Behavioural interventions in the rehabilitation of acute v. chronic non-organic (conversion/factitious) motor disorders
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Published on: September 1, 2023
Allan P Shapiro1, Robert W Teasell
1Rheumatology Institute,K-370, St Joseph's Health Care, 268 Grosvenor St, London, Ontario N6A 4V2, Canada. allan.shapiro@sjhc.london.on.ca
Background:
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.
Aims:
The present study contrasts two behavioural treatments to elucidate the factors underlying successful in-patient rehabilitation of this population.
Method:
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.
Results:
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.
Conclusions:
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.