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Background Conversion disorder (CD) is a largely enigmatic disorder, one that requires a thorough ruling-out process. Prior research suggests that metaphors and conceptualization are rooted in physical experience, and that we interpret our affective world through metaphors. Spatial metaphors (interaction of affect and vertical space) are a prominent example of the grounding of metaphors. This is a relatively unpaved direction of research of CD. Objectives The present pilot study sought to explore this view by investigating the “healthy is up, sick is down” spatial metaphors (e.g., “fell ill” and “top shape”) in patients with CD, examining the correlation between the processing of bodily-related words, CD, and vertical space. We hypothesized that patients with CD, who experience their bodies as ill, will demonstrate a downwards bias when processing bodily-related words; corresponding to the “healthy is up, sick is down” spatial metaphor. Methods A total of 8 female patients (ages M-38.13 SD-10.44) and 42 female controls (ages M-36.4 SD-14.57) performed a visual attention task. Participants were asked to identify a spatial probe at the top or the bottom of a screen, following either a bodily related (e.g., arm) or non–bodily related (e.g., clock) prime word. Results As predicted, when processing bodily-related words, patients with CD demonstrated a downwards attention bias. Moreover, the higher the patient's level of somatization, the faster the patient detected lower (vs upper) spatial targets. Conclusions This study suggests that the changed health paradigm of patients with CD is grounded in sensorimotor perception. Further research could propose new diagnostic and treatment options for CD.

Patients with alien hand (AH) syndrome from medial frontal lesions exhibit involuntary but seemingly purposeful contralesional upper limb movements. Two observations about AH patients have received little, if any, experimental confirmation. The first is that AH is triggered opportunistically by nearby objects. The second is that AH behaviors are increased in conditions of fatigue or anxiety, i.e. under reduced attentional control. A prominent account explains AH as reduced intention-driven (endogenous) executive control. This account predicts that erroneous AH behaviors should be driven by environmental (i.e. exogenous) factors, such as distractor proximity to the hand. AH errors should be less influenced by the intention or action plan (i.e. endogenous factors), such as the semantic relatedness of distractors to targets. Moreover, due to capacity limitations of the endogenous controller, AH behaviors should increase under conditions of secondary task load. We tested these predictions with an AH patient in two experiments using a naturalistic coffee-making task. Experiment 1 demonstrated that the affected hand was highly perseverative and strongly influenced by exogenous but not endogenous factors. The non-alien hand made fewer errors. Experiment 2 showed that there was a disproportionate increase in perseverations and exogenous errors of the affected hand under secondary task load. The non-alien hand was significantly less disrupted by dual task conditions. These data provide experimental support for previous anecdotal observations about AH behavior in naturalistic settings, and are consistent with a unilateral defect in endogenous control.

Objectives Hemoptysis, an important and alarming symptom, often indicates serious disease. This study was designed to assess the different causes of hemoptysis, the relative importance of the different diagnostic modalities employed, and the outcome in an Israeli population cohort. Design A retrospective analysis of 208 patients with hemoptysis at the Hadassah University Hospital, Jerusalem, Israel between January 1980 and August 1995. Results Bronchiectasis (20%), lung cancer (19%), bronchitis (18%), and pneumonia (16%) accounted for most causes of hemoptysis. In contrast to older studies, active tuberculosis was a rare finding (1.4%). Bronchiectasis and bleeding diathesis were major causes of moderate to severe hemoptysis while bronchitis and lung cancer were commonly associated with milder degrees of bleeding. CT scan was the most sensitive diagnostic test when employed alone, with a positive yield of 67%. However, it failed to locate at least three cases of lung cancer. When combining a CT study together with a bronchoscopy, the positive yield increased to 93%. The mortality rate for patients with mild to moderate hemoptysis was low (2.5% and 6%, respectively), while patients with massive hemoptysis had high mortality rates (38%). Patients with lung cancer or bleeding diathesis had higher mortality rates compared with the rest of the cohort. Conclusions Hemoptysis is a common symptom with a good prognosis in most cases. However, patients exhibiting massive bleeding or those with lung malignancy and patients with bleeding diathesis had a poorer prognosis. Patients older than 50 years with a positive smoking history need an extensive evaluation and follow-up to exclude lung carcinoma. The combined use of bronchoscopy and chest CT has the best yield in evaluating hemoptysis.