BEHAVIORAL-MANAGEMENT OF CONVERSION DISORDER - RETROSPECTIVE STUDY

Objective: To assess whether operant behavioral treatment of conversio n disorder provides effective and durable symptom resolution, and to e valuate the prognostic value of duration of symptoms, as to the time r equired to effect symptom resolution. Design: Retrospective case serie s (consecutive sample). Setting: Inpatient rehabilitation unit in a te rtiary care center. Patients: The first 10 patients with conversion di sorder treated by the author. There were 5 men and 5 women, age range 19 to 69 years, mean 32.7 years. The duration of conversion disorder s ymptoms (all involving gait) ranged from 0.5 to more than 112 weeks (m ean 27.8 weeks, median 12 weeks). Follow-up range was 7 to 36 months ( mean 20 months). Intervention: All patients were treated as inpatients using a behavioral approach. A 'pseudo-scientific' explanation of the symptoms was provided, with an explanation that stressors can exacerb ate symptoms. Patients were in a wheelchair when not in therapy, and a physical therapy program was devised, using a treatment sequence base d treatment of the analogous neurological condition. Other therapies w ere also utilized for positive reinforcement of normal function. All p atients had psychological cal evaluation, with treatment as indicated. Patients were hospitalized long enough to restore normal gait and beg in psychological treatment. Main Outcome Measures: Functional Independ ence Measure ambulation score at admission, discharge, and follow-up, and descriptive data, including symptom recurrence after discharge, ne w neurological symptoms after discharge, new treatment since discharge , and new psychiatric or neurological diagnosis since discharge. Resul ts: All patients attained normal ambulation before discharge (n = 10, Wilcoxon signed rank test p = .002). At followup, 7 of 9 patients main tained normal ambulation (Wilcoxon signed rank test of pretreatment am bulation score versus followup ambulation score p = .1016). Two patien ts resumed partial dependence on wheelchair use. There was a Spearman correlation coefficient of .68196 (p = .0298) when comparing duration of symptoms against duration of treatment. No patient had symptom subs titution or new diagnosis made during the follow up period. Conclusion s: (1) Behavioral treatment of conversion disorder is effective, and a ppears to provide a clinically (but not statistically) significant lon g-lasting resolution of symptoms. (2) There is a strong positive corre lation between duration of conversion symptoms and the time required t o eradicate them. (C) 1996 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitat ion.