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Bu sayfa, 26. Dünya Psikiyatri Kongresi'nde sunulan çalışmanın yapay zekâ desteğiyle hazırlanmış Türkçe özetidir. Çalışmanın sahibi sunan yazarlardır; atıf için orijinal kaynağa başvurun.

EV0481

Conversion disorder and dissociation: a case report highlighting diagnostic challenges and iatrogenic risk

CONVERSION DISORDER AND DISSOCIATION: A CASE REPORT HIGHLIGHTING DIAGNOSTIC CHALLENGES AND IATROGENIC RISK

In a case of functional neurological disorder with dissociative features arising in the context of a comorbid neurological condition and treated with intensive pharmacotherapy for years, longitudinal reassessment and gradual reduction of the medication burden led to complete recovery.

The aim of this report is to demonstrate that, although conversion disorder has historically been conceptualized alongside dissociative phenomena, current models of functional neurological disorder (FND) emphasize a positive clinical diagnosis and multidimensional formulation, and to discuss how diagnostic uncertainty can contribute to prolonged pharmacotherapy, polypharmacy, and preventable adverse effects. The method is a qualitative case report based on longitudinal psychiatric follow-up and serial clinical assessments; data sources include weekly psychiatric interviews, multidisciplinary assessment, collateral information from the family, previous medical records, and neuroimaging and electroencephalography investigations obtained during earlier hospitalizations. A 43-year-old woman with a complex psychiatric and neurological history was referred for mutism, reduced eye contact, restricted movement, and loss of functional independence that had progressed over three months. Psychiatric symptoms began in 2010, in the context of drug-resistant epilepsy and a history of DRESS syndrome, with a depressive episode accompanied by self-harm, suicide attempts, and auditory and visual hallucinations; the patient underwent numerous hospitalizations and received intensive pharmacological treatment, including pulse therapy and cyclophosphamide, but sustained clinical improvement was not achieved, and previous brain magnetic resonance imaging and electroencephalography had shown no abnormalities that could explain her presentation. At the receiving service, longitudinal reassessment and multidisciplinary review raised the possibility of functional neurological disorder with prominent dissociative features on the basis of phenomenology, temporal course, previous diagnostic formulations, treatment history, and functional impairment, rather than relying on the absence of structural or electrophysiological abnormalities. A gradual reduction in the medication burden, with discontinuation of nearly all medications, was implemented alongside multidisciplinary clinical management and diagnostic reformulation; this was followed by progressive improvement, with complete remission of the presenting symptoms and a reduction in previously reported symptoms. The case highlights how longitudinal and multidisciplinary assessment can facilitate diagnostic reformulation, reducing unnecessary treatment and iatrogenic harm while improving patient safety and quality of life.

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