Clinicians and Cognitive Bias: A Case of Frontotemporal Dementia Misdiagnosed as Conversion Disorder
Year: 2019
Type: article
Study design: Case Report
Abstract: Every specialty of medicine is concerned with misdiagnosis.Recent developments in behavioral economics offer a helpful perspective on nonrational influences or cognitive biases that intrude on important decision making.The case presented here highlights how cognitive bias can affect both diagnosis and treatment of patients."Ms.A," a 47-year-old woman with a 2.5-year history of worsening symptoms of depression, anxiety, impaired speech, bradykinesia, and incoordination, was referred to a tertiary medical center for further evaluation and treatment of conversion disorder complicated by depression and anxiety.Symptom onset followed the suicide of her college-age son, and her symptoms eventually rendered her nearly mute and unable to perform activities of daily living.Previous psychiatric and neurological evaluations had been conducted approximately 6 months before her referral and were inconclusive.Neuropsychological testing revealed abnormalities in memory and speech.These findings were interpreted as effort dependent and labeled as possible conversion disorder (also known as functional neurological disorder).CSF studies were reported to be normal.A brain MRI report described possible cerebral atrophy.The patient's medical history included asthma and hyperlipidemia.Her only prior psychiatric history was mild depression approximately 8 years earlier, for which she was treated with several selective serotonin reuptake inhibitors.Ms.A had been raised by her adoptive mother and her biological father, and there was no history of abuse or trauma.After completing an associate's degree, she was employed until the presenting illness rendered her disabled.She was married and had two children.Family history of psychiatric illness included suicides in her son and a grandfather.Ms. A was admitted to the psychiatric hospital for diagnostic clarification and treatment.The working diagnosis on admission was severe major depression with catatonia, although concern was also noted for an underlying neurological illness, and her prior diagnosis of conversion disorder was retained.Trials of benzodiazepines, various antidepressants and antipsychotics, and an acute course of ECT were ineffective.A neurological
Source: American Journal of Psychiatry
Authors: Benjamin R. Braus, Teresa A. Rummans, Maria I. Lapid, Robert J. Morgan, Shirlene M. Sampson, Elliot M. Handler, Joel E. Dimsdale
Institutions: Mayo Clinic, University of California San Diego
Language: English
Subfield: Family Practice
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2970111921