Lecture
Motor conversion disorders
Seizures - Sudden attacks occurring after acute psychological trauma,
develop against a background of narrowed consciousness, characterized by varied, complex expressive movements, for example, arching of the body supported on the back of the head and heels (hysterical arc). Duration ranges from several minutes to several hours.
Memory of the seizure and its circumstances is fragmentary
Distinctive features of conversion: often develop gradually, always in the presence of other people, longer duration, occur after emotional experiences, bizarre movements, no changes on the EEG, no tongue biting, no urination, no post-ictal sleep, injuries are rare.
Seizures may occur without convulsions, in the form of various crises (hypertensive, cardiac), attacks of suffocation, trembling of the body ("the shakes"), prolonged sobbing
Paresis and paralysis
Signs of conversion paralysis:
1) appearance of pain or a sensation of weakness in the limbs during the period preceding the onset of paralysis or paresis;
2) absence of pathological reflexes;
3) normal or increased deep reflexes;
4) reduced or normal muscle tone;
5) absence of muscle atrophy (except in disorders lasting many months or years);
6) normal function of the affected limb when the patient's attention is distracted;
7) active resistance during passive movements involving all the «affected» muscles;
8) inconsistency with the physiological data on the localization of the paralysis;
9) involvement of muscles «paralyzed» for a required function in the performance of another function
despite «paralysis» of the foot flexors, the patient may be able to walk on tiptoe;
10) demonstration of effort when attempting to move the «affected» limb: exaggerated grimaces, facial flushing, etc.;
11) combination with other hysterical manifestations, for example, with anesthesias and seizures;
12) involvement of muscle groups in accordance with popular notions: for example, affecting exactly one half of the body along the midline;
13) sudden appearance or disappearance of symptoms under the influence of strong emotional experiences
Astasia-abasia - Inability to stand (astasia) and walk (abasia) while muscle strength, tone, and sensitivity are preserved
Hysterical gait, its types: 1) zigzag (movement along a broken line in the shape of the letter «Z»); 2) shuffling; 3) stilted; 4) sliding; 5) genuflecting; 6) balancing; 7) choreiform; 8) hopping; 9) waving
Joint contractures - immobility in one or several joints without impairment of innervation. They involve either individual muscle groups or their entire complex, which can cause the patient to freeze in the most bizarre posture.
Camptocormia - forward bending of the trunk at almost a right angle, inability to straighten up
strong resistance to attempts to passively change the position
Occupational dyskinesias: for example, «writer's cramp» - a spasm of the fingers holding a pencil or pen, which makes writing letters and numbers impossible
Hysterical spasms of the pharynx - «hysterical globus sensation» - a feeling of a lump, tightness, an obstruction in the throat. May occur while eating (dysphagia) or be felt constantly
as a rule, more pronounced with liquid than with solid food, usually combined with severe pain. Often forms part of functional respiratory disorders
Hysterical speech disorders
Aphonia (whispered speech or hoarseness)
Hysterical muteness (mutism) the ability to communicate through gestures and writing is preserved
Hysterical stuttering
Late age of symptom onset (not before puberty), instability and brevity
Grimaces and facial expressions that do not correspond to the actual difficulty of articulation;
Atypical, loud, and exaggerated intake of air while breathing;
Absence of emotional reaction to the disorder
Changes in speech arising on a religious basis and accompanied by psychopathological phenomena of religious content.
These include meryachenie – repetition of the words, movements, and gestures of other people, combined with unquestioning execution of commands while consciousness remains formally clear
Oculomotor disorders
1) eyelid paralysis. In hysteria, a mild spasm of the orbicularis oculi muscle is noted, whereas in true paralysis the levator palpebrae muscle is affected;
2) blepharospasm – a strong bilateral spasm of the orbicularis oculi muscles, preventing or hindering eye opening;
3) spastic convergent strabismus
Hyperkinesis, tics
The most common hyperkinesis is tremor, which may have any localization and be observed either in isolation or in combination with other types of hyperkinesis
+Diagnostic difficulty due to polymorphism, absence of a unified motor pattern
hysterical tics should be diagnosed only in cases where other hysterical symptoms are observed alongside them, and the tics are characterized by variability, brevity, and a lack of stereotypy
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