Conversion and dissociative disorders in the Sultanate of Oman

Functional neurological disorder in Saudi Arabia: A retrospective study

OBJECTIVES

To describe the clinical profile of a sample of Saudi patients with Functional Neurological Disorder (FND).

METHOD

A retrospective chart review of FND patients seen from 2021-2023 at a neuropsychiatry clinic at an academic tertiary care center in Jeddah, Saudi Arabia.

RESULTS

Out of 473 patients seen in the clinic during the review period, 52 (11%) had FND. Mean age was 34 years (standard deviation = 10.7), and 77% were female. Family dispute (39%) was the most reported risk factor, followed by sexual abuse (15%). The most common FND symptoms were nonepileptic seizures (61.5%) and abnormal movements (30.8%). Pain was reported by 57.7% and cognitive symptoms by 36.5%. FND symptoms were frequently attributed to supernatural causes (67.3%). During the last follow-up visit, 53.9% of patients reported FND symptom improvement, whereas 21.2% reported no change, 10.2% reported worsening, and 15% were lost to follow-up. The proportion of patients without symptom improvement was higher among patients with cognitive symptoms (45.5% vs 18% respectively, X2 = 10.08, df = 3, p = .018). The mean number of visits was highest in patients reporting worsening and the lowest was among patients reporting no change (F = 4.21, p = .017).

CONCLUSION

The role of family disputes in FND in the Middle East, the role of supernatural concepts in how FND is perceived, and the relatively high rate of subjective improvement within this sample of Saudi FND patients merit further exploration. Cognitive symptoms may be another prognostic indicator. Prospective multicenter studies of those with FND using standardized assessment measures are needed.

The symptom of functional weakness: a controlled study of 107 patients

Functional weakness describes weakness which is both internally inconsistent and incongruent with any recognizable neurological disease. It may be diagnosed as a manifestation of conversion disorder or dissociative motor disorder. Other names include psychogenic or 'non-organic' paralysis. We aimed to describe the incidence, demographic and clinical characteristics of cases with functional weakness of less than 2 years duration, and to compare these with controls with weakness attributable to neurological disease. Both cases and controls were recruited from consultant neurologists in South East Scotland. Participating patients underwent detailed assessments which included: physical examination, structured psychiatric interview (Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders), measures of symptoms, disability and distress [Short Form (36) Health Survey, Hospital and Anxiety Depression Scale], and assessment of their illness beliefs using an augmented version of the Illness Perception Questionnaire. In total, 107 cases (79% female, mean age 39 years, median duration of illness 9 months) were recruited. This number suggests a minimum annual incidence of 3.9/100 000. Forty-six controls (83% female, median age 39 years, duration 11 months) were also recruited. Compared to controls, cases had similar levels of disability but more physical symptoms, especially pain. They had a higher frequency of psychiatric disorders, especially current major depression (32 versus 7%, P < 0.0001), generalized anxiety disorder (21 versus 2%, P < 0.005), panic disorder (36 versus 13%, P < 0.001) and somatization disorder (27 versus 0%, P < 0001). There was no difference in median self-rated anxiety and depression scores. Paradoxically, they were less likely than controls to agree that stress was a possible cause of their illness (24 versus 56%, P < 0.001). Cases were twice as likely as controls to report that they were not working because of their symptoms (65 versus 33%, P < 0.0005). Functional weakness is a commonly encountered clinical problem. Patients with this symptom are as disabled as patients with weakness of similar duration due to neurological disease. There is a paradox between the frequency of depression and anxiety diagnoses and the patient's willingness to accept these as potentially relevant to their symptoms. We discuss the theoretical and practical implications of these findings for the concept of conversion disorder.

Conversion and somatization disorders; dissociative symptoms and other characteristics

OBJECTIVE

There is a difference in classification of conversion disorder in ICD-10 and DSM-IV. Conversion disorder is included in dissociative disorders in ICD-10. In view of this, we aimed to clarify this discrepancy in the classification of this diagnosis.

METHODS

We assessed 87 patients with conversion disorder and 71 patients with somatization disorder for sociodemographic characteristics, suicide ideation, psychiatric symptoms and dissociative symptoms using the Patient Information Form, the Dissociative Experience Scale (DES), the Symptom Check List (SCL-90-R) and the Suicide Ideation Scale.

RESULTS

The number of the high school graduates, singles and students with conversion disorders was higher than the number of patients with the same characteristics who have somatization disorder. In conversion disorder, the SCL-90-R total score and the score in paranoid ideation, psychoticism subgroups were higher than the scores in somatization disorders. There were no statistical differences in suicide ideation and the total score of dissociative symptoms between the two disorders. The number of patients whose total DES score of 30 and above was higher in conversion disorders.

DISCUSSION

As a result of this present study, we concluded that to enlighten the concepts of conversion, further somatization and dissociation studies are necessary.