eMedicine Specialties > Psychiatry > Psychosomatic

Conversion Disorders: Follow-up

Author: Scott A Marshall, MD, Senior Fellow, Neurocritical Care, Johns Hopkins University School of Medicine, Division of Neurosciences Critical Care; Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Coauthor(s): Mark E Landau, MD, Neurology Program Director, National Capital Consortium, Associate Professor, Uniformed Services University of the Health Science, Neurophysiology Section, Department of Neurology, Walter Reed Army Medical Center; Craig G Carroll, DO, Staff Neurologist, Head of Clinical Neurophysiology Section, Naval Medical Center Portsmouth; Bryan Schwieters, MD, Consulting Physician, Schwieters Medical PLLC and St Joseph's Hospital
Contributor Information and Disclosures

Updated: Dec 22, 2008

Follow-up

Prognosis

  • Spontaneous resolution in most - Approximately 75%
  • Recurrence of same or different conversion symptoms - Approximately 25% in 15-year follow-up studies
  • False-positive diagnosis of conversion disorder
    • Approximately 25% are diagnosed with neurological disease in 10-year follow-up that could account for presenting symptoms.
    • Multiple sclerosis, neurodegenerative diseases, structural myelopathy, peripheral neuropathy, dystonia, and myopathy accounted for the false-positive diagnoses.
  • Good prognostic factors - Acute onset of symptoms, short duration of symptoms, healthy premorbid functioning, higher intelligence, absence of coexisting psychopathology, presence of an identifiable stressor, male gender, change in marital status (marriage or divorce), isolated sensory symptoms, very young age, and good premorbid medical health status.1
  • Poor prognostic symptoms - Pseudoseizure (psychogenic nonepileptic seizure), psychogenic tremor, subclinical (undiagnosed) personality pathology, concomitant medical illness, the presence of a stuffed animal brought to the hospital by the patient,35 poor perception of own well-being, motor symptoms, and pending litigation.1
  • Recent retrospective study of psychogenic nonepileptic seizure over a 5-year period showed 47% of patients were unemployed, 26% were not living independently, and only 16% were seizure free at 21 months post diagnosis of psychogenic nonepileptic seizure.36
  • Of children with a diagnosis of conversion disorder, 85% are symptom free at 5 years with a reported improvement in status in another 5%.37

Patient Education

  • Sensitively review the disorder with the patient and the family in such a way as to not place blame. During such follow-up for review of completed imaging and other studies, continue to emphasize the importance of pain or other symptoms that the patient may be having.
  • Continue to reassure the patient that the negative test results are good news and bode well for their eventual recovery.
  • Frequent brief office visits to ensure the expected resolution of their symptoms may be helpful.
  • Web sites that may provide further information and support for patient and family education include the following:

Miscellaneous

Medicolegal Pitfalls

  • Delay in diagnosing organic disease due to lack of appropriate evaluation
  • Unnecessary interventional or invasive diagnostic tests resulting in iatrogenic illness
  • Overly direct or confrontational presentation of the diagnosis, which may entrench the symptom and lead to prolonged patient disability
 
Acknowledgments

The opinions expressed in this work belong solely to those of the authors. They should not be interpreted as necessarily representative or endorsed by the Uniformed Services University, The United States Army, The Department of Defense, or any other agency of the federal government. 



More on Conversion Disorders

Overview: Conversion Disorders
Differential Diagnoses & Workup: Conversion Disorders
Treatment & Medication: Conversion Disorders
Follow-up: Conversion Disorders
Multimedia: Conversion Disorders
References
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Further Reading

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Keywords

hysteria, conversion reaction, voluntary motor deficit, sensory function deficit, malingering, conversion symptoms, psychogenic hemiparesis, psychogenic paralysis, pseudoseizure, pseudo-seizure, psychogenic seizure, psychogenic movement disorder, psychogenic tremor, PNES, psychogenic nonepileptic seizures

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Contributor Information and Disclosures

Author

Scott A Marshall, MD, Senior Fellow, Neurocritical Care, Johns Hopkins University School of Medicine, Division of Neurosciences Critical Care; Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
Scott A Marshall, MD is a member of the following medical societies: American Academy of Neurology, Neurocritical Care Society, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

Mark E Landau, MD, Neurology Program Director, National Capital Consortium, Associate Professor, Uniformed Services University of the Health Science, Neurophysiology Section, Department of Neurology, Walter Reed Army Medical Center
Mark E Landau, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.

Craig G Carroll, DO, Staff Neurologist, Head of Clinical Neurophysiology Section, Naval Medical Center Portsmouth
Craig G Carroll, DO is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.

Bryan Schwieters, MD, Consulting Physician, Schwieters Medical PLLC and St Joseph's Hospital
Bryan Schwieters, MD is a member of the following medical societies: American Medical Association and American Psychiatric Association
Disclosure: Nothing to disclose.

Medical Editor

Barry I Liskow, MD, Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Residency Program, University of Kansas School of Medicine; Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center
Barry I Liskow, MD is a member of the following medical societies: American Academy of Clinical Psychiatrists, American Academy of Psychiatrists in Alcoholism and Addictions, American Medical Association, American Psychiatric Association, and Research Society on Alcoholism
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Speaking and teaching; Northstar Grant/research funds Research; Novartis Grant/research funds research; Pfizer  Speaking and teaching; Sanofi-avetis Grant/research funds research; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration and American Psychosomatic Society
Disclosure: Nothing to disclose.

 
 
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