Systematic review of misdiagnosis of conversion symptoms and “hysteria”

Abstract

Objective Paralysis, seizures, and sensory symptoms that are unexplained by organic disease are commonly referred to as "conversion" symptoms. Some patients who receive this diagnosis subsequently turn out to have a disease that explains their initial presentation. We aimed to determine how frequently this misdiagnosis occurs, and whether it has become less common since the widespread availability of brain imaging. Design Systematic review. Data sources Medline, Embase, PsycINFO, Cinahl databases, and searches of reference lists. Review methods We included studies published since 1965 on the diagnostic outcome of adults with motor and sensory symptoms unexplained by disease. We critically appraised these papers, and carried out a multivariate, random effect, meta-analysis of the data. Results Twenty seven studies including a total of 1466 patients and a median duration of follow-up of five years were eligible for inclusion. Early studies were of poor quality. There was a significant (P < 0.02) decline in the mean rate of misdiagnosis from the 1950s to the present day; 29% (95% confidence interval 23% to 36%) in the 1950s; 17% (12% to 24%) in the 1960s; 4% (2% to 7%) in the 1970s; 4% (2% to 6%) in the 1980s; and 4% (2% to 6%) in the 1990s. This decline was independent of age, sex, and duration of symptom in people included in the studies. Conclusions A high rate of misdiagnosis of conversion symptoms was reported in early studies but this rate has been only 4% on average in studies of this diagnosis since 1970. This decline is probably due to improvements in study quality rather than improved diagnostic accuracy arising from the introduction of computed tomography of the brain.

Sintomas somatoformes em medicina de família: um estudo descritivo da incidência e evolução em uma unidade de saúde familiar de Portugal

“…Seis meses após a primeira consulta, apenas em 3% dos pacientes se chegou a um diagnóstico orgânico, valor que está de acordo com Stone et al 23 , que, numa revisão sistemática dos sintomas de conversão (paralisias, convulsões e cegueira), encontraram uma redução progressiva do número de erros até a década de 1970, para posteriormente estabilizar nos 4%.…”

Conversion disorder: advances in our understanding

“…However, follow-up studies done after 1970 have, on average, reported a significantly lower rate of mis diagnosis of conversion symptoms, namely in the order of 0.4%-4%. 15,16 This difference may be explained by improvements in the quality of the follow-up studies and, to a lesser extent, the advances made in neuroimaging techniques.…”

Afasia global sem hemiparesia: AVC ou transtorno conversivo?

“…Todavia, estudos mais recentes demonstram que a taxa de re-diagnóstico diminuiu muito, atribuindo tal mudança ao desenvolvimento de métodos diagnósticos mais apurados (Mace e Trimble, 1996;Binzer e Kullgren, 1998;Crimlisk et al, 1998). Outra explicação para a redução de erros diagnósticos observada após a década de 1970 é a melhoria na qualidade desses estudos, já que os anteriores apresentavam importantes falhas metodológicas (Stone et al, 2005).…”