conversion disorder treatment recommendations

LANDSTUHL, Germany (Oct. 16, 2008) Physical therapist Lt. Cmdr. Mitchel Ideue, Officer in Charge of Inpatient Services at Landstuhl Regional Medical Center, in Landstuhl, Germany, gives Army Sgt. Charlie McCall a physical therapy treatment. (U.S. Army photo by Michelle Barrera) (Photo credit: Wikipedia)

As Ford and Folks noted, a wide variety of treatment interventions have been suggested for conversion disorders. As they note, a plethora of therapies suggest that nothing is very effective and that most therapies help to some degree with conversion disorder. Treatment interventions have included psychoanalysis, supportive therapy, hypnosis, physical therapy, amobarbital interviewing, and behavior therapy. Concurrent mood or anxiety disorders associated with conversion disorder may also require pharmacological treatment. Direct confrontation of a patient’s conversion symptom has no real benefit, and the interview should be carefully conducted so as to avoid a confrontational stance; otherwise, a confrontation is only likely to exacerbate the patient’s defensiveness.

A careful psychosocial evaluation and examination of possible precipitating life events and past history of psychological trauma should lead to an appropriate treatment intervention. Several case studies have demonstrated the utility of behavioral applications in treating conversion disorder. It should be evident from the information in the prior section on organic illness and misdiagnosis of conversion disorder that the prognosis for conversion disorder is not encouraging. However, two studies reported favorable outcomes. Carter reported that 83% of ninety inpatients and outpatients were well or significantly improved at 4- to 6-year follow-up. Hafeiz found that there was an immediate favorable response to treatment in all of sixty-one psychiatric outpatients and only twelve patients had relapses at the end of 1 year. His treatment consisted of faradic stimulation, somlec (electro-sleeping machine), sodium amylobarbitone, and methylamphetamine. A good prognosis for conversion disorder is associated with an acute or recent onset of symptomatology, a definite identification of a precipitant, good premorbid health, and the absence of concurrent organic illness or a major psychiatric condition.nmn