Hysterical and comorbid mental disorders in outpatient neurological practice

Introduction. Particular problems in diagnosing hysteria are determined by its inordinate changeability, which explains the traditional ambiguity of ideas concerning its essence and the specific diagnostic problems. As we know, a significant number of patients with conversion and dissociative disorders present at neurological clinics, thus constituting the distinct cohort of “difficult patients”.
Study aim. Identifying the current clinical-dynamic regular patterns of hysterical disorders (taking into account the temporal pathological morphosis) for purposes of providing substantiation for their psychopathological essence and the optimal therapeutic-diagnostic tactics in respect of the pertinent cohort of patients.
Materials and methods. Between 2016 and 2018 at the “Practical Neurology” Medical Center we have examined 80 patients (71 women and 9 men) aged between 17 and 72. The criteria for inclusion into this group were the presence of hysterical symptoms as the main disorder in the clinical picture, and meeting the criteria for being the so-called «difficult patient», which are well-known in clinical practice. After having excluded the presence of organic neurological pathology, and taking into account the specifics of their current complaints (which correspond to conversion and somatoform disorders), the patients have been seen by a psychiatrist on condition of having obtained their informed consent. The examination was carried out by means of collecting anamnestic data from patients and people closely involved with them. Disorders were diagnosed in accordance with the ICD-10 criteria and with the use of the brief scale for assessing the mental status of MMSE (Mini-mental State Examination). Statistical processing of obtained data has been carried out with the use of Statistica 10. rus software. Comparative study of frequencies has been carried out with the F-test – φ* criterion; differences with р <0.05 were seen as reliable.
Results. Hysterical disorders in the examined patients have been differentiated within four clusters: 1) motor disorder (n = 24 (30 %)); 2) sensory disorders (n = 29 (36.2 %)); 3) somatoform disorders (n =5 (6.3 %)); and 4) dissociative disorders (n = 22 (27.5 %)). Comorbid mental disorders in the examinees were represented by: 1) affective disorders F30–39 (n = 42 (52.5 %)); 2) schizophrenia  spectrum disorders F20–29 (n = 20 (25 %)); 3) personality disorders F60–69 (n = 14 (17.5 %)); 4) organic mental disorders F00–09 (n = 3 (3.75 %)); 5) posttraumatic stress disorder F43 (n = 1 (1.3 %)). Hysterical disorders manifest high comorbidity with other mental disorders, above all, – the affective ones, schizophrenia spectrum disorders, and the pathology of personality. The nature of comorbid pathology determines the clinical-dynamic regular patterns of hysterical syndromes, the diagnostic problems of prime concern, and the tactics of therapy. 
Conclusion. Interdisciplinary approach contributes to improving the effectiveness of therapeutic-diagnostic assistance provided to patients with hysterical and comorbid mental disorders.

1. Romasenko L.V. Pathological morphosis of hysterical disorders. X clinical Pavlovian readings. Tenth issue.] Patomorfoz istericheskikh rasstroistv. Conference proceedings “Х klinicheskiye Pavlovskiye chteniya. Issue 10th”. Saint-Petersburg, 2006. P. 20–25. (In Russ.)

2. Janet P. Neuroses. Мoscow: Kosmos, 1911. 315 p. (In Russ.).

3. Jakubik А. Hysteria (methodology, theory, psychopathology). М.: Medicine, 1982. 44 р. (In Russ.).

4. Semke V.Ya. Hysterical states. М.: Medicine, 1988. 224 р. (In Russ.).

5. Woodruff R., Clayton P., Guze S. Hysteria: Studies of diagnosis, outcome, and prevalence. JAMA 1971;215:425–8. DOI: 10.1001/jama.1971.03180160025006. PMID: 5107385.

6. Stone J., Carson A., Duncan R. et al. Symptoms “unexplained by organic disease” in 1144 new neurology outpatients: how often does the diagnosis change at follow-up? Brain 2009;132:2878–88. DOI: 10.1093/brain/awp220. PMID: 19737842.

7. Lempert T., Dieterich M., Huppert D., Brandt T. Psychogenic disorders in neurology: frequency and clinical spectrum. Acta Neurol Scand 1990;82: 335–40. DOI: 10.1111/j.1600-0404.1990. tb03312.x. PMID: 2281751.

8. Reynolds E.H. Hysteria, conversion and functional disorders: A neurological contribution to classification issues. Br J Psychiatr 2012;201:253–4. DOI: 10.1192/bjp.bp.111.107219. PMID: 23028080.

9. North C.S. The classification of hysteria and related disorders: historical and phenomenological considerations. Behav Sci 2015;5(4):496–517. DOI: 10.3390/bs5040496. PMID: 26561836.

10. Dyukova G.M. The main principles of diagnosing hysteria in neurology. Selected lectures. М.: Eidos-Media, 2006. P. 316–337. (In Russ.).

11. Diukova G.M., Golubev V.I., Pogromov A.P., Mnatsakanyan M.G. Functional disorders: pathogenesis and systematic of clinical presentation. Zurnal Nevrologii i Psihiatrii = Neurology and Psychiatry Journal 2016;12:137–44. (In Russ.).

12. International Classification of Diseases (10th revision). Classification of mental and behavioral disorders. Clinical descriptions and diagnostic guidelines. Saint Petersburg: Overlaid, 1994. 303 р. (In Russ.).

13. Folstein M.F., Folstein S.E., McHugh P.R. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189–98. DOI: 10.1016/0022-3956(75)90026-6. PMID: 1202204.