 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Joslyn Cassady, PhD1, David Kirschke, MD2, Timothy Jones, MD3, Allen Craig, MD3, and William Schaffner, MD4. (1) Wyoming Department of Health, Epidemic Intelligence Service Officer, CDC, 2300 Capitol Avenue, Cheyenne, WY 82002, 307-777-7716, jcassa@state.wy.us, (2) Tennessee Department of Health, Epidemic Intelligence Service Officer, 4th Floor, Cordell Hull Building, 425 Fifth Avenue, Nashville, TN 37247, (3) Communicable and Environmental Disease Services, Tennessee Department of Health, 4th Floor, Cordell Hull Building, 425 Fifth Avenue, Nashville, TN 37247, (4) Vanderbilt University, School of Medicine, Nashville, TN 37247
Background: Conversion disorder is a psychiatric syndrome, characterized by neurologic dysfunction in the absence of underlying organic illness, causing considerable impairment. Outbreaks of conversion disorder are rarely reported. In October 2001, we investigated a cluster of cases of unexplained neurologic illness among Amish girls in one state. Methods: A case of conversion disorder was defined as unexplained neurologic symptoms, including lower extremity weakness and being bedridden for more than a week, in an Amish resident of County A with onset between January 2000 and February 2002. We reviewed the medical records of all case-patients, consulted with local health providers, performed active case finding, administered a structured questionnaire, and met with Amish community members. Results: Five case-patients were identified among an Amish social cohort; all were girls aged 12-14 years. The clinical characteristics of all five patients included voluntary motor deficits, anorexia, and weight loss. Thorough medical evaluations failed to identify an organic etiology, and evidence for social transmission of symptoms was identified. All five patients met the Diagnostic and Statistical Manual-IV criteria for conversion disorder. Social stressors were identified, including a crisis in the church, that preceded illness onset. Family behavioral interventions were recommended. Three months after the investigation, four of five patients showed improvement. Conclusions: An outbreak of conversion disorder was likely precipitated by a crisis in the church. Learning objectives: The participant will be able to 1) describe the diagnostic criteria for conversion disorder 2) recognize the importance of interdisciplinary approaches to investigating outbreaks in culturally distinct communities.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.