HYSTERIA IN CHILD

HYSTERIA (HYSTERICAL CONVERSION REACTION) IN CHILD

In hysteria, now recognized as a dissociative (conversion) disorder, the child (usually a preadolescent or an adolescent) with a psychopathic personality presents with manifestations simulating an organic disease, say recurrent abdominal pain, sensation of compression of the throat (globus hystericus), blindness, gait disturbances, paralysis, sensory loss, urinary retention, seizures or dyspnea.

A good history-taking and clinical workup usually lead to the correct diagnosis without resorting to painstaking investigations. The patients has a tendency to be indifferent to the queries and relates manifestation in a detached manner.

Common Presentations

Hysterical seizures, a common presentation, are remarkable by absence of tongue-biting, apnea and incontinence. The patient tends to forcibly to hold the eyes closed  and seizure activity  is bizarre. Quite often, seizures are marked by rhythmic thrusting and writing of trunk. Nocturnal seizures, stereotyped aura, cyanotic skin changes and postictal confusion are infrequent in pseudo-seizures seen in hysteria. Moreover, serum prolactin level remain normal after the pseudo-seizures. EEG too shows no spike and wave forms or postictal slowing.

Hysterical blindness is characterized by tunnel vision and absence of papillary abnormality and fundoscopic abnormality.

Hysterical ataxia is characterized by inability to stand or walk without any deficit on neurologic examination when tested in lying position. The gait is bizarre and there is extreme lurching on the sides. In cerebellar ataxia, on the other hand, the patient walks on a wide base and has difficulty in maintaining in balance.

Hysterical paralysis is characterized by presence of normal muscle tone, tendon reflexes and plantars, and positive Hoover test. The last named consists in keeping hand under the allegedly paralysed leg and asking the patient to raise the normal leg against resistance. As the patient forcefully lifts the leg, the examiner’s hand can feel downward pressure of the effected leg against the examiner’s hand. This occurs only in hysteria.

Hyperventilation syndrome is a state characterized by dyspnea, tightness or stabbing pain in chest, headache, abdominal pain, muscle pains, paresthesia, palpitations, dryness of mouth, vertigo, choking, weakness, blurred vision, confusion and syncope. The syndrome occurs in episodes. The causes include acute anxiety state, uremia, salicylate poisoning, hypernatremic dehydration, diabetic ketoacidosis, and Reye syndrome. Treatment is primarily of the cause.

Management

Treatment of hysteria is primarily early detection and symptom removal. The symptom removal (normalization) can be attained by insisting on adherence to routine and contracting differential reinforcing and removal of secondary reinforcers. The child should never be accused of feigning the symptoms. Appropriate antidepressants and anxiolytics may be warranted.