title: Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study.
abstract: BACKGROUND
  Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of 'positive signs' on neurological examination. Only few signs have been validated, and little is known about their reliability.
  
  
  OBJECTIVE
  The aim was to examine the clinical value of bedside positive signs in the diagnosis of CD presenting with weakness, gait or sensory symptoms by assessing their specificity, sensitivity and their inter-rater reliability.
  
  
  METHODS
  Standardised video recorded neurological examinations were performed in 20 consecutive patients with CD and 20 'organic' controls. Ten previously validated sensory and motor signs were grouped in a scale. Thirteen additional motor/sensory 'positive signs', 14 gait patterns and 1 general sign were assessed in a pilot validation study. In addition, two blinded independent neurologists rated the video recordings to assess the inter-rater reliability (Cohen's κ) of each sign.
  
  
  RESULTS
  A score of ≥ 4/14 on the sensory motor scale showed a 100% specificity (CI 85 to 100) and a 95% sensitivity (CI 85 to 100). Among the additional tested signs, 10 were significantly more frequent in CD than controls. The interobserver agreement was acceptable for 23/38 signs (2 excellent, 10 good, 11 moderate).
  
  
  CONCLUSIONS
  Our study confirms that six bedside 'positive signs' are highly specific for CD with good-excellent inter-rater reliability; we propose to consider them as 'highly reliable signs'. In addition 13 signs could be considered as 'reliable signs' and six further signs as 'suggestive signs' while all others should be used with caution until further validation is available.
authors.affiliation: Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Corinna
authors.initials: C
authors.lastname: Daum
authors.affiliation: Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Fulvia
authors.initials: F
authors.lastname: Gheorghita
authors.affiliation: Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Spatola
authors.affiliation: Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Vesna
authors.initials: V
authors.lastname: Stojanova
authors.affiliation: Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Medlin
authors.affiliation: Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Vingerhoets
authors.affiliation: Psychiatric Liaison Service, Psychiatry Department, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Berney
authors.affiliation: Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Gholam-Rezaee
authors.affiliation: Psychiatric Liaison Service, Psychiatry Department, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Giorgio E
authors.initials: GE
authors.lastname: Maccaferri
authors.affiliation: Psychiatric Liaison Service, Psychiatry Department, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Monica
authors.initials: M
authors.lastname: Hubschmid
authors.affiliation: Department of Neurology and Clinical Neurosciences, University Hospital (CHUV), Lausanne, Switzerland.
authors.forename: Selma
authors.initials: S
authors.lastname: Aybek
mesh_terms: D000328:Adult; D000368:Aged; D003291:Conversion Disorder / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000175:diagnosis*; D015588:Observer Variation; D010865:Pilot Projects; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D012678:Sensation Disorders / Q000175:diagnosis*
keywords: Hysteria