Article Text

other Versions

PDF
Review
The value of ‘positive’ clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review
  1. Corinna Daum1,
  2. Monica Hubschmid2,
  3. Selma Aybek1
  1. 1Department of Neurology, Clinical Neurosciences Department, University Hospital (CHUV), Lausanne, Switzerland
  2. 2Psychiatric Liaison Service, Psychiatry Department, University Hospital (CHUV), Lausanne, Switzerland
  1. Correspondence to Dr Selma Aybek, Department of Neurology, Clinical Neurosciences Department, University Hospital (CHUV), Service de Neurologie- BH13, Bugnon 44,  Lausanne 1011, Switzerland; selma.aybek{at}chuv.ch

Abstract

Experts in the field of conversion disorder have suggested for the upcoming DSM-V edition to put less weight on the associated psychological factors and to emphasise the role of clinical findings. Indeed, a critical step in reaching a diagnosis of conversion disorder is careful bedside neurological examination, aimed at excluding organic signs and identifying ‘positive’ signs suggestive of a functional disorder. These positive signs are well known to all trained neurologists but their validity is still not established. The aim of this study is to provide current evidence regarding their sensitivity and specificity. We conducted a systematic search on motor, sensory and gait functional signs in Embase, Medline, PsycINfo from 1965 to June 2012. Studies in English, German or French reporting objective data on more than 10 participants in a controlled design were included in a systematic review. Other relevant signs are discussed in a narrative review. Eleven controlled studies (out of 147 eligible articles) describing 14 signs (7 motor, 5 sensory, 2 gait) reported low sensitivity of 8–100% but high specificity of 92–100%. Studies were evidence class III, only two had a blinded design and none reported on inter-rater reliability of the signs. Clinical signs for functional neurological symptoms are numerous but only 14 have been validated; overall they have low sensitivity but high specificity and their use should thus be recommended, especially with the introduction of the new DSM-V criteria.

Statistics from Altmetric.com

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.