Transtorno de conversão

Perturbação de conversão (português europeu) ou transtorno de conversão (português brasileiro) é um problema de saúde em que o doente apresenta sintomas neurológicos como dormência, cegueira e paralisia, ou crises psicogénicas não epilépticas, mas sem causas orgânicas identificáveis. Portanto deve-se descartar todas causas neurológicas antes de chegar a esse diagnóstico de exclusão.

É diagnosticado de dois a quatro vezes mais em mulheres e entre adultos jovens, sendo raro em crianças.[1]

Classificação

É classificado como um transtorno somatoforme pelo Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)[2] e como um transtorno dissociativo pela classificação internacional de doenças (CID-10).

Anteriormente conhecido como "histeria", o transtorno tem sido conhecido desde há milénios, apesar de ter surgido com maior proeminência no fim do século XIX, quando os neurologistas Jean-Martin Charcot e Sigmund Freud e o psiquiatra Pierre Janet focaram os seus estudos no assunto. O termo "conversão" tem a sua origem na doutrina de Freud, na qual a ansiedade é "convertida" em sintomas físicos.[3] Apesar de pensar-se que teria desaparecido do mundo ocidental no século XX algumas pesquisas sugeriram que é tão comum como outrora.[4]

Diagnóstico

O transtorno de conversão se apresenta com sintomas que geralmente se assemelham de acidente vascular cerebral, esclerose múltipla, epilepsia focal, desequilíbrio hidroeletrolítico ou paralisia. Deve-se descartar todos diagnósticos diferenciais com seus respectivos exames específicos antes de um diagnóstico de transtorno de conversão.[5]

Tratamento

Os tratamentos para a síndrome de conversão incluem psicoterapia comportamental, fisioterapia, controle do estresse, terapia ocupacional e estimulação magnética transcraniana. Os planos de tratamento considerarão a duração e a apresentação dos sintomas e podem incluir um ou vários dos tratamentos acima.[6] Deve-se tratar transtorno de humor ou ansiedade associado com antidepressivos e psicoterapia. Existem algumas evidências de baixa qualidade que psicanálise pode ser útil, apesar de não ser eficaz na maioria dos casos.[7]

Referências

  1. ↑ Deveci A, Taskin O, Dinc G, Yilmaz H, Demet MM, Erbay-Dundar P, Kaya E, Ozmen E (2007). "Prevalence of pseudoneurologic conversion disorder in an urban community in Manisa, Turkey". Soc Psychiatry Psychiatr Epidemiol. 42 (11): 857–64. doi:10.1007/s00127-007-0233-9. PMID 17639308.
  2. ↑ Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, American Psychiatric Association
  3. ↑ Josef Breuer & Sigmund Freud, "Studies in Hysteria", 1895
  4. ↑ Akagi, H. & House, A.O., 2001, The epidemiology of hysterical conversion. In P. Halligan, C. Bass, J. Marshall (Eds.) Hysterical Conversion: clinical and theoretical perspectives (pp. 73–87). Oxford: Oxford University Press.
  5. ↑ Stone J, Carson A, Sharpe M (2005). "Functional symptoms and signs in neurology: assessment and diagnosis". J. Neurol. Neurosurg. Psychiatry. 76 Suppl 1: i2–12. doi:10.1136/jnnp.2004.061655. PMC 1765681. PMID 15718217.
  6. ↑ "Conversion disorder". Mayo Foundation for Medical Education and Research. Retrieved 25 October 2013.
  7. ↑ Feinstein A (2011). "Conversion disorder: advances in our understanding". CMAJ. 183 (8): 915–20. doi:10.1503/cmaj.110490. PMC 3091899. PMID 21502352.

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