hiccups, unresponsiveness and difficulty in speaking. It is quiet a common presentation with more occurrence in females than males.(3)
Patient A , 23, M, was brought to the emergency by family members with chief complaints of unresponsiveness lasting for 2-3hrs.Patient was apparently well 1 day back prior to the incident and had slept well. On waking up in the morning, patient was restless and aloof from his family members. All of a sudden he sat on the bed and thereafter was unresponsive. He was not responding to any verbal communication with his family. Family members also reported that his limbs were limp. Although there was no history suggestive of soiling of clothes, clenching of teeth or jerky movements of limbs.
Patient was seen by a Medicine Consultant in emergency. He was still unresponsive and not responding to any communication. His vitals such as pulse, B.P, respiration were within normal limits. Patient was not responsive for a complete neurological assessment but planters and other reflexes were bilaterally normal. Patient was admitted in the medicine ward and started on treatment. His blood investigations such as CBC, RBS, LFT, RFT, HBA1C, ABG were sent which came out to be normal.
In ward patient became responsive he was conscious and well oriented. The GPE and neurological examination were done and were found to be normal. Patient was also sent for CT Head which turned out to be normal. Family members had reported the presence of a stressor and so psychiatry consultation was done. Patient was intubate which revealed interpersonal stressor in the form of issues with wife were present. Mental Status Examination was done which revealed not abnormality. There was no psychiatric history in the patient or his family. Although one similar episode lasting for 5-10mins was reported by the wife, which had happened following an argument between them and had resolved on its own? No history of any substance abuse was present. Patient was started on treatment and counselling was done. The patient was discharged after 3days. No episodes were reported during his stay in hospital. Patient was reportedly fine on subsequent follow ups and was maintained on treatment and counselling.
There is always a dilemma while diagnosing Conversion Disorder, especially in males. This may be due to the fear of misdiagnosis or misinterpretation of any sign or symptom. The usual symptoms present as paraesthesia, unresponsiveness, inability to speak, hiccups, blindness, jerky movements (Chadda, R.K. 1999; Singh, M. et al., 2013; & Singh, M. et al., 2020). This leads to a substantial delay in diagnosis and further treatment of the patient. A patient being brought to the emergency is usually subjected to investigations before considering any psychopathology; also at times the history being reported by the patient or the accompanying relatives may not contain any conclusive information about any stressor or conflict. Conversion Disorder has prevalence in both genders (males & females). There is a reportedly marked difference regarding its occurrence in both the genders. It is considered to be prevalent more in females as compared to males (Singh, M. et al., 2020; & Mumford, D. B. et al., 2000). The reasons for cause of conflict or stress may also differ in both genders. Issues such as unemployment, financial constrains, familial and related to education are more of concern in males. Whereas, issues such as difficult marriage, problems with in-laws can be considered as more problematic issues in females.
To treat Conversion reaction, we need to consider both pharmacological and psychological approaches. A psychopharmacological approach is considered more effective than either of them alone. Antidepressants (such as SSRI’S) and Anxiolytics (such as Benzodiazepines) considered the treatment of choice along with psychotherapy. A good rapport should be established with the patient at the time of treatment. Interventions such as cognitive behaviour therapy should be applied for thought reconstructuring and behaviour modification. The emotional stressors and issues should be highlighted and discussed. Psychodynamics, Psychotherapy can also be used to address the stressors and conflicts. Acute onset al.,ong with a prominent conflict and an early treatment usually amount to good prognosis. Associated depression longer duration can amount to bad prognosis (Silver, F.W. 1996; Campo, J.V., & Negrini, B.J. 2000; Toone, B.K. 1990; & Bathla, M. et al., 2016).
Gender biased is one of the biggest reasons why Conversion Disorder is missed in males. Furthermore the fear of misdiagnosing amount to the diagnosis getting delayed and also delays in treatment. This can cause a longer period of illness in a patient so a correct and thorough interviewing along with psychopharmacological intervention should be carried out.
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