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Abreaction for conversion disorder: systematic review with meta-analysis

  • Norman A Poole (a1), Axel Wuerz (a2) and Niruj Agrawal (a3)

Abstract

Background

The value of drug interviews in the treatment of conversion disorder is at present unknown.

Aims

To review all the available papers published in English that report on the use of drug interviews for treating conversion/dissociative disorder.

Method

Databases (including EMBASE, MEDLINE and PsycINFO) were searched from 1920 to 2009. Selected publications had to report on the use of drug interviews in people diagnosed with a conversion/dissociative disorder. Qualitative and quantitative data were extracted. Predictors of a positive response were ascertained using meta-analytic techniques.

Results

Fifty-five papers meeting inclusion criteria were identified. No studies compared the intervention with a suitable control group. However, two studies reported high response rates when drug interview was used in individuals with treatment-resistant conversion disorder. In the meta-analysis, the use of suggestion and occurrence of emotional catharsis during the interview were positively associated with recovery. Combining two medications and comorbid psychiatric disorder were negatively associated with recovery.

Conclusions

The evidence for effectiveness of drug interviews is of poor quality but it may be of benefit in the treatment of acute and treatment-resistant conversion disorder. A proactive approach during the interview, making suggestions the individual will respond, could influence outcome. Comorbid psychiatric disorder should be treated conventionally. Experimental studies to determine efficacy are required.

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Copyright

Corresponding author

Norman A. Poole, MBChB, MRCPsych, MSc, Locum Consultant Liaison Psychiatrist, St Bartholomew's Hospital, East London Foundation Trust, West Smithfield, London EC1A 7BE, UK. Email: norman.poole@googlemail.com

Footnotes

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Declaration of interest

None.

Footnotes

References

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Abreaction for conversion disorder: systematic review with meta-analysis

  • Norman A Poole (a1), Axel Wuerz (a2) and Niruj Agrawal (a3)
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eLetters

"Disappearing therapies" ; Drug-assisted interviews: Are they revisiting?

K.A.L.A. Kuruppuarachchi MD, FRCPsych(UK), Professor of Psychiatry
17 December 2010

The review article on Abreaction for conversion disorder: systematic review with meta-analysis (Poole et al. 2010) has been read with interest as it raises some important issues regarding disappearing practices in theworld.

Abreaction may be incorporated in psychotherapeutic interventions (Abse 1966). It facilitates patients to express/release distressing emotions in therapeutic settings and the benefits of drug assisted catharsis (when indicated in certain clinical situations) have been highlighted(Walton 1978). It may be considered as a shortcut to the hypnotherapy and other psychotherapies when dealing with various neurotic disorders. Terms such as narco-analysis, narco-catharsis have been emerged to describe the usage of drug assisted interviewing techniques in therapeutic situations .Obviously this is a less time consuming technique and the therapist does not need much training to perform it compared with the other psychotherapies.

Drug assisted interviews can be performed not only for the assessment/management of patients with conversion disorders but also for catatonic patients. This technique has been used widely in developing countries such as Sri Lanka in the past and some clinicians still practicethis very occasionally. “Chemical Abreaction” has been used to distinguishorganic disorders from “functional disorders” when the neuro-radiology wasin an infantile era. Good old days (about 3-4 decades ago) psychiatric trainees in our countries were trained and expected to be competent in carrying out drug assisted interviews for a variety of clinical conditions. Psychiatrists performed them routinely. However the current day practice is entirely different. After discovering/inventing new treatment modalities these “old techniques” are disappearing from the world and many trainees are not familiar with or even unheard of these therapies.

Drugs such as Amylobarbitone have been used in abreaction and in themanagement of catatonia. About 3-4 decades ago, as registrars in psychiatry we used to interview poorly accessible catatonic patients undersodium amytal and managed to elicit some important psychopathology and even managed to feed them during the lucid period following the therapy. However the lucid period is brief and the patient tends to revert back to the previous state soon. It is interesting to note that the patients with organic brain syndromes such as catatonia following encephalitis or other organic insults would become more drowsy and temporary deteriorate in cognitive functioning whereas the patients with “functional” problems suchas catatonia due to depression , catatonic schizophrenics would become more accessible under sodium amytal interview. Unfortunately research particularly case controlled studies etc. with regard to this disappearing area of clinical practice seem to be scanty and there are a few published case reports.

The historical perspectives of barbiturate–assisted interviews and its place in clinical practice and limitations have been highlighted (Patrick & Howels 1990).

Various theories such as Dopamine, Serotonine, GABA dysfunction in understanding the aetiology of catatonia have been discussed and the role of benzodiazepines and its therapeutic response through potentiation of GABA neurotransmission have been suggested.

Even though there are limitations in these “disappearing therapies”, they may be still having a role to play even in modern psychiatric practice. Hence the trainees should be made aware of these treatment modalities.

References;

Poole NA, Wuerz A, Agrawal N. Abreaction for conversion disorder: systematic review with meta-analysis. The British Journal of Psychiatry 2010; 197:91-95.

Abse DW. Hysteria and Related Mental Disorders, An Approach to Psychological Medicine. Bristol, John Wright & Sons LTD, 1966.

Walton HF. Individual Psychotherapy. In: Forrest A. Affleck J. Zeally A. eds. Companion to Psychiatric Studies, Second edition, Edinburgh. Longman Group Limited, Churchill Livingstone, 1978:549-554.

Patrick M. Howells R. Barbiturate-assisted interviews in modern clinical practice. Psychological Medicine 1990; 20: 763-765.
... More

Conflict of interest: None Declared

Write a reply

"Disappearing therapies" ; Drug-assisted interviews: Are they revisiting?

K.A.L.A. Kuruppuarachchi MD, FRCPsych(UK), Professor of Psychiatry
08 December 2010

The review article on Abreaction for conversion disorder: systematic review with meta-analysis (Poole et al. 2010) has been read with interest as it raises some important issues regarding disappearing practices in theworld.

Abreaction may be incorporated in psychotherapeutic interventions (Abse 1966). It facilitates patients to express/release distressing emotions in therapeutic settings and the benefits of drug assisted catharsis (when indicated in certain clinical situations) have been highlighted(Walton 1978). It may be considered as a shortcut to the hypnotherapy and other psychotherapies in dealing with various neurotic disorders. Terms such as narco-analysis, narco-catharsis have been emerged to describe the usage of drug assisted interviewing techniques in therapeutic situations .Obviously this is a less time consuming technique and the therapist does not need much training to perform it compared with the other psychotherapies.

Drug assisted interviews can be performed not only for the assessment/management of patients with conversion disorders but also for catatonic patients. This technique has been used widely in developing countries such as Sri Lanka in the past and some clinicians still practicethis very occasionally. “Chemical Abreaction” has been used to distinguishorganic disorders from “functional disorders” when the neuro-radiology wasin an infantile era. Good old days (about 3-4 decades ago) psychiatric trainees in our countries were trained and expected to be competent in carrying out drug assisted interviews for a variety of clinical conditions. Psychiatrists performed them routinely. However the current day practice is entirely different. After discovering/inventing new treatment modalities these “old techniques” are disappearing from the world and many trainees are not familiar with or even unheard of these therapies.

Drugs such as Amylobarbitone have been used in abreaction and in themanagement of catatonia. About 3-4 decades ago, as registrars in psychiatry we used to interview poorly accessible catatonic patients undersodium amytal and managed to elicit some important psychopathology and even managed to feed them during the lucid period following the therapy. However the lucid period is brief and the patient tends to revert back to the previous state soon. It is interesting to note that the patients with organic brain syndromes such as catatonia following encephalitis or other organic insults would become more drowsy and temporary deteriorate in cognitive functioning whereas the patients with “functional” problems suchas catatonia due to depression , catatonic schizophrenics would become more accessible under sodium amytal interview. Unfortunately research particularly case controlled studies etc.with regard to this disappearing area of clinical practice seem to be scanty and there are a few published case reports.

The historical perspectives of barbiturate–assisted interviews and its place in clinical practice and limitations have been highlighted (Patrick & Howels 1990).

Various theories such as Dopamine, Serotonine, GABA dysfunction in understanding the aetiology of catatonia have been discussed and the role of benzodiazepines and its therapeutic response through potentiation of GABA neurotransmission have been suggested.

Even though there are limitations in these “disappearing therapies”, they may be still having a role to play even in modern psychiatric practice. Hence the trainees should be made aware of these treatment modalities.

References;

Poole NA, Wuerz A, Agrawal N. Abreaction for conversion disorder: systematic review with meta-analysis. The British Journal of Psychiatry 2010; 197:91-95.

Abse DW. Hysteria and Related Mental Disorders, An Approach to Psychological Medicine. Bristol, John Wright & Sons LTD, 1966.

Walton HF. Individual Psychotherapy. In: Forrest A. Affleck J. Zeally A. eds. Companion to Psychiatric Studies, Second edition, Edinburgh. Longman Group Limited, Churchill Livingstone, 1978:549-554.

Patrick M. Howells R. Barbiturate-assisted interviews in modern clinical practice. Psychological Medicine 1990; 20: 763-765.
... More

Conflict of interest: None Declared

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