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ave you ever been faced with medical or neurologic symptoms in a patient who, despite a thorough workup, does not appear to H have a medical or neurologic condition that explains those symptoms? Have you wondered how to address (and treat) these symptoms when you suspect that they may reflect a psychological or psychiatric etiology? If you have, then the following case vignette (of a woman presenting to the emergency room with apparent convulsions and apnea) should pro- vide the forum for answers to these and other questions related to conver- sion disorders. Case Report Ms. A, a 35-year-old divorced woman with a history of severe child- hood asthma, presented to the emergency room with a week-long com- plaint of jerking movements (which began in her left shoulder and then spread down her left arm and both legs). She maintained full awareness during and after these episodes, which lasted for a minute or 2, but stated that she had developed difficulty walking because of them. The episodes were often immediately followed by 10 to 15 seconds of gagging and ap- nea. Although members of her family (who accompanied her to the emer- gency room) were very concerned that these new problems could signal a serious medical illness, Ms. A. appeared neither alarmed nor anxious. She denied any significant psychiatric history but did recall receiving some counseling around the time of the death (5 years ago that month) of her 3-year-old daughter (from Tay-Sachs disease). When her jerking movements emerged, Ms. A moved in with her parents. Her neurologic and general physical examinations, as well as her laboratory assessment (including head imaging, an electroencephalogram (EEG), and basic lab- oratory studies), were unremarkable. The psychiatric consultant felt that Ms. A met DSM-IV criteria for conversion disorder.

Conversion Disorder Presenting With Neurologic and Respiratory Symptoms