Differential Diagnosis

Careful history taking and physical examination should be used to rule out neurologic disease. A high index of suspicion should be maintained for physical disorders that have a vague onset, such as systemic lupus erythematosus, multiple sclerosis, polymyositis, Lyme disease, and drug toxicity or poisoning. Schizophrenia and depression may have associated conversion disorders. In somatization disorders, the symptoms are more chronic and involve multiple organ systems. With hypochondriasis, patients are usually without loss of function and display the conviction that some terrible undiscovered illness is present. Hypochondriacal patients will be overly concerned with symptoms. In cases of factitious symptoms, usually associated with malingering, patients will consciously complain about symptoms to get out of undesirable duty or to receive sympathy or undeserved compensation. These patients rarely have neurologic complaints. 7 Amobarbital interviews have been used to diagnose both conversion disorder and/or coexisting diagnoses. They may be therapeutic as well. 8

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