Psychosomatics 39:519-527, December 1998
© 1998 The Academy of Psychosomatic Medine
Motor Conversion Disorder
A Prospective 2- to 5-Year Follow-Up Study
Michael Binzer, M.D., and
Gunnar Kullgren, M.D., Ph.D.
Received March 31, 1998; revised June 15, 1998; accepted June 25, 1998. From the Departments of Neurology and Psychiatry, Umeå University, Sweden. Address reprint requests Dr. Binzer, Department of Neurology, Esbjerg County Hospital, Østergade 80, DK–6700, Esbjerg, Denmark. e-mail: michael.binzer{at}adr.dk
|
ABSTRACT
|
In this prospective study, 30 patients with motor conversion disorder were assessed for key psychiatric and demographic variables. At reassessment 2 to 5 years later, 19 patients had completely recovered and 8 patients had improved, whereas only 3 were unchanged or worse. Contrary to other follow-up studies, none of the patients received a rediagnosis of neurological disease. The presence of a personality disorder and overall personality pathology, particularly within cluster C, the presence of a concomitant somatic disease, low DSM-IV Axis V score, and high score on the Becks Hopelessness Scale proved to be associated with poor outcome.
Key Words: Motor Conversion Disorder • Conversion Disorder • Outcome
|
INTRODUCTION
|
Despite several conceptual changes during the last few years, the diagnostic validity of conversion disorder is still unestablished,1,2 and diagnostic boundaries have often been ill-defined in previous studies. It is unlikely that there are any universal etiological concepts, and at present a multidimensional approach to the understanding of conversion reactions is still usually employed in which there are both separate and simultaneous biological, psychodynamic, sociocultural, and behavioral explanations.3–7
Prognostic studies differ substantially in outcome, with recovery rates varying from 15% to 74%.8–14 Factors associated with favorable outcome are male gender, acute onset of symptoms, precipitation by a stressful event, good premorbid health, and absence of organic disease or a concomitant psychiatric disorder.11–18 Part of this research, however, is hampered by unsystematic diagnostic procedures and poorly defined sample selection. Most studies are retrospective and have been done in a tertiary setting, leading to significant referral bias and findings that lack replication in studies with more homogeneous and representative samples. Further limitations in previous studies have been variations in the quality of the initial neurological assessment and absence of standardized instruments for assessment of psychiatric diagnoses, especially personality disorders. In early follow-up studies, the incidence of organic disease explaining the initial symptoms was unexpectedly high,8,12,16 whereas in more recent studies subsequent rediagnosis of neurological disease is much less frequent.17–19
The aim of the present study, conducted between 1992 and 1995, was to follow a neurologically and psychiatrically well-investigated sample of patients with newly diagnosed motor conversion disorder during a period of 2 to 5 years and thereafter relate their outcome to initial assessment of various psychiatric and demographic variables. We were interested in following the consultation behavior of these patients and finding whether they were rediagnosed with a neurological diagnosis. We also hoped to be able to identify possible predictors associated with long-term prognosis of conversion. The main differences, compared with most previous studies, were the prospective design, the exclusion of patients with concomitant neurological disease, and the use of standardized instruments for assessment of psychiatric disorders.
|
PATIENTS AND METHODS
|
Patients
Thirty consecutive inpatients fulfilling the DSM-IV diagnostic criteria for motor conversion disorder were assessed neurologically and psychiatrically at the Neurological Departments of Umeå University Hospital and Kalmar County Hospital. A further five patients, all refugees from foreign countries, had to be omitted because of language problems, but there were no dropouts because of lack of consent. Both hospitals have primary catchment areas of about 130,000 inhabitants, and both regions comprise a medium-sized town, mostly with light industry, while the remaining area can be considered rural. Although the University Hospital offers services to a population of about 900,000 people, there are seldom referrals outside the primary catchment area. Of the total of 30 patients, 20 were referred directly to neurological services, while 4 patients were referred from other departments within the same hospital, and the remaining 6 patients came from other hospitals for a second opinion. None of the patients had initially been referred to psychiatric services.
The possibility of a somatic cause of the patients' symptoms was carefully excluded by means of clinical investigation and relevant radiological, neurophysiological, and biochemical investigations. Isolated cases of tremor and odd-looking gait disturbances, as well as an unknown but probably rather substantial number of patients with known neurological disease, were omitted because of the risk of including patients whose symptoms might have an organic cause, and because we felt that the inclusion of these patients might complicate interpretation of the results. Patients with comorbid somatization disorder or posttraumatic stress disorder were likewise excluded, and only patients with a symptom duration not exceeding 3 months were included in this study.
Initial Assessment
Psychiatric diagnoses were assessed with the Structured Clinical Interview for DSM-III-R, Version I (SCID-I) for clinical syndromes and SCID-II for personality disorders, which are structured clinical interviews linked to the diagnostic system DSM-III-R.20,21 At a later stage, all patients in the study were reassessed according to DSM-IV criteria so the correct diagnosis could be confirmed in all cases. The presence of concomitant somatic disease was registered (Axis III), and the level of stress preceding the symptom onset was assessed according to Axis IV. The patients scored their level of psychological, social, and occupational functioning during the last year according to Axis V on DSM-IV with a recently validated self-report version of the Global Assessment of Functioning (GAF) that yields a score.22 The degree of depressive symptoms was assessed with the Hamilton Psychiatric Rating Depression Scale (Ham-D).23
We also registered various clinical and demographic variables, such as degree of disability, symptom lateralization, and the educational level of patients. The results of these initial assessment have been reported in a previous paper.24 Additional assessments were made by using the following questionnaire ratings: The Illness Behavior Questionnaire (IBQ),25 Beck's Hopelessness Scale (BHS),26 Karolinska Scale of Personality (KSP),27,28 Locus of Control (LOC),29 and patient memories of childrearing experiences, the Egna Minnen Beträffand Uppfostran (EMBU).30
Assessment at Follow-Up
Follow-up by telephone interview or direct examination was done by one of us (MB) after 6 months and 1 year. At final follow-up 2.5 to 5 years after symptom onset (mean interval 3 years 8 months), only 3 patients regularly had any contact with the Neurological Department. The patients were contacted by telephone by one of us (MB), and all patients gave consent for a structured interview. The interview included inquiries about past and present health; perceived disability; working status; contacts with general practitioners (GPs), outpatient departments, and other health professionals (i.e., physiotherapists, chiropractors, healers); and admissions to general and psychiatric hospitals.
The patients' GPs were contacted by telephone to get information about current clinical status, the number of GP consultations since symptom onset, any new diagnoses, and other consultations with health professionals during the follow-up period. Fourteen of the patients had changed their GP during the follow-up period, either because of dissatisfaction (eight patients) or because they had changed address (six patients). Despite this, we succeeded in reaching the present GP in all cases.
Statistics
Analyses to test hypotheses about clinical, demographic, and psychometric factors relating to symptom outcome were performed with the Statistical Package for the Social Sciences. The relationship between index factors and outcome was tested by nonparametric statistics (chi-square test for discontinuous variables and Mann-Whitney U test for continuous variables).
|
RESULTS
|
All of the original 30 patients (12 men, 18 women) participated in the follow-up study. The mean age of the patients at symptom onset was 38.8 years (range: 18–74); no gender differences existed between the groups. Further vital data on the patients, including Axes I to V diagnoses according to DSM-IV at symptom onset as well as final outcome, are in Table 1. Symptom outcome was registered according to whether the patient as well as the patient's GP judged the symptom to be completely remitted, improved, unchanged, or worse. Nineteen patients were judged as having a complete remission of initial symptoms, eight patients were improved, and only three patients were unchanged or worse. All but 3 of the 19 patients with total recovery were already symptom-free at the 6-month control time. The GP's judgment corresponded very well to the patient's own perception of symptoms in all cases except two. Both these patients perceived their symptoms as unchanged, but their GPs judged them as improved and registered them as such.
Analysis of initial variables showed that only six variables discriminated between the patients in complete remission (n=19) and the patients who were still symptomatic (n=11): the presence of a personality disorder, the presence of a concomitant somatic disease at symptom onset, low DSM-IV Axis V score, high cluster-C score, high global-index score (i.e., the total number of fulfilled criteria according to the SCID II interview), and high BHS score (Table 2). Age, gender, degree of disability, educational status, the presence of an Axis I disorder, Ham-D score, as well as IBQ, KSP, LOC, and EMBU items all failed to show any significant correlation with outcome.
The patients without complete remission were found to have significantly higher consultation rates with GPs as well as outpatient visits, and these patients were much more likely to be unemployed or on sick leave (Table 3). According to the patients' GPs, the reasons for consultations were mostly of psychosomatic character, especially fatigue and diffuse pain complaints such as tension headache, low back pain, and gastrointestinal pain. Two patients (No. 4 and No. 30) had received a new somatic diagnosis not registered at initial assessment, namely, angina pectoris and gastrointestinal cancer, respectively. None of the patients had been rediagnosed with a neurological diagnosis. Only 3 patients (No. 5, No. 6, and No. 8) had seen a psychiatrist during the follow-up period, two because of affective disease and one because of an anxiety disorder.
|
DISCUSSION
|
This is the first study, to our knowledge, in which consecutive patients with newly diagnosed motor conversion disorder were assessed and thereafter followed prospectively for between 2 and 5 years. Initial neurological and psychiatric assessments were of high quality, and standardized instruments were applied. There were no study dropouts. The study's limitations are its rather small size, the sampling bias, and the fact that follow-up assessments were based on telephone interviews with the patients and on information from their GPs instead of on direct examination.
It is generally believed that most patients with a diagnosis of conversion disorder usually recover fairly rapidly,3 although patients who end up in tertiary referral centers have been found to have a poorer prognosis.8,12,18 Symptom outcome would be expected to depend on the type and history of the presenting symptom as well as the presence of concomitant organic and/or psychiatric disease.
The present study included only patients with motor symptoms who are generally thought to have a better prognosis than those who have, for example, seizures, and the remission rate in this study of over 60%, with only 10% of the patients being unchanged or worse, seems to support the findings from earlier studies.13–15 Mace and Trimble, in a recent follow-up study,18 found no such difference in outcome related to the type of presenting symptom, but the patients in this study probably had a longer symptom history at initial assessment, in which many patients with transient motor symptoms may never have reached tertiary referral because of spontaneous symptom remission. This notion is supported by our findings that all but three of the patients with full recovery at the final follow-up were already symptom-free after 6 months, most of them, indeed, even earlier. These results are in line with a recent Dutch study,17 in which 96% of the patients who had improved during a hospital stay eventually ended up with a good outcome after a follow-up period from 1.5 to 9.5 years.
Consultation Behavior
As expected, consultation behavior differed in the two outcome groups. The lack of symptom improvement had a decisive impact on GP consultation rates, as also on visits at outpatient wards, corresponding well with Mace and Trimbles findings.18 Possible confounding factors could be the higher presence of somatic disease in the bad-outcome group or the deliberate scheduling of more frequent visits as a component of management of chronic somatoform disorders. However, a very substantial amount of the visits were due to the patients actively seeking out GPs because of psychosomatic complaints, indicating that the high consultation rates probably could not be explained by objective need alone. Despite the high frequency of Axes I and II diagnoses at initial assessment, it is striking that only three patients had been in contact with a psychiatrist during the follow-up period. This finding supports the notion that conversion patients prefer to avoid the psychiatric domain and instead, as in this study, tend to present multiple somatic complaints. Unfortunately, we had no raw data on consultation rates before symptom presentation, but we did have information about past admissions to both somatic and psychiatric hospitals. We found no differences when cross-tabulating with the two outcome groups. It would seem reasonable to believe that consultation behavior should be attributed to illness behavior, but initial IBQ scores, especially the disease conviction and hypochondriasis items, failed to predict outcome or consultation behavior. These findings were disappointing but are in line with the study findings of Mace and Trimble.18
No Rediagnosis of Neurological Disease
Two new somatic diagnoses appeared during the observation period, which is probably not more than one would expect in the background population. It is interesting and important to note that none of the patients in this study received a rediagnosis of neurological disease, as has been the case in other follow-up studies.8,16–19 Of note, Slater and Glithero8 found that over half of the cases at follow-up 2–10 years later had received such a rediagnosis, in which the original symptom initially judged as a conversion symptom retrospectively could be attributed to a neurological syndrome. Slaters report, when published in 1965, produced deep skepticism and suspicion among clinicians toward the diagnosis of hysteria and is still one of the most cited articles in the literature on this topic. As the results of this study, as well as other recent follow-up studies suggest,17–19 we would argue that sophisticated neurological investigations and well-validated diagnostic instruments for psychiatric diagnosis should make rediagnosis much less common in the future.
Possible Predictors of Outcome
Our main interest in this study was the identification of possible predictors of poor outcome, which consequently might be able to influence management of future cases of patients with motor conversion symptoms. Not unexpectedly, the presence of a personality disorder at symptom onset was a significant risk factor for poor outcome. Other studies support this finding,8,14,15,18 and Chandrasekaran et al., in a recent Indian follow-up study, found "hysterical personality" to be the only significant predictor for poor outcome.31 In our study, 5 of the 15 patients with a personality disorder were histrionic, and of these 5, 2 were unchanged or worse, 1 patient was only partly improved, and 2 patients had completely recovered. Although there was thus a trend toward worse outcome for the patients with a histrionic personality disorder, the results did not reach significance.
When looking closer at the total amount of fulfilled criteria for different personality disorders registered by the SCID interview, the patients with poor outcome proved to have a significantly higher global index (i.e., the mean total number of criteria for all personality disorders), compared with the patients who had recovered. The results indicate that subclinical personality pathology, especially within cluster C, might be associated with poor outcome in motor conversion disorder.
As in Mace and Trimbles study,18 other DSM-IV Axis I diagnoses were not found to be associated with outcome, nor was the degree of the stress factor triggering the conversion reaction, as described by Axis IV in DSM-IV. Crimlisk et al. found that conversion patients with coexistent anxiety and depression actually fared better at follow-up.19 The contradictory results in this study could have been influenced by the patients' extreme resistence to psychiatric assessment, possibly resulting in inadequate treatment of major psychiatric syndromes.
Concomitant somatic diseases (Axis III diagnoses) interestingly proved to be a predictor of poor outcome. Apart from a significant symptom improvement in one of the patients with lumbar disc prolapse after surgery and a partial improvement in the patient with gastritis, there were no meaningful changes in disease severity reported in the remaining patients. The additional stress of having a chronic somatic disease thus could be a contributing factor to the maintenance and eventual "chronification" of a conversion reaction.
Low DSM-IV Axis V scores, self-assessed by the patients at symptom onset and reflecting their general well-being during the previous year, also seemed to be a possible predictor for a less favorable outcome. This could, however, be due to the higher amount of concomitant somatic disease among these patients, but is probably not due to the actual motor deficit, bearing in mind that all patients were assessed within 3 months of symptom onset. It should also be borne in mind that the scores ranged from 40 to 95 and that some patients thus perceived their lives as almost completely trouble-free. It is especially interesting that two of the three patients with the poorest outcome (Nos. 2 and 3) actually had the highest Axis V scores in the patient group who were not fully recovered. These few patients with high Axis V scores also gave the classic clinical impression of lá belle indifference, but in this study they definitely constituted a minority.
Scores on the BHS also proved to be higher in the patient subgroup with poor outcome. When looking closer at the three subitems on the BHS, significantly higher scores regarding negative future expectations were registered among the patients with poor outcome (U=48, P<0.01), whereas no difference was found for the affective and cognitive subitems (i.e., feelings about the future and loss of motivation). The patients who in the long run fared worse, thus already at symptom start, had apparently very pessimistic future expectations and may not have seen any other solution than the subconscious development and maintenence of a conversion symptom. However, it is far from certain that high hopelessness can be seen as an independent contributing factor to bad outcome considering the greater (though not quite significant) number of patients with comorbid depression in the persistent symptomatic group. Thus, the finding may simply correlate with a higher degree of depression and an extremely high correlation between the BHS and Ham-D results (Spearmans rho=0.81, P<0.001) and would seem to support this line of thought.
In Mace and Trimble's study, poor outcome was associated with higher age.18 This finding could not be reproduced in the present study, but it was an interesting and maybe coincidental finding that all patients with poor outcome were between 30 and 50 years of age at symptom onset. The younger patients (n=8) and elderly (n=4) all recovered completely. Another interesting finding that did not quite reach significance was the observation that all patients with dominant hemisphere symptoms recovered completely, whereas only 4 out of 10 patients with left-sided symptoms recovered. The patients with bilateral symptoms had the worse prognosis. The more frequent left-sided presentation of conversion symptoms has been noted in earlier studies32,33 but has not, to our knowledge, been commented on as a possible prognostic factor.
Patients' locus of control (i.e., the extent to which an individual perceives events and actions as being a consequence of his/her own behavior and ability rather than chance) might have been expected to influence outcome, as might patients' educational status, but this was not the case in our study. The failure of childhood experiences being associated with outcome would seem to contradict the importance of psychodynamic theories regarding prognosis, but might still be a possible predisposing factor.
Conclusion
Given the aforementioned limitations of our study, there are a number of clinical implications. Long-term outcome in motor conversion disorder appears to be significantly associated with the presence of a personality disorder, as also subclinical personality pathology at symptom onset. Closer scrutiny of personality and consequent psychological therapy in certain cases thus seems warranted in these patients. Furthermore, bad outcome was associated with low DSM-IV Axis V scores (i.e., patients' perception of their general well-being) and with negative future expectations according to BHS assessment. The presence of a concomitant somatic disorder also proved to be important for outcome and again stresses the need for careful and well-conducted neurological and psychiatric assessments in patients who present with pseudo-neurological symptoms, bearing in mind the substantial possibility of other coinciding illnesses. When these investigations are conducted sensibly and with well-validated instruments, the risk of subsequent neurological rediagnosis would appear to be slight for patients with motor symptoms and probably negligible for patients with isolated motor symptoms, as in this study. This risk would probably be expected to be higher in conversion disorders with other symptom presentations (i.e., fugues, seizures, and mixed presentations) and deserves future research.
|
REFERENCES
|
-
Mace CJ: Hysterical conversion II: a critique. Br J Psychiatry 1992; 161:378–389[Abstract/Free Full Text]
-
Birket-Smith M: Somatoforme Tilstande: en Deskriptiv og Sammenlignende Undersøgelse af Patienter med Somatiske Symptomer uden Organisk Grundlag. Copenhagen, Denmark, FaDLs Forlag, 1998
-
Ford CV, Folks DG: Conversion disorders: an overview. Psychosomatics 1985; 26:371–383[Abstract/Free Full Text]
-
Hollender MH: Conversion hysteria (a post-Freudian reinterpretation of 19th-century psychosocial data). Arch Gen Psychiatry 1972; 26:311–314[Abstract/Free Full Text]
-
Marsden CS: Hysteria—a neurologists view. Psychol Med 1986; 16:277–288[Medline]
-
Merskey H: Conversion symptoms revised. Semin Neurol 1990; 10:221–228[Medline]
-
Binzer M, Kullgren G: Conversion symptoms—what can we learn from previous studies? Nordic Journal of Psychiatry 1996; 50:143–152
-
Slater E, Glithero E: A follow-up of patients diagnosed as suffering from "hysteria." J Psychosom Res 1965; 9:9–13[Medline]
-
Krull F, Scifferdecker K: Inpatient treatment of conversion disorder: a clinical investigation of outcome. Psychother Psychosom 1990; 53:161–165[Medline]
-
Maxion H, Fegers S, Pfluger R, et al: Risik of aktoren klassischer konversions syndrome—psychogene anfälle und paresen—beobachtungen einer neurologischen klinik bei 172 patienten. Psychother Med Psychol 1989;39:121–126
-
Hafeiz HB: Hysterical conversion: a prognostic study. Br J Psychiatry 1980; 136:548–551[Abstract/Free Full Text]
-
Gatfield PD, Guze SB: Prognosis and differential diagnosis of conversion reactions. Diseases of the Nervous System 1962; 23:623–631[Medline]
-
Carter AB: The prognosis of certain hysterical symptoms. BMJ 1948; 1:1076–1078.
-
Lempert T, Schmidt D: Natural history and outcome of psychogenic seizures: a clinical study in 50 patients. J Neurol 1990; 237:35–38[Medline]
-
Ljungberg L: Hysteria: a clinical, prognostic and genetic study. Acta Psychiat Neurolog Scand 1957; (suppl 12):37–48
-
Watson CG, Buranen C: The frequency and identification of false-positive conversion reactions. J Nerv Ment Dis 1979; 167:243–247[Medline]
-
Couprie W, Wijdicks EFM, Rooijmans HGM, et al: Outcome in conversion disorder: a follow-up study. J Neurol Neurosurg Psychiatry 1995; 58:750–752[Abstract/Free Full Text]
-
Mace CJ, Trimble MR: Ten-year prognosis of conversion disorder. Br J Psychiatry 1996; 169:282–288[Abstract/Free Full Text]
-
Crimlisk HL, Bhatia K, Cope H, et al: Slater revisited: 6-year follow-up of patients with medically unexplained motor symptoms. BMJ 1998; 316:582–586[Abstract/Free Full Text]
-
Spitzer RL, Williams JBW, Gibbon M: Structured Clinical Interview for DSM-III-R. New York, New York State Psychiatric Institute, Biometrics Research, 1987
-
Spitzer RL, Williams JBW, Gibbon M, et al: The structured clinical interview for DSM-III-R (SCID). 1. History, rationale and description. Arch Gen Psychiatry 1992; 49:624–629[Abstract/Free Full Text]
-
Bodlund O, Kullgren G, Ekselius L, et al: Axis V—global assessment of functioning scale. Evaluation of a self-report version. Acta Psychiatr Scand 1993; 88:322–327[Medline]
-
Hamilton MA: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960; 23:56–62
-
Binzer M, Andersen P, Kullgren G: Clinical characteristics of patients with motor disability due to conversion disorder—a prospective control group study. J Neurol Neurosurg Psychiatry 1997; 63:83–88[Abstract/Free Full Text]
-
Pilowsky I, Spence ND: Manual for the Illness Behaviour Questionnaire (IBQ). Adelaide, Australia, University of Adelaide, 1983
-
Beck AT, Weissman A: The measurement of pessimism: the Hopelessness Scale. J Consult Clin Psychol 1974; 42:861–865[Medline]
-
Schalling D: Contribution to validation of some personality concepts (medical thesis). Department of Psychology, Stockholm University, 1970
-
Schalling D: Psychopathy-related personality variables and the psychophysiology of socialization, in Psychopathic Behaviour: Approaches to Research, edited by Hare RD, Scalling D. London, UK, John Wiley and Sons, 1978, pp. 85–106
-
Eisemann M, Perris C, Palm U, et al: LOC—Presentation of a Swedish instrument for assessing locus of control, in Cognitive Psychotherapy—An Update, edited by Perris C, Eisemann M. Umeå, Sweden, 1988, pp. 45–48
-
Perris C, Jacobsson L, Lindström H, et al: Development of a new inventory for assessing memories of parental rearing behaviour. Acta Psychiatr Scand 1980; 61:265–274[Medline]
-
Chandrasekaran R, Goswami U, Sivikumar V, et al: Hysterical neurosis—a follow-up study. Acta Psychiatr Scand 1994; 89:78–80[Medline]
-
Stern DB: Handedness and the lateral distribution of conversion reactions. J Nerv Ment Dis 1977; 164:122–128[Medline]
-
Galin D, Diamond R, Braff D: Lateralization of conversion symptoms: more frequent on the left. Am J Psychiatry 1977; 134:578–580[Free Full Text]
This article has been cited by other articles:
|
|
|
|
 
G. Gallizzi, P. Kaly, and J. Takagishi
Lower Extremity Paralysis in a Male Preadolescent
Clinical Pediatrics,
February 1, 2008;
47(1):
86 - 88.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. Stone, R. Smyth, A. Carson, S. Lewis, R. Prescott, C. Warlow, and M. Sharpe
Systematic review of misdiagnosis of conversion symptoms and "hysteria"
BMJ,
October 29, 2005;
331(7523):
989.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Cathebras and M. Koenig
Spinal Cord Astrocytoma Mistaken for Conversion Disorder
Psychosomatics,
April 1, 2005;
46(2):
187 - 188.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Reuber, A J Mitchell, S J Howlett, H L Crimlisk, and R A Grunewald
Functional symptoms in neurology: questions and answers
J. Neurol. Neurosurg. Psychiatry,
March 1, 2005;
76(3):
307 - 314.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A J Carson, S Best, K Postma, J Stone, C Warlow, and M Sharpe
The outcome of neurology outpatients with medically unexplained symptoms: a prospective cohort study
J. Neurol. Neurosurg. Psychiatry,
July 1, 2003;
74(7):
897 - 900.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J Stone, M Sharpe, P M Rothwell, and C P Warlow
The 12 year prognosis of unilateral functional weakness and sensory disturbance
J. Neurol. Neurosurg. Psychiatry,
May 1, 2003;
74(5):
591 - 596.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. STONE, M. ZEIDLER, and M. SHARPE
Misdiagnosis of Conversion Disorder
Am J Psychiatry,
February 1, 2003;
160(2):
391 - 391.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J Stone, A Zeman, and M Sharpe
Functional weakness and sensory disturbance
J. Neurol. Neurosurg. Psychiatry,
September 1, 2002;
73(3):
241 - 245.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Ron
Explaining the unexplained: understanding hysteria
Brain,
June 1, 2001;
124(6):
1065 - 1066.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Vuilleumier, C. Chicherio, F. Assal, S. Schwartz, D. Slosman, and T. Landis
Functional neuroanatomical correlates of hysterical sensorimotor loss
Brain,
June 1, 2001;
124(6):
1077 - 1090.
[Abstract]
[Full Text]
[PDF]
|
|
|
Get information about faster international access.
Privacy Policy
Copyright © 1998
Academy of Psychosomatic Medicine.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
TOP
ABSTRACT
INTRODUCTION
