Robert Fisher

Nonepileptic seizures: Clinical case conference: Conversion disorder

Stonnington CM, Barry JJ, Fisher RS. American Journal of Psychiatry. 2006: 163 1510-1517

Early recognition of a conversion disorder will limit unnecessary tests and medications. Long-term benefit likely requires a comprehensive treatment approach, recognition of risk factors, and treatment of comorbid conditions, with a focus on cognitive styles that perpetuate symptoms. The quality of the doctor-patient relationship can influence outcome. Hard-to-treat patients may engender feelings of powerlessness, frustration, and mistrust in their treaters, which, if unprocessed, may lead to a poor relationship and excessive use of medications, tests, and procedures. There are few published reports on prospective studies or controlled trials of treatment for patients with nonepileptic seizures. The existing medical literature supports a multidisciplinary treatment approach, with specific interventions, such as cognitive behavior therapy for cognitive restructuring and psychodynamic therapy for addressing symptom connections to trauma and dissociation. Adjunctive group therapy or family therapy works well for certain patients. Hypnosis can be beneficial, although it is not essential for a good outcome. Judicious medication treatment for comorbid disorders, alone or in combination with psychotherapy, is often needed for sustained recovery.