Cognitive rehabilitation treatment for mental slowness in conversion disorder:A case report

Cognitive rehabilitation treatment (CRT) has been described in patients with brain injury, but it has not been attempted in cases of cognitive dysfunction without organic cause. This case report describes CRT of neurocognitive impairment in a 54-year-old female patient with conversion disorder (CD). She experienced difficulties with regard to speaking, motor function, and pain symptoms, which developed after stressful life circumstances. Baseline neuropsychological assessment (NPA) showed mental slowness and impaired (working) memory. Time Pressure Management (TPM) was used as CRT to teach the patient a compensatory strategy to overcome mental slowness in 12 sessions. During treatment, physical symptoms were monitored with the Physical Symptom Questionnaire (LKV), and mental slowness with the Mental Slowness Questionnaire (MSQ). After treatment, the LKV score dropped from 85 to 47, indicating 54% treatment response. Mental slowness showed improvement based on the MSQ and was confirmed by an NPA after treatment. Other neurocognitive functions improved as well and the motoric CD symptoms subsided. This case report suggests that improvement of mental slowness, as well as motor CD symptoms, can be achieved by TPM in non-organic neurocognitive impairment in CD. This finding has not been described in the literature. Further research is warranted to explore the efficacy of TPM in CD.Keywords: conversion disorder, neurocognitive impairment, cognitive rehabilitation treatment, time pressure management, pain