Clinical Analysis Of Conversion Disorder(CD) In Children

Background Conversion disorder(CD)in children,also known as hysterical physical disorders or Conversion disorder,may have psychological and social factors as an incentive.It has varieties of clinical manifestations,including sensory disorders,moving disorders,reflex disorders,visceral function disorders and other physical symptoms.The onset of CD has a clear relationship with the stressful events,and the course of disease always procrastinates.In recent years,the morbidity of Children Psychological Problems is rising,and the detection rate of CD also increases.CD patients usually have somatic symptoms when they see a doctor.Since some clinicians lack of awareness of the disease,they may misdiagnosis it as physical disease,and give unnecessary treatment,which delays pathogenetic condition and causes psychological and economic burden.At present,there are few comprehensive report about the clinical analysis of the pathogenic factors,clinical manifestation and misdiagnosis of Conversion disorder(CD)in children.Objective The purpose of this study was to analysis pathogenic factors,clinical manifestation and the reasons of misdiagnosis of CD in children,improve the awareness of the disease in pediatrician,reduce misdiagnosis rate,and provide clinical basis for early diagnosis and prevention of CD.Methods As for case group,we collected clinical data of 27 examples of CD in Children going to First Affiliated Hospital of Xinxiang Medical College from January 1st,2014 to December 30 th,2015.Some of the examples were hospitalized,and some were outpatient.As for control group,we selected 30 examples healthy children from a primary school and a middle school in Henan province.We collected clinical data via the Eysenck Personality Questionnaire(EPQ),Evaluation of parental rearing patterns(EMBU),and family envioronment scale-Chinese version(FES-CV).We compared related data btween the groups of Children,and analysised the pathogenic factors,clinical manifestation,and reasons of misdiagnosis of CD in Children.Statistical analyses were performed using SPSS version 17.0.Results 1.General information of conversion disorder(CD)in children were as follows:(1)Gender:15 cases were male accounting for 55.56%,and 12 cases were female accounting for 44.44%.(2)Age distribution:1 case was 7 years old accounting for 3.70%;4 cases were 8 years old accounting for 14.81%;7 cases were 9 years old accounting for 25.93%;3 cases were 10 years old accounting for 11.11%;6 cases were 11 years old accounting for 22.22%;2 cases were 12 years old accounting for 7.41%;2 cases were 13 years old accounting for 7.41%;and 2 cases were 14 years old accounting for 7.41%.(3)The onset time: 2 cases were in March accounting for 7.41%;4 cases were in April accounting for 14.81%;3 cases were in May accounting for 11.11%;4 cases were in June accounting for 14.81%;3 cases were in July accounting for 11.11%;8 cases were in September accounting for 29.63%;1 case was in October accounting for 3.70%;1 case was in November accounting for 3.70%;and 1 case was in December accounting for 3.70%.2.The clear causes before the onset were as follows: 12 cases had great school stress accounting for 44.44%;5 cases were reluctant to go to school accounting for 18.52%;7 cases had physical illnesses accounting for 25.93%;and 3 cases had problem getting along with classmates accounting for 11.11%.3.The character in the case group was as follows: 11 cases were of outward instability accounting for 40.74%;3 cases were of outward stability accounting for 11.11%;8 cases were of inward instability accounting for 29.63%;and 5 cases were of inward stability accounting for 18.52%.4.Family factors were as follows:(1)There were significant differences of parental rearing pattern among parents' emotional warmth and understanding factor(t=-6.289,P= 0.000;t=-2.218,P=0.031),father excessive interference factor(t=-2.106,P= 0.040)and mother's punishment and severity factor(t=1.238,P=0.000)between the two groups of Children.Parents' emotional warmth and understanding factor and father excessive interference factor in the case group were lower than that in the control group,while mother's punishment and severity factor in the case group was higher than that in the control group.(2)Family environment:there were significant differences among intimacy(t=-3.407,P= 0.001),contradiction(t= 3.310,P= 0.002)and entertainment(t=-2.555,P= 0.013)between the two groups of Children.Intimacy and entertainment in the case group were lower than that in the control group,and contradiction was higher than that in the control group.5.Other relevant factors: social and culture(urban and rural)factors,whether being left,whether resident,and somatic factor were independent risk factors(P<0.05,95%CI not including 1),which influenced the incidence of CD in children.Genetic factors,academic burden,teacher criticizing,classmates confliction,and learning achievement were non independent related factors(P>0.05).6.(1)The clinical symptom was as follows: Neurological symptoms accounted for 85.19%;digestive system symptoms accounted for 66.67%;circulatory system symptoms accounted for 51.85%;respiratory symptoms accounted for 25.93%;and others accounted for 11.11%.(2)6 cases(22.22%)had only one kind of clinical symptom;12(44.44%)had two kinds;3(11.11%)had 3 kinds;and 6(22.22%)had more than 3 kinds.(3)There were no significant differences in the clinical symptoms of different genders(P>0.05).7.Misdiagnosis: Ten outpatient cases were all preliminary diagnosised as CD in Children.Among the seventeen hospitalized cases,nine cases were misdiagnosised,and the proportion of misdiagnosis among hospitalized cases reached 52.94%.Conclusions 1.The age of CD in Children were mostly between 8-11 years old.The onset mostly happened during April to September.The peak was in September.2.There were clear psychological factors before the onset.3.The main character of CD in Children was the type of outward instability.4.Family factors,social and cultural factors,being left behind,living on campus,together with the body factors affected the incidence of CD.5.There were various clinical symptoms and most may include two or more clinical features.6.It was often misdiagnosised as somatic disease.Pediatrician should enhance the knowledge of the disease during clinical work and reduce the possibility of misdiagnosis and mistreatment.