La belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder

La belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder

Petra J van Meerkerk-Aanen,1 Lars de Vroege,1,2 David Khasho,1 Aziza Foruz,1 J Thies van Asseldonk,3 Christina M van der Feltz-Cornelis1,2 1Clinical Center of Excellence for Body, Mind, and Health, GGz Breburg, 2Department Tranzo, Tilburg School of Behavioral and Social Sciences, Tilburg University...

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Autores principales: van Meerkerk-Aanen PJ, de Vroege L, Khasho D, Foruz A, van Asseldonk JT, van der Feltz-Cornelis CM
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2017
Materias:
conversion disorder
consultation
misdiagnosis
progressive supranuclear palsy (PSP)
la belle indifference
neurology
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
Acceso en línea:https://doaj.org/article/196ac3155f34420885a9c31241d5ea2f
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spelling oai:doaj.org-article:196ac3155f34420885a9c31241d5ea2f2021-12-02T07:15:24ZLa belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder1178-2021https://doaj.org/article/196ac3155f34420885a9c31241d5ea2f2017-08-01T00:00:00Zhttps://www.dovepress.com/la-belle-indifference-revisited-a-case-report-on-progressive-supr-peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Petra J van Meerkerk-Aanen,1 Lars de Vroege,1,2 David Khasho,1 Aziza Foruz,1 J Thies van Asseldonk,3 Christina M van der Feltz-Cornelis1,2 1Clinical Center of Excellence for Body, Mind, and Health, GGz Breburg, 2Department Tranzo, Tilburg School of Behavioral and Social Sciences, Tilburg University, 3Department of Neurology, Elisabeth Hospital, Tilburg, the Netherlands Background: Since the advent of computed tomography and magnetic resonance imaging scans, neurological disorders have less often been falsely labeled as conversion disorder (CD). However, misdiagnosis of a neurological disorder as CD still occurs, especially in cases with insidious onset. Misinterpretation of la belle indifférence may contribute to such misdiagnosis. Here, we describe a case of progressive supranuclear palsy/Richardson’s syndrome (PSPS) misdiagnosed as a case of CD.Case: A 62-year-old woman consulted two different neurologists in 2012 because of falling spells since 2009 and was diagnosed with CD. She was referred to the Clinical Center of Excellence for Body, Mind, and Health for treatment of CD. After neurological examination, blood tests, and psychiatric examination, in which la belle indifférence and a history of incest were found, CD was confirmed. However, despite treatment for CD, the patient’s physical symptoms deteriorated over a year. After repeated physical and psychiatric examinations, neurocognitive assessment, and consultation with a third neurologist because of suspicion of neurological disease, the patient was diagnosed with PSPS.Conclusion: La belle indifférence may be a psychological sign in the context of CD, but it may also be an expression of lack of mimic due to Parkinsonism or of eye movement disorder in the context of neurological illness. A diagnosis of CD should not be considered definitive if no improvement occurs in terms of physical, mental, and cognitive symptoms despite appropriate therapy. In case of deterioration, neurological reexamination and reinterpretation of la belle indifférence should be considered. Keywords: conversion disorder, consultation, misdiagnosis, progressive supranuclear palsy, la belle indifférence, neurologyvan Meerkerk-Aanen PJde Vroege LKhasho DForuz Avan Asseldonk JTvan der Feltz-Cornelis CMDove Medical Pressarticleconversion disorderconsultationmisdiagnosisprogressive supranuclear palsy (PSP)la belle indifferenceneurologyNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 13, Pp 2057-2067 (2017)
institution DOAJ
collection DOAJ
language EN
topic conversion disorder
consultation
misdiagnosis
progressive supranuclear palsy (PSP)
la belle indifference
neurology
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
spellingShingle conversion disorder
consultation
misdiagnosis
progressive supranuclear palsy (PSP)
la belle indifference
neurology
Neurosciences. Biological psychiatry. Neuropsychiatry
RC321-571
Neurology. Diseases of the nervous system
RC346-429
van Meerkerk-Aanen PJ
de Vroege L
Khasho D
Foruz A
van Asseldonk JT
van der Feltz-Cornelis CM
La belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder
description Petra J van Meerkerk-Aanen,1 Lars de Vroege,1,2 David Khasho,1 Aziza Foruz,1 J Thies van Asseldonk,3 Christina M van der Feltz-Cornelis1,2 1Clinical Center of Excellence for Body, Mind, and Health, GGz Breburg, 2Department Tranzo, Tilburg School of Behavioral and Social Sciences, Tilburg University, 3Department of Neurology, Elisabeth Hospital, Tilburg, the Netherlands Background: Since the advent of computed tomography and magnetic resonance imaging scans, neurological disorders have less often been falsely labeled as conversion disorder (CD). However, misdiagnosis of a neurological disorder as CD still occurs, especially in cases with insidious onset. Misinterpretation of la belle indifférence may contribute to such misdiagnosis. Here, we describe a case of progressive supranuclear palsy/Richardson’s syndrome (PSPS) misdiagnosed as a case of CD.Case: A 62-year-old woman consulted two different neurologists in 2012 because of falling spells since 2009 and was diagnosed with CD. She was referred to the Clinical Center of Excellence for Body, Mind, and Health for treatment of CD. After neurological examination, blood tests, and psychiatric examination, in which la belle indifférence and a history of incest were found, CD was confirmed. However, despite treatment for CD, the patient’s physical symptoms deteriorated over a year. After repeated physical and psychiatric examinations, neurocognitive assessment, and consultation with a third neurologist because of suspicion of neurological disease, the patient was diagnosed with PSPS.Conclusion: La belle indifférence may be a psychological sign in the context of CD, but it may also be an expression of lack of mimic due to Parkinsonism or of eye movement disorder in the context of neurological illness. A diagnosis of CD should not be considered definitive if no improvement occurs in terms of physical, mental, and cognitive symptoms despite appropriate therapy. In case of deterioration, neurological reexamination and reinterpretation of la belle indifférence should be considered. Keywords: conversion disorder, consultation, misdiagnosis, progressive supranuclear palsy, la belle indifférence, neurology
format article
author van Meerkerk-Aanen PJ
de Vroege L
Khasho D
Foruz A
van Asseldonk JT
van der Feltz-Cornelis CM
author_facet van Meerkerk-Aanen PJ
de Vroege L
Khasho D
Foruz A
van Asseldonk JT
van der Feltz-Cornelis CM
author_sort van Meerkerk-Aanen PJ
title La belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder
title_short La belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder
title_full La belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder
title_fullStr La belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder
title_full_unstemmed La belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder
title_sort la belle indifférence revisited: a case report on progressive supranuclear palsy misdiagnosed as conversion disorder
publisher Dove Medical Press
publishDate 2017
url https://doaj.org/article/196ac3155f34420885a9c31241d5ea2f
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