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Recurrent conversion disorder — Clinical Guidelines

Overview

Recurrent conversion disorder involves physical symptoms affecting voluntary motor or sensory functions without an identifiable organic cause, often linked to psychological factors 1 2.

Diagnosis

Clinical Presentation: Symptoms mimic neurological disorders but lack organic pathology 6 7.

Diagnostic Process: Often initially evaluated by neurologists; diagnosis influenced by patient interaction 3.

Exclusionary Approach: Comprehensive neurological and radiological evaluations typically normal 6.

Psychological Assessment: Rarely explicitly documented in referral patterns; psychological attribution uncommon 5.

Management

First-Line Treatments: Psychotherapy, particularly cognitive-behavioral therapy (CBT) 5.

Adjunctive Therapies: Use of major tranquilizers (e.g., sodium pentothal, hypnosis) for symptom control 10.

Communication: Effective patient communication crucial for diagnosis and management 3.

Special Populations

No Specific Guidelines: Limited evidence addressing recurrent conversion disorder in pregnancy, pediatrics, or elderly populations directly from provided abstracts.

Key Recommendations

Integrate Neurological and Psychiatric Collaboration: Establish a unified approach between neurologists and psychiatrists to improve diagnosis and management 2 (Evidence: Moderate).

Prioritize Psychological Support: Initiate psychological interventions, particularly CBT, as primary treatment 5 (Evidence: Moderate).

Utilize Tranquilizers for Symptom Control: Consider major tranquilizers temporarily to manage severe symptoms when organic causes are ruled out 10 (Evidence: Weak).

References

1 Teive HA, Germiniani FM, Munhoz RP, Paola Ld. 126 hysterical years - the contribution of Charcot. Arquivos de neuro-psiquiatria 2014. link 2 Reynolds EH. Hysteria, conversion and functional disorders: a neurological contribution to classification issues. The British journal of psychiatry : the journal of mental science 2012. link 3 Friedman JH. Neuropsychiatric disorders: What do neurologists think about conversion disorder?. Nature reviews. Neurology 2011. link 4 Verhoeven J, Mariën P, Engelborghs S, D'Haenen H, De Deyn P. A foreign speech accent in a case of conversion disorder. Behavioural neurology 2005. link 5 Crimlisk HL, Bhatia KP, Cope H, David AS, Marsden D, Ron MA. Patterns of referral in patients with medically unexplained motor symptoms. Journal of psychosomatic research 2000. link00167-7) 6 Russo MB, Brooks FR, Fontenot J, Dopler BM, Neely ET, Halliday AW. Conversion disorder presenting as multiple sclerosis. Military medicine 1998. link 7 Lacy TJ, McManis SE. Psychogenic stridor. General hospital psychiatry 1994. link90104-x) 8 Bryant RA, McConkey KM. Visual conversion disorder: a case analysis of the influence of visual information. Journal of abnormal psychology 1989. link 9 Rosenberg ML. The eyes in hysterical states of unconsciousness. Journal of clinical neuro-ophthalmology 1982. link 10 Peters J. The neurologist's use of rating scales, EEG, and tranquilizers in dealing with hysterical symptoms. Behavioral neuropsychiatry 1974. link

Recurrent conversion disorder