Advertisement

Psychotherapy for Conversion Symptoms?

Summary and Comment |
July 29, 2014

Psychotherapy for Conversion Symptoms?

  1. Steven Dubovsky, MD

Eclectic psychotherapy might work — if patients accept that their symptoms are psychogenic.

  1. Steven Dubovsky, MD

Psychogenic nonepileptic seizures (PNES, pseudoseizures) are conversion symptoms involving seizure-like movements in patients with normal electroencephalographic results. In this 4-month study on whether treatment affects PNES frequency, 38 patients with PNES and no epilepsy were randomized to one of four approaches: treatment as usual, sertraline (dose, ≤200 mg/day), 12 weekly sessions of manualized “cognitive-behavioral therapy–informed psychotherapy” (CBT-ip), or CBT-ip plus sertraline.

CBT-ip involved presenting the diagnosis; elements of education, behavioral analysis, cognitive therapy, interpersonal therapy, mindfulness, and dynamic psychotherapy; and teaching coping skills. Data from 34 patients were analyzed.

Both psychotherapy and psychotherapy/sertraline were associated with significantly fewer self-reported monthly seizures. The reduction in seizure frequency with sertraline was not statistically significant. Group numbers were too small for analyses of secondary measures, with most not corrected for multiple comparisons.

Comment

The most that can be concluded from this pilot study is that patients who are willing to accept the psychogenic nature of their conversion symptoms — typically, a minority of these patients — may be able to substitute more-mature solutions to cognitive, intrapsychic, and interpersonal problems. However, the primary outcome was patients' reports of seizure frequency; patients were not blinded to treatment; and the study was not designed (and was too small) to assess secondary outcomes, even though raters of these measures were blinded to patients' group assignments. With the exception of one secondary outcome (self-reported emergency department visits), corrections do not appear to have been made for multiple comparisons, further limiting conclusions. Nevertheless, eclectic psychotherapy for somatization has promise for patients who can mobilize some insight into the mind–body connection. Addressing anxiety and depression can improve quality of life in these patients (NEJM JW Psychiatry Aug 31 2009).

  • Disclosures for Steven Dubovsky, MD at time of publication Grant / Research support Otsuka; Tower Foundation; Research for Health, Hoffman-La Roche; Pfizer; Takeda Editorial boards Mind and Brain; Bulletin of the Menninger Clinic; Current Psychiatry; Journal of Psychosomatic Research

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement