Cushing’s Disease Presenting with Functional Neurological (Conversion) Disorder

Table 1

Multidisciplinary treatments provided to a patient with Cushing’s disease presenting with functional neurological disorder.

Diagnosis	Treatment regimen
Catatonia	(i) Intravenous lorazepam (treatment) up to 2 mg four times per day (discontinued after improvement in catatonia); (ii) Oral clonazepam (maintenance) 2 mg twice per day
Depression	(i) Psychotherapy; (ii) Sertraline 200 mg daily
Psychosis	(i) Psychotherapy; (ii) Aripiprazole 25 mg daily
Cushing’s disease	(i) Ketoconazole 250 mg three times per day; (ii) Cabergoline 0.5 mg three times per day (weekdays only); (iii) Transsphenoidal pituitary microadenoma resection (planned procedure)
Psychogenic nonepileptic seizures	(i) Patient education; (ii) Psychotherapy; (iii) Antiepileptic medications were downtitrated; (a) Levetiracetam was decreased from 1500 mg twice per day to 500 mg twice per day; (b) Valproic acid 1000 mg three times per day was discontinued
Functional movement disorder	(i) Patient education; (ii) Psychotherapy; (iii) Physical therapy for leg strength, standing, and walking; (iv) Occupational therapy for hand dexterity (e.g., writing, drawing, and stress ball)
Functional speech disorder	(i) Patient education; (ii) Psychotherapy; (iii) Speech therapy