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Pearls


‘Truth serum’ soothes patients with conversion disorder

Vol. 3, No. 9 / September 2004
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Conversion disorders result from stress expressed as a physical symptom. Extreme psychological stress after a death, loss, or trauma can manifest as weakness, paralysis, blindness, deafness, or mutism.

Intravenous amobarbital (Amytal)—so-called “truth serum”—is highly effective for extreme conversion symptoms without psychogenic seizures.1 Clinicians who are not skilled in hypnosis might consider amobarbital after ruling out a neurologic or organic cause.

USING AMOBARBITAL

Amobarbital—100 to 500 mg for adults, 25 to 50 mg for children—is given slowly over 10 to 15 minutes and usually works rapidly. Stop the IV as soon as an effect is noticed or the patient starts feeling drowsy.

Other side effects include disinhibition, which may help the patient overcome his or her stress. Amobarbital is contraindicated during pregnancy and in patients with:

  • pulmonary disease, as it may slow respiration
  • porphyria, an iron metabolism disorder that can be exacerbated with barbiturate use.2

When interviewing a patient before amobarbital treatment, I focus solely on symptom relief. Follow-up psychotherapy can then help the patient understand what caused the stress.

CASE 1: BLINDING VISION

Mr. A, age 25, was hospitalized after complaining he was “blind.” Neurologic and medical examination and brain CT showed no abnormalities. History revealed that Mr. A had a hemorrhoid and was curious about how it looked. He was startled upon seeing the hemorrhoid, after which he had trouble seeing.

The psychiatrist gave amobarbital, 300 mg IV over 30 minutes. Fifteen minutes into the medication, Mr. A began to see shadows, leaves, then people. After another 15 minutes, his sight was normal. He was discharged that day; psychiatric follow-up was arranged.

CASE 2: ON THE SIDELINES

Joey, age 9, was admitted to the pediatric unit after developing acute paralysis. Neurologic and medical work-ups, including CT, were negative.

When I visited him, Joey told me that he was anxious about going to school. I gave him amobarbital, 25 mg over 15 minutes. Then, because he told me he is a football fan, I had Joey imagine that he was a pro quarterback. Within minutes Joey was jogging up and down the hallway. He was discharged; outpatient psychiatric follow-up was scheduled.

References

1. Sadock BJ, Sadock VA. Kaplan and Sadock’s synopsis of psychiatry: behavioral sciences/clinical psychiatry (9th ed). Baltimore, MD: Lippincott Williams and Wilkins 2002;649-50.

2. Ibid:1018-9

Dr. Newmark is chief, department of psychiatry, Cooper University Hospital, Camden, NJ, and professor of psychiatry, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Camden.

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