Devenir des troubles de conversion chez les enfants et adolescents

RésuméLes troubles de conversion ont une prévalence notable en population neuropédiatrique. Ils mobilisent de multiples professionnels de santé dans la prise en charge. Les données actuelles de la littérature sur le devenir des troubles de conversion sont limitées et la place des comorbidités ainsi que leur évolution ont rarement été évaluées chez les jeunes. Cette revue de la littérature étudie l’évolution des troubles de conversion en terme de guérison et les comorbidités psychiatriques associées chez les enfants et adolescents. La revue s’est faite à partir d’une recherche sur Pubmed et PsychInfo, où 11 études ont répondu aux critères d’inclusion : (i) trouble de conversion répondant aux critères du DSM, (ii) population pédiatrique, (iii) études longitudinales évaluant le devenir du trouble de conversion et/ou les comorbidités psychiatriques. La plupart des troubles de conversion chez les enfants et adolescents a évolué favorablement, avec disparition de la symptomatologie conversive, dans 70 à 92 % des cas, pour une durée de suivi variant de 1 à 6 ans. Les comorbidités psychiatriques associées au trouble concernaient entre 13 et 84 % des enfants et adolescents selon les études. Vingt-huit à 41 % de cette population pédiatrique a présenté un trouble psychiatrique à distance de la symptomatologie conversive. Les principales comorbidités retrouvées étaient des troubles anxieux et des troubles de l’humeur. Bien que les troubles de conversion évoluent majoritairement vers une guérison chez les enfants et adolescents, le pronostic de cette pathologie est plus sombre devant la persistance ou la survenue à distance de comorbidités psychiatriques.

SummaryBackgroundConversion disorders are significantly prevalent among neuropaediatric population. Their management requires deep somatic investigations and mobilizes many health professionals. Current literature presents limited amount of data regarding the futur of conversion disorders. Their associated comorbidities and their outcomes have rarely been studied in young people. However, conversion disorders are frequently associated to other psychiatric disorders as mood and anxious disorders. This literature review examines the evolution of conversion disorders in terms of healing and psychiatric comorbidity in children and adolescents.MethodsThis review was made from a search on PubMed and PsychInfo. Eleven studies met the inclusion criteria: (i) conversion disorder meet the criteria of the DSM, (ii) studied population of children aged between 5 and 18 (iii) longitudinal studies evaluating the outcomes of conversion disorder and/or psychiatric comorbidities at diagnosis and at 12 months of evolution (at least).ResultsThe studies selected refer to samples ranging from 13 to 204 patients. Subjects included are aged from 6 to 18 years at the time of inclusion, with an average age of 12.2 years. Psychiatric or psychological cares, inpatient or outpatient, were proposed to a majority of included patients. Most conversion disorders in children and adolescents have evolved favorably, with disappearance of conversion symptoms for 70 to 92% of cases, after a follow-up period going from 1 to 6 years. Psychiatric comorbidities related to conversion disorder touched from 13% to 84% of children and adolescents, depending on the studies. In 28% to 41% of the pediatric population, psychiatric disorder appeared after the conversion symptoms. The most frequent comorbidities were found to be anxiety disorders and mood disorders.ConclusionThe presence of psychiatric comorbidity at diagnosis does not seem to be associated with a more unfavorable evolution for the conversion disorder itself. More than three quarters of conversion disorders in children and adolescents move towards healing after a follow-up of at least 1 year, suggesting a good prognosis and a good development of this disorder. However, the emergence or persistence of psychiatric comorbidities, remote from conversion disorder, has an impact on the future of young and is an unfavorable sign. It is necessary to have a global vision of the patient, looking in particular for the associated comorbidities and taking into account the interactions with relatives, especially within his family and with his peers. Prospective studies in the longer-term future of these disorders are necessary regarding their complexity during pre- and post-pubertal.