Question

A 29-year-old patient is admitted to the neurology unit for evaluation of seizures. Workup is negative, and there has not been any seizure activity captured on electroencephalogram during his seizure episodes. Neurological examination is negative. The patient is noted to be very sad, and a psychiatric consult is called. Nurses have noted conflict between the patient and his wife during her visits. As the consultant, which one of the following would be the highest on your list of differential diagnoses?

A. Obsessive-compulsive disorder
B. Conversion disorder (functional neurological symptom disorder)
C. Somatic symptom disorder
D. Social phobia
E. Panic disorder

Answer 1

The 29-year-old patient with unexplained seizure-like episodes, sadness, and psychosocial stress likely has Conversion disorder, particularly because neurologic and EEG evaluations were negative.

Step-by-step explanation:

The most likely diagnosis for a 29-year-old patient admitted for evaluation of seizures, with no seizure activity on electroencephalogram (EEG) and a negative neurological examination, but with observed sadness and interpersonal conflict, is Conversion disorder (also known as functional neurological symptom disorder). This condition is characterized by neurological symptoms that are not attributable to a medical condition or another mental disorder but are associated with psychological factors. Given the negative workup for other neurological issues and the presence of psychosocial stressors, conversion disorder would be at the top of the differential diagnosis list over the other options provided (Obsessive-compulsive disorder, Somatic symptom disorder, Social phobia, and Panic disorder).