https://storyset.com/illustration/woman-reading/bro
Abnormal Psychology
Conversion Disorder/ FND
Jason C., Paul, Jihun, Kenny, Francis, Micheal, Jason N.
Patient: Lisa
Our scenario...
- We are health professionals treating Lisa
- Lisa's issue: paralysis of both legs but no history of any physical injury
- Husband ended 25yr relationship
- Loved him
- was financially dependent
- later diagnosed with conversion disorder
https://storyset.com/illustration/hospital-wheelchair/bro
What is conversion disorder?
Introduction
A condition where a person experiences physical and/or sensory issues that cannot be explained neurologically.
(The Children Hospital of Philadelphia, 2017)
https://storyset.com/illustration/shrug/bro
Isn't a common problem
How common is it?
- 4 to 12 people out of every 100,000 each year
- only around 5% of patients in a hospital are diagnosed
- estimates for the prevalence of conversion disorder are only between 0.011% and 0.5%
https://storyset.com/illustration/doctor/amico
Depends on several factors:
- When it happens in your life
- Whether or not you receive care for the condition
How long does it last
https://storyset.com/illustration/save-time/pana
Poorly understood...
Causes
- Can occur with or without known psychological factors
- Usually after a period of emotional or physical distress or psychological conflict
https://storyset.com/illustration/student-stress/rafiki
Loss of one or more bodily functions, for example...
Signs & Symptoms
- Loss of balance or difficulty walking
- Hearing problems or deafness
- Difficulty speaking or inability to speak
Symptoms are usually acute, but can reoccur if the cause is not dealt with
(The Children Hospital of Philadelphia, 2017)
(Goodrich & Sharma, 2013)
- Counseling — psychotherapy (talking therapy)
- Physical therapy — maintain patient's movement
- Medications — to supplement the counseling treatment for stress and anxiety
Treatments
What are some potential ways to treat/manage conversion disorder?
Treatments
https://storyset.com/illustration/injury/amico
Cognitive Behaviour Therapy
Cognitive Behavioural Therapy
(CBT)
- how you think and act affects how you feel.
- It can help in many different situations — with both mental and physical health problems (Australian Association of Cognitive Behavioural Therapy).
What is it?
(National Social Anxiety Centre, 2016)
Pros
- focused on changing the patient's thought patterns and behaviour to change how they feel
- Highly structured -- able to be delivered across many formats
- Skills learnt in CBT are applicable to daily life
Cons
General Pros and Cons
https://storyset.com/illustration/advantages/pana
- patient's committment (and cooperation) is required for the treatment to be effective
- progress cannot be seen immediately and requires time investment
Source: The CBT Clinic, 2016
https://storyset.com/illustration/bad-idea/rafiki
- learning ways to build productive habits
- learning healthy stress release techniques to resolve source(s) of stress
How does it work?
https://storyset.com/illustration/marriage-counseling/cuate
- Goal-setting: setting achievable, reasonable goals to resolve any troubling situations
- Self-talk/Journalling: sharing thoughts and feelings, whilst keeping track of them through journals
Some approaches could include ...
- Practicing self-awareness: helping the patient to become more aware of their own ways of thinking
- Reflection: encouraging patient to challenge their old ways of thinking
Ara. J (2019), Bangladesh
- Patient X, 14-yo Muslim unmarried female
- Grew up in a strict Muslim household
- Often verbally abused by her father
Let's take a look at a case study...
- Had an affair at 10 yo, relationship broke down shortly after
- suffered physical abuse from parents
https://storyset.com/illustration/blaming/bro
- later diagnosed with conversion disorder
CBT as her treatment...
- psychoeducation - explaining how thoughts and emotions can influence feelings -> more optimistic about recovery
Undergoing CBT...
- ventilation - allowed her to express her individual feelings and opinions on the situation -> reduce stress
- Assertiveness training - trained to express thoughts and ideas openly, directly and honestly
https://storyset.com/illustration/psychologist/bro
Success!
- case was terminated by the 11th session
- stopped experiencing her initial symptoms
- client rating of her condition had significantly decreased from 10 to 2 (on a scale of 10)
Result?
Medications
Medications
https://storyset.com/illustration/oncology-patient/bro
How is it different from CBT?
- Frequently used in the emergency department
- Helps aleviate immediate symptoms that CBT otherwise cannot
- immediate symptoms could be physical, emotional or mental
- CBT's focus is more long-term than short-term
How is it different?
IV Haloperidol versus Midazolam in Management of Conversion Disorder
(Jafari et al., 2015)
Haloperidol vs Midazolam
- Haloperidol is well-known to be used for conversion disorder symptoms
- But Midazolam produced fewer side effects
- Study was conducted to compare effectiveness of both drugs
Clinical Trial
How was it carried out?
- Double-blind randomized clinical trial conducted (Jafari et al., 2015)
- 140 patients with conversion disorder - aged 18-60 yrs old
- Divided into 2 groups, one with haloperidol and the other midazolam
- Effects of the drug recorded at 1 hour, 24 hours and 1 week time intervals
Haloperidol was more effective...
- 92% of patients in the IV haloperidol group recovered from symptoms
- only 64% with midazolam recovered from symptoms
How did it go?
BUT, more patients experienced side-effects with haloperidol...
- 17% wth IV haloperidol experienced side-effects
- only 4% with midazolam experienced side-effects
Nobay et al., 2003
- Used both haloperidol and midazolam
A similar study...
- identical efficacy of both on managing psychological stress
Evaluation
What are the reasons for these differences?
- Different environments beween studies
- The first study was done in a stressful environment
- Sedation speed and severity of side-effects not investigated
Haloperidol was more effective than midozolam...
Wrapping up...
However, Midazolam came with fewer side effects compared to Haloperidol
An alternative to Haloperidol?
- Haloperidol // traditional anti-psychotic but due to side effects it's use is restricted
Quetiapine vs Haloperidol
- Quetiapine // a newer anti-psychotic that can treat schizophrenia, bipolar disorder etc.
- balances levels of dopamine and serotonin
- improved mood and behaviour
(Ghanbarizadeh et al., 2018)
S. Ghanbarizadeh et al., 2017
- single-blind trial conducted on 144 FND patients between ages 18-60
- patients did not know which treatment they received
- 73 for Haloperidol (5mg)
- 71 for quetiapine (50mg)
A study done ...
- some patients were given a placebo (control) treatment
- used to compare results with the actual drugs
Quetiapine was a safer alternative to Haloperidol...
- Quetiapine was slightly more effective (91.55% of patients)
- only 90.41% of haloperidol patients relieved their symptoms
Results?
- Quetiapine also had lower % of side-effects (7.04%) such as weariness and sleepiness
- 9.59% with Haloperidol had side-effects
- Extrapyrimidal side-effects include involuntary muscle contraction, body and facial movements
Physical Therapy
Physical Therapy
https://storyset.com/patient
What is physical therapy?
- performed by licensed physical therapists
What is it?
- type of treatment focused at improving movement and physical health
- useful in managing physical symptoms such as paralysis, weakness etc.
- many different types: orthopaedic, neurological, cardiovascular etc
https://storyset.com/illustration/physical-therapy-exercise/rafiki
Outpatient PT in treating motor FND symptoms
"adherence to outpatient physical therapy was associated with symptom improvement" (Maggio et al., 2019)
A study on outpatient PT...
- hypothesised that they positively correlated with each other
50 patients
from Massachusetts General Hospital
How many particpated?
- 40 females and 10 males
- all diagnosed with conversion disorder
- all patients experienced a motor-related symptom(s)
- 42 had functional movement disorder (e.g. gait disorder, tremor etc)
- 21 had limb weakness (with some having both)
"an initial 1-hour assessment, including a clinical interview, focused neurologic examination, and mobility screening"
(Maggio et al., 2019)
Initial procedures
Patients were encouraged to attend ...
Main process
- 6-12 sessions a week
- 60 minutes each session
- attendance was tracked over 4 months
https://storyset.com/illustration/orthopedic/pana
Marked improvement!
How did it turn out?
- patients who attended more sessions showed greater improvement
- marked improvement -- "substantially enhanced ability to manage motor-based activities of daily living or near-complete symptom resolution at the final session"
Some limitations
Limitations
- small sample size - only 50 participants, not representative of entire population
- lack of patient self-report - could help see their psychological progress
- lack of standardised treatments - each patient had treatment tailored to their own needs
Almost there!
Summary & Conclusion
https://storyset.com/illustration/end-of-school/bro
Physical symptoms
but no neurological issues...
What was conversion disorder again?
- usually caused by stressful events
- psychological impact -> physical symptoms
- can happen again if the cause is not resolved
https://storyset.com/illustration/overwhelmed/bro
What are some treatments available?
- psychotherapy - guide and motivate patient to build a healthier mentality
- medications - ideal for immediate relief of symptoms
- physical therapy - enhance and/or maintain patient's physical range of movement
https://storyset.com/illustration/occupational-therapy/bro
A primary focus on ...
- cause is likely psychological from her break-up
- medications and physical therapy can accompany the CBT
Going back to Lisa...
Cognitive Behavioural Therapy (CBT)
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Thank you for listening!
:D