TY - JOUR
T1 - Medically unexplained illness and the diagnosis of hysterical conversion reaction (HCR) in women's medicine wards of Bangladeshi hospitals
T2 - A record review and qualitative study
AU - Kendall, Emily A.
AU - Zaman, Rashid Uz
AU - Naved, Ruchira Tabassum
AU - Rahman, Muhammad Waliur
AU - Kadir, Mohammad Abdul
AU - Arman, Shaila
AU - Azziz-Baumgartner, Eduardo
AU - Gurley, Emily S.
N1 - Funding Information:
Many thanks to Prof. A. R. M. Saifuddin Ekram and Prof. Abu Bakar, to the surveillance physicians and other respondents, to the icddr,b field workers Abu Jafar, Kaousar Ahmmed, Rafiqul Islam and Abdul Mazed, and to Steve Luby for helpful discussions and manuscript review. This study was funded by the Centers for Disease Control and Prevention (CDC), United States of America, under cooperative agreement U01/ CI000298, and by the National Institutes of Health (NIH), Fogarty International Center grant R24 TW007988. icddr,b acknowledges with gratitude the commitment of the CDC and NIH to its research efforts.
PY - 2012/10/22
Y1 - 2012/10/22
N2 - Background: Frequent reporting of cases of hysterical conversion reaction (HCR) among hospitalized female medical patients in Bangladesh's public hospital system led us to explore the prevalence of " HCR" diagnoses within hospitals and the manner in which physicians identify, manage, and perceive patients whom they diagnose with HCR.Methods: We reviewed admission records from women's general medicine wards in two public hospitals to determine how often and at what point during hospitalization patients received diagnoses of HCR. We also interviewed 13 physicians about their practices and perceptions related to HCR.Results: Of 2520 women admitted to the selected wards in 2008, 6% received diagnoses of HCR. HCR patients had wide-ranging symptoms including respiratory distress, headaches, chest pain, convulsions, and abdominal complaints. Most doctors diagnosed HCR in patients who had any medically-unexplained physical symptom. According to physician reports, women admitted to medical wards for HCR received brief diagnostic evaluations and initial treatment with short-acting tranquilizers or placebo agents. Some were referred to outpatient psychiatric treatment. Physicians reported that repeated admissions for HCR were common. Physicians noted various social factors associated with HCR, and they described failures of the current system to meet psychosocial needs of HCR patients.Conclusions: In these hospital settings, physicians assign HCR diagnoses frequently and based on vague criteria. We recommend providing education to increase general physicians' awareness, skill, and comfort level when encountering somatization and other common psychiatric issues. Given limited diagnostic capacity for all patients, we raise concern that when HCR is used as a "wastebasket" diagnosis for unexplained symptoms, patients with treatable medical conditions may go unrecognized. We also advocate introducing non-physician hospital personnel to address psychosocial needs of HCR patients, assist with triage in a system where both medical inpatient beds and psychiatric services are scarce commodities, and help ensure appropriate follow up.
AB - Background: Frequent reporting of cases of hysterical conversion reaction (HCR) among hospitalized female medical patients in Bangladesh's public hospital system led us to explore the prevalence of " HCR" diagnoses within hospitals and the manner in which physicians identify, manage, and perceive patients whom they diagnose with HCR.Methods: We reviewed admission records from women's general medicine wards in two public hospitals to determine how often and at what point during hospitalization patients received diagnoses of HCR. We also interviewed 13 physicians about their practices and perceptions related to HCR.Results: Of 2520 women admitted to the selected wards in 2008, 6% received diagnoses of HCR. HCR patients had wide-ranging symptoms including respiratory distress, headaches, chest pain, convulsions, and abdominal complaints. Most doctors diagnosed HCR in patients who had any medically-unexplained physical symptom. According to physician reports, women admitted to medical wards for HCR received brief diagnostic evaluations and initial treatment with short-acting tranquilizers or placebo agents. Some were referred to outpatient psychiatric treatment. Physicians reported that repeated admissions for HCR were common. Physicians noted various social factors associated with HCR, and they described failures of the current system to meet psychosocial needs of HCR patients.Conclusions: In these hospital settings, physicians assign HCR diagnoses frequently and based on vague criteria. We recommend providing education to increase general physicians' awareness, skill, and comfort level when encountering somatization and other common psychiatric issues. Given limited diagnostic capacity for all patients, we raise concern that when HCR is used as a "wastebasket" diagnosis for unexplained symptoms, patients with treatable medical conditions may go unrecognized. We also advocate introducing non-physician hospital personnel to address psychosocial needs of HCR patients, assist with triage in a system where both medical inpatient beds and psychiatric services are scarce commodities, and help ensure appropriate follow up.
KW - Bangladesh
KW - Conversion disorder
KW - Diagnosis
KW - Health services needs and demand
KW - Mental health
KW - Physician's practice patterns
KW - Somatoform disorders
KW - Women's health services
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U2 - 10.1186/1472-6874-12-38
DO - 10.1186/1472-6874-12-38
M3 - Article
C2 - 23088583
AN - SCOPUS:84867648831
SN - 1472-6874
VL - 12
JO - BMC Women's Health
JF - BMC Women's Health
M1 - 38
ER -