Conversion Disorders Follow-up

Updated: Nov 09, 2015
  • Author: Scott A Marshall, MD; Chief Editor: David Bienenfeld, MD  more...
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Follow-up

Prognosis

Approximately 75% of patients will experience spontaneous resolution. Approximately 25% of patients will experience recurrence of the same or different conversion symptoms at 15-year follow-up.

  • 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. [2]

  • 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, [38] poor perception of own well-being, motor symptoms, and pending litigation. [2]

  • 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. [39]

  • Of children with a diagnosis of conversion disorder, 85% are symptom free at 5 years with a reported improvement in status in another 5%. [40]

Next:

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.

Websites that may provide further information and support for patient and family education include the following:

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