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      Drugs & Diseases > Psychiatry

      Conversion Disorder in Emergency Medicine Treatment & Management

      Updated: Nov 07, 2022
      • Author: Seth Powsner, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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      Treatment

      Approach Considerations

      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. [33]

      Next:

      Prehospital Care

      Treat patients as if their symptoms have an organic origin. Prehospital personnel most often cannot distinguish a conversion reaction from an organic illness.

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      Emergency Department Care

      Emergency physicians must be aware that the diagnosis of conversion disorder does not exclude the presence of underlying disease, and diagnosis should not be made solely on the basis of negative workup results. Approach each patient as if their symptoms had an organic basis, and treat them accordingly.

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      Consultations

      Consultation is often necessary and should be considered during ED discharge planning for any patients without previous histories of conversion reaction.

      • Consultation may be a cost-effective method to eliminate unnecessary hospitalization by streamlining these patients to appropriate outpatient psychiatric follow-up. [17]

      • Neurologic consultation may help if the neurological examination is equivocal.

      • Psychiatric consultation may be necessary if an organic cause is virtually excluded. Thoughtful questioning may elicit the underlying stressor.

      • Another treatment technique is suggestive therapy: an authoritative, not confrontative, pronouncement that "this problem usually resolves in a few hours" is often successful, especially with children. Appropriate attention, for example, repeated vital signs plus adjunctive antianxiety medication, can increase odds of success with adults. [20, 29] Other suggestive therapies for symptom removal include hypnosis and amobarbital interviews. [17]

      • Behavior-oriented treatment strategies may be helpful. [30, 31] The goals are to unlearn maladaptive responses and to learn more appropriate responses. Attempt to eliminate the patient's belief that the extremity is paralyzed by telling the patient (1) that all tests indicate the muscles and nerves are functioning normally, (2) the brain is communicating with the nerves and muscles, and (3) this apparent lost ability is recoverable. Although confronting the patient with the fact that the symptoms are not organic is counterproductive, a strategic/paradoxical behavioral intervention around the possibility of psychiatric diagnosis may help. [32]

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