The patient does not have the insight that the symptoms have no organic cause. Confronting the patient and insisting that nothing "real" is wrong is not helpful in alleviating symptoms and may worsen the patient's condition. The symptoms should be neither trivialized nor reinforced. If the precipitating factor is identified, correction of the situation should be attempted. Meanwhile, the patient should receive reassurance that no serious medical problem has been identified. If both the results of initial testing and exam are negative, it should be suggested to the patient that the symptoms will resolve. Nonspecific supportive therapy should be prescribed. For instance, in the example cited at the beginning of this chapter, it could be suggested that the patient visit her father less often, call daily instead, and have her husband accompany her to the hospital. She should expect the blindness to resolve if she follows this course. 29
Referral is mandatory. Patients with conversion disorders may need repetitive reassurance and suggestion that symptoms will resolve before returning to full function. Periodic follow-up is also important to monitor for subtle organic disease. Between 25 and 50 percent of patients diagnosed with conversion disorders later develop serious organic conditions. -I0
Most conversion disorders are brief and quickly resolve. Favorable prognostic factors are (1) lack of other psychiatric disorders, (2) sudden severe stress as a precipitating cause, and (3) absence of medical problems. Some cases are resistant and require hypnosis or amobarbital interview for resolution. This should be coordinated by the primary care provider. Lorazepam has also been found helpful in management of this condition. Approximately 25 percent of patients will have another episode over the ensuing 1 to 6 years, which may involve the same or a new symptom complex.2!0
Some patients develop a chronic form of the disorder with complications including contractures and atrophy of muscle groups. In addition, unnecessary diagnostic tests may lead to iatrogenic complications.
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HYPNOTISM is by no means a new art. True, it has been developed into a science in comparatively recent years. But the principles of thought control have been used for thousands of years in India, ancient Egypt, among the Persians, Chinese and in many other ancient lands. Miracles of healing by the spoken word and laying on of hands are recorded in many early writings.