NeuroRehabilitation - Volume 8, issue 3

Authors: Teasell, Robert W. | Shapiro, Allan P.

Article Type: Introduction

DOI: 10.3233/NRE-1997-8301

Citation: NeuroRehabilitation, vol. 8, no. 3, pp. 155-156, 1997

Authors: Merskey, Harold

Article Type: Research Article

Abstract: Although hysteria is connected with the idea of the womb causing illness, including headache, pain was only one of many symptoms which have been classed under the term hysteria. Patterns of anxiety with bodily symptoms and depression contributed to ancient and early modern concepts of the diagnosis. Pain became moderately prominent as a hysterical symptom from about the 18th century onwards. Only in the 19th century, with advances in anatomy, physiology and clinical medicine did it become possible to prove that there was a limited group of symptoms which resulted from the patient's idea of illness. The explanation of hysterical …symptoms has depended substantially upon Freudian theory which is now undergoing a serious challenge. Hysterical pains can only be diagnosed rarely, if at all, and different efforts to describe hysteria in patients with pain have only been partially successful. Attempts to classify pain as a behavioral disorder have also been substantially unsuccessful. This may be because the psychological causes of pain are not so common as previously thought. There is also increasing reason to believe that unexplained pains have a physiological basis. Show more

Keywords: Pain, Hysteria, Psychological, Pathophysiological, Repression, Post-traumatic illness

DOI: 10.3233/NRE-1997-8302

Citation: NeuroRehabilitation, vol. 8, no. 3, pp. 157-162, 1997

Authors: Teasell, Robert W. | Shapiro, Allan P.

Article Type: Research Article

Abstract: Conversion disorders are unexplained symptoms or deficits that mimic neurological problems and affect voluntary motor and sensory functions. Historically, conversion symptoms were thought to reflect underlying psychological conflicts although recent behavioural theories view them as learned responses to stressful life circumstances and emphasize environmental contingencies in the maintenance of the disorder. Although early studies often revealed underlying organic disease in patients initially diagnosed with Conversion Disorder, this now occurs less frequently because of increased sophistication of diagnostic tools and better understanding of neurological disorders. However, misdiagnosis is still common because of reliance on ‘negative’ diagnostic testing and unvalidated ‘positive signs’ …misinterpreted as indicative of hysteria. Psychological factors may affect the course of almost every major category of disease and in many cases a diagnosis of hysteria is not indicated and the more appropriate diagnosis is Psychological Factors Affecting A Medical Condition. It is not possible to definitively differentiate between conscious and unconscious production of symptoms thus blurring the distinction between Conversion and Factitious disorders. Show more

Keywords: Conversion disorder, Factitious disorder, Psychological conflict

DOI: 10.3233/NRE-1997-8303

Citation: NeuroRehabilitation, vol. 8, no. 3, pp. 163-174, 1997

Authors: Speed, John | Mooney, George

Article Type: Research Article

Abstract: Conversion disorder, initially described by Freud over a century ago, has been treated in many ways over the years. A behavioral model of the onset of conversion disorders was first described 50 years ago, and led to efforts to treat it in a behavioral fashion, initially in psychiatric settings. A quarter century ago, the first systematic operant behavioral approach to conversion disorder in an inpatient rehabilitation setting was described. Subsequently, there have been several further reports of this approach, both in psychiatric and rehabilitation settings. Although literature on the topic remains sparse, the operant approach generally seems to be effective …and durable. Show more

Keywords: Conversion disorder, Behavioral treatment, Operant conditioning

DOI: 10.3233/NRE-1997-8304

Citation: NeuroRehabilitation, vol. 8, no. 3, pp. 175-181, 1997

Authors: Shapiro, Allan P. | Teasell, Robert W.

Article Type: Research Article

Abstract: Conversion or factitious disorders manifesting as chronic motor disorders are difficult and complex management problems. A number of published case studies and series have illustrated that these patients may respond to a rehabilitation program emphasizing physical therapies and behaviour therapy. However, this standard behavioral approach was not successful with the majority of our patients. In contrast, an alternative strategic-behavioral rehabilitation approach developed for intractable cases proved highly effective. Among 17 patients who underwent the strategic behavioural approach, 13 showed complete or near complete resolution of symptomatology. Nine of these successfully treated patients had previously failed to improve using a standard …behavioral rehabilitation program. Show more

Keywords: Conversion disorder, Hysteria, Paralysis, Behaviour therapy, Factitious disorder, Strategic therapy

DOI: 10.3233/NRE-1997-8305

Citation: NeuroRehabilitation, vol. 8, no. 3, pp. 183-192, 1997

Authors: Mai, François M.

Article Type: Research Article

Abstract: Chronic pain is common; it is found in up to 15% of randomly selected population samples, and psychosocial factors including those provoked by physical trauma associated with industrial and motor vehicular accidents are very common in etiology. The diagnosis of post-traumatic stress disorder may be appropriate in many of these cases. The objectives of this paper are to review the psychological and social factors which contribute to the etiology of chronic pain syndromes. It reviews also the relationship of pain to Depressive, Anxiety and Substance Abuse Disorders and the principles of management of Pain Disorder. Supportive psychotherapy, pharmacotherapy (in particular …tricyclic antidepressant medication) and behavioral rehabilitation programs may all be helpful in producing symptomatic improvement. An interdisciplinary pain clinic, particularly one which involves non-medical health professionals such as psychologists, social workers, occupational therapists and physiotherapists are very helpful in the management of complex cases. Show more

Keywords: Pain, Somatoform, Psychogenic pain

DOI: 10.3233/NRE-1997-8306

Citation: NeuroRehabilitation, vol. 8, no. 3, pp. 193-200, 1997

Authors: Shapiro, Allan P. | Teasell, Robert W.

Article Type: Research Article

Abstract: Chronic soft tissue pain disorders are not well understood from a pathophysiological standpoint. Psychological difficulties are common, clinical signs incompatible with conventional understanding of the nervous system are often present and these disorders usually fail to respond to medical interventions. When this constellation of factors is combined with unresolved litigation/compensation issues, it is not surprising that chronic pain disorders are often misdiagnosed as hysterical or psychological in origin. Unfortunately, this psychiatric diagnosis itself may have significant negative consequences which too often are not appreciated and can significantly increase the likelihood of treatment failure.

Keywords: Myofascial pain, Fibromyalgia, Conversion, Hysteria, DSM, Diagnosis, Chronic pain

DOI: 10.3233/NRE-1997-8307

Citation: NeuroRehabilitation, vol. 8, no. 3, pp. 201-222, 1997

Authors: Mooney, George | Speed, John

Article Type: Research Article

Abstract: Over one million mild traumatic brain injuries (TBI) occur annually in the United States. Most of these patients recover full function within about 3 months, but a significant minority do not. Failure to recover as expected following a diagnosed or suspected mild TBI is most commonly related to a concurrent diagnosis or alternative diagnosis or condition. Consideration during the diagnostic process must be given to alternative organic conditions (prior or unsuspected severe TBI, pain, medication side effects or dementia), pre-existing non-organic conditions (active or dormant psychiatric conditions, pre-existing personality characteristics, or social/economic factors), non-clinical conditions (compensation/litigation, malingering) or post-injury psychiatric …morbidity (notably depression, anxiety, post-traumatic stress disorder, panic disorder, or conversion disorder). Scrupulous care must be given during the history, physical examination, and neuropsychologic assessment of the patient to evaluate for different or contributory diagnostic possibilities; not all patients that have symptoms following a blow to the head have traumatic brain injury as the sole etiologic agent for their symptoms. Accurate diagnosis will lead to better treatment and optimal outcomes. Future research should focus on early identification of the ‘slow to recover’ group to allow early and appropriate treatment. Show more

Keywords: Traumatic brain injury, Depression, Anxiety, Conversion disorder, Litigation

DOI: 10.3233/NRE-1997-8308

Citation: NeuroRehabilitation, vol. 8, no. 3, pp. 223-233, 1997

Article Type: Other

DOI: 10.3233/NRE-1997-8309

Citation: NeuroRehabilitation, vol. 8, no. 3, pp. 235-235, 1997

Article Type: Other

DOI: 10.3233/NRE-1997-8310

Citation: NeuroRehabilitation, vol. 8, no. 3, pp. 237-237, 1997