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4 results

  • Early intervention for conversion disorder: neurologists and psychiatrists working together
  • Selma Aybek, Monica Hubschmid, Corinna Mossinger, Alexandre Berney, François Vingerhoets
  • Journal: Acta Neuropsychiatrica / Volume 25 / Issue 1 / February 2013
  • Published online by Cambridge University Press: 22 February 2013, pp. 52-56
  • Print publication: February 2013
  • View abstract
    Objective

    To evaluate the efficacy of an early multidisciplinary (neurology and psychiatry) intervention for conversion disorder (CD).

    Methods

    Consecutive patients newly diagnosed with CD from 2005 to 2007 were compared to a control group of newly diagnosed CD patients receiving usual care. At 3 years, a questionnaire evaluated self‐rated subjective outcome, symptom severity, SF‐36 scores, employment status and medical care use.

    Results

    Data from 12 cases (mean age 25.5 ± 8.2; 9 females) and 11 controls (mean age 34.7 ± 13.5; 10 females) showed that 83% of cases had a good subjective outcome (symptom improved or cured) when only 36% of controls had a good outcome (p < 0.05). Cases significantly improved their SF‐36 scores on subscales involving physical complaints compared to controls. A minority (20%) of cases reduced or ceased professional activity when 70% of controls did (p < 0.001). Only 16% of cases sought further medical advice for the initial symptom when 73% of controls did. Both groups accepted psychiatric referrals (83% of cases and 73% of controls) and found it beneficial.

    Conclusions

    Early intervention involving both neurologists and psychiatrists is effective for CD in alleviating physical complaints, reducing sick leave and health care use.

  • Chapter 28 - Respiratory dysfunction
  • from Section 1 - Clinical manifestations
  • Edited by Louis R. Caplan, Jan van Gijn
  • Book: Stroke Syndromes, 3ed
  • Published online: 05 August 2012
  • Print publication: 12 July 2012, pp 319-328
  • View abstract

    Summary

    The prevalence of poststroke dementia (PSD) varies largely according to the composition of cohorts, setting, and delay after stroke. The cognitive syndrome of vascular dementia (VaD) is characterized by: memory deficit, dysexecutive syndrome, slowed information processing, and mood and personality changes. Cortical VaD relates to large vessel disease, cardiac emboli, and hypoperfusion. It prominently shows cortical and corticosubcortical arterial territorial and distal field infarcts. The occurrence of dementia depends on two factors: the total volume of brain loss because of infarcts and hemorrhages, and the location of these lesions. Many instances of dementia occurring in stroke patients are probably the consequence of the cumulative effect of the cerebrovascular lesions, Alzheimer pathology, and white matter changes. Patients with dementia after stroke are significantly less often treated with aspirin or warfarin than nondemented patients. Trials of secondary prevention of stroke usually exclude patients with obvious dementia.