A 23-Year-Old With Blindness After a Fall She Can't Remember

Jeffrey S. Forrest, MD; Alexander B. Shortridge

Disclosures

November 27, 2019

The treatment of conversion disorder requires a comprehensive multidisciplinary approach. An initial neurologic consultation serves to corroborate this possible diagnosis by eliminating organic causes of the symptoms present. Psychiatric consultation serves to address mental health conditions that are commonly comorbid with conversion disorder, including mood disorders, anxiety disorders, posttraumatic stress disorders, somatic symptom disorders, and dissociative disorders. One approach to both diagnosis and treatment for some patients with a conversion disorder is a sodium amytal interview.[14] These interviews have revealed the underlying psychological conflict in some instances. They have also helped in rehabilitation efforts.

Antidepressant medication has not been found to treat the conversion disorder itself. No specific antidepressant is widely recognized as effective in the treatment of conversion disorder. Thus, the recommendation is to prescribe medication as needed to treat comorbid psychiatric conditions.[15] Research studies also support cognitive behavioral therapy and hypnotherapy as effective treatments for conversion disorder. Often, psychodynamic-orientated psychotherapy has not been effective in many patients who deny any underlying mental conflicts. However, supportive psychotherapy that emphasizes that physical therapy can be effective has been useful.

Physical therapy is indicated to treat the motor symptoms of conversion disorders. Evidence suggests that inpatient physical therapy treatment is highly effective in treating motor symptoms in such conditions. One study found that patients with conversion disorder who were given physical therapy maintained partial or complete symptom remission for up to 1 year after completion of a physical rehabilitation program.[15] The collaboration of specialists in the multidisciplinary team is essential to ensure optimal management for conversion disorder symptoms.

The long-term outcome of conversion disorder widely varies depending on the nature of the symptoms. Positive prognostic factors for conversion disorder include sudden symptom onset, short symptom duration, precipitation by an early identifiable stressor, good premorbid functioning, and the absence of comorbid psychiatric disorders.[3] Conversion disorders that have predominant motor features, by contrast, frequently have less favorable outcomes.[16] One meta-analysis demonstrated 66%-100% of patients with such conditions had the same or worse symptoms at follow-up; only 20% demonstrated full remission of symptoms. The same analysis found conversion disorder syndromes that featured visual symptoms had better outcomes, with 46%-78% of patients showing improvement or full remission at follow-up.

This patient in this case was treated with a multidisciplinary approach. Psychiatric consultation was obtained for optimization of the patient's antidepressant regimen for her comorbid depressive symptoms. A regimen of intensive outpatient therapy, including cognitive behavioral therapy, was also provided to assist with the myriad of psychological stressors besetting the patient. A physical therapy regimen was initiated to treat her left lower-extremity weakness. After several weeks of treatment, the patient's symptoms resolved.

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