The patient is a 9-year-old girl, dropped out of school, belonging to lower socioeconomic status, with no significant medical or psychiatric history in the family, was brought to OPD during the lockdown. The child's functioning before the illness was adequate with good academic performance. The family members gave a history of sudden onset spells of unresponsiveness that were usually preceded by a stressful event and were often associated with concomitant symptoms of headache, light-headedness and palpitations. These spells had been occurring intermittently over the last year, during which period, her family had sought consultation from a neurologist. She was diagnosed with psychogenic non-epileptic seizures; her EEG revealed no abnormality, and she was not on any pharmacological treatment.
During the lockdown, the garment factory in which her father worked was shut down, because of which he lost his job. This led to a financial crisis in the family as her father was the chief earning member, and they faced difficulties in paying their rent and meeting the expenditure for daily essentials. The patient was exposed to discussions among parents over money matters. She would be constantly preoccupied with the financial issues of the family. She became anxious and upset when she came to know that her mother was contemplating working as a domestic help to meet the financial needs of the family. She would repeatedly ask her family members to allow her to share the workload at home. Even though she was a student of primary school, she tried to tutor students younger to her in her neighbourhood, as an attempt to earn money for the family. She would remain anxious most of the time and have a sudden outburst of crying. This would often be followed by an unresponsive spell. Previously, these episodes would occur one to two times in a month, whereas now they started to occur three to four times/day. The family members initially sought help from a local faith healer, but after perceiving no improvement, she was brought to the psychiatry OPD. Her general and systemic physical examination did not reveal any abnormality. Her BP was 100/60 mm Hg, PR was 88/min, RR was 16/min and BMI was 17.9. Blood investigations revealed no abnormality. On MSE, she was well kempt, ETEC was made but not sustained and rapport could be established with great difficulty. Her affect was constricted. She reported preoccupations with the financial problems of the family and ideas of guilt about not being able to contribute to the family. Based on the history and clinical assessment, a diagnosis of conversion disorder with seizures was made as per ICD-10. A differential diagnosis of syndromal depressive or anxiety disorder in addition to her pre-existing conversion symptoms was also entertained; however, on evaluation, she did not fulfil the criteria for a separate comorbid diagnosis. The patient was referred to a clinical psychologist for psychotherapeutic intervention. Psychosocial stressors were explored in detail. On Children's Apperception Test, the major themes obtained were of uncertainty, loss of finances and lack of food, failure and poor problem solving ability. The intervention focused on teaching emotional self-regulation skills and breathing exercises for relaxation. The child was asked to keep a record of the frequency of episodes and skill practice. After the initial three sessions, the next sessions were conducted telephonically to enable the family to save travel fare. By the fifth week of treatment, the patient's episodes of headache and unresponsive spells had reduced to one to two times per week.