Demystifying Conversion Disorder: A Guide for Primary Care Clinicians

MPR

What approaches have been found helpful for CD?

Dr Tsui

There is strong evidence4 to support multidisciplinary inpatient treatment with a team that consists of rehabilitation specialists and psychologists. There is also some support for CBT and hypnotherapy as interventions.

Case Study

The neurologist demonstrated to the patient that when he was distracted by moving his right leg, strength returned to his left leg. He explained, “Your brain is having trouble sending a message to your leg to make it move, but when you are distracted, the message can get through. This test shows me there is a problem with the function of your nervous system, not damage to it.”

The patient had already noticed that distraction improved his symptoms and was receptive to the diagnosis. The patient and physician discussed the role of using distraction techniques during walking, and the physician provided further self-help information for functional neurologic symptoms.5

At a follow-up visit, the patient stated that “understanding the physical basis of the diagnosis had made a big difference to him.” He now had confidence that “it was the correct diagnosis and further tests would not be helpful.” Now that he knew the diagnosis, he “felt less anxious about it, paid less attention to it, and as a consequence seemed to experience it much less.”

References

1.      Stone J, Edwards M. Trick or treat? Showing patients with functional (psychogenic) motor symptoms their physical signs. Neurology. 2012 Jul 17;79(3):282-4.

2.      Tsui P, Deptula A, Yuan DY. Conversion disorder, functional neurological symptoms disorder, and chronic pain: comorbidity, assessment, and treatment. Curr Pain Headache Rep. 2017 Jun;21(6):29.

3.      American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth ed. Arlington: American Psychiatric Association; 2013.

4.      McCormack R, Moriarty J, Mellers JD, Shotbolt P, Pastena R, Landes N, Goldstein L, Fleminger S, David AS. Specialist inpatient treatment for severe motor conversion disorder: a retrospective comparative study. J Neurol Neurosurg Psychiatry. 2014;85:893–8.

5. Stone J. Functional and Neurological Symptoms: A Patient’s Guide. Available at: www.neurosymptoms.org. Accessed: May 11, 2017.