Conversion Disorder And Medication Management

Introduction

Conversion disorder, which is also called a functional disorder or functional neurological disorder (FND), refers to a group of symptoms experienced by a person and cannot be explained by a neurological disease or other medical condition. It is a psychiatric disorder as there is no basis for it. The symptoms are functional and real, resembling any neurological disorder that significantly impacts a person's ability to function. Abnormal movement, weakness, paralysis, seizures, and visual or hearing disturbances are the characteristics of conversion disorder.¹

The exact cause of conversion disorder is unknown. However, it might be triggered by a reaction to stress or psychological or physical trauma.² Moreover, it's more likely to happen with other medical conditions like somatic symptom disorders or dissociative disorders. These disorders fall under the same group and have similar symptoms that cause distress and disruption of daily life. Treating conversion disorder can be complex, but a combination of psychotherapy (mental health therapy), psychiatric medications, and a multidisciplinary approach to rehabilitation has been successful.

Types of medications used in conversion disorder

Antidepressants

Patients with conversion disorder suffer from a variety of stress disorders like depression and anxiety as comorbid conditions. Treatment with medications like antidepressants, specifically those that target pain, is effective and helps recovery by alleviating the mood disorder and potentially improving overall functioning. A study demonstrated the potential benefits of combining multiple types of antidepressants. The combination of citalopram (Celexa), a selective serotonin reuptake inhibitor (SSRI) with paliperidone (Invega), an atypical antipsychotic, showed a promising effect in improving the symptoms.^3,4

Antianxiety medications

Anxiety is one of the mood disorders that coexist with individuals suffering from conversion disorder.⁵ Studies reported that a patient's condition improves with SSRI. Antianxiety medications like benzodiazepines and barbiturates are habit-forming if used long and must be carefully administered and particularly valuable for promptly managing symptoms of anxiety.³ The choice of prescribing antianxiety medication must be made case by case considering the symptoms and regular assessment of the treatment approach.

Antipsychotics

Conversion disorder is a mental health condition; therefore, the focus of treatment typically involves addressing underlying psychological factors and providing psychotherapy. Antipsychotics (medications that manage psychosis-related conditions and symptoms) are the first suggested therapy in most cases. A recent study reported that antipsychotics like quetiapine and haloperidol relieve the symptoms in patients with conversion disorder.⁶ In a few cases, a combination of antipsychotics with antidepressants or antianxiety medications was effective in resolving the symptoms. 

How medications work in conversion disorder

Targeting symptoms

A health care provider or a physician must be in alliance with the patients and encourage discussion of their feelings. Physicians list the patient’s symptoms and exclude major neurological disorders. Weakness is the common presenting symptom. The types of therapy that proved to be helpful are hypnotherapy, physical or occupational therapy, and medication. Family therapy improves communication.⁷

Balancing brain chemicals

Imbalance of chemicals in the brain is stress-related, causing anxiety and depression, and they are the coexisting diseases with the conversion disorder. Antianxiety, antidepressants or mood stabilisers are prescribed to alleviate the symptoms and improve the patient's normal functioning of life.

Addressing underlying causes

Psychological, emotional, and social factors play an important role in the arising of conversion disorder in an individual. Psychological assessment, psychotherapy, trauma-informed care, stress management, and family therapy aim to resolve emotional conflicts and develop coping mechanisms.

Medication treatment guidelines for conversion disorder

Prescription by a specialist

It is important to consult a neurologist (a doctor specialising in the brain and nervous system) or psychiatrist (a doctor specialising in mental health) to understand the condition and ensure comprehensive care. The doctor will assess symptoms, consider individual needs, and accordingly provide tailored medication regimens. Some individuals may experience spontaneous improvement in the symptoms over time, while others may require ongoing treatment and support.

Early intervention and a comprehensive treatment approach are generally associated with better outcomes. Antianxiety and antidepressants are prescribed to manage mood symptoms. Psychotherapy, particularly cognitive behavioural therapy (CBT) and psychodynamic therapy can help address underlying psychological factors and provide coping strategies.⁸

Individualised treatment plan

The goal of an individualised treatment plan for conversion disorder, is to address the unique challenges and factors associated with the condition. One of the underlying factors in the conversion disorder is stress. Thus, the use of scales to assess the occurrence of stressful events in life can help the healthcare provider to identify the source of stress. 

Anxiety and depression scale help identify the degree of mood disorders that exist along with the conversion disorder. Providing education and support to the patients and their loved ones helps to foster understanding and coping skills and provides a supportive environment. All of these contribute to long-term recovery and management of the condition. 

Other interventions, such as relaxation techniques, stress management strategies, or occupational therapy, may also be included based on individual requirements.

Regular monitoring and adjustments

Patients' responses to treatment vary in this condition. Adjustments to the treatment plan are made as necessary to optimise the outcomes. Regular assessments are conducted to evaluate the patient's progress. The physician and the patient must be in open and honest communication. The treatment plan must be adaptable to accommodate the needs of the patient. By implementing regular monitoring and adjustments, it will improve the quality of life of an individual.

Potential side effects of medications for conversion disorder

Medications like antidepressants, antianxiety and antipsychotics may have potential side effects.^9,10,11

Common side effects

• Drowsiness (feeling very sleepy)
• Dizziness
• Sedation
• Dry mouth
• Movement disorders 
• Metabolic changes

Less common side effects

• Sexual dysfunctions
• Hormonal changes
• Suicidal thoughts
• Hyponatraemia (severe fall in sodium, salt levels)
• Seizures
• Unconsciousness

Risks and benefits of medication

The prescribed medications have some potential risks and benefits.

Risks include:

• Using the medications for prolonged periods may develop dependence or withdrawal symptoms
• The medications are associated with some side effects that range from mild to severe

On the other hand, the benefits include:

• Alleviating and controlling the conversion disorder symptoms
• Improve the patient's well-being 

Alternative treatment options for conversion disorder

Psychotherapy

Psychotherapy is the first suggested treatment for conversion disorder. The therapy focuses on increasing a person's emotions, and improving the ability of communication. CBT is the most effective psychotherapy. It works by examining the patients thoughts, emotions, and the surrounding situation, to know how these factors impact their behaviour.

Hypnosis (hypnotherapy) is another psychotherapy that used particularly in severe cases. The hypnotherapy can increase the functioning and reduce the symptoms. This therapy seems to be effective in the case of coexisting conditions. It is helpful for patients with sensory loss or speech symptoms. Additionally, the healthcare provider might suggest counselling sessions for the patient.⁸ 

Physical therapy

Physical therapy or occupational therapy is another first-line treatment suggested in combination with CBT.¹² Research has shown that it helps manage complications like muscle weakness and stiffness. The physical therapy builds the patient’s motor skills. In addition to seeing a psychiatrist, the patient must be referred to a neurologist to determine other neurological conditions.

Complementary and alternative medicine

Adjunctive therapies have limited scientific evidence supporting their effectiveness. They have an indirect impact on the symptoms, and management of the condition. In conversion disorder, non-epileptic seizures may occur. They are different and do not result from abnormal brain activity. It is reported in some of the studies that antiepileptics are tapered or continued as a treatment as they work as mood stabilisers. In addition, Transcranial Magnetic Stimulation is one of the methods in where, the affected area of the brain responsible for the symptoms is stimulated. This particular method is still in research.¹²

Summary

• Conversion disorder, is a condition characterised by the presence of physical symptoms that cannot be explained by underlying medical conditions
• Common symptoms include weakness, paralysis, sensory loss, and speech difficulties
• Treatment typically is a multidisciplinary approach including psychotherapy with medications like antidepressants or antianxiety for symptom management