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    The Art of Handling Conversion

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    tricia isabella
    This document discusses conversion disorder in the emergency room setting. It provides information on the signs and symptoms, diagnostic criteria, differential diagnosis, and treatment approaches for conversion disorder. Key points include: - Conversion disorder involves physical symptoms that cannot be explained by medical factors and are thought to be related to psychological stressors. - Common symptoms include weakness, sensory disturbances, pseudoseizures, and gait abnormalities. Symptoms often lack objective neurological signs. - Diagnosis involves ruling out other medical or neurological conditions and assessing for disproportionate symptoms and inconsistent findings. - Treatment involves both pharmacotherapy like benzodiazepines to relieve symptoms, as well as psychotherapies like CBT to address underlying psychological issues.

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    The Art of Handling Conversion

    Uploaded by

    tricia isabella
    41 views22 pages
    This document discusses conversion disorder in the emergency room setting. It provides information on the signs and symptoms, diagnostic criteria, differential diagnosis, and treatment approaches for conversion disorder. Key points include: - Conversion disorder involves physical symptoms that cannot be explained by medical factors and are thought to be related to psychological stressors. - Common symptoms include weakness, sensory disturbances, pseudoseizures, and gait abnormalities. Symptoms often lack objective neurological signs. - Diagnosis involves ruling out other medical or neurological conditions and assessing for disproportionate symptoms and inconsistent findings. - Treatment involves both pharmacotherapy like benzodiazepines to relieve symptoms, as well as psychotherapies like CBT to address underlying psychological issues.

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    This document discusses conversion disorder in the emergency room setting. It provides information on the signs and symptoms, diagnostic criteria, differential diagnosis, and treatment approaches for conversion disorder. Key points include: - Conversion disorder involves physical symptoms that cannot be explained by medical factors and are thought to be related to psychological stressors. - Common symptoms include weakness, sensory disturbances, pseudoseizures, and gait abnormalities. Symptoms often lack objective neurological signs. - Diagnosis involves ruling out other medical or neurological conditions and assessing for disproportionate symptoms and inconsistent findings. - Treatment involves both pharmacotherapy like benzodiazepines to relieve symptoms, as well as psychotherapies like CBT to address underlying psychological issues.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    41 views22 pages

    The Art of Handling Conversion

    Uploaded by

    tricia isabella
    This document discusses conversion disorder in the emergency room setting. It provides information on the signs and symptoms, diagnostic criteria, differential diagnosis, and treatment approaches for conversion disorder. Key points include: - Conversion disorder involves physical symptoms that cannot be explained by medical factors and are thought to be related to psychological stressors. - Common symptoms include weakness, sensory disturbances, pseudoseizures, and gait abnormalities. Symptoms often lack objective neurological signs. - Diagnosis involves ruling out other medical or neurological conditions and assessing for disproportionate symptoms and inconsistent findings. - Treatment involves both pharmacotherapy like benzodiazepines to relieve symptoms, as well as psychotherapies like CBT to address underlying psychological issues.

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    © All Rights Reserved
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    of 22

    The Art of Handling

    Conversion
    Disorder in
    Emergency Room
    DR. DAMBA BESTARI SP.KJ
    Mental duluan atau
    fisik duluan
    Body and Mental Connection
    Tubuh dan mental: dua aspek dari satu substansi
    Mental: Menggerakkan tubuh menjadi tubuh yang hidup
    Istilah psikogenik: Pro dan Kontra
    Holistik
    HPA Axis: Stres dapat memengaruhi sistem tubuh sampai ke tingkat molekuler

    Andri, 2013. Psikosomatik: Apa dan Bagaimana?


    Courtesy of
    Dirty
    Medicine
    Conversion Disorder

    • Functional Neurological Symptom Disorder (DSM V)


    • Dapat terjadi pada berbagai usia, > remaja hingga dewasa muda
    • Jenis kelamin perempuan: 70%-95%
    • Populasi umum: 0.1% to 0.7%,
    • Populasi klinis: 3.3% to 6.3% and 14% to 33%
    Conversion Disorder
    • La belle indifference: klasik
    • It is characterized by the inappropriate and paradoxical absence of distress
    despite the presence of an unpleasant symptom. Patients often deny
    emotional difficulty.
    • Unfortunately, la belle indifférence, histrionic personality, and secondary gain
    are clinical features that appear to have no diagnostic significance. They can
    easily be absent in patients with conversion disorder; they can be easily be
    present in patients with traditional neurologic disorder.
    • 5 orang dengan hysterical conversion reactions mengalami cedera dan infark
    pada cerebral hemisphere kiri
    Etiologi

    • Stres kronis
    • Konflik emosional
    • Riwayat kekerasan traumatis
    • Komorbiditas dengan gangguan psikiatri lain
    • Gangguan Kepribadian Histerionik, Ambang
    Kriteria Diagnosis
    Sign and
    Symptoms
    Sign and Symptoms

    1. Physical
    Absence of a physical disorder is an important diagnostic feature. Individuals with conversion
    disorder often have physical signs but lack objective neurological signs to substantiate their
    symptoms.
    2. Weakness
    Weakness usually involves whole movements rather than muscle groups. Weakness affects the
    extremities more often than ocular, facial, or cervical movements.
    With the use of various clinical techniques, weakness of one limb can be demonstrated to cause
    contraction of opposing muscle groups. Discontinuous resistance during testing of power or give-
    way weakness may exist.
    Muscle wasting is absent, and reflexes are normal.
    Sign and Symptoms
    3. Sensory symptoms
    Sensory loss or distortion often is inconsistent when tested on more than one
    occasion and is often incompatible with peripheral nerve or root distribution.
    Discrete patches of anesthesia or hemisensory loss that stop in the midline may be
    present. Classic dermatomes in patients with numbness usually are not followed.
    4. Visual symptoms
    Visual symptoms include monocular diplopia, triplopia, field defects, tunnel vision,
    and bilateral blindness associated with intact pupillary reflexes.
    Optokinetic nystagmus may be observed in patients with apparent blindness when
    exposed to a rotating striped drum.
    Sign and Symptoms

    5. Gait disturbances
    Astasia-abasia is a motor coordination disorder characterized by the inability to stand
    despite normal ability to move legs when lying down or sitting. Patients walk normally if
    they think they are not being observed.
    Occasionally, while being observed, patients actively attempt to fall. This contrasts with
    those patients with organic disease who attempt to support themselves.
    6. Pseudoseizures
    During an attack, marked involvement of the truncal muscles with opisthotonos and
    lateral rolling of the head or body is present. All 4 limbs may exhibit random thrashing
    movements, which may increase in intensity if restraint is applied.
    Sign and Symptoms

    7. Cyanosis is rare unless patients deliberately hold their breath.


    Reflexes (eg, pupillary, corneal) are retained but may be difficult to test due
    to tightly closed lids.
    Tongue biting and incontinence are rare unless the patient has some
    degree of medical knowledge about the natural course of the disease.
    In contrast to true seizures, pseudoseizures primarily occur in the presence
    of other people and not when the patient is alone or asleep.
    Kejang Konversi vs Kejang Neurologis

    Abbasi O.H, Aw T. 2017.


    Psychogenic Non-Epileptic Seizures:
    Clinical Issues for Psychiatrists
    Tatalaksana
    Farmakologi
    • Anti anxietas bila perlu
    Clobazam 10 mg p.o
    Lorazepam 0.5-1 mg p.o
    Injeksi Diazepam 2 mg i.m
    Tatalaksana

    • Psikoterapi: Terapi Utama!


    (CBT, Psikoterapi psikodinamika)
    • Memperbaiki coping mechanism,
    regulasi emosi, pola pikir
    • Saling melengkapi dengan
    psikofarmaka (keseimbangan)
    Dont’s
    1. Memberikan komentar bahwa semua gejala
    hanya psikis, tidak nyata
    2. Menyatakan tidak ada yang salah secara medis
    3. Buru-buru menyarankan untuk selalu berpikir
    positif (toxic positivity)
    4. Melakukan pemeriksaan penunjang yang kurang
    diperlukan secara berulang kali
    Do’s
    1. Bersikap tenang, empatik dan hangat
    2. Berempati terhadap keluhan, tanpa terlalu berlebihan
    3. Berikan pasien privacy
    4. Sadari bila ada transferensi dari pasien
    5. Jelaskan bagaimana pikiran dan tubuh saling memengaruhi
    6. Berikan obat yang sesuai untuk meredakan keluhan (less is more)
    7. Konsultasi dengan neurolog dan psikiater
    8. Berikan psikoterapi suportif dan relaksasi
    Menu Relaksasi

    Mencari dukungan sosial (support system) orang2 suportif


    Tulis jurnal/buku harian
    Hobi: Menonton film, membaca buku, melukis
    Lakukan relaksasi pernapasan/relaksasi otot progresif
    Pertahankan pola makan sehat, tidur cukup dan olahraga.
    Diagnosis Banding
    • Gangguan Neurologis
    • Factitious disorder
    • Somatic symptom disorder
    • Illness anxiety disorder
    • Malingering
    “The sorrow which has no
    vent in tears may make
    other organs weep”
    (Henry Maudsley)
    ◦ TERIMA KASIH
    Referensi
    1. Conversion Disorder in Emergency Medicine Treatment & Management, Oct 26, 2017.
    Medscape. Seth Powsner, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP
    2. Andri, 2016. Diagnosis and treatment of psychosomatic Disorder
    3. Ruffalo M. 2020. On the Psychoanalytic Treatment of Conversion Disorder. Pscyhiatric Times.
    4. Abbasi O.H, Aw T. 2017. Psychogenic Non-Epileptic Seizures: Clinical Issues for
    Psychiatrists
    5. Jhaveri D, Tye S, 2020. Depression and the Brain. Queensland brain institute.
    6. Peeling J; Muzio MR. 2021. Conversion Disorder. Available at
    https://www.ncbi.nlm.nih.gov/books/NBK551567/

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