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Conversion disorder revisited: severe parasomnia discovered

K Bokey1

  • 1Department of Veterans' Affairs, Repatriation General Hospital, Concord, New South Wales.

The Australian and New Zealand Journal of Psychiatry
|December 1, 1993
PubMed
Summary

A Vietnam veteran

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Area of Science:

  • Neurology
  • Sleep Medicine
  • Psychiatry

Background:

  • Reappraisal of a long-standing conversion disorder diagnosis in a 49-year-old Vietnam veteran.
  • Consideration of newly described sleep-related movement and behavior disorders.

Observation:

  • Polysomnography revealed nocturnal "pseudoseizures" were caused by a severe mixed parasomnia.
  • The parasomnia included REM sleep behavior disorder and a non-REM parasomnia.
  • Abnormal sleep architecture included reduced REM latency and increased REM density.

Findings:

  • The patient's nocturnal behavioral disturbances were successfully treated with clonazepam.
  • Daytime "pseudoseizures" decreased in frequency, and overall well-being improved.
  • A link between parasomnias and psychological trauma is recognized.

Implications:

  • Physical disorders, specifically parasomnias, can mimic or underlie psychologically-driven symptoms.
  • Polysomnographic studies are crucial to rule out treatable parasomnias before diagnosing psychological causes for nocturnal disturbances.
  • This case highlights the importance of a thorough differential diagnosis in complex behavioral presentations.

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