Psychiatric Medications Q 32
Meryl, age 19, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. Meryl asks the nurse, “Why has this happened to me?” What is the nurse’s best response?
A. "You've developed this paralysis so you can stay with your parents. You must deal with this conflict if you want to walk again."
B. "It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical."
C. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened."
D. "It isn't uncommon for someone with your personality to develop a conversion disorder during times of stress."
Correct Answer: C. “Your problem is real but there is no physical basis for it. We’ll work on what is going on in your life to find out why it’s happened.”
The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is resolved, her symptoms will disappear.
Option A: Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn’t help her understand and resolve the underlying conflict. Conversion disorder, also known as functional neurological symptom disorder (FND), is a psychiatric disorder characterized by symptoms affecting sensory or motor function. These signs and symptoms are inconsistent with patterns of known neurologic diseases or other medical conditions. Although conversion disorder has no organic basis, the symptoms significantly impact a patient’s ability to function.
Option B: Saying that it must be awful not to be able to move her legs wouldn’t answer the client’s question; knowing that the cause is psychological wouldn’t necessarily make her feel better. Psychological, social, and biological factors can all contribute to, precipitate, or perpetuate conversion disorder. Often, there is a trauma, adverse life event, or acute/chronic stressor preceding symptoms of conversion disorder. Many patients with conversion disorder are found to have a history of childhood abuse, both emotional and sexual. Other psychological factors contributing to conversion disorder include poor coping skills and internal psychological conflicts.
Option D: Patients with conversion disorder are more likely to have certain psychiatric disorders (depression, anxiety, and personality disorders) than patients with known neurologic conditions. They are also more likely to have a history of multiple somatic complaints, including symptoms like generalized fatigue, weakness, or pain, without a known cause.