المؤلفون: Stone, Jon, Sharpe, Michael

المساهمون: Geddes, John R., Andreasen, Nancy C., Goodwin, Guy M.

المصدر: New Oxford Textbook of Psychiatry ; page 1350-1360

الوصف: Conversion disorder (now also called functional neurological symptom disorder) describes symptoms (of motor and sensory dysfunction such as limb weakness, tremor, visual loss, with or without ‘blackouts’), which can be positively identified as being inconsistent with neurological disease. The disorder is common in neurological services and frequently seen by psychiatrists working in such settings. It is often associated with chronic severe disability. The diagnosis previously hinged on the neurologist’s demonstration of the lack of disease and the psychiatrist’s hypothesis of a ‘conversion’ of stress into a physical symptom. It is now based on positive findings on neurological assessment supplemented by a psychiatric assessment to confirm the diagnosis. Comorbid anxiety and depression disorders are common. Treatment is multi-disciplinary. Explanation of the condition to the patient is a crucial initial step supplemented, where necessary, by psychological treatment (especially for dissociative or non-epileptic attacks) and physiotherapy for functional motor symptoms. The prognosis without treatment is poor once the disability is established.

الإتاحة: https://doi.org/10.1093/med/9780198713005.003.0133Test

المؤلفون: Stone, Jon R.

مصطلحات موضوعية: Book Review

وصف الملف: text/html

العلاقة: http://jaar.oxfordjournals.org/cgi/content/short/lft036v2Test; http://dx.doi.org/10.1093/jaarel/lft036Test

الإتاحة: https://doi.org/10.1093/jaarel/lft036Test
http://jaar.oxfordjournals.org/cgi/content/short/lft036v2Test

المؤلفون: Stone, Jon, Warlow, Charles, Sharpe, Michael

مصطلحات موضوعية: Original Articles

الوصف: Functional weakness describes weakness which is both internally inconsistent and incongruent with any recognizable neurological disease. It may be diagnosed as a manifestation of conversion disorder or dissociative motor disorder. Other names include psychogenic or ‘non-organic’ paralysis. We aimed to describe the incidence, demographic and clinical characteristics of cases with functional weakness of less than 2 years duration, and to compare these with controls with weakness attributable to neurological disease. Both cases and controls were recruited from consultant neurologists in South East Scotland. Participating patients underwent detailed assessments which included: physical examination, structured psychiatric interview (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders), measures of symptoms, disability and distress [Short Form (36) Health Survey, Hospital and Anxiety Depression Scale], and assessment of their illness beliefs using an augmented version of the Illness Perception Questionnaire. In total, 107 cases (79% female, mean age 39 years, median duration of illness 9 months) were recruited. This number suggests a minimum annual incidence of 3.9/100 000. Forty-six controls (83% female, median age 39 years, duration 11 months) were also recruited. Compared to controls, cases had similar levels of disability but more physical symptoms, especially pain. They had a higher frequency of psychiatric disorders, especially current major depression (32 versus 7%, P < 0.0001), generalized anxiety disorder (21 versus 2%, P < 0.005), panic disorder (36 versus 13%, P < 0.001) and somatization disorder (27 versus 0%, P < 0001). There was no difference in median self-rated anxiety and depression scores. Paradoxically, they were less likely than controls to agree that stress was a possible cause of their illness (24 versus 56%, P < 0.001). Cases were twice as likely as controls to report that they were not working because of their symptoms (65 versus 33%, P ...

وصف الملف: text/html

العلاقة: http://brain.oxfordjournals.org/cgi/content/short/133/5/1537Test; http://dx.doi.org/10.1093/brain/awq068Test

الإتاحة: https://doi.org/10.1093/brain/awq068Test
http://brain.oxfordjournals.org/cgi/content/short/133/5/1537Test

المؤلفون: Stone, Jon, Carson, A., Duncan, R., Coleman, R., Roberts, R., Warlow, C., Hibberd, C., Murray, G., Cull, R., Pelosi, A., Cavanagh, J., Matthews, K., Goldbeck, R., Smyth, R., Walker, J., MacMahon, A.D., Sharpe, M.

مصطلحات موضوعية: Original Articles

الوصف: It has been previously reported that a substantial proportion of newly referred neurology out-patients have symptoms that are considered by the assessing neurologist as unexplained by ‘organic disease’. There has however been much controversy about how often such patients subsequently develop a disease diagnosis that, with hindsight, would have explained the symptoms. We aimed to determine in a large sample of new neurology out-patients: (i) what proportion are assessed as having symptoms unexplained by disease and the diagnoses given to them; and (ii) how often a neurological disorder emerged which, with hindsight, explained the original symptoms. We carried out a prospective cohort study of patients referred from primary care to National Health Service neurology clinics in Scotland, UK. Measures were: (i) the proportion of patients with symptoms rated by the assessing neurologist as ‘not at all’ or only ‘somewhat explained’ by ‘organic disease’ and the neurological diagnoses recorded at initial assessment; and (ii) the frequency of unexpected new diagnoses made over the following 18 months (according to the primary-care physician). One thousand four hundred and forty-four patients (30% of all new patients) were rated as having symptoms ‘not at all’ or only ‘somewhat explained’ by ‘organic disease’. The most common categories of diagnosis were: (i) organic neurological disease but with symptoms unexplained by it (26%); (ii) headache disorders (26%); and (iii) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow-up only 4 out of 1030 patients (0.4%) had acquired an organic disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients’ original symptoms. Eight patients had died at follow-up; five of whom had initial diagnoses of non-epileptic attacks. Seven other types of diagnostic change with very different implications to a ‘missed diagnosis’ were found and a new classification of diagnostic revision is presented. One-third of new neurology ...

وصف الملف: text/html

العلاقة: http://brain.oxfordjournals.org/cgi/content/short/awp220v1Test; http://dx.doi.org/10.1093/brain/awp220Test

الإتاحة: https://doi.org/10.1093/brain/awp220Test
http://brain.oxfordjournals.org/cgi/content/short/awp220v1Test

المؤلفون: Stone, Jon, Carson, A., Duncan, R., Coleman, R., Roberts, R., Warlow, C., Hibberd, C., Murray, G., Cull, R., Pelosi, A., Cavanagh, J., Matthews, K., Goldbeck, R., Smyth, R., Walker, J., MacMahon, A.D., Sharpe, M.

مصطلحات موضوعية: Original Articles

الوصف: It has been previously reported that a substantial proportion of newly referred neurology out-patients have symptoms that are considered by the assessing neurologist as unexplained by ‘organic disease’. There has however been much controversy about how often such patients subsequently develop a disease diagnosis that, with hindsight, would have explained the symptoms. We aimed to determine in a large sample of new neurology out-patients: (i) what proportion are assessed as having symptoms unexplained by disease and the diagnoses given to them; and (ii) how often a neurological disorder emerged which, with hindsight, explained the original symptoms. We carried out a prospective cohort study of patients referred from primary care to National Health Service neurology clinics in Scotland, UK. Measures were: (i) the proportion of patients with symptoms rated by the assessing neurologist as ‘not at all’ or only ‘somewhat explained’ by ‘organic disease’ and the neurological diagnoses recorded at initial assessment; and (ii) the frequency of unexpected new diagnoses made over the following 18 months (according to the primary-care physician). One thousand four hundred and forty-four patients (30% of all new patients) were rated as having symptoms ‘not at all’ or only ‘somewhat explained’ by ‘organic disease’. The most common categories of diagnosis were: (i) organic neurological disease but with symptoms unexplained by it (26%); (ii) headache disorders (26%); and (iii) conversion symptoms (motor, sensory or non-epileptic attacks) (18%). At follow-up only 4 out of 1030 patients (0.4%) had acquired an organic disease diagnosis that was unexpected at initial assessment and plausibly the cause of the patients’ original symptoms. Eight patients had died at follow-up; five of whom had initial diagnoses of non-epileptic attacks. Seven other types of diagnostic change with very different implications to a ‘missed diagnosis’ were found and a new classification of diagnostic revision is presented. One-third of new neurology ...

وصف الملف: text/html

العلاقة: http://brain.oxfordjournals.org/cgi/content/short/132/10/2878Test; http://dx.doi.org/10.1093/brain/awp220Test

الإتاحة: https://doi.org/10.1093/brain/awp220Test
http://brain.oxfordjournals.org/cgi/content/short/132/10/2878Test

المؤلفون: Stone, Jon, Carson, Alan

المساهمون: Davey, Patrick, Sprigings, David

المصدر: Oxford Medicine Online

الوصف: In this chapter, the focus is on patients who present with physical symptoms, such as weakness, or seizures, which can be positively identified as inconsistent with pathological diseases. These are called functional and dissociative neurological symptoms, although there are many other terms that could be used, such as conversion disorder, psychogenic symptoms, somatization, hysterical symptoms, medically unexplained symptoms, non-organic symptoms, and pseudoseizures, to name a few.

الإتاحة: https://doi.org/10.1093/med/9780199568741.003.0241Test

المؤلفون: Stone, Jon R.

مصطلحات موضوعية: Caribbean and Latin America

وصف الملف: text/html

العلاقة: http://ahr.oxfordjournals.org/cgi/content/short/104/5/1721Test; http://dx.doi.org/10.1086/ahr/104.5.1721Test

الإتاحة: https://doi.org/10.1086/ahr/104.5.1721Test
http://ahr.oxfordjournals.org/cgi/content/short/104/5/1721Test

المؤلفون: Stone, Jon, Carson, Alan

المساهمون: Dworetzky, Barbara A., Baslet, Gaston C.

المصدر: Oxford Medicine Online

الوصف: Patients with dissociative (nonepileptic) seizures (DS) commonly, although not always, present with comorbid somatic and psychological symptoms. This chapter reviews the epidemiology, diagnosis, and treatment of other functional somatic symptoms and disorders in relation to DS with a particular emphasis on other functional neurological symptoms such as movement disorder and sensory disturbance. Clinical assessment is presented as the start of treatment in patients with multiple functional symptoms including DS. The chapter discusses the importance of making a diagnosis of functional disorders, especially those in neurological settings, using positive evidence from the physical examination, such as Hoover’s sign for limb weakness or the tremor entrainment test for tremor. Practical methods of explaining these diagnoses to patients are reviewed, emphasizing the importance of transparency, educational materials, and presenting a model that focuses on mechanism more than etiology. The chapter concludes with a review of the evidence for treatment of a range of functional disorders often comorbid with DS.

الإتاحة: https://doi.org/10.1093/med/9780190265045.003.0018Test

المؤلفون: Carson, Alan, Stone, Jon

المصدر: Oxford Medicine Online

الوصف: Functional neurological symptoms are a common cause of disability and distress in any neurological service. Varying terminology, including hysteria, conversion disorder, dissociative, non-organic, and psychogenic, reflects the shifting nature of medical thinking, over time, regarding these presentations. They also emphasize the importance of a historical understanding when grappling with this area. This chapter traces this history, from Briquet’s monumental treatise on hysteria in 1859 to a randomized controlled trial of non-epileptic seizures in 2010. In the process, familiar figures such as Freud and Janet are encountered and the electrical treatments of Yealland, for hysteria, are re-evaluated. The chapter highlights how the application of functional neuroimaging perhaps raises more questions than it answers, at the current time, but how it has also aided the reawakening of clinical and research interest in this core area of clinical neurology.

الإتاحة: https://doi.org/10.1093/med/9780199658602.003.0004Test

المؤلفون: Stone, Jon R.

المصدر: Oxford Handbooks Online

الإتاحة: https://doi.org/10.1093/oxfordhb/9780195301052.003.0025Test