Mental health articles

OF mental health care and mentally ill

How to treatment of conversion disorder

Studies of interventions in conversion disorder are largely uncontrolled studies of cohorts of people with the disorder or case studies. At the time of writing, few randomized controlled trials – the gold standard of intervention research – had been conducted. This makes it difficult to ascribe any successes found in the published research to the specific intervention as any changes may be due to placebo effects or non-specific therapy effects. Such caution may be increased following the findings of Letonoff et al., who described three cases of psychogenic paraplegia, with symptoms including complete loss of motor control and sensation in the lower extremities and incontinence.

Each individual ‘ambulated out of the hospital without assistance’, albeit up to several months following their diagnosis, with no other treatment than being told that their test results and medical examinations indicated no physical problems. Nevertheless, a number of case studies (e.g. Wald et al. 2004) have shown cognitive behavioural interventions, including imaginal exposure to trauma memories, to be of benefit. A different approach was taken by Ataoglu et al. (2003). They used a therapeutic technique called paradoxical intention, in which individuals are encouraged to maintain or even exacerbate their symptoms. They compared this approach with use of an anxiolytic, diazepam, in 30 patients diagnosed with pseudoseizures. Of the 15 patients who completed paradoxical intention treatment, 14 showed some improvement; of the 15 treated with diazepam, 9 showed improvements at the end of six weeks of treatment. One of the very few randomized trials of treatments of conversion disorder was reported by Moene et al. (2003). They assigned patients with motor conversion disorders with symptoms including paralysis, gait disturbance, coordination problems, aphonia, and pseudo-epileptic seizures either to a waiting list control or active treatment.

Treatment involved 10 sessions of hypnosis focusing on suggestions of symptom reduction and age regression to enable emotional insight. The waiting list control group design did not allow long-term follow-up measures to be taken. However, at the end of therapy, patients in the intervention condition showed signifi cantly more improvement on video-based measures of their disorder than those in the control group.

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