Aguirre ÁAA, Martínez LH, Núñez OL

Language: Spanish
References: 12
Page: 480-487
PDF size: 430.13 Kb.

ABSTRACT

Background: According to the DSM-IV, somatomorphic disorders include: somatization, indifferentiated somatomorphic disorder, conversión, pain, hypochondriasis, body dysmorphic and non specified. Objectives: To describe the most frequent pseudoneurological features in patients with somatomorphic disorders that often constitute diagnosis challenges, in order to identify the factors that influence or are related to the appearance of symptoms. Another objective, is to improve the knowledge of this type of disorders among the physicians. Material and method: This is an observational, descriptive partially prospective, transversal. We reviewed the medical records of patients discharged with the diagnosis of pseudoneurological disorders from march 1st 2001 to May 31st of 2004. They were 33 patients submitted to different paraclinical studies as CT scan, MRI, EEG depending the symptomatology, to discard organic pathology, or having an organic disease, it was impossible to correlate the symptomatology. We excluded non hospitalized patients or those with the possible diagnosis of pseudoneurological disorders that finally had a demonstrated organic disease. Results:33 cases, 29 females (87.94%) y 4 males (12.1%)( P ‹ 0.0001). 7 (21.2%) were teachers, 6 (18.2%) housekeepers, 5 (15.2%) secretaries y 4 (12.1%) physicians: 21 (63.6%) were married and 8 (29.2%) single. The more frequent neurological features were: pseudoepileptic seizures in 15 patients (45.5%), abnormal movements in 4 (12.1%); gait disorders in 4 (12.1%). The 15 patients with pseudoseizures. 12 (80%) had CT scan, 13 VEEG and 14 EEG. The pseudineurological signs were described. Conclusions: The knowledge of the features that lead to the suspicion of somatomorphic disorders is very important for neurologists in order to identify the real disorder and refer the patient to the adequate specialist to prescribe an appropriate treatment. Systematization of clinical features and apparent signs that are found in this type of patients will allow to achieve an appropriate approach and will avoid unnecessary expenses for the study of the cases.

REFERENCES

1. Murice V, Allan H. Ropper Adams y Victor´s Principles of Neurology. 7ª Ed. The McGraw-Hill; 2002, p. 1483-504.

2. Guerra-Cid LR. Problemas taxonómicos en la patología psicosomática. Interpsiquis; 2004.

3. Interian A PhD, Gara. The value of pseudoneurological symptoms for asessing psychopathology in primary care. 2004; 66(1): 141-46.

4. Hales RE, Stuart C, Yudofsky JA, Talbott. DSM-IV tratado de psiquiatría. Tomo 1. 3ª Ed. Masson; 2001, p. 663-729.

5. Mazzuca R. Los excesos de la histeria. Interpsiquis; 2004.

6. Del Val-Gurutz-Linazzasoro LJ. Trastornos del Movimiento. 2ª Ed. Masson; 2002, p. 119-29.

7. Madhavi T, Jankovic J. Psychogenic Movement Disorders: Diagnosis and Management. CNS Drugs 2004; 18(7): 437-52.

8. Galdar MG, López-Ibar JJ, Andreasen N. Tratado de Psiquiatría. Tomo 2. 2003, p. 1114-238.

9. Barsky AJ. The patient with hypochondriasis. N Engl J Med 2001; 345(19): 1395-399.

10. De Waal, et al. Somatoform disorders in general practice: prevalence,functional impairment and comorbidity with anxiety and depressive disorders. British Journal of Psychiatry Jun 2004; 184: 470-76.

11. Waller E, Dipl Psych et al. Attachment representation and illness behavior in somatoform disorders. The Journal of Nervous and mental Disease 2004; 192(3): 200-9.

12. Stone, Zeman A, Sharpe M. Functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry 2002; 73: 241-5.