Nonepileptic seizures, sometimes described as pseudoseizures, resemble epileptic seizures but are not associated withthe electroencephalographic abnormalities or a clinical coursecharacteristic of true epilepsy. Most cases resolve within 3months of diagnosis. Referring to nonclassic presentations for seizures as spells can help avoid medicalization of these symptoms.
The course of the condition is often benign, although20% to 25% of patients experience a recurrence. Goodprognostic characteristics include symptoms of paralysis, aphonia, blindness; acute onset; above-average intelligence; presence of an identifiable stressor; and earlydiagnosis and psychiatric treatment. Poor prognostic characteristics include tremor and pseudoseizures. The rate ofmisdiagnosis of conversion symptoms averages 4%. Myasthenia gravis, multiple sclerosis, dystonias, and dyskinesias(abnormal movements) are conditions commonly mistakenfor conversion disorder.
Pain disorder is diagnosed instead of a conversion disorder if pain is the predominant physical symptom. The DSM-IV divides pain disorders into those associated with psychological factors, those with both psychological and medical factors, and those in which the medical condition is the major factor in the pain symptom (Table 16-5). The diagnosis is considered acute if the condition lasts less than 6 months and chronic when it lasts 6 months or more.
RAP is the most common recurrent pain complaint of childhood and accounts for 2% to 4% of pediatric office visits. It is defined by intermittent pain with full recovery between episodes lasting more than 3 months. There is a strong relation between RAP and anxiety in children. Approximately 90% of pediatric patients have no clinical findings to account for their abdominal pain.
Common types of headaches are migraine and tension-type headache. Migraine may be associated with dizziness, gastrointestinal symptoms, and cyclic vomiting syndrome, characterized by recurrent and stereotypic episodes of intense,
A. Pain in one or more anatomic sites is the predominant focus and is of sufficient severity to warrant clinical attention.
B. The pain causes clinically significant distress or impairment in social, occupational, or other important functions.
C. Psychological factors have an important role in the onset, severity, exacerbation, or maintenance of the pain.
D. The symptom or deficit is not intentionally produced or feigned (factitious disorder, malingering).
E. The pain is not better accounted for by a mood, anxiety, or psychotic disorder and does not meet criteria for dyspareunia.
Specify the following:
Acute: duration <6 months
Chronic: duration ≥6 months unexplained vomiting. Psychological factors frequently play a significant role in the complaint of a headache.
Functional chest pain can be seen in 10% of school-aged children and adolescents. Other common pain disorders are musculoskeletal pains (limb pain and back pain), fibromyalgia, and complex regional pain syndrome type I (previously known as reflex sympathetic dystrophy).
Reassurance is the primary treatment of pain disorder.Symptom diaries, including the events that precede and follow the pain episode, aid in initial assessment and ongoingmanagement of the problem. Minimizing secondary psychological consequences of recurrent pain syndromes isimportant.