From the Guidelines
The treatment approach for conversion disorder during intoxication should prioritize a multidisciplinary approach, including medical stabilization, psychiatry consultation, and psychotherapy, particularly cognitive-behavioral therapy, to address both the intoxication and the underlying psychological factors. This approach is supported by the American College of Physicians' position paper on substance use disorders, which emphasizes the importance of managing addiction as a chronic medical condition 1. The use of cognitive-behavioral therapy is also recommended by the 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope, which suggests that cognitive behavioral therapy may be beneficial in patients with pseudosyncope, a condition related to conversion disorder 1.
When managing conversion disorder during intoxication, it is essential to first ensure medical stabilization, which includes monitoring vital signs, ensuring airway protection, and managing the acute intoxication through appropriate detoxification protocols. Once the patient is medically stable, a supportive, non-confrontational approach should be adopted, avoiding direct challenges to the symptoms as "not real" or suggesting the patient is fabricating them. Instead, acknowledge the symptoms while explaining that they may be related to psychological stress manifesting physically.
Some key points to consider in the treatment approach include:
- Medical stabilization and detoxification
- Psychiatry consultation to address underlying psychological factors
- Psychotherapy, particularly cognitive-behavioral therapy, to help the patient manage symptoms and develop coping strategies
- Physical therapy to address any physical manifestations of the conversion disorder
- A non-confrontational and supportive approach to avoid exacerbating the patient's symptoms or creating unnecessary stress
The use of benzodiazepines such as lorazepam or diazepam may be considered for severe anxiety or agitation, but should be limited due to the risk of respiratory depression when combined with other substances 1. Overall, a comprehensive and multidisciplinary approach is essential to effectively manage conversion disorder during intoxication and provide the best chance for symptom resolution.
From the Research
Treatment Approach for Conversion Disorder
The treatment approach for conversion disorder during intoxication is not directly addressed in the provided studies. However, the following points can be considered:
- A holistic approach, including psychotherapy, can be beneficial in the treatment of conversion disorder 2.
- A positive diagnosis, which is an integral part of treatment, should be made by explaining to patients that their physical complaint has a psychological cause 3.
- Combined consultation (medicine and psychiatry) can be a useful tool to help patients, and coordination between specialists and general practitioners is an important part of this treatment 3.
- Antidepressant treatment can be effective in patients with psychogenic movement disorder, a subtype of conversion disorder, especially those with primary conversion symptoms and recent or current depression or anxiety 4.
- A thorough general medical and neurological examination is necessary to exclude somatic causes of symptoms and to make a precise differential diagnosis 5.
Key Considerations
- Conversion disorder should be diagnosed when all relevant investigations are inconclusive 2.
- The diagnosis of conversion disorder is problematic, and misdiagnosis of neurological disease as conversion disorder is a concern 6.
- A psychological explanation for the symptoms cannot always be found, and feigning is very difficult to either disprove or prove 6.
- Simplified criteria for diagnosis and cooperation between neurology and psychiatry in the management of patients with conversion disorder are suggested 6.