eMedicine Specialties > Emergency Medicine > Psychosocial

Conversion Disorder: Treatment & Medication

Author: Seth Powsner, MD, Professor of Psychiatry and Emergency Medicine, Yale University School of Medicine; Medical Director, Crisis Intervention Unit, Section of Emergency Medicine, Yale-New Haven Hospital
Coauthor(s): Susan Dufel, MD, FACEP, Program Director, Associate Professor, Department of Traumatology and Emergency Medicine, Division of Emergency Medicine, University of Connecticut School of Medicine
Contributor Information and Disclosures

Updated: Nov 4, 2008

Treatment

Prehospital Care

Treat patients as if their symptoms have an organic origin. Prehospital personnel most often cannot distinguish a conversion reaction from an organic illness.

Emergency Department Care

Emergency physicians must be aware that the diagnosis of conversion disorder does not exclude the presence of underlying disease, and diagnosis should not be made solely on the basis of negative workup results. Approach each patient as if their symptoms had an organic basis, and treat them accordingly.

Consultations

Consultation is often necessary and should be considered during ED discharge planning for any patients without previous histories of conversion reaction.

  • Consultation may be a cost-effective method to eliminate unnecessary hospitalization by streamlining these patients to appropriate outpatient psychiatric follow-up.
  • Neurologic consultation may help if the neurological examination is equivocal.
  • Psychiatric consultation may be necessary if an organic cause is virtually excluded. Thoughtful questioning may elicit the underlying stressor.
  • Another treatment technique is suggestive therapy: an authoritative, not confrontative, pronouncement that "this problem usually resolves in a few hours" is often successful, especially with children. Appropriate attention, for example, repeated vital signs plus adjunctive antianxiety medication, can increase odds of success with adults.
  • Other suggestive therapies for symptom removal include hypnosis and amobarbital interviews. Using a behaviorally oriented treatment strategy, the goals are to unlearn maladaptive responses and to learn more appropriate responses. Attempt to eliminate the patient's belief that the extremity is paralyzed by telling the patient (1) that all tests indicate the muscles and nerves are functioning normally, (2) the brain is communicating with the nerves and muscles, and (3) this apparent lost ability is recoverable. Confronting the patient with the fact that the symptoms are not organic is counterproductive.

Medication

Drug therapy has not proven reliable. However, a number of psychiatrists recommend a sedative or antianxiety agent. It is usually easiest to give a benzodiazepine, eg, lorazepam 0.5-1 mg (along with a suggestion that symptoms are likely to remit in an hour or so). Amobarbital is falling out of favor as a sedative, or for an Amytal interview, but has been a traditional medication.

More on Conversion Disorder

Overview: Conversion Disorder
Differential Diagnoses & Workup: Conversion Disorder
Treatment & Medication: Conversion Disorder
Follow-up: Conversion Disorder
References
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References

  1. Stone J, Zeman A, Simonotto E, et al. FMRI in patients with motor conversion symptoms and controls with simulated weakness. Psychosom Med. Dec 2007;69(9):961-9. [Medline].

  2. Liepert J, Hassa T, Tuscher O, et al. Electrophysiological correlates of motor conversion disorder. Mov Disord. Sep 10 2008;[Medline].

  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revisions. Washington DC: American Psychiatric Association; 2000.

  4. Binzer M, Andersen PM, Kullgren G. Clinical characteristics of patients with motor disability due to conversion disorder: a prospective control group study. J Neurol Neurosurg Psychiatry. Jul 1997;63(1):83-8. [Medline].

  5. Binzer M, Kullgren G. Motor conversion disorder. A prospective 2- to 5-year follow-up study. Psychosomatics. Nov-Dec 1998;39(6):519-27. [Medline].

  6. Breuer J, Freud S. Studies on hysteria. In: Translated from the German and edited by James Strachey, in collaboration with Anna Freud, assisted by Alix Strachey and Alan Tyson. Case I Fräulein Anna O. (Breuer). New York: Basic Books; 1957:21.

  7. Brown RJ, Cardena E, Nijenhuis E, et al. Should conversion disorder be reclassified as a dissociative disorder in DSM V?. Psychosomatics. Sep-Oct 2007;48(5):369-78. [Medline].

  8. Drake ME Jr. Conversion hysteria and dominant hemisphere lesions. Psychosomatics. Nov-Dec 1993;34(6):524-30. [Medline].

  9. Dula DJ, DeNaples L. Emergency department presentation of patients with conversion disorder. Acad Emerg Med. Feb 1995;2(2):120-3. [Medline].

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  11. Glick TH, Workman TP, Gaufberg SV. Suspected conversion disorder: foreseeable risks and avoidable errors. Acad Emerg Med. Nov 2000;7(11):1272-7. [Medline].

  12. Hodgman CH. Conversion and somatization in pediatrics. Pediatr Rev. Jan 1995;16(1):29-34. [Medline].

  13. Kent DA, Tomasson K, Coryell W. Course and outcome of conversion and somatization disorders. A four-year follow-up. Psychosomatics. Mar-Apr 1995;36(2):138-44. [Medline].

  14. Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med. Dec 2007;69(9):881-8. [Medline].

  15. Lloyd GG. Acute behaviour disturbances. J Neurol Neurosurg Psychiatry. Nov 1993;56(11):1149-56. [Medline].

  16. Mace CJ. Hysterical conversion. I: A history. Br J Psychiatry. Sep 1992;161:369-77. [Medline].

  17. Mai FM. "Hysteria" in clinical neurology. Can J Neurol Sci. May 1995;22(2):101-10. [Medline].

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  19. Schwingenschuh P, Pont-Sunyer C, Surtees R, et al. Psychogenic movement disorders in children: A report of 15 cases and a review of the literature. Mov Disord. Aug 29 2008;[Medline].

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  22. Solvason HB, Harris B, Zeifert P, et al. Psychological versus biological clinical interpretation: a patient with prion disease. Am J Psychiatry. Apr 2002;159(4):528-37. [Medline].

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  24. Stone J, Smyth R, Carson A, et al. Systematic review of misdiagnosis of conversion symptoms and "hysteria". BMJ. Oct 29 2005;331(7523):989. [Medline].

  25. Teasell RW, Shapiro AP. Misdiagnosis of conversion disorders. Am J Phys Med Rehabil. Mar 2002;81(3):236-40. [Medline].

  26. Tobiano PS, Wang HE, McCausland JB, et al. A case of conversion disorder presenting as a severe acute stroke. J Emerg Med. Apr 2006;30(3):283-6. [Medline].

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Further Reading

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Keywords

conversion disorder, conversion reactions, hysteria, depression, somatoform disorder, psychiatric condition, psychological conflict, psychological need, paralysis, sensory disturbances, pseudoseizures, involuntary movements, maladaptive response to stress, psychosocial stress, organic brain disorder, la belle indifférence, optokinetic nystagmus, monocular diplopia, triplopia, field defects, tunnel vision, bilateral blindness, astasia-abasia

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Contributor Information and Disclosures

Author

Seth Powsner, MD, Professor of Psychiatry and Emergency Medicine, Yale University School of Medicine; Medical Director, Crisis Intervention Unit, Section of Emergency Medicine, Yale-New Haven Hospital
Seth Powsner, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, American Medical Association, American Psychiatric Association, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Susan Dufel, MD, FACEP, Program Director, Associate Professor, Department of Traumatology and Emergency Medicine, Division of Emergency Medicine, University of Connecticut School of Medicine
Susan Dufel, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey Glenn Bowman, MD, MS, Consulting Staff, Highfield MRI, Columbus, Ohio
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Robert Harwood, MD, MPH, FACEP, FAAEM, Program Director, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine
Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, University Hospitals, Case Western Reserve School of Medicine
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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