conversion disorder?

[justwanttohelp09]

My 16 yr old niece has pain and is passing out anytime she eats. While "out" she has tremors, drools, and is unresponsive. The doctors have ruled out true seizures, and all tests by gastro, neuro, and cardio, are negative. They have referred her to psych. She was also diagnosed with shingles several years ago and has had 3-4 outbreaks the last few years. She occasionally has loss of vision in one eye that was previously affected by the shingles. She had an undiagnosed dizziness/rocking problem when she was 8 or 9. She also has a history of bulimia (to what extent I do not know), trouble at school including loss of friends, and her father's death. She was admitted to the hospital 4-5 weeks ago for severe abdominal pain, at which time they believed she had a twisted fat pad (?) but they did not find it upon surgery. They removed her appendix because they were in there, and looked at her other organs. That pain subsided, then the pain began to happen everytime she ate. She also vomited everything she ate. Now, she does not vomit, but has the pain and the pseudoseizues. My question is which angle should we pursue? The doctors she has seen have referred her to psych., but my sister believes it is physical based on her medical history.

[Kevin Kennedy, Ph.D.]

Situations like your niece's are complicated and mystifying when symptoms are serious and obvious to all who can observe, and yet do not fit an identifiable disorder. The referral to psychiatry is reasonable, but I would be careful not to close the door on organic reasons for her presentation nonetheless. Has she been receiving coordinated care, such as in a pediatric hospital setting?

[justwanttohelp09]

Thank you for taking the time to answer my question . Yes, she has been admitted a few different times to various hospitals , the latest being Children's Hospital in the Detroit area. She was there for a few days during which she had the EEG while exhibiting the seizure like episodes. They said it was not a true seizure, and they were the latest ones to refer to psych. Since my last post, Children's called my sister back to tell her the urine culture was positive for E.coli. I know that is the usual cause for UTI's, but it is possible the more serious strain could cause her symptoms? My sister is hesitant to go the psych. route, so your caution about following up on an organic reason will be pursued. I believe she is now seeing an infectious disease specialist because she thinks the shingles may still be to blame. Thanks again for your time.

[Kevin Kennedy, Ph.D.]

The video EEG was a good idea - it's really the only way to distinguish true seizure activity from so-called pseudo-seizures. So, while it is prudent to pursue the psychiatry evaluation, it is too early to abandon the medical front. My quess is that the gastro people will ultimately pion down what is occurring.