Psychosocial interventions for conversion and dissociative disorders in adults
Information
- DOI:
- https://doi.org/10.1002/14651858.CD005331.pub3Copy DOI
- Database:
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- Cochrane Database of Systematic Reviews
- Version published:
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- 17 July 2020see what's new
- Type:
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- Intervention
- Stage:
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- Review
- Cochrane Editorial Group:
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Cochrane Common Mental Disorders Group
- Copyright:
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- Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Authors
Contributions of authors
CAG has been principal investigator and thus is overall responsible for the review update. Part of this has been co‐ordinating the team, screening all abstracts and full texts, performing data extraction and risk of bias, and cowriting the final review.
OJS has participated in screening of abstracts and full texts, is responsible for all the data analysis and results, has cowritten the final review, and has contributed with knowledge and advice on Cochrane procedures and gold standards for good practice.
HEC has part‐taken in data extraction and risk of bias assessment, assisted with the data analysis, contributed invaluable knowledge on the process of working with evidence‐based research, and prepared the 'Summary of findings' tables and GRADE assessment.
RR has contributed with knowledge as the author of the original review, has partaken in screening of abstracts and full texts, and has been part of quality assurance of the final text.
US has contributed with the original idea to update the review, has partaken in screening of abstracts and full texts, has contributed with specialised knowledge on the topic, written the background sections on the disorder, and participated in the preparation of the discussion and conclusion.
Dr Rachel Ruddy and Professor Allan House conceived and wrote the original review published in 2005.
Sources of support
Internal sources
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Clinic of Liaison Psychiatry and Department of Specialized Treatment, Region Zealand , Denmark
These clinics have funded part of Christina A Ganslevs' participation as principal investigator, have also funded part of Ulf Søgaards' time, as well as provided invaluable support and clinical knowledge on the topic.
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Department of Psychiatric Research, Region Zealand Healthcare Service, Denmark , Denmark
The research department assisting and supporting the production of this update. This department has also part funded the participation of Christina A Ganslev, Ole Jakob Storebø and Ulf Søgaard.
External sources
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No external sources of support, UK
This review had no external sources of support
Declarations of interest
CAG: none.
OJS: none.
HEC: none.
RR: none.
US: none.
Acknowledgements
We would like to thank the Psychiatric Research Unit, Region Zealand Denmark, and the Department of Specialized Treatment, Psychiatry Region Zealand Denmark, for their willingness to support this project.
We would like to thank Cochrane Mental Health Group for help with formulating both the search and the aims of the update. In addition, Information Specialist Trine Kaestel, Psychiatric Research Unit, for her assistance on executing the search and various other helpful assistance.
We would like to thank Rachel Ruddy and Alan House for writing the original version of this review back in 2005, and for their encouragement for a new team to take up this work.
Finally, we would like to thank our co‐author Ulf Sogaard for instigating this project and to Dr Kjartan Bergqvist for doing some of the initial research to determine if it was feasible with an update.
Version history
| Published | Title | Stage | Authors | Version |
| 2020 Jul 17 | Psychosocial interventions for conversion and dissociative disorders in adults | Review | Christina A Ganslev, Ole Jakob Storebø, Henriette E Callesen, Rachel Ruddy, Ulf Søgaard | |
| 2005 Oct 19 | Psychosocial interventions for conversion disorder | Review | Rachel Ruddy, Allan House | |
| 2004 Apr 19 | Psychosocial interventions for conversion disorder | Protocol | Rachel Ruddy, Allan A.O. House | |
Differences between protocol and review
The original review did not publish its protocol, so this update has taken the 2005 review itself to be protocol.
This update follows the aims and primary outcome of the original review, but there are certain differences between the original review and this update.
Title: we changed the title, from "Psychosocial interventions for conversion disorders" to "Psychosocial interventions for conversion and dissociative disorders for adults". This is in order to reflect the scope of what is being investigated, both here and in the original review.
Secondary outcomes: we added 'level of functioning' as a secondary outcome as this is often reported by patients as being important to them in their everyday lives. In addition, we divided the secondary outcome of mental state, so it allows focus on depression and anxiety separately, as well as mental state as a whole.
As this added up to a total of eight secondary outcomes, we decided not to include certain secondary outcomes from the original review, namely relapse, social adjustment, and patient and carer satisfaction.
Time points: to create consistency in the data, the authors decided to change the time points, so 'end of treatment' is now the primary time point, with short‐ and long‐term follow‐up (short term being up five months and less and long term being six months or more).
Participants: to ensure better quality data that more accurately reflect the population of interest, we have tightened the inclusion criteria for the number of participants with a relevant disorder. Where the previous review used over 50%, we now only considered the study for inclusion where over 80% of participants fulfilled current diagnostic criteria or any earlier diagnostic equivalent.
The main author of the original review (RR) has been part of the author team for this update and confirmed the differences.
Notes
None.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Adult; Aged; Aged, 80 and over; Humans; Middle Aged; Young Adult;
PICOs
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1: Inpatient paradoxical intention therapy versus outpatient diazepam, Outcome 1: Reduction in physical signs: no conversion symptoms in last 2 weeks
Comparison 1: Inpatient paradoxical intention therapy versus outpatient diazepam, Outcome 2: Mental state – anxiety (Hamilton)
Comparison 1: Inpatient paradoxical intention therapy versus outpatient diazepam, Outcome 3: Dropout rate
Comparison 2: Inpatient treatment programme plus hypnosis versus inpatient treatment programme, Outcome 1: Reduction in physical signs: severity of impairment (VRMC)
Comparison 2: Inpatient treatment programme plus hypnosis versus inpatient treatment programme, Outcome 2: Mental state (SCL‐90)
Comparison 2: Inpatient treatment programme plus hypnosis versus inpatient treatment programme, Outcome 3: Dropout rate
Comparison 3: Outpatient hypnosis versus wait list, Outcome 1: Reduction in physical signs: severity of impairment (VRMC)
Comparison 3: Outpatient hypnosis versus wait list, Outcome 2: Dropout rate
Comparison 4: Behavioural therapy plus routine clinical care versus routine clinical care, Outcome 1: Reduction in physical signs: number of weekly fits
Comparison 4: Behavioural therapy plus routine clinical care versus routine clinical care, Outcome 2: Reduction in physical signs: symptom severity (Clinical Global Impression CGI)
Comparison 4: Behavioural therapy plus routine clinical care versus routine clinical care, Outcome 3: Mental state – anxiety (HADS)
Comparison 4: Behavioural therapy plus routine clinical care versus routine clinical care, Outcome 4: Mental state – depression (HADS)
Comparison 4: Behavioural therapy plus routine clinical care versus routine clinical care, Outcome 5: Dropout rate
Comparison 5: Cognitive behavioural therapy versus standard medical care, Outcome 1: Reduction in physical signs: monthly seizure frequency (reduction in %)
Comparison 5: Cognitive behavioural therapy versus standard medical care, Outcome 2: Reduction in physical signs: monthly seizure frequency
Comparison 5: Cognitive behavioural therapy versus standard medical care, Outcome 3: Reduction in physical sign: seizure freedom
Comparison 5: Cognitive behavioural therapy versus standard medical care, Outcome 4: Level of functioning
Comparison 5: Cognitive behavioural therapy versus standard medical care, Outcome 5: Quality of life (QOLIE31)
Comparison 5: Cognitive behavioural therapy versus standard medical care, Outcome 6: Mental state – anxiety
Comparison 5: Cognitive behavioural therapy versus standard medical care, Outcome 7: Mental state – depression
Comparison 5: Cognitive behavioural therapy versus standard medical care, Outcome 8: Mental state (SCL‐90)
Comparison 5: Cognitive behavioural therapy versus standard medical care, Outcome 9: Dropout rate
Comparison 5: Cognitive behavioural therapy versus standard medical care, Outcome 10: Use of health services (number of general practitioner consultations)
Comparison 6: Psychoeducational follow‐up programmes versus treatment as usual, Outcome 1: Reduction in physical signs: seizure frequency (self‐made scale)
Comparison 6: Psychoeducational follow‐up programmes versus treatment as usual, Outcome 2: Reduction in physical signs: physical symptom load (SF‐36 – physical)
Comparison 6: Psychoeducational follow‐up programmes versus treatment as usual, Outcome 3: Level of functioning (WSAS)
Comparison 6: Psychoeducational follow‐up programmes versus treatment as usual, Outcome 4: Quality of life (QOLIE10‐P)
Comparison 6: Psychoeducational follow‐up programmes versus treatment as usual, Outcome 5: Mental state – anxiety (HADS)
Comparison 6: Psychoeducational follow‐up programmes versus treatment as usual, Outcome 6: Mental state – depression
Comparison 6: Psychoeducational follow‐up programmes versus treatment as usual, Outcome 7: Dropout rate
Comparison 6: Psychoeducational follow‐up programmes versus treatment as usual, Outcome 8: Use of health services (number hospital visits)
Comparison 7: Specialised cognitive behavioural therapy‐based physiotherapy inpatient programme versus wait list, Outcome 1: Level of functioning (Functional Independence Measure Motor (FIM))
Comparison 7: Specialised cognitive behavioural therapy‐based physiotherapy inpatient programme versus wait list, Outcome 2: Mental state (SF‐12)
Comparison 7: Specialised cognitive behavioural therapy‐based physiotherapy inpatient programme versus wait list, Outcome 3: Dropout rate
Comparison 8: Specialised cognitive behavioural therapy‐based physiotherapy outpatient intervention compared to treatment as usual (TAU), Outcome 1: Reduction in physical signs: physical symptom load (SF‐36 – Physical Component)
Comparison 8: Specialised cognitive behavioural therapy‐based physiotherapy outpatient intervention compared to treatment as usual (TAU), Outcome 2: Level of functioning (WSAS)
Comparison 8: Specialised cognitive behavioural therapy‐based physiotherapy outpatient intervention compared to treatment as usual (TAU), Outcome 3: Mental state – anxiety (HADS)
Comparison 8: Specialised cognitive behavioural therapy‐based physiotherapy outpatient intervention compared to treatment as usual (TAU), Outcome 4: Mental state – depression (HADS)
Comparison 8: Specialised cognitive behavioural therapy‐based physiotherapy outpatient intervention compared to treatment as usual (TAU), Outcome 5: Dropout rate
Comparison 9: Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) versus standard care, Outcome 1: Reduction in physical signs: conversions symptoms (SDQ20)
Comparison 9: Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) versus standard care, Outcome 2: Quality of life (SF‐36)
Comparison 9: Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) versus standard care, Outcome 3: Mental state – depression (BDI‐II)
Comparison 9: Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) versus standard care, Outcome 4: Dropout rate
Comparison 9: Brief psychotherapeutic intervention (psychodynamic interpersonal treatment approach) versus standard care, Outcome 5: Use of health services (emergency department visits)
Comparison 10: Cognitive behavioural therapy plus adjunctive physical activity versus cognitive behavioural therapy alone, Outcome 1: Reduction in physical signs: overall physical impact (Psychogenic Movement Disorder Scale (PMDRS)
Comparison 10: Cognitive behavioural therapy plus adjunctive physical activity versus cognitive behavioural therapy alone, Outcome 2: Mental state – anxiety (BAI)
Comparison 10: Cognitive behavioural therapy plus adjunctive physical activity versus cognitive behavioural therapy alone, Outcome 3: Mental state – depression (Hamilton)
Comparison 10: Cognitive behavioural therapy plus adjunctive physical activity versus cognitive behavioural therapy alone, Outcome 4: Dropout rate
Comparison 11: Hypnosis versus diazepam, Outcome 1: Reduction in physical signs: symptom freedom
Comparison 12: Outpatient motivational interviewing and mindfulness‐based psychotherapy compared with psychotherapy alone, Outcome 1: Reduction in physical signs: decrease in seizure frequency
Comparison 12: Outpatient motivational interviewing and mindfulness‐based psychotherapy compared with psychotherapy alone, Outcome 2: Changes in monthly visits
Comparison 12: Outpatient motivational interviewing and mindfulness‐based psychotherapy compared with psychotherapy alone, Outcome 3: Quality of life
Comparison 12: Outpatient motivational interviewing and mindfulness‐based psychotherapy compared with psychotherapy alone, Outcome 4: Dropout rate
| Paradoxical intention therapy compared with diazepam for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: outpatient and inpatient Intervention: paradoxical intention therapy Comparison: diazepam over 45 days | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Diazepam | Paradoxical intention therapy | |||||
| Reduction in physical signs (number of patients without any conversive attacks in last 2 weeks) End of treatment | Study population | RR 1.44 (0.91 to 2.28) | 30 | ⊕⊝⊝⊝ | Paradoxical intention therapy may have no effect on physical signs at end of treatment. | |
| 600 per 1000 | 864 per 1000 | |||||
| Level of functioning | — | — | — | — | — | No studies assessed this outcome. |
| Quality of life | — | — | — | — | — | No studies assessed this outcome. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; ICD‐10:International Classification of Diseases, Tenth Revision; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded two levels due to imprecision (wide confidence intervals; based on one study with few patients). | ||||||
| Hypnosis + treatment as usual compared with treatment as usual for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: inpatient Intervention: hypnosis + TAU Comparison: TAU | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| TAU | Hypnosis + TAU | |||||
| Reduction in physical signs (Severity of impairment) Measured by the VRMC scale (higher is better) Range: 1–7 End of treatment | The mean reduction in physical signs in the control group was 5.9 | MD 0.49 lower (1.28 lower to 0.30 higher) | — | 45 | ⊕⊝⊝⊝ | Hypnosis + TAU may have no effect on physical signs at end of treatment |
| Level of functioning | — | — | — | — | — | No studies assessed this outcome |
| Quality of life | — | — | — | — | — | No studies assessed this outcome |
| Adverse events | — | — | — | — | — | No studies assessed this outcome |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; ICD‐10:International Classification of Diseases, Tenth Revision; MD: mean difference; TAU: treatment as usual; VRMC: The Video Rating Scale for Motor Conversion Symptoms. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to high risk of bias. | ||||||
| Hypnosis compared with wait list for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: outpatient Intervention: hypnosis Comparison: wait list | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Wait list | Hypnosis | |||||
| Reduction in physical signs (Severity of impairment) Measured by the VRMC scale (higher is better) Range: 1–7 End of treatment | The mean reduction in physical signs in the control group was 3.8 | MD 2.10 higher (1.34 higher to 2.86 higher) | — | 49 | ⊕⊕⊝⊝ | Hypnosis may have little effect on reduction in physical signs at end of treatment |
| Level of functioning | — | — | — | — | — | No studies assessed this outcome |
| Quality of life | — | — | — | — | — | No studies assessed this outcome |
| Adverse events | — | — | — | — | — | No studies assessed this outcome |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; ICD‐10:International Classification of Diseases, Tenth Revision; MD: mean difference; VRMC: Video Rating Scale for Motor Conversion Symptoms. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to high risk of bias. | ||||||
| Behavioural therapy + TAU compared with TAU for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: inpatient Intervention: behavioural therapy + TAU Comparison: TAU | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| TAU | Behavioural therapy + TAU | |||||
| Reduction in physical signs Number of weekly seizures, as assessed by daily self‐reported treatment diary End of treatment | The mean reduction in physical signs in the control group was 27.8 | MD 21.40 lower (27.88 lower to 14.92 lower) | — | 18 | Very lowa,b ⊕⊝⊝⊝ | Behavioural therapy + TAU may have little effect on reduction in physical signs at end of treatment. |
| Reduction in physical signs (symptom severity) Measured by Clinical Global Impression scale (lower is better) Range: 1–7 End of treatment | The mean reduction in physical signs in the control group was 4.48 | MD 2.90 lower (3.41 lower to 2.39 lower) | — | 90 | Very lowa,b ⊕⊝⊝⊝ | Behavioural therapy + TAU may have little effect on reduction in physical signs at end of treatment. |
| Level of functioning | — | — | — | — | — | No studies assessed this outcome. |
| Quality of life | — | — | — | — | — | No studies assessed this outcome. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; ICD‐10:International Classification of Diseases, Tenth Revision; MD: mean difference. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded two levels due to high risk of bias. | ||||||
| Cognitive behavioural therapy compared with standard medical care for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: outpatient Intervention: cognitive behavioural therapy Comparison: standard medical care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Standard medical care | Cognitive behavioural therapy | |||||
| Reduction in physical signs Reduction in monthly seizure frequency as assessed by a daily self‐reported seizure diary End of treatment | Study population | RR 1.56 (0.39 to 6.19) | 16 | ⊕⊝⊝⊝ | Cognitive behavioural therapy may have little or no effect on reducing physical signs at end of treatment. | |
| 286 per 1000 | 446 per 1000 | |||||
| Reduction in physical signs Monthly seizure frequency as assessed by a daily self‐reported seizure diary (lower is better) End of treatment | The mean reduction in physical signs in the control group was 6.75 | MD –4.75 lower (18.73 lower to 9.23 higher) | — | 61 | ⊕⊕⊝⊝ | Cognitive behavioural therapy may have little or no effect on reducing physical signs at end of treatment. |
| Reduction in physical sign Seizure freedom as assessed by a daily self‐reported seizure diary End of treatment | Study population | RR 2.33 (0.30 to 17.88) | 16 | ⊕⊝⊝⊝ | Cognitive behavioural therapy may have little or no effect on reducing physical signs at end of treatment. | |
| 143 per 1000 | 333 per 1000 | |||||
| Level of functioning As measured by the GAF (range 0–100) scale and the WSAS scale (0–40) (lower is better) End of treatment | — | SMD 0.44 higher (1.69 lower to 2.57 higher) I2 = 91% | — | 74 | ⊕⊝⊝⊝ | Cognitive behavioural therapy may have little or no effect on level of functioning at end of treatment. |
| Quality of life As assessed by QOLIE31 (higher is better) Range: 15–97 End of treatment | The mean quality of life in the control group was 9.7 | MD 11.20 higher (7.98 lower to 30.38 higher) | — | 16 | ⊕⊝⊝⊝ | Cognitive behavioural therapy may have little or no effect on quality of life at end of treatment. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; GAF: global assessment of functioning; ICD‐10:International Classification of Diseases, Tenth Revision; MD: mean difference; QOLIE31: quality of life in epilepsy inventory; RR: Risk Ratio; SMD: standardised mean difference; WSAS: work and social adjustment scale. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to high risk of bias. | ||||||
| Systematic follow‐up programme compared with TAU for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: outpatient Intervention: systematic follow‐up programme Comparison: TAU | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| TAU | Systematic follow‐up programme | |||||
| Reduction in physical signs End of treatment | — | — | — | — | — | No studies assessed this outcome at end of treatment. |
| Level of functioning As assessed by WSAS scale (lower is better) Range: 0–40 End of treatment | The mean level of functioning in the control group was 25.52 | MD 7.12 lower (12.47 lower to 1.77 lower) | — | 43 | ⊕⊝⊝⊝ | Psychoeducational follow‐up programme may have little effect on level of functioning at end of treatment. |
| Quality of life | — | — | — | — | — | No studies assessed this outcome. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; ICD‐10:International Classification of Diseases, Tenth Revision; MD: mean difference; TAU: treatment as usual; WSAS: Work and Social Adjustment Scale. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded two levels due to high risk of bias. | ||||||
| Specialised CBT‐based physiotherapy programme compared with wait list for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: inpatient Intervention: specialised CBT‐based physiotherapy programme Comparison: wait list | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Wait list | Specialised CBT‐based physiotherapy | |||||
| Reduction in physical signs End of treatment | — | — | — | — | — | No studies assessed this outcome. |
| Level of functioning As measured by FIM (higher is better) Range: 18–126 End of treatment | The mean level of functioning in the control group was 80.9 | MD 9.20 higher (6.06 higher to 12.34 higher) | — | 118 | ⊕⊕⊝⊝ | Specialised CBT‐based physiotherapy may slightly improve level of functioning at end of treatment. |
| Quality of life | — | — | — | — | — | No studies assessed this outcome. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CBT: cognitive behavioural therapy; CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; FIM: Functional Independence Measure Motor; ICD‐10:International Classification of Diseases, Tenth Revision; MD: mean difference. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to high risk of bias. | ||||||
| Specialised CBT‐based physiotherapy‐led intervention compared with TAU for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: outpatients at day hospital Intervention: specialised CBT‐based physiotherapy‐led intervention Comparison: TAU | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| TAU | Specialised CBT‐based physiotherapy‐led intervention | |||||
| Reduction in physical signs End of treatment | — | — | — | — | — | No studies assessed this outcome at end of treatment. |
| Level of functioning As assessed by WSAS scale (lower is better) Range: 0–40 End of treatment | The mean level of functioning in the control group was 26.9 | MD 7.10 lower (11.40 lower to 2.80 lower) | — | 54 | ⊕⊝⊝⊝ | Specialised CBT‐based physiotherapy intervention may slightly improve level of functioning at end of treatment. |
| Quality of life | — | — | — | — | — | No studies assessed this outcome. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CBT: cognitive behavioural therapy; CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; ICD‐10:International Classification of Diseases, Tenth Revision; TAU: treatment as usual; WSAS: Work and Social Adjustment Scale. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to high risk of bias. | ||||||
| Brief psychotherapeutic intervention compared with standard care for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: outpatients Intervention: brief psychotherapeutic intervention Comparison: standard care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Standard care | Brief psychotherapeutic intervention | |||||
| Reduction in physical signs As assessed by SDQ‐20 (lower is better) Range: 20–100 End of treatment | Study population | RR 0.12 (0.01 to 2.00) | 19 | ⊕⊝⊝⊝ | Brief psychotherapeutic intervention may have no effect on physical signs at end of treatment. | |
| 400 per 1000 | 48 per 1000 | |||||
| Level of functioning | — | — | — | — | — | No studies assessed this outcome. |
| Quality of life As assessed by SF‐36 (lower is better) Range: 0–100 End of treatment | The mean quality of life in the control group was 50.56 | MD 6.99 lower (28.09 lower to 14.11 higher) | 16 | ⊕⊝⊝⊝ | Brief psychotherapeutic intervention may have little effect on quality of life after end of treatment. | |
| Adverse events | No studies assessed this outcome. | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; ICD‐10:International Classification of Diseases, Tenth Revision; MD: mean difference; RR: Risk Ratio; SDQ‐20: somatoform dissociation questionnaire; SF‐36: 36‐item Short Form. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to high risk of bias. | ||||||
| CBT + APA compared with CBT alone for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: outpatients Intervention: CBT + APA Comparison: CBT | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| CBT | CBT + APA | |||||
| Reduction in physical signs (overall physical impact) As measured by PMDRS, total score (lower is better) Range: 0–128 End of treatment | The mean reduction in physical signs in the control group was 33.2 | MD 5.60 higher (15.48 lower to 26.68 higher) | — | 21 | ⊕⊝⊝⊝ | CBT + APA may have no effect on physical signs at end of treatment. |
| Level of functioning | — | — | — | — | — | No studies assessed this outcome. |
| Quality of life | — | — | — | — | — | No studies assessed this outcome. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). APA: adjunctive physical activity; CBT: cognitive behavioural therapy; CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; ICD‐10:International Classification of Diseases, Tenth Revision; MD: mean difference; PMDRS: Psychogenic Movement Disorders Rating Scale. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to high risk of bias. | ||||||
| Hypnosis compared with diazepam for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: emergency unit Intervention: hypnosis Comparison: diazepam | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Diazepam | Hypnosis | |||||
| Reduction in physical signs Number with symptom freedom End of treatment | Study population | RR 0.69 (0.39 to 1.24) | 40 | ⊕⊝⊝⊝ | Hypnosis may have no effect on physical signs at end of treatment. | |
| 650 per 1000 | 448 per 1000 | |||||
| Level of functioning | — | — | — | — | — | No studies assessed this outcome. |
| Quality of life | — | — | — | — | — | No studies assessed this outcome. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; ICD‐10:International Classification of Diseases, Tenth Revision; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to high risk of bias. | ||||||
| Psychotherapy preceded by motivational interviewing compared with psychotherapy alone for conversion disorder | ||||||
| Patient or population: people with conversion disorder according to DSM‐IV or ICD‐10 criteria Settings: outpatient Intervention: psychotherapy preceded by motivational interviewing Comparison: psychotherapy alone | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Certainty of the evidence | Comments | |
|---|---|---|---|---|---|---|
| Assumed risk | Corresponding risk | |||||
| Psychotherapy | Psychotherapy preceded by motivational interviewing | |||||
| Reduction in physical signs Decrease in seizure frequency End of treatment | The mean reduction in physical signs in the control group was 34.8 | MD 41.40 higher (4.92 higher to 77.88 higher) | — | 54 | ⊕⊝⊝⊝ | Psychotherapy preceded by motivational interviewing may have little effect on physical signs at end of treatment. |
| Level of functioning | — | — | — | — | — | No studies assessed this outcome. |
| Quality of life As measured by QOLIE10 (lower is better) Range: 10–50 End of treatment | The mean quality of life in the control group was 1.8 | MD 5.40 higher (0.26 higher to 10.54 higher) | — | 47 | ⊕⊝⊝⊝ | Psychotherapy preceded by motivational interviewing may have little effect on quality of life at end of treatment. |
| Adverse events | — | — | — | — | — | No studies assessed this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; DSM‐IV:Diagnostic and Statistical Manual of Mental Disorders 4th Edition; ICD‐10:International Classification of Diseases, Tenth Revision; MD: mean difference; QOLIE10: quality of life in epilepsy. | ||||||
| GRADE Working Group grades of evidence | ||||||
| aDowngraded one level due to high risk of bias. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Reduction in physical signs: no conversion symptoms in last 2 weeks Show forest plot | 1 | 30 | Risk Ratio (IV, Fixed, 95% CI) | 1.44 [0.91, 2.28] |
| 1.1.1 End of treatment | 1 | 30 | Risk Ratio (IV, Fixed, 95% CI) | 1.44 [0.91, 2.28] |
| 1.2 Mental state – anxiety (Hamilton) Show forest plot | 1 | 30 | Mean Difference (IV, Fixed, 95% CI) | ‐3.73 [‐6.96, ‐0.50] |
| 1.2.1 End of treatment | 1 | 30 | Mean Difference (IV, Fixed, 95% CI) | ‐3.73 [‐6.96, ‐0.50] |
| 1.3 Dropout rate Show forest plot | 1 | 30 | Risk Ratio (M‐H, Fixed, 95% CI) | Not estimable |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 2.1 Reduction in physical signs: severity of impairment (VRMC) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.1.1 End of treatment | 1 | 45 | Mean Difference (IV, Fixed, 95% CI) | ‐0.49 [‐1.28, 0.30] |
| 2.1.2 Follow‐up | 1 | 45 | Mean Difference (IV, Fixed, 95% CI) | 0.13 [‐0.55, 0.81] |
| 2.2 Mental state (SCL‐90) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 2.2.1 End of treatment | 1 | 45 | Mean Difference (IV, Fixed, 95% CI) | 1.42 [‐36.02, 38.86] |
| 2.2.2 Follow‐up | 1 | 45 | Mean Difference (IV, Fixed, 95% CI) | ‐5.97 [‐44.22, 32.28] |
| 2.3 Dropout rate Show forest plot | 1 | 49 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.88 [0.14, 5.79] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 3.1 Reduction in physical signs: severity of impairment (VRMC) Show forest plot | 1 | 49 | Mean Difference (IV, Fixed, 95% CI) | 2.10 [1.34, 2.86] |
| 3.1.1 End of treatment | 1 | 49 | Mean Difference (IV, Fixed, 95% CI) | 2.10 [1.34, 2.86] |
| 3.2 Dropout rate Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 3.2.1 End of treatment | 1 | 49 | Risk Ratio (IV, Fixed, 95% CI) | 4.17 [0.50, 34.66] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 4.1 Reduction in physical signs: number of weekly fits Show forest plot | 1 | 18 | Mean Difference (IV, Fixed, 95% CI) | ‐21.40 [‐27.88, ‐14.92] |
| 4.1.1 End of treatment | 1 | 18 | Mean Difference (IV, Fixed, 95% CI) | ‐21.40 [‐27.88, ‐14.92] |
| 4.2 Reduction in physical signs: symptom severity (Clinical Global Impression CGI) Show forest plot | 1 | 90 | Mean Difference (IV, Fixed, 95% CI) | ‐2.90 [‐3.41, ‐2.39] |
| 4.2.1 End of treatment | 1 | 90 | Mean Difference (IV, Fixed, 95% CI) | ‐2.90 [‐3.41, ‐2.39] |
| 4.3 Mental state – anxiety (HADS) Show forest plot | 2 | 108 | Mean Difference (IV, Random, 95% CI) | ‐5.47 [‐7.08, ‐3.86] |
| 4.3.1 End of treatment | 2 | 108 | Mean Difference (IV, Random, 95% CI) | ‐5.47 [‐7.08, ‐3.86] |
| 4.4 Mental state – depression (HADS) Show forest plot | 2 | 108 | Mean Difference (IV, Random, 95% CI) | ‐4.99 [‐6.44, ‐3.53] |
| 4.4.1 Follow‐up | 2 | 108 | Mean Difference (IV, Random, 95% CI) | ‐4.99 [‐6.44, ‐3.53] |
| 4.5 Dropout rate Show forest plot | 2 | Risk Ratio (IV, Random, 95% CI) | Subtotals only | |
| 4.5.1 End of treatment | 2 | 118 | Risk Ratio (IV, Random, 95% CI) | 0.24 [0.06, 0.90] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 5.1 Reduction in physical signs: monthly seizure frequency (reduction in %) Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 5.1.1 End of treatment | 1 | 16 | Risk Ratio (IV, Fixed, 95% CI) | 1.56 [0.39, 6.19] |
| 5.2 Reduction in physical signs: monthly seizure frequency Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 5.2.1 End of treatment | 1 | 61 | Mean Difference (IV, Fixed, 95% CI) | ‐4.75 [‐18.73, 9.23] |
| 5.2.2 Follow‐up | 1 | 59 | Mean Difference (IV, Fixed, 95% CI) | ‐3.50 [‐12.69, 5.69] |
| 5.3 Reduction in physical sign: seizure freedom Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 5.3.1 End of treatment | 1 | 16 | Risk Ratio (IV, Fixed, 95% CI) | 2.33 [0.30, 17.88] |
| 5.4 Level of functioning Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 5.4.1 End of treatment | 2 | 74 | Std. Mean Difference (IV, Random, 95% CI) | 0.44 [‐1.69, 2.57] |
| 5.4.2 Follow‐up | 1 | 53 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.63 [‐1.18, ‐0.08] |
| 5.5 Quality of life (QOLIE31) Show forest plot | 1 | 16 | Mean Difference (IV, Fixed, 95% CI) | 11.20 [‐7.98, 30.38] |
| 5.5.1 End of treatment | 1 | 16 | Mean Difference (IV, Fixed, 95% CI) | 11.20 [‐7.98, 30.38] |
| 5.6 Mental state – anxiety Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 5.6.1 End of treatment | 2 | 74 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.31 [‐0.78, 0.15] |
| 5.6.2 Follow‐up | 1 | 53 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.31 [‐0.85, 0.23] |
| 5.7 Mental state – depression Show forest plot | 2 | Std. Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 5.7.1 End of treatment | 2 | 74 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.25 [‐0.71, 0.21] |
| 5.7.2 Follow‐up | 1 | 53 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.32 [‐0.86, 0.23] |
| 5.8 Mental state (SCL‐90) Show forest plot | 1 | 16 | Mean Difference (IV, Fixed, 95% CI) | ‐70.60 [‐121.59, ‐19.61] |
| 5.8.1 End of treatment | 1 | 16 | Mean Difference (IV, Fixed, 95% CI) | ‐70.60 [‐121.59, ‐19.61] |
| 5.9 Dropout rate Show forest plot | 2 | Risk Ratio (IV, Random, 95% CI) | Subtotals only | |
| 5.9.1 End of treatment | 2 | 83 | Risk Ratio (IV, Random, 95% CI) | 0.37 [0.02, 8.01] |
| 5.9.2 Follow‐up | 1 | 64 | Risk Ratio (IV, Random, 95% CI) | 1.41 [0.25, 7.87] |
| 5.10 Use of health services (number of general practitioner consultations) Show forest plot | 1 | 46 | Mean Difference (IV, Fixed, 95% CI) | ‐1.00 [‐3.32, 1.32] |
| 5.10.1 Follow‐up | 1 | 46 | Mean Difference (IV, Fixed, 95% CI) | ‐1.00 [‐3.32, 1.32] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 6.1 Reduction in physical signs: seizure frequency (self‐made scale) Show forest plot | 1 | 27 | Mean Difference (IV, Fixed, 95% CI) | ‐0.80 [‐1.44, ‐0.16] |
| 6.1.1 Follow‐up | 1 | 27 | Mean Difference (IV, Fixed, 95% CI) | ‐0.80 [‐1.44, ‐0.16] |
| 6.2 Reduction in physical signs: physical symptom load (SF‐36 – physical) Show forest plot | 1 | 186 | Mean Difference (IV, Fixed, 95% CI) | ‐0.26 [‐3.76, 3.24] |
| 6.2.1 Follow‐up | 1 | 186 | Mean Difference (IV, Fixed, 95% CI) | ‐0.26 [‐3.76, 3.24] |
| 6.3 Level of functioning (WSAS) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 6.3.1 End of treatment | 1 | 43 | Mean Difference (IV, Fixed, 95% CI) | ‐7.12 [‐12.47, ‐1.77] |
| 6.3.2 Follow‐up | 1 | 43 | Mean Difference (IV, Fixed, 95% CI) | ‐6.11 [‐11.67, ‐0.55] |
| 6.4 Quality of life (QOLIE10‐P) Show forest plot | 1 | 27 | Mean Difference (IV, Fixed, 95% CI) | ‐9.30 [‐14.06, ‐4.54] |
| 6.4.1 Follow‐up | 1 | 27 | Mean Difference (IV, Fixed, 95% CI) | ‐9.30 [‐14.06, ‐4.54] |
| 6.5 Mental state – anxiety (HADS) Show forest plot | 1 | 192 | Mean Difference (IV, Fixed, 95% CI) | ‐0.47 [‐1.67, 0.73] |
| 6.5.1 Follow‐up | 1 | 192 | Mean Difference (IV, Fixed, 95% CI) | ‐0.47 [‐1.67, 0.73] |
| 6.6 Mental state – depression Show forest plot | 2 | 219 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.30 [‐1.08, 0.48] |
| 6.6.1 Follow‐up | 2 | 219 | Std. Mean Difference (IV, Random, 95% CI) | ‐0.30 [‐1.08, 0.48] |
| 6.7 Dropout rate Show forest plot | 2 | Risk Ratio (IV, Random, 95% CI) | Subtotals only | |
| 6.7.1 End of treatment | 1 | 64 | Risk Ratio (IV, Random, 95% CI) | 1.76 [0.82, 3.78] |
| 6.7.2 Follow‐up | 2 | 259 | Risk Ratio (IV, Random, 95% CI) | 0.54 [0.00, 70.37] |
| 6.8 Use of health services (number hospital visits) Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 6.8.1 End of treatment | 1 | 64 | Risk Ratio (IV, Fixed, 95% CI) | 0.18 [0.02, 1.43] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 7.1 Level of functioning (Functional Independence Measure Motor (FIM)) Show forest plot | 1 | 118 | Mean Difference (IV, Fixed, 95% CI) | 9.20 [6.06, 12.34] |
| 7.1.1 End of treatment | 1 | 118 | Mean Difference (IV, Fixed, 95% CI) | 9.20 [6.06, 12.34] |
| 7.2 Mental state (SF‐12) Show forest plot | 1 | 118 | Mean Difference (IV, Fixed, 95% CI) | 9.10 [4.96, 13.24] |
| 7.2.1 End of treatment | 1 | 118 | Mean Difference (IV, Fixed, 95% CI) | 9.10 [4.96, 13.24] |
| 7.3 Dropout rate Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 7.3.1 End of treatment | 1 | 60 | Risk Ratio (IV, Fixed, 95% CI) | 0.23 [0.03, 1.97] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 8.1 Reduction in physical signs: physical symptom load (SF‐36 – Physical Component) Show forest plot | 1 | 57 | Mean Difference (IV, Fixed, 95% CI) | 9.20 [4.00, 14.40] |
| 8.1.1 Follow‐up | 1 | 57 | Mean Difference (IV, Fixed, 95% CI) | 9.20 [4.00, 14.40] |
| 8.2 Level of functioning (WSAS) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 8.2.1 End of treatment | 1 | 54 | Mean Difference (IV, Fixed, 95% CI) | ‐7.10 [‐11.40, ‐2.80] |
| 8.2.2 Follow‐up | 1 | 57 | Mean Difference (IV, Fixed, 95% CI) | ‐6.70 [‐12.07, ‐1.33] |
| 8.3 Mental state – anxiety (HADS) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 8.3.1 End of treatment | 1 | 54 | Mean Difference (IV, Fixed, 95% CI) | ‐0.60 [‐3.05, 1.85] |
| 8.3.2 Follow‐up | 1 | 57 | Mean Difference (IV, Fixed, 95% CI) | ‐1.00 [‐3.71, 1.71] |
| 8.4 Mental state – depression (HADS) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 8.4.1 End of treatment | 1 | 54 | Mean Difference (IV, Fixed, 95% CI) | ‐3.60 [‐7.13, ‐0.07] |
| 8.4.2 Follow‐up | 1 | 57 | Mean Difference (IV, Fixed, 95% CI) | ‐3.20 [‐5.53, ‐0.87] |
| 8.5 Dropout rate Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 8.5.1 End of treatment | 1 | 60 | Risk Ratio (IV, Fixed, 95% CI) | 0.20 [0.02, 1.61] |
| 8.5.2 Follow‐up | 1 | 60 | Risk Ratio (IV, Fixed, 95% CI) | 0.50 [0.05, 5.22] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 9.1 Reduction in physical signs: conversions symptoms (SDQ20) Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 9.1.1 End of treatment | 1 | 19 | Risk Ratio (IV, Fixed, 95% CI) | 0.12 [0.01, 2.00] |
| 9.1.2 Follow‐up | 1 | 17 | Risk Ratio (IV, Fixed, 95% CI) | 1.12 [0.08, 15.19] |
| 9.1.3 Follow‐up 10 months | 1 | 15 | Risk Ratio (IV, Fixed, 95% CI) | 0.16 [0.01, 2.66] |
| 9.2 Quality of life (SF‐36) Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 9.2.1 End of treatment | 1 | 16 | Mean Difference (IV, Fixed, 95% CI) | ‐6.99 [‐28.09, 14.11] |
| 9.2.2 Follow‐up 4 months | 1 | 16 | Mean Difference (IV, Fixed, 95% CI) | ‐19.53 [‐43.91, 4.85] |
| 9.2.3 Follow‐up 10 months | 1 | 14 | Mean Difference (IV, Fixed, 95% CI) | ‐11.43 [‐36.16, 13.30] |
| 9.3 Mental state – depression (BDI‐II) Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 9.3.1 End of treatment | 1 | 16 | Risk Ratio (IV, Fixed, 95% CI) | 1.29 [0.10, 17.14] |
| 9.3.2 Follow‐up 4 months | 1 | 16 | Risk Ratio (IV, Fixed, 95% CI) | 3.86 [0.50, 29.55] |
| 9.3.3 Follow‐up 10 months | 1 | 14 | Risk Ratio (IV, Fixed, 95% CI) | 1.00 [0.08, 13.02] |
| 9.4 Dropout rate Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 9.4.1 End of treatment | 1 | 23 | Risk Ratio (IV, Fixed, 95% CI) | 1.09 [0.18, 6.48] |
| 9.4.2 Follow‐up 4 months | 1 | 23 | Risk Ratio (IV, Fixed, 95% CI) | 1.09 [0.28, 4.32] |
| 9.4.3 Follow‐up 10 months | 1 | 23 | Risk Ratio (IV, Fixed, 95% CI) | 0.82 [0.23, 2.87] |
| 9.5 Use of health services (emergency department visits) Show forest plot | 1 | 19 | Mean Difference (IV, Fixed, 95% CI) | ‐0.16 [‐1.25, 0.93] |
| 9.5.1 End of treatment | 1 | 19 | Mean Difference (IV, Fixed, 95% CI) | ‐0.16 [‐1.25, 0.93] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 10.1 Reduction in physical signs: overall physical impact (Psychogenic Movement Disorder Scale (PMDRS) Show forest plot | 1 | 21 | Mean Difference (IV, Fixed, 95% CI) | 5.60 [‐15.48, 26.68] |
| 10.1.1 End of treatment | 1 | 21 | Mean Difference (IV, Fixed, 95% CI) | 5.60 [‐15.48, 26.68] |
| 10.2 Mental state – anxiety (BAI) Show forest plot | 1 | 21 | Mean Difference (IV, Fixed, 95% CI) | ‐3.40 [‐8.01, 1.21] |
| 10.2.1 End of treatment | 1 | 21 | Mean Difference (IV, Fixed, 95% CI) | ‐3.40 [‐8.01, 1.21] |
| 10.3 Mental state – depression (Hamilton) Show forest plot | 1 | 21 | Mean Difference (IV, Fixed, 95% CI) | ‐0.50 [‐3.32, 2.32] |
| 10.3.1 End of treatment | 1 | 21 | Mean Difference (IV, Fixed, 95% CI) | ‐0.50 [‐3.32, 2.32] |
| 10.4 Dropout rate Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 10.4.1 End of treatment | 1 | 29 | Risk Ratio (IV, Fixed, 95% CI) | 1.87 [0.40, 8.65] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 11.1 Reduction in physical signs: symptom freedom Show forest plot | 1 | Risk Ratio (IV, Fixed, 95% CI) | Subtotals only | |
| 11.1.1 End of treatment | 1 | 40 | Risk Ratio (IV, Fixed, 95% CI) | 0.69 [0.39, 1.24] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 12.1 Reduction in physical signs: decrease in seizure frequency Show forest plot | 1 | 54 | Mean Difference (IV, Fixed, 95% CI) | 41.40 [4.92, 77.88] |
| 12.1.1 End of treatment | 1 | 54 | Mean Difference (IV, Fixed, 95% CI) | 41.40 [4.92, 77.88] |
| 12.2 Changes in monthly visits Show forest plot | 1 | 54 | Mean Difference (IV, Fixed, 95% CI) | ‐0.21 [‐0.55, 0.13] |
| 12.2.1 End of treatment | 1 | 54 | Mean Difference (IV, Fixed, 95% CI) | ‐0.21 [‐0.55, 0.13] |
| 12.3 Quality of life Show forest plot | 1 | 47 | Mean Difference (IV, Fixed, 95% CI) | 5.40 [0.26, 10.54] |
| 12.3.1 End of treatment | 1 | 47 | Mean Difference (IV, Fixed, 95% CI) | 5.40 [0.26, 10.54] |
| 12.4 Dropout rate Show forest plot | 1 | 60 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.60 [0.29, 8.92] |
| 12.4.1 End of treatment | 1 | 60 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.60 [0.29, 8.92] |
