J Speed1. 1. Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City 84132, USA.
Abstract
OBJECTIVE: To assess whether operant behavioral treatment of conversion disorder provides effective and durable symptom resolution, and to evaluate the prognostic value of duration of symptoms, as to the time required to effect symptom resolution. DESIGN: Retrospective case series (consecutive sample). SETTING: Inpatient rehabilitation unit in a tertiary care center. PATIENTS: The first 10 patients with conversion disorder treated by the author. There were 5 men and 5 women, age range 19 to 69 years, mean 32.7 years. The duration of conversion disorder symptoms (all involving gait) ranged from 0.5 to more than 112 weeks (mean 27.8 weeks, median 12 weeks). Follow-up range was 7 to 36 months (mean 20 months). INTERVENTION: All patients were treated as inpatients using a behavioral approach. A 'pseudo-scientific' explanation of the symptoms was provided, with an explanation that stressors can exacerbate symptoms. patients were in a wheelchair when no in therapy, and a physical therapy program was devised, using a treatment sequence based treatment of the analogous neurological condition. Other therapies were also utilized for positive reinforcement of normal function. All patients had psychological evaluation, with treatment as indicated. Patients were hospitalized long enough to restore normal gait and begin psychological treatment. MAIN OUTCOME MEASURES: Functional Independence Measure ambulation score at admission, discharge, and follow-up, and descriptive data, including symptom recurrence after discharge, new neurological symptoms after discharge, new treatment since discharge, and new psychiatric or neurological diagnosis since discharge. RESULTS: All patients attained normal ambulation before discharge (n = 10, Wilcoxon signed rank test p = .002). At followup, 7 of 9 patients maintained normal ambulation (Wilcoxon signed rank test of pretreatment ambulation score versus followup ambulation score p = .1016). Two patients resumed partial dependence on wheelchair use. There was a Spearman correlation coefficient of .68196 (p = .0298) when comparing duration of symptoms against duration of treatment. No patient had symptom substitution or new diagnosis made during the follow-up period. CONCLUSION: (1) Behavioral treatment of conversion disorder is effective, and appears to provide a clinically (but not statistically) significant long-lasting resolution of symptoms. (2) There is a strong positive correlation between duration of conversion symptoms and the time required to eradicate them.
OBJECTIVE: To assess whether operant behavioral treatment of conversion disorder provides effective and durable symptom resolution, and to evaluate the prognostic value of duration of symptoms, as to the time required to effect symptom resolution. DESIGN: Retrospective case series (consecutive sample). SETTING: Inpatient rehabilitation unit in a tertiary care center. PATIENTS: The first 10 patients with conversion disorder treated by the author. There were 5 men and 5 women, age range 19 to 69 years, mean 32.7 years. The duration of conversion disorder symptoms (all involving gait) ranged from 0.5 to more than 112 weeks (mean 27.8 weeks, median 12 weeks). Follow-up range was 7 to 36 months (mean 20 months). INTERVENTION: All patients were treated as inpatients using a behavioral approach. A 'pseudo-scientific' explanation of the symptoms was provided, with an explanation that stressors can exacerbate symptoms. patients were in a wheelchair when no in therapy, and a physical therapy program was devised, using a treatment sequence based treatment of the analogous neurological condition. Other therapies were also utilized for positive reinforcement of normal function. All patients had psychological evaluation, with treatment as indicated. Patients were hospitalized long enough to restore normal gait and begin psychological treatment. MAIN OUTCOME MEASURES: Functional Independence Measure ambulation score at admission, discharge, and follow-up, and descriptive data, including symptom recurrence after discharge, new neurological symptoms after discharge, new treatment since discharge, and new psychiatric or neurological diagnosis since discharge. RESULTS: All patients attained normal ambulation before discharge (n = 10, Wilcoxon signed rank test p = .002). At followup, 7 of 9 patients maintained normal ambulation (Wilcoxon signed rank test of pretreatment ambulation score versus followup ambulation score p = .1016). Two patients resumed partial dependence on wheelchair use. There was a Spearman correlation coefficient of .68196 (p = .0298) when comparing duration of symptoms against duration of treatment. No patient had symptom substitution or new diagnosis made during the follow-up period. CONCLUSION: (1) Behavioral treatment of conversion disorder is effective, and appears to provide a clinically (but not statistically) significant long-lasting resolution of symptoms. (2) There is a strong positive correlation between duration of conversion symptoms and the time required to eradicate them.
Authors: Alan L Peterson; Joseph F McGuire; Sabine Wilhelm; John Piacentini; Douglas W Woods; John T Walkup; John P Hatch; Robert Villarreal; Lawrence Scahill Journal: Behav Ther Date: 2015-09-11
Authors: Glenn Nielsen; Jon Stone; Audrey Matthews; Melanie Brown; Chris Sparkes; Ross Farmer; Lindsay Masterton; Linsey Duncan; Alisa Winters; Laura Daniell; Carrie Lumsden; Alan Carson; Anthony S David; Mark Edwards Journal: J Neurol Neurosurg Psychiatry Date: 2014-11-28 Impact factor: 10.154