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


OBJECTIVE
The present study contrasts two behavioural treatments to elucidate the factors underlying successful in-patient rehabilitation of this population.


METHODS
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.
Rheumatology Institute,K-370, St Joseph's Health Care, 268 Grosvenor St, London, Ontario N6A 4V2, Canada. allan.shapiro@sjhc.london.on.ca
Allan P
AP
Shapiro
Robert W
RW
Teasell
D000208:Acute Disease; D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D002908:Chronic Disease; D003291:Conversion Disorder / Q000628:therapy*; D018592:Cross-Over Studies; D005162:Factitious Disorders / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011596:Psychomotor Disorders / Q000628:therapy*; D016896:Treatment Outcome