Qurat-ul Ain Khan, Sana Younus, Hania Hasan, Muhammad Zaman Khan.
Association of bipolar I disorder with conversion disorder and syncope- a retrospective clinical study from Pakistan.
Pak J Neurological Sci Dec ;15(2):17-22.

Background: Bipolar I disorder (BD I) is a chronic mood disorder that begins in early adulthood. Its association with conversion disorder and syncope has not been widely studied, especially in Pakistani population. Aims: We aim to study the association of bipolar disorder with conversion and syncope. Method: Medical records of all consecutive patients diagnosed with bipolar I disorder according to DSM-IV TR in the inpatient and outpatient psychiatric setting at the Agha Khan University Hospital, Karachi from July 2013 to June 2016 were retrieved and those with mood disorder secondary to neurological or medical condition or due to substance abuse were excluded from the study. The diagnosis was made as documented in medical records and the study is retrospective in nature. Details about their demographics and disease characteristics were collected on pre-designed forms and analyzed using chi-square and multivariate analysis. Results: Of the 469 patients who had BD I, 33 (7%) had conversion symptoms and 6 (1.3 %) had syncope. In both groups, patients were mostly between 16 and 40 years of age and majority of them were females. Loss of consciousness (LOC) was the most frequent symptom in conversion group and 9 of 33 patients first presented with conversion without mood symptoms. 4 of 6 patients in the syncope group had mania and syncope as the initial presentation. Limitations: Retrospective nature of the study and low prevalence of syncope and conversion patients. For making a diagnosis of BD I, we used the codes in the medical records and there was not a way to double check the diagnosis. Conclusion: BD I patients can have symptoms of conversion and/ or syncope or atypical presentation which can cause delayed diagnosis and treatment of BD I. Recognizing this association is important to improve management options especially in middle and low-income countries including Pakistan. This has important implications for clinicians in the management of BD I.

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