Conversion Disorder in Emergency Medicine Follow-up

Updated: Nov 09, 2015
  • Author: Seth Powsner, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Follow-up

Further Outpatient Care

Any patient diagnosed with a conversion reaction in the ED should be encouraged to pursue psychiatric follow-up. This can be suggested as a way to reduce and manage stress and mitigate exacerbation of physical symptoms (side-stepping arguments about etiology of symptoms). Psychiatric follow-up is especially helpful for rare cases of more serious psychiatric syndromes presenting to an emergency department with physical symptoms.

Many patients have spontaneous remission after outpatient psychotherapy or suggestive therapy.

As of yet, there are no well-established treatment regimens for conversion disorder. There has been more success with the other somatoform disorders.

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Transfer

All transfers must comply with Consolidated Omnibus Budget Reconciliation Act (COBRA)/Emergency Medical Transfer and Active Labor Act (EMTALA) regulations (see COBRA Laws and EMTALA).

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Complications

Errors in diagnosis of conversion disorder are not uncommon. With newer diagnostic testing, instances of false-positive diagnoses of conversion disorder in which a neurological disease is later identified are around 4%.

Authors have reported various organic diseases in patients who were initially diagnosed with conversion disorder. In one case report, a woman reporting leg weakness and back pain was subsequently diagnosed with sporadic Creutzfeldt-Jakob disease. [29] Other patients with underlying psychiatric illnesses were found to have disk herniations, epidural abscesses, or cerebral hemorrhages. [30, 31] In another case series, 5 patients were identified as having sarcoma-induced osteomalacia, cerebellar medulloblastoma, Huntington chorea, transverse myelitis, and lower extremity dystonia. [32] Although these case reports were rare, the initial diagnosis of conversion disorder without a complete neurologic examination, appropriate imaging, and other diagnostic testing should be discouraged. [33]

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Prognosis

Prognostic studies differ in outcome, with recovery rates ranging from 15-74%. Factors associated with favorable outcomes are male gender, acute onset of symptoms, precipitation by a stressful event, good premorbid health, and an absence of organic or psychiatric disorder. [34]

Many patients with conversion reactions have spontaneous remission or demonstrate marked or complete recovery after brief psychotherapy.

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