Highlights
- •Medically unexplained visual loss represents a consistent clinical presentation.
- •Retrospective case–control review of patients within a neuro-ophthalmology clinic
- •Data extracted on neurological, ophthalmological and psychiatric clinical course
- •Female excess, mean age symptom onset 37.5 years and chronic clinical course
Abstract
Purpose
To compare the clinical and demographic characteristics of adult patients with nonorganic
or medically unexplained visual loss (MUVL) to those with other common conditions
presenting to a neuro-ophthalmology clinic.
Methods
Case–control design: a retrospective review of medical notes on a consecutive case
series of 49 patients assessed at the King's College Hospital neuro-ophthalmology
clinic with unexplained visual loss and matched with the next assessed patient identified
from clinic records. Patients presented post-symptom onset with a mean clinical course
of 30 months (SD = 67 months) and standard clinical examination used to confirm diagnoses, alongside ancillary
investigations if required.
Results
Seventy-two percent (n = 36) of MUVL patients were female. In comparison with patients with organic visual
disorders, MUVL cases presented with significantly higher rates of bilateral (cf.
unilateral) visual impairment (41%, n = 20), premorbid psychiatric (27%, n = 13) as well as functional (24%, n = 12) diagnoses and psychotropic medication usage (22%, n = 11). Medically unexplained cases were significantly more likely to report preceding
psychological stress (n = 9; 18%).
Conclusions
Medically unexplained visual impairment may be regarded as part of the spectrum of
medically unexplained disorders seen in the general hospital setting. Research is
needed to determine long-term outcomes and effective tailored interventions.
Keywords
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References
- Diagnostic and Statistical Manual of Mental Disorders (5th Ed.): DSM-5.American Psychiatric Association, Arlington, VA2013
- Visual evoked potential-based acuity assessment in normal vision, artificially degraded vision, and in patients.Br. J. Ophthalmol. 2008; 92: 396-403
- Visual impairment in hysteria.Doc. Ophthalmol. 1992; 82: 369-382
- The “sunglasses sign” predicts nonorganic visual loss in neuro-ophthalmologic practice.Neurology. 2008; 70: 218-221
- The cost of somatisation among the working-age population in England for the year 2008–2009.Ment. Health Fam. Med. 2010; 7: 71
- Introduction to the special issue on medically unexplained symptoms: background and future directions.Clin. Psychol. Rev. 2007; 27: 769-780
- Functional visual loss.Neurol. Clin. 2010; 28: 789-802
- The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review.Clin. Psychol. Rev. 2007; 27: 781-797
- The treatment of patients with medically unexplained symptoms in primary care: a review of the literature.Ment. Health Fam. Med. 2010; 7: 209
- Surgery and medical treatment in persistent somatizing patients.J. Psychosom. Res. 1992; 36: 439-447
- The use of hospitalizations by persistent somatizing patients.Psychol. Med. 1992; 22: 173-180
- Medically unexplained visual loss in adult patients.Curr. Opin. Neurol. 2009; 22: 41-45
- Medically unexplained visual loss in adult patients.Eye. 2004; 18: 917-922
- Hysterical conversion: a prognostic study.Br. J. Psychiatry. 1980; 136: 548-551
- Assessment and management of medically unexplained symptoms.Br. Med. J. 2008; 336: 1124
- A controlled treatment study of somatoform disorders including analysis of healthcare utilization and cost-effectiveness.J. Psychosom. Res. 2003; 54: 369-380
- Functional visual loss: I. A true psychiatric disorder?.Psychol. Med. 1983; 13: 307-314
- Functional visual loss in adults and children: patient characteristics, management and outcomes.Ophthalmology. 2005; 112: 1821-1828
- A one-session treatment for patients suffering from medically unexplained symptoms in primary care: a randomized clinical trial.Psychosomatics. 2007; 48: 294-303
- Assessment of patients with suspected non-organic visual loss using pattern appearance visual evoked potentials.Graefes Arch. Clin. Exp. Ophthalmol. 2007; 245: 502-510
- Psychogenic tremor: long term prognosis in patients with electrophysiologically-confirmed disease.Mov. Disord. 2009; 24: 72-76
- Neuro-ophthalmology and psychiatry.Gen. Hosp. Psychiatry. 1993; 15: 102-114
- Functional visual loss in idiopathic intracranial hypertension.Ophthalmology. 2009; 116: e1801
- Conversion disorder: a problematic diagnosis.J. Neurol. Neurosurg. Psychiatry. 2011; 82: 1267-1273
- Medically unexplained symptoms: an epidemiological study in seven specialities.J. Psychosom. Res. 2001; 51: 361-367
- Frequent attenders with medically unexplained symptoms: service use and costs in secondary care.Br. J. Psychiatry. 2002; 180: 248-253
- Prevalence of organic neuro-ophthalmologic disease in patients with functional visual loss.Am J. Ophthalmol. 2003; 135: 670-675
- Non-epileptic seizures and child sexual abuse: a critical review of the literature.Clin. Psychol. Rev. 2006; 26: 1020-1040
- The prognosis of patients with hysterical visual impairment.Acta Ophthalmol. (Copenh). 1989; 67: 159-163
- Patients with multiple unexplained symptoms: their characteristics, functional health, and health care utilization.Arch. Intern. Med. 1986; 146: 69-72
- Treating patients with medically unexplained symptoms in primary care.J. Gen. Intern. Med. 2003; 18: 478-489
- Making sense of medically unexplained symptoms in general practice: a grounded theory study.Ment. Health Fam. Med. 2013; 10: 101-111
- Prevalence of psychosocial disturbances in children with nonorganic visual loss.J. Am. Assoc. Pediatr. Ophthalmol. Strabismus. 2004; 8: 457-461
- Functional vision loss: a diagnosis of exclusion.Optometry. 2007; 78: 523-533
- Tip of iceberg: when unusual vision complaints with a normal examination prompt a closer look.Clinical Case Reports. 2014; 2: 10-13
- Patients with medically unexplained symptoms.Br. J. Hosp. Med. 1993; 51: 421-427
- Interactive effect of stressful life events and the serotonin transporter 5-HTTLPR genotype on posttraumatic stress disorder diagnosis in 2 independent populations.Arch. Gen. Psychiatry. 2009; 66: 1201-1209
Article info
Publication history
Published online: December 29, 2015
Accepted:
December 28,
2015
Received in revised form:
December 1,
2015
Received:
September 4,
2015
Identification
Copyright
© 2016 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
