An approach to conversion disorder with comorbid major depression using pharmacotherapy and psychodrama techniques: a case report Conversion disorder (CD) is a psychiatric disorder commonly seen in clinical and emergency psychiatry departments; it may occur with psychological factors and lead to changes in motor and sensory functioning in a way that suggests a physical disorder. Multiple mental illnesses such as depressive disorder can accompany CD. In addition to antidepressant or antipsychotic drug treatments, psychotherapy techniques can be applied in the treatment of CD. In this report, we aim to present a case of major depressive disorder with accompanying CD where we intervened applying drug therapy together with psychodrama techniques, a type of psychotherapy that is not frequently used in CD.
Psikolojik etkenlerle ortaya çıkabilen, fiziksel bir bozukluğu düşündürecek biçimde motor ve duyusal işlevsellikte değişikliklerle giden konversiyon bozukluğu (KB) psikiyatri klinik ve acil servislerinde sık görülen bir ruhsal hastalıktır. KB’ye depresif bozukluk gibi birden çok ruhsal hastalıkta eşlik edebilmektedir. KB’nin tedavisinde antidepresan, antipsikotik ilaç tedavileri yanında psikoterapi teknikleri de uygulanabilmektedir. Bu makalede, KB’ye eşlik eden majör depresif bozukluk tanıları bulunan, ilaç tedavisi ile beraber KB’de sık kullanılmayan bir psikoterapi türü olan psikodrama teknikleri uygulayarak yanıt aldığımız bir olguyu sunmayı amaçladık.
Guggenheim GF. Somatoform Disorders: In Sadock BJ, Sadock VA (editors). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. Seventh ed. Philadelphia: Lippincott Williams & Wilkins Publishers, 2000, 3097-3114.
Salgirtay A. A Study on Emergency Patients Presenting to the Psychiatry Clinic of Ankara University in the Course of One Year. Specialization Thesis, Ankara University Medical Faculty, 1979. (Turkish)
Bediz AU, Aydemir C, Basterzi AD, Kisa C, Cebeci S, Goka E. Physicians’ attitudes towards patients with conversion disorder. 37th National Congress of Psychiatry, abstract book, 2001, 78-79. (Turkish)
Ford CV, Folks DG. Conversion disorders: an overview. Psychosomatics 1985; 26:371-374, 380-383. [CrossRef]
Isik E. Neuroses. First ed. Ankara: City Printshop, 1996, 299-312. (Turkish)
Widiger TA, Mullins-Sweatt SN. Categorical and dimensional models of personality disorders: In Oldham JM, Skodol AE, Bender DS (editors). Textbook of Personality Disorders. First ed. Washington: American Psychiatric Publishing Inc., 2005, 35-57.
Ulusahin A, Ozturk MO. Mental Health and Disorders. Thirteenth ed. Ankara: Danube Printing, 2015, 398-408. (Turkish)
Ozen S, Ariciogullari Z. Neuroleptic induced pharyngeal dystonia occuring at a conversion disorder background: a case report. Bulletin of Clinical Psychopharmacology 2000; 10:228- 32. (Turkish)
Kaygisiz A, Alkin T. Comorbidity of axis-I and axis-II mental disorders in conversion disorder. Turk Psikiyatr Derg 1999; 10:33-39. (Turkish)
Dilbaz N, Bitlis V, Dogan S, Usseli I, Erdogan S. Psychiatric symptoms in patients with a diagnosis of conversion disorder. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 1994; 7:5-9. (Turkish)
Bowman ES, Markand ON. Psychodynamics and psychiatric diagnoses of pseudoseizures subjects. Am J Psychiatry 1996; 153:57-63. [CrossRef]
Kroenke K. Efficacy of treatment for somatoform disorders: a review of randomized controlled trials. Psychosom Med 2007; 69:881-888. [CrossRef]
Khalil TM, Abdel-Moty E, Asfour SS, Fishbain DA, Rosomoff RS, Rosomoff HL. Functional electric stimulation in the reversal of conversion disorder paralysis. Arch Phys Med Rehabil 1988; 69:545-547.
Erol O. Psychotherapeutic interview. Turkiye Klinikleri J Psychiatry-Special Topics 2009; 2:45-51. (Turkish)
Diseth TH, Christie HJ. Trauma-related dissociative (conversion) disorders in children and adolescents–an overview of assessment tools and treatment principles. Nord J Psychiatry 2005; 59:278- 292. [CrossRef]
Hopp JL, LaFrance WC Jr. Cognitive behavioral therapy for psychogenic neurological disorders. Neurologist 2012; 18:364- 372. [CrossRef]
Kellerman PF. Focus on Psychodrama. London: Jessica Kingsley Publ. 1992, cit. from the Turkish transl. Psikodramaya Derinlemesine Bakis. Gokler B, Gokler Danisman I, Mavili Aktas A (translation ed.) First ed. Ankara: Nobel Publishing, 2013. (Turkish)
Ozbek A, Leutz G. On-Stage Interaction in Psychodrama Group Therapy. Second ed. Ankara: Abdulkadir Ozbek Psychodrama Institute Publ., 2003, 31-51. (Turkish)
Yavas I. Use of monodrama in the treatment of prolonged grief reaction, a case report. 22 nd International Congress of Group Psychotherapy, Proceedings Book, 1998, 179-188. (Turkish)
Ozdel O, Atesci F, Kalkan-Oguzhanoglu N. An anorexia nervosa case and an approach to this case with pharmacotherapy and psychodrama techniques. Turk Psikiyatri Derg 2003; 14:153-159. (Turkish)
Cohen D, Delaroche P, Flament MF, Mazet P. Case report: individual psychodrama for treatment resistant obsessive- compulsive disorder. Neuropsychiatr Enfance Adolesc 2014; 62:19-21. [CrossRef]
Okyayuz HU. The Use of Monodrama and Psychodrama Methods in the Psychotherapy of Borderline Patients. Unpublished final paper in psychodrama, Dr Abdulkadir Ozbek Psychodrama Institute, Ankara, 2000. (Turkish)
Babaoglu AN. Monodrama and Catathymic Image Experience Techniques Used Jointly and Mutually in Individual Psychotherapy. Unpublished final paper in psychodrama, Istanbul, 1997. (Turkish)
Ozer-Danis G, Uneri OS. A lesser known aspect of psychodrama: monodrama. Klinik Psikiyatri Dergisi 2017; 20:238-242. (Turkish)
Dogan O. Conversion disorder: In Gulec C, Koroglu E (editors). Basic Book of Psychiatry. Second ed. Ankara: Physicians’ Publication Union, 2007, 377-385. (Turkish)
Basar HM. Executive Functions and Dissociative Symptoms in Conversion Disorder Patients. Specialization Thesis in Medicine, Ministry of Health, Istanbul Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry-Neurology and Neurosurgery, Dept. for Mental Health and Diseases, Istanbul, 2015. (Turkish)
Allin M, Streeruwitz A, Curtis V. Progress in understanding conversion disorder. Neuropsychiatr Dis Treat 2005; 1:205-209.
Fritz GK, Campo JV. Somatoform disorders: In Lewis M (editor). Child and Adolescent Psychiatry: A Comprehensive Textbook. Third ed. Philadelphia: Lippincott Williams & Wilkins Publishers, 2002, 847-858.
Ackerman M, Ackerman S. The use of psychodrama in a post- partum depression. J Am Coll Neuropsychiatr 1962; 1:67-70.
Burwell D. Psychodrama and the depressed elderly. Can Nurse 1977; 73:54-55.
Rezaeian MP, Sen AK, Sen-Mazumdar DP. The usefulness of psychodrama in the treatment of depressed patients. Indian J Clin Psychol 1997; 24:82-88.
Uysal S. The Contribution of the Psychodrama Method to Depression Therapy in Group Psychotherapy. Final paper in psychodrama, Dr. Abdulkadir Ozbek Psychodrama Institute, Ankara, 2007. (Turkish)
Costa EM, Antonio R, Soares MB, Moreno RA. Psychodramatic psychotherapy combined with pharmacotherapy in major depressive disorder: an open and naturalistic study. Braz J Psychiatr 2006; 28:40-43. [CrossRef]
van der Kolk BA, van der Hart O. Pierre Janet and the breakdown of adaption in psychological trauma. Am J Psychiatry 1989; 146:1530-1540. [CrossRef]
Freud S, Breuer J. Studies on hysteria. Human Emotions: A Reader, 30, 1998.
Tezcan E, Atmaca M, Kuloglu M, Gecici O, Buyukbayram A, Tutkun H. Dissociative disorders in Turkish inpatients with conversion disorder. Compr Psychiatry 2003; 44:324-330. [CrossRef]
Sar V, Akyuz G, Kundakci T, Kiziltan E, Dogan O. Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry 2004; 161:2271-2276. [CrossRef]
Coons PM. Depersonalization and Derealization: In Michelson LK and Ray WJ (editors). Handbook of Dissociation: Theoretical, Empirical, and Clinical Perspectives. Springer Science & Business Media, 1996, 291-305. [CrossRef]
Kozlowska K. The developmental origins of conversion disorders. Clin Child Psychol Psychiatry 2007; 12:487-510. [CrossRef]