Rosh Emergency Medicine Practice Test

A patient presenting with recurrent seizures and no change in symptoms on anticonvulsants might likely be diagnosed with which condition?

1. Conversion disorder

2. Factitious disorder

3. Malingering

4. Somatic symptom disorder

The correct answer is: Conversion disorder

The diagnosis of conversion disorder is often considered in cases where a patient presents with recurrent seizures that do not respond to anticonvulsant medications. Conversion disorder, formerly known as hysteria, involves the manifestation of neurological symptoms, such as seizures, that are not explained by a medical condition. In this scenario, the key point is that the seizures are recurrent and do not improve with standard treatment, suggesting that they may not have a physiological basis typically expected in epileptic seizures. Patients with conversion disorder experience real symptoms that can significantly impact their lives, but these symptoms arise from psychological factors rather than direct physiological issues. In contrast, the other choices—factitious disorder, malingering, and somatic symptom disorder—although related to the presentation of symptoms, involve different motivations or understandings of the illness. Factitious disorder involves patients who deliberately produce or feign symptoms for the sake of playing the sick role, while malingering involves intentional deception for external benefits, such as avoiding work. Somatic symptom disorder includes a focus on physical symptoms that cause distress, but with less emphasis on the underlying psychological mechanisms leading to them. Therefore, in the context of a patient with seizures resistant to anticonvulsants, conversion disorder is the most appropriate diagnosis, as it aligns