Psychogenic Dizziness? (Full Version)

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gshumrak -> Psychogenic Dizziness? (January 30, 2008 11:18:13 PM)

Has anyone ever treated a person with psychogenic dizziness?  I currently am treating a pt with conversion disorder who presents with astasia abasia and dizziness all the time.  Psychiatrists and neurologists are pretty sure this is all conversion.  I am doing vestibular PT interventions and balance and gait training.  SO far her gait has improved significantly but still greatly impaired but the dizziness has stayed the same.  Any ideas or sources/references would be great.



orthotherapist -> RE: Psychogenic Dizziness? (January 31, 2008 9:32:15 AM)

If it is a conversion disorder this is a psychiatric diagnosis and in my opinion therapy would not be warranted - she needs to see a psychiatrist to address the issue which are affecting her.



gshumrak -> RE: Psychogenic Dizziness? (February 1, 2008 7:55:55 PM)

She is in the inpatient psych unit at the hospital in which I work.  PT is very warranted with pt's with conversion disorder.  You work in collaboration with the psychiatrists.  She has been seen since early Decemeber 5x a week as an inpatient and she has improved a lot.  SHe couldn't even walk a foot without falling over now she is walking 1000+ but still with LOB.  She is starting to plateau, so I was looking for new treatment ideas. 

There are some very good articles in Physical Therapy about pt's with conversion and how they benefit most from a multi disciplinary approach.  Often times they are admitted to acute rehab floors for this as well. 



tucker -> RE: Psychogenic Dizziness? (February 2, 2008 10:26:19 PM)

Don't you just want to plant a hidden camera in her room and see how she walks when nobody is watching?   Nowadays, you could just...acccidentally...leave the cell phone with video on in the room.  But seriously, how do you differentiate between conversion and malingering without knowing what goes on behind the door.

Sorry, but I was burned before by a malingerer...I had 2 patients in the acute setting who presented with flaccid hemiplegia (although not consistent) and conversion disorder was suspected since there was no neurological explanation.  Worked with them a few days and once I told them they were going to be sent to inpatient rehab...both spontaneusly recovered the following day.  Walked into the room and they showed me how they could move without any problems..."Look, I'm back to normal!...Now I can go home instead of the rehab!" 



blast7 -> RE: Psychogenic Dizziness? (February 3, 2008 12:40:19 PM)

gshumrak, I have seen a fair number of patients with conversion disorder and agree with your statement that P.T. is absolutely indicated.  Many times the conversion disorder is without the patient even knowing that they are "faking".  However even with those patients that do know what they are doing there is usually some underlying psychological cause and P.T. can still help.  I would continue with your current treatment plan and avoid making any specific statements that the patient can hold onto.   I also try to redirect the patient to get away from these negative thoughts.  I would keep your plan of care as is and use more positive reinforcement, encouragement of increased activity as well as participation in social activities in the hospital.   Clinically I have had great success with these patients when as you said there is a multi disciplinary approach.  It does not work if you tell them straight to their face they are faking.  Let me know if you need any more ideas.



gshumrak -> RE: Psychogenic Dizziness? (February 4, 2008 11:11:39 PM)

Thanks for your help blast7.  I have been focusing on her improving function, being super encouraging.  I am trying to think of more social activities more meaningful to her as well. 



blast7 -> RE: Psychogenic Dizziness? (February 5, 2008 11:30:40 PM)

How old is the patient and what does psych think?



gshumrak -> RE: Psychogenic Dizziness? (February 10, 2008 5:42:57 PM)

She is 35 y/o but if you saw her you would think she was 20.  SHe is very immature. Psyc believes the underlying conflict that is the root of the conversion disorder is that she is in a bad relationship, engaged for the past 2-3 years to a drunk, and that this "illneess" or sick role is a way of postponing the wedding. SHe is not very open about talking about her relationship.   They are working with her and her family, her parents are very supportive of her and are able to help her financially if she leaves the relationship.  Psyc. is still concerned that there might be an organic neurological problem, but she has been seen by one of the top neurologists specializing in vestibular disorders in the country and he beleives this is not organic.  SHe has had VEMP testing and many other vestibular tests, all negative.
Interestingly enough, I work with her monday thru friday and she has been doing better each day, but monday after her fiance visits her for the weekend, she does markedly worse. 
It really is fascinating.



orthotherapist -> RE: Psychogenic Dizziness? (February 11, 2008 11:25:43 AM)

I still have a hard time understanding how therapy is not warranted in this case - if the "sick role" is a way of postponing the wedding arent you feeding into her having the sick role ("if something is wrong with me look at all the attention I get"  - attention she is probably not getting from her fiance) by continuing to treat her and giving her attention. 

Please educate me on how therapy is appropriate in these cases  - this is not my area of expertise.  Are there journal articles that I can review?






gshumrak -> RE: Psychogenic Dizziness? (February 12, 2008 8:45:52 PM)

You have to think of someone with conversion disorder just like you do someone who has the same physical symptoms from organic diseases. It is best done as a multi-d approach with psych or neuropsych and therapies.  Here are a couple articles to give you a little background.

Ness, D. Physical Therapy Management for Conversion Disorder: a case series.  Journal of neurological physical therapy 2007, 31, 30-39.

Baik, J. Lang, A.  Gait Abnormalities in Psychogenic Movement Disorders.  Movement Disorders.  2007, 22:3.





orthotherapist -> RE: Psychogenic Dizziness? (February 13, 2008 10:35:32 AM)

Thank you - I will take a look. 



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