BMJ 1998;316:582-586 ( 21 February )

Papers

Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms

See editorial by O'Brien

Helen L Crimlisk, research fellow, a Kailash Bhatia, senior lecturer, a Helen Cope, senior lecturer, b Anthony David, professor of cognitive neuropsychiatry, b C David Marsden, professor of neurology, a Maria A Ron, professor of neuropsychiatry. a

a Institute of Neurology, London WC1N 3BG, b Institute of Psychiatry, London SE5 8AF

Correspondence to: Professor Ron M.RON{at}ion.ucl.ac.uk

Objective: To investigate psychiatric and neurological morbidity, diagnostic stability, and indicators of prognosis in patients previously identified as having medically unexplained motor symptoms.
Design: Follow up study.
Setting: National Hospital for Neurology and Neurosurgery, London---a secondary and tertiary referral hospital for neurological disorders.
Subjects: 73 patients with medically unexplained motor symptoms admitted consecutively in 1989-91. 35 (48%) patients had absence of motor function (for example, hemiplegia) and 38 (52%) had abnormal motor activity (for example, tremor, dystonia, or ataxia).
Main outcome measures: Neurological clinical diagnosis at face to face reassessment by a neurologist and a psychiatric diagnosis after a standardised assessment interview---the schedule for affective disorders and schizophrenia---conducted by a psychiatrist.
Results: Good follow up data were available for 64 subjects (88%). Only three subjects had new organic neurological disorders at follow up that fully or partly explained their previous symptoms. 44/59 (75%) subjects had had psychiatric disorders; in 33 (75%) patients, the psychiatric diagnosis coincided with their unexplained motor symptoms. 31/59 (45%) patients had a personality disorder. Three subjects had developed new psychiatric illnesses at follow up, but in only one did the diagnosis account for the previous motor symptoms. Resolution of physical symptoms was associated with short length of symptoms, comorbid psychiatric disorder, and a change in marital status during follow up.
Conclusions: Unlike Slater's study of 1965, a low incidence of physical or psychiatric diagnoses which explained these patients' symptoms or disability was found. However, a high level of psychiatric comorbidity existed.

Key messages

  • Motor symptoms that remain unexplained medically despite thorough investigation are a common clinical problem, but the emergence of a subsequent organic explanation for these symptoms is rare

  • The prevalence of coexistent affective and anxiety disorders is high and many patients also have a personality disorder

  • Patients with a shorter duration of symptoms and coexistent anxiety or depression are likely to do better at follow up

  • Reinvestigation of these patients is both expensive and potentially dangerous and should be avoided where no clear clinical indication exists



© BMJ 1998
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Assessment and management of medically unexplained symptoms
Simon Hatcher and Bruce Arroll
BMJ 2008 336: 1124-1128. [Extract] [Full Text] [PDF]

Systematic review of misdiagnosis of conversion symptoms and "hysteria"
Jon Stone, Roger Smyth, Alan Carson, Steff Lewis, Robin Prescott, Charles Warlow, and Michael Sharpe
BMJ 2005 331: 989. [Abstract] [Full Text] [PDF]

Prognosis of symptoms that are medically unexplained
Michael Götz and Allan House
BMJ 1998 317: 536. [Extract] [Full Text] [PDF]

Researching laterally
BMJ 1998 316: 0. [Full Text]

Hysteria can be diagnosed with confidence
BMJ 1998 316: 0. [Full Text]

Medically unexplained neurological symptoms
Michael D O' Brien
BMJ 1998 316: 564-565. [Extract] [Full Text]

This article has been cited by other articles:

  • Stone, J., Carson, A., Duncan, R., Coleman, R., Roberts, R., Warlow, C., Hibberd, C., Murray, G., Cull, R., Pelosi, A., Cavanagh, J., Matthews, K., Goldbeck, R., Smyth, R., Walker, J., MacMahon, A.D., Sharpe, M. (2009). Symptoms 'unexplained by organic disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up?. Brain 132: 2878-2888 [Abstract] [Full text]  
  • Hatcher, S., Arroll, B. (2008). Assessment and management of medically unexplained symptoms. BMJ 336: 1124-1128 [Full text]  
  • Brousseau, K., Arciniegas, D., Carmosino, M., Corboy, J. (2007). The differential diagnosis of Axis I psychopathology presenting to a university-based multiple sclerosis clinic. Mult Scler 13: 749-753 [Abstract]  
  • Reuber, M., Howlett, S., Khan, A., Grunewald, R. A. (2007). Non-Epileptic Seizures and Other Functional Neurological Symptoms: Predisposing, Precipitating, and Perpetuating Factors. Psychosomatics 48: 230-238 [Abstract] [Full text]  
  • Owens, C., Dein, S. (2006). Conversion disorder: the modern hysteria. Adv. Psychiatr. Treat. 12: 152-157 [Abstract] [Full text]  
  • STONE, J., SMYTH, R., CARSON, A., WARLOW, C., SHARPE, M. (2006). La belle indifference in conversion symptoms and hysteria: Systematic review. Br. J. Psychiatry 188: 204-209 [Abstract] [Full text]  
  • Fink, P., Steen Hansen, M., Sondergaard, L. (2005). Somatoform Disorders Among First-Time Referrals to a Neurology Service. Psychosomatics 46: 540-548 [Abstract] [Full text]  
  • Stone, J., Smyth, R., Carson, A., Lewis, S., Prescott, R., Warlow, C., Sharpe, M. (2005). Systematic review of misdiagnosis of conversion symptoms and "hysteria". BMJ 331: 989- [Abstract] [Full text]  
  • Cathebras, P., Koenig, M. (2005). Spinal Cord Astrocytoma Mistaken for Conversion Disorder. Psychosomatics 46: 187-188 [Full text]  
  • Reuber, M, Mitchell, A J, Howlett, S J, Crimlisk, H L, Grunewald, R A (2005). Functional symptoms in neurology: questions and answers. J. Neurol. Neurosurg. Psychiatry 76: 307-314 [Abstract] [Full text]  
  • Stone, J, Carson, A, Sharpe, M (2005). Functional symptoms in neurology: management. J. Neurol. Neurosurg. Psychiatry 76: i13-i21 [Full text]  
  • Stone, J., Sharpe, M., Binzer, M. (2004). Motor Conversion Symptoms and Pseudoseizures: A Comparison of Clinical Characteristics. Psychosomatics 45: 492-499 [Abstract] [Full text]  
  • Carson, A J, Best, S, Postma, K, Stone, J, Warlow, C, Sharpe, M (2003). The outcome of neurology outpatients with medically unexplained symptoms: a prospective cohort study. J. Neurol. Neurosurg. Psychiatry 74: 897-900 [Abstract] [Full text]  
  • Stone, J, Sharpe, M, Rothwell, P M, Warlow, C P (2003). The 12 year prognosis of unilateral functional weakness and sensory disturbance. J. Neurol. Neurosurg. Psychiatry 74: 591-596 [Abstract] [Full text]  
  • STONE, J., ZEIDLER, M., SHARPE, M. (2003). Misdiagnosis of Conversion Disorder. Am. J. Psychiatry 160: 391-391 [Full text]  
  • Peters, S., Stanley, I., Rose, M., Kaney, S., Salmon, P. (2002). A randomized controlled trial of group aerobic exercise in primary care patients with persistent, unexplained physical symptoms. Fam Pract 19: 665-674 [Abstract] [Full text]  
  • Stone, J, Sharpe, M, Carson, A, Lewis, S C, Thomas, B, Goldbeck, R, Warlow, C P (2002). Are functional motor and sensory symptoms really more frequent on the left? A systematic review. J. Neurol. Neurosurg. Psychiatry 73: 578-581 [Abstract] [Full text]  
  • Stone, J, Zeman, A, Sharpe, M (2002). Functional weakness and sensory disturbance. J. Neurol. Neurosurg. Psychiatry 73: 241-245 [Abstract] [Full text]  
  • BASS, C., PEVELER, R., HOUSE, A. (2001). Somatoform disorders: severe psychiatric illnesses neglected by psychiatrists. Br. J. Psychiatry 179: 11-14 [Abstract] [Full text]  
  • Ron, M. (2001). Explaining the unexplained: understanding hysteria. Brain 124: 1065-1066 [Full text]  
  • Wade, D. T (2001). Medically unexplained disability - a misnomer, and an opportunity for rehabilitation. Clin Rehabil 15: 343-347 [Abstract]  
  • (2001). What to do about medically unexplained symptoms. DTB 39: 5-8 [Abstract] [Full text]  
  • Geddes, J. (2000). Answering clinical questions about prognosis. Evid. Based Ment. Health 3: 100-101 [Full text]  
  • Halligan, P. W, Bass, C., Wade, D. T (2000). New approaches to conversion hysteria. BMJ 320: 1488-1489 [Full text]  
  • Carson, A. J, Ringbauer, B., Stone, J., McKenzie, L., Warlow, C., Sharpe, M. (2000). Do medically unexplained symptoms matter? A prospective cohort study of 300 new referrals to neurology outpatient clinics. J. Neurol. Neurosurg. Psychiatry 68: 207-210 [Abstract] [Full text]  
  • Binzer, M., Kullgren, G. (1998). Motor Conversion Disorder: A Prospective 2- to 5-Year Follow-Up Study. Psychosomatics 39: 519-527 [Abstract] [Full text]  
  • Götz, M., House, A. (1998). Prognosis of symptoms that are medically unexplained. BMJ 317: 536-536 [Full text]  
  • (1998). Ultimate Diagnosis of Patients with Unexplained Neurologic Symptoms. JWatch General 1998: 9-9 [Full text]  
  • Brien, M. D O' (1998). Medically unexplained neurological symptoms. BMJ 316: 564-565 [Full text]  

Rapid Responses:

Read all Rapid Responses

Paroxysmal neurological disorders in medically unexplained motor dysfunctions
K R Nair
bmj.com, 26 Dec 1999 [Full text]
Revisiting Slater revisited:
David PJ Osborn, et al.
bmj.com, 2 Oct 2002 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ