Placebo-induced conversion reaction: A neurobehavioral and EEG study of hysterical aphasia, seizure, and coma.

Abstract

A patient in her mid-20's with an alleged idiosyncratic reaction to phenytoin (Dilantin) was studied by an objective double-dissociation method. Under carefully monitored conditions an iv saline placebo was administered. A variety of dose-dependent pseudoneurologic symptoms developed, including hysterical aphasia, pseudoseizures, and profound unresponsiveness. Optokinetic nystagmus, the visual threat reflex, corneal reflex, the auditory startle response, and responses to deep pain were completely lost. Despite the dramatic nature of symptoms, however, the EEG remained normal, and S responded to cues she overheard concerning her "drug" level. Later, no reactions occurred when, thinking it was something else, S actually received phenytoin. Hysterical aphasias and the implications for afferent theories of conversion reactions are discussed. A speculative model that pertains to dissociative phenomena (e.g., hidden-observer effect, selective awareness, and amnesia) and the controlled aspect of consciousness is suggested. (27 ref)

Non-organic language disorders: Three case reports

“…A comparison of our three cases with the case reported by Levy and Jankovic (1983) and Poulin et al (2007) When comparing our participants with each other and with the case reported by Levy and Jankovic (1983) and Poulin et al (2007), a number of similarities occur both in demographic and medical history, and in linguistic performance. All were known to have a prior history of psychiatric or social problems.…”

“…Therefore in this report we describe three new cases of language disorders with cerebral lesions as documented by neuro-imaging, but with a linguistic presentation that is totally incompatible with true aphasia and therefore not related to the documented lesions. We will argue the validity of the diagnosis and compare our linguistic and behavioural findings with the cases reported by Levy and Jankovic (1983) and Poulin et al (2007). We will attempt to identify common medical and social characteristics.…”

“…Subsequently these cases will be compared for language (semantics, phonology, morphology, and grammatica) and behavioural reactions (frustrations, self corrections, perseverations, associative deformations) with the participants described by Levy and Jankovic (1983) and Poulin et al (2007) …”

“…In these three reports the patients shared the presence of a psychiatric history, the acute onset of the language disorder, and the presence of agrammatism. In the fourth report language and speech alterations were induced by administration of placebo in a patient suffering from seizures (Levy & Jankovic, 1983). At this occasion the patient had slowness of speech and response, hypophonia, and decreased comprehensibility.…”

The Role of Hypnosis in the Detection of Psychogenic Seizures

“…But, in some types of pathologies (e.g., conversion or dissociative disorders), various subsystems process the incoming information in an uncoordinated or chaotic manner, provoking the dissociation of somatic, behavioral or cognitive ways of responding. A relevant clinical example was informed by Levy and Jankovic (1983). They described a patient with frequent psychogenic seizures who demonstrated a complete absence of optokinetic nystagmus, visual threat, corneal reflexes, as well as lack of response to very painful proceedings.…”