Behavioural interventions in the rehabilitation of acute v. chronic non-organic (conversion/factitious) motor disorders

• Published in: British journal of psychiatry Vol. 185; no. 2; pp. 140 - 146
• Main Authors: Shapiro, Allan P., Teasell, Robert W.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01-08-2004; RCP
• Subjects: Acute Disease; Adult; Behavior modification; Behavior Therapy - methods; Behavioural approaches; Canada; Chart reviews; Chronic Disease; Chronic mental disorders; Clinical outcomes; Conversion; Conversion disorder; Conversion Disorder - therapy; Counseling; Cross-Over Studies; Etiology; Factitious Disorders - therapy; Female; Hospitals; Humans; Inpatient care; Interdisciplinary aspects; Intervention; Interventions; Male; Motor performance; Movement disorders; Pain; Patients; Psychiatry; Psychomotor Disorders - therapy; Rehabilitation; Treatment Outcome
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.185.2.140

Repeated case series have documented the effectiveness of multidisciplinary in-patient behavioural treatment for conversion disorders. However, in the absence of controlled research, treatment success could be attributed to providing patients with a face-saving opportunity to get better.
The present study contrasts two behavioural treatments to elucidate the factors underlying successful in-patient rehabilitation of this population.
Thirty-nine patients underwent a standard behavioural programme. Using a crossover design, patients who did not improve underwent a strategic-behavioural treatment in which they and their families were told that full recovery constituted proof of an organic aetiology whereas failure to recover was definitive proof of a psychiatric aetiology.
Chart review indicated that the standard behavioural treatment was effective for 8/9 'acute' patients but only for 1/28 'chronic' patients. Of the 21 patients with chronic motor disorder who then under went the strategic-behavioural intervention, 13 were symptom-free at discharge.
The strategic intervention was superior to standard behavioural treatment for patients with chronic motor disorder. Treatment components previously deemed critical for the effectiveness of behavioural treatment may be unnecessary.