Cochrane · systematic review · CD005331
Psychosocial interventions for conversion and dissociative disorders in adults
Ganslev, CA, Storebø, OJ, Callesen, HE, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Common Mental DisordersAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
51
current version
GRADE rated
19
No studies
32
Included studies
NR
No studies 32 · 62.7%Ungraded 0 · 0%Very low 16 · 31.4%Low 3 · 5.9%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Paradoxical intention therapy compared with diazepam
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs (number of patients without any conversive attacks in last 2 weeks) End of treatment Paradoxical intention therapy vs diazepam | RR 1.44 [0.91, 2.28] | 1 study · 30 participants | Very low Downgraded: risk of bias, imprecision |
Level of functioning Paradoxical intention therapy vs diazepam | no estimate extracted | NR | No studies |
Quality of life Paradoxical intention therapy vs diazepam | no estimate extracted | NR | No studies |
Adverse events Paradoxical intention therapy vs diazepam | no estimate extracted | NR | No studies |
Hypnosis plus treatment as usual compared with treatment as usual
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs (Severity of impairment) Measured by the VRMC scale (higher is better) Hypnosis plus treatment as usual vs treatment | no estimate extracted | 1 study · 45 participants | Very low Downgraded: risk of bias, imprecision |
Level of functioning Hypnosis plus treatment as usual vs treatment | no estimate extracted | NR | No studies |
Quality of life Hypnosis plus treatment as usual vs treatment | no estimate extracted | NR | No studies |
Adverse events Hypnosis plus treatment as usual vs treatment | no estimate extracted | NR | No studies |
Hypnosis compared with wait list
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs (Severity of impairment) Measured by the VRMC scale (higher is better) Hypnosis vs wait list | no estimate extracted | 1 study · 49 participants | Low Downgraded: risk of bias, imprecision |
Level of functioning Hypnosis vs wait list | no estimate extracted | NR | No studies |
Quality of life Hypnosis vs wait list | no estimate extracted | NR | No studies |
Adverse events Hypnosis vs wait list | no estimate extracted | NR | No studies |
Behavioural therapy plus treatment as usual compared with treatment as usual
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs Number of weekly seizures, as assessed by daily self‐reported treatment diary End of treatment Behavioural therapy plus treatment as usual vs treatment | no estimate extracted | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in physical signs (symptom severity) Measured by Clinical Global Impression scale (lower is better) Behavioural therapy plus treatment as usual vs treatment | no estimate extracted | 1 study · 90 participants | Very low Downgraded: risk of bias, imprecision |
Level of functioning Behavioural therapy plus treatment as usual vs treatment | no estimate extracted | NR | No studies |
Quality of life Behavioural therapy plus treatment as usual vs treatment | no estimate extracted | NR | No studies |
Adverse events Behavioural therapy plus treatment as usual vs treatment | no estimate extracted | NR | No studies |
Cognitive behavioural therapy as compared with standard medical care
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs Reduction in monthly seizure frequency as assessed by a daily self‐reported seizure diary End of treatment Cognitive behavioural therapy as vs standard medical care | RR 1.56 [0.39, 6.19] | 1 study · 16 participants | Very low Downgraded: risk of bias, imprecision |
Reduction in physical signs Monthly seizure frequency as assessed by a daily self‐reported seizure diary (lower is better) End of treatment Cognitive behavioural therapy as vs standard medical care | no estimate extracted | 1 study · 61 participants | Low Downgraded: imprecision |
Reduction in physical sign Seizure freedom as assessed by a daily self‐reported seizure diary End of treatment Cognitive behavioural therapy as vs standard medical care | RR 2.33 [0.3, 17.88] | 1 study · 16 participants | Very low Downgraded: risk of bias, imprecision |
Level of functioning As measured by the GAF (range 0–100) scale and the WSAS scale (0–40) (lower is better) End of treatment Cognitive behavioural therapy as vs standard medical care | no estimate extracted | 2 studies · 74 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Quality of life As assessed by QOLIE31 (higher is better) Cognitive behavioural therapy as vs standard medical care | no estimate extracted | 1 study · 16 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Cognitive behavioural therapy as vs standard medical care | no estimate extracted | NR | No studies |
Psychoeducational follow‐up programme compared with treatment as usual
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs End of treatment Psychoeducational follow‐up programme vs treatment | no estimate extracted | NR | No studies |
Level of functioning As assessed by WSAS scale (lower is better) Psychoeducational follow‐up programme vs treatment | no estimate extracted | 1 study · 43 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Psychoeducational follow‐up programme vs treatment | no estimate extracted | NR | No studies |
Adverse events Psychoeducational follow‐up programme vs treatment | no estimate extracted | NR | No studies |
Specialised cognitive behavioural therapy‐based physiotherapy compared with waitlist
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs End of treatment Specialised cognitive behavioural therapy‐based physiotherapy vs waitlist | no estimate extracted | NR | No studies |
Level of functioning As measured by FIM (higher is better) Specialised cognitive behavioural therapy‐based physiotherapy vs waitlist | no estimate extracted | 1 study · 118 participants | Low Downgraded: risk of bias, imprecision |
Quality of life Specialised cognitive behavioural therapy‐based physiotherapy vs waitlist | no estimate extracted | NR | No studies |
Adverse events Specialised cognitive behavioural therapy‐based physiotherapy vs waitlist | no estimate extracted | NR | No studies |
Specialised cognitive behavioural therapy‐based physiotherapy intervention compared with treatment as usual
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs End of treatment Specialised cognitive behavioural therapy‐based physiotherapy intervention vs treatment | no estimate extracted | NR | No studies |
Level of functioning As assessed by WSAS scale (lower is better) Specialised cognitive behavioural therapy‐based physiotherapy intervention vs treatment | no estimate extracted | 1 study · 54 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life Specialised cognitive behavioural therapy‐based physiotherapy intervention vs treatment | no estimate extracted | NR | No studies |
Adverse events Specialised cognitive behavioural therapy‐based physiotherapy intervention vs treatment | no estimate extracted | NR | No studies |
Brief psychotherapeutic intervention compared with standard care
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs As assessed by SDQ‐20 (lower is better) Brief psychotherapeutic intervention vs standard care | RR 0.12 [0.01, 2] | 1 study · 19 participants | Very low Downgraded: risk of bias, imprecision |
Level of functioning Brief psychotherapeutic intervention vs standard care | no estimate extracted | NR | No studies |
Quality of life As assessed by SF‐36 (lower is better) Brief psychotherapeutic intervention vs standard care | no estimate extracted | 1 study · 16 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Brief psychotherapeutic intervention vs standard care | no estimate extracted | NR | No studies |
Cognitive behavioural therapy plus adjunctive physical activity compared with cognitive behavioural therapy alone
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs (overall physical impact) As measured by PMDRS, total score (lower is better) Cognitive behavioural therapy plus adjunctive physical activity vs cognitive behavioural therapy alone | no estimate extracted | 1 study · 21 participants | Very low Downgraded: risk of bias, imprecision |
Level of functioning Cognitive behavioural therapy plus adjunctive physical activity vs cognitive behavioural therapy alone | no estimate extracted | NR | No studies |
Quality of life Cognitive behavioural therapy plus adjunctive physical activity vs cognitive behavioural therapy alone | no estimate extracted | NR | No studies |
Adverse events Cognitive behavioural therapy plus adjunctive physical activity vs cognitive behavioural therapy alone | no estimate extracted | NR | No studies |
Hypnosis compared with diazepam
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs Number with symptom freedom End of treatment Hypnosis vs diazepam | RR 0.69 [0.39, 1.24] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Level of functioning Hypnosis vs diazepam | no estimate extracted | NR | No studies |
Quality of life Hypnosis vs diazepam | no estimate extracted | NR | No studies |
Adverse events Hypnosis vs diazepam | no estimate extracted | NR | No studies |
Psychotherapy preceded by motivational interviewing compared with psychotherapy alone
Population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Reduction in physical signs Decrease in seizure frequency End of treatment Psychotherapy preceded by motivational interviewing vs psychotherapy alone | no estimate extracted | 1 study · 54 participants | Very low Downgraded: risk of bias, imprecision |
Level of functioning Psychotherapy preceded by motivational interviewing vs psychotherapy alone | no estimate extracted | NR | No studies |
Quality of life As measured by QOLIE10 (lower is better) Psychotherapy preceded by motivational interviewing vs psychotherapy alone | no estimate extracted | 1 study · 47 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events Psychotherapy preceded by motivational interviewing vs psychotherapy alone | no estimate extracted | NR | No studies |