To estimate the frequency of depression and anxiety in dissociative (conversion disorder) patients reporting at a tertiary care Psychiatric facility of Fauji Foundation Hospital Rawalpindi.
This descriptive cross-sectional study was carried out in the Department of Psychiatry of a tertiary care facility, Fauji Foundation Hospital Rawalpindi. 100 consecutive patients between ages of 13-60 years, diagnosed as conversion disorder from December 2009 to May 2010 were included in the study. The diagnosis was based on 1CD-10 (International classification of mental disorders, 10th edition) criteria. All underwent detailed assessments which included physical examination, ICD-10 diagnostic criteria of conversion disorder, demographic profile assessment, and Hospital Anxiety and Depression Scale (HAD). The data were analyzed using SPSS package version 10.
Majority of patients were young, female, formally educated, rural residents, unmarried, unemployed, having no family history of mental illness and presented via out-patients department. Dissociative convulsions (63%) were the most common presentation followed by dissociative motor disorder (24%), mixed dissociative disorder (8%), dissociative anesthesia and sensory symptoms (4%) and trance and possession disorder (1%). HAD scale analysis revealed that both anxiety and depression scores were clinically significant in majority of patients.
Our study showed substantially high rates of depression (61%) and anxiety (60%) in Conversion Disorder patients. Further research involving larger sample size and longitudinal follow up is required to elucidate possible perspective. (Rawal Med J 2010;35: ).
Conversion disorder, depression, anxiety.
Conversion disorder is judged to be caused by psychological factors as the illness is preceded by conflicts or other stressors. The symptoms are not intentionally produced, are not caused by substance use, and the gain is primarily psychological and not social, monetary, or legal.1 As the duration of disorder increases co-morbid psychopathologies and the level of anxiety and especially the prevalence of depression increase.2 The etiology, pathogenesis, phenomenology and management continues to arouse debate.3 The proper diagnosis of these patients has important implications for their clinical course.4
Conversion disorder patients have been females with average onset age of 25.9±7.5, a maximum of 11 years of education and prominent stress.2 Another study reported many had motor symptoms, seizures or convulsions, mixed presentations and sensory symptoms.5 Mixed symptoms were seen in 38% followed by 26% motor symptoms in a study from Pakistan.6 Anxiety, depression , borderline personality disorder, somatization disorder and post traumatic stress disorder are very common co morbid illnesses associated with conversion disorder.2,7-10 Temporal relationship of a stressful event is very common.2, 3,7,11
Key words: Conversion disorder, depression, anxiety.