From the Guidelines
Conversion disorder, now known as functional neurological symptom disorder, should be treated with a multidisciplinary approach combining psychotherapy, physical therapy, and sometimes medications to address underlying anxiety or depression, as recommended by the most recent consensus guidelines 1. The treatment approach should focus on function rather than cause, and early intervention is crucial to improve outcomes. According to the latest studies, approximately 75% of patients show improvement when treatment begins promptly 1.
Key Components of Treatment
- Psychotherapy: cognitive behavioral therapy (CBT) is particularly effective in addressing underlying psychological issues 1
- Physical therapy: to improve mobility and reduce symptoms such as paralysis or tremors 1
- Medications: antidepressants like SSRIs (e.g., sertraline 50-200mg daily or fluoxetine 20-80mg daily) may be prescribed for 6-12 months if mood symptoms are present, while benzodiazepines like lorazepam (0.5-2mg as needed) can be used short-term for acute anxiety, but with caution due to dependency risks 1
Additional Considerations
- Education and explanatory approaches can help patients understand their symptoms and diagnosis, reducing anxiety and improving outcomes 1
- Symptomatic treatment, such as reduction of excessive musculoskeletal tension, can also be beneficial 1
- Psychological support, including counseling and CBT, can address psychosocial issues and cognitive features related to the disorder 1 By prioritizing a multidisciplinary approach and focusing on function rather than cause, healthcare providers can improve outcomes and reduce morbidity, mortality, and improve quality of life for patients with conversion disorder, now known as functional neurological symptom disorder.
From the Research
Definition and Symptoms of Conversion Disorder
- Conversion disorder is a psychiatric illness in which psychological conflicts are manifested as physical symptoms, such as blindness, paralysis, dystonia, anesthesia, and psychogenic non-epileptic seizures (PNES) 2.
- The disorder consists of involuntary sensory or motor symptoms and deficits that cannot be explained by a general medical condition 3.
- Symptoms of conversion are common in neurologic and psychiatric settings, affecting up to 20% of patients 4.
Diagnosis and Treatment of Conversion Disorder
- The diagnosis of conversion disorder can be challenging, and it is often missed on initial medical and neurological evaluations due to the lack of a definitive organic diagnosis 2.
- Improvements in the accuracy of diagnosis have been made possible by improved technologies such as neuroimaging 5.
- Treatment options for conversion disorder include cognitive behavioral therapy, neuropsychiatric management, pharmacotherapy, and a multidisciplinary approach to rehabilitation 5, 3, 4.
- Cognitive-behavioral therapy looks promising as the psychological treatment of choice, although more definitive data are still awaited 4.
Etiology and Prognosis of Conversion Disorder
- The etiology of conversion disorder is still uncertain, although advances in neuroscience and technology are providing reproducible findings and new insights 4.
- The full syndrome of conversion disorder is associated with a guarded prognosis and a troubled psychosocial outcome 4.
- Outcome studies show that the rate of misdiagnosis has declined precipitously since the 1970s and is now around 4% 4.
Treatment Outcomes and Response
- Combining selective serotonin reuptake inhibitors and cognitive behavioral therapy may be beneficial in treating conversion disorder, although this is based on studies of depression and anxiety disorders rather than conversion disorder specifically 6.
- The response to combined treatment varies across disorders and by specific patient characteristics, with younger patients and those with milder symptoms responding more quickly to treatment 6.