Systematic review of misdiagnosis of conversion symptoms and "hysteria"

October 2005
BMJ: British Medical Journal (International Edition);10/29/2005, Vol. 331 Issue 7523, p989
Academic Journal
Objective: Paralysis, seizures, and sensory symptoms that are unexplained by organic disease are commonly referred to as "conversion" symptoms. Some patients who receive this diagnosis subsequently turn out to have a disease that explains their initial presentation. We aimed to determine how frequently this misdiagnosis occurs, and whether it has become less common since the widespread availability of brain imaging. Design: Systematic review. Data sources Medline, Embase, PsycINFO, Cinahl databases, and searches of reference lists. Review methods: We included studies published since 1965 on the diagnostic outcome of adults with motor and sensory symptoms unexplained by disease. We critically appraised these papers, and carried out a multivariate, random effect, meta-analysis of the data. Results: Twenty seven studies including a total of 1466 patients and a median duration of follow-up of five years were eligible for inclusion. Early studies were of poor quality. There was a significant (P < 0.02) decline in the mean rate of misdiagnosis from the 1950s to the present day; 29% (95% confidence interval 23% to 36%) in the 1950s; 17% (12% to 24%) in the 1960s; 4% (2% to 7%) in the 1970s; 4% (2% to 6%) in the 1980s; and 4% (2% to 6%) in the 1990s. This decline was independent of age, sex, and duration of symptom in people included in the studies. Conclusions: A high rate of misdiagnosis of conversion symptoms was reported in early studies but this rate has been only 4% on average in studies of this diagnosis since 1970. This decline is probably due to improvements in study quality rather than improved diagnostic accuracy arising from the introduction of computed tomography of the brain.


Related Articles

  • Guilt, fear after medical error can be bridged.  // Medical Ethics Advisor;Dec2007, Vol. 23 Issue 12, p135 

    This article explains that transparency about medical errors can help address the problems of guilt, fears and loneliness that caregivers and the patient and patient's family feel. It explains that medical error prevention and defusing of potential lawsuits are just part of the solution to the...

  • Commentary: Doctors are obliged to be honest with their patients. Wu, Albert W // BMJ: British Medical Journal (International Edition);05/19/2001, Vol. 322 Issue 7296, p1238 

    Comments on the debate over medical errors, with specific reference to a case in which a junior doctor failed to read an electrocardiogram that had been ordered before a patient died of a myocardial infraction. Responsibility of doctors to be honest with their patients; Number of mistakes made...

  • Body of evidence. Le Page, Michael; Wilson, Clare // New Scientist;11/11/2006, Vol. 192 Issue 2577, p48 

    The article focuses on efforts being made worldwide to reduce medical errors. Many times patients die due to the doctor's negligence in maintaining hygiene or prescribing wrong drugs. The concentration is towards reducing the errors in treatment, rather than in the original diagnosis. Flaws in...

  • Clarification of Terminology in Medication Errors: Definitions and Classification. Ferner, Robin E.; Aronson, Jeffrey K. // Drug Safety;Aug2006, Vol. 29 Issue 11, p1011 

    We have previously described and analysed some terms that are used in drug safety and have proposed definitions. Here we discuss and define terms that are used in the field of medication errors, particularly terms that are sometimes misunderstood or misused. We also discuss the classification...

  • Shotgun suits wound everyone. Starr, David S. // Cortlandt Forum;Dec2007, Vol. 20 Issue 12, p51 

    The article discusses on a misread biopsy followed by unnecessary breast surgery that entraps all the physicians involved with the patient's care into a lawsuit. Defendants of the case were three doctors who misdiagnosed a patient's benign breast mass as carcinoma. They all presented a united...

  • Trainees in difficulty. Long, Andrew // Archives of Disease in Childhood -- Fetal & Neonatal Edition;Jul2009, Vol. 94 Issue 7, p3 

    The article discusses the issues concerning the term trainee in difficulty and problem doctor which affects the consultant trainers in Great Britain. It emphasizes that the issue is all about the patient safety and managing the on-call rota. It offers information on the document "Medical Error"...

  • Admitting responsibility for mistakes. Holden, John // GP: General Practitioner;5/18/2007, p46 

    The article offers suggestions on how general practitioners (GPs) can best deal with mistakes in their medical practice in Great Britain. According to the author, GPs should acknowledge any complaints that patients make regardless of the nature of their charges. He also suggests that GPs should...

  • Mistakes In Hospitals Go Unchallenged, Study Finds.  // RN;Apr2005, Vol. 68 Issue 4, p18 

    This article reports that less than 10% of clinicians would challenge a colleague making a patient care error, a new national survey of nurses, physicians, allied health professionals, and administrators reveals. Co-sponsored by the American Association of Critical-Care Nurses (AACN) and...

  • Fixing America's Hospitals. Kalb, Claudia // Newsweek;10/16/2006, Vol. 148 Issue 16, p44 

    The article offers a look at patient safety in United States hospitals. According to the article, each year 100,000 people die and 1.5 million people are injured due to medical errors. The author argues that although physicians will always make mistakes, it is important that systems be...


Read the Article


Sign out of this library

Other Topics