Let $n$ be a natural number which isn't a square and $$\sqrt{n}=[a_0;\overline{a_1,a_2\dotsb a_r}]$$
then consider the convergents
$$\frac{x_1}{y_1}=[a_0;a_1,a_2\dotsb a_{r-1}]$$
$$\frac{x_2}{y_2}=[a_0;a_1,a_2\dotsb a_{r-1},a_r,a_1\dotsb a_{r-1}]$$
etc
I conjecture that $x_k^2-ny_k^2=\pm 1$. And that all solutions of the positive and negative Pell equations have this form.
If $p^2-nq^2=1$ then $0<\frac{p}{q}-\sqrt{n}<\frac{1}{2\sqrt{n}q^2}$. And if $p^2-nq^2=-1$ then $0<\sqrt{n}-\frac{p}{q}<\frac{1}{2\sqrt{n}q^2}$. In both cases $q^2\left|\frac{p}{q}-\sqrt{n}\right|<\frac{1}{2\sqrt{n}}$, so $\frac{p}{q}$ is in some sense a very good approximation of $\sqrt{n}$, and the last number in the period, $a_r$ seems to always be $2\lfloor\sqrt{n}\rfloor$ and larger than all of $a_1,a_2\dotsb a_{r-1}$, so the next best rational approximation of $\sqrt{n}$ would have a "much" bigger denominator than $q$, so it should make sense for the solutions to the Pell equation to appear before $a_r$.
$$\sqrt{397}=[19;\overline{1,12,3,4,9,1,2,1,2,1,1,2,1,2,1,9,4,3,12,1,38}]$$
$$\frac{20478302982}{1027776565}=[19;1,12,3,4,9,1,2,1,2,1,1,2,1,2,1,9,4,3,12,1]$$
This is the fundamental solution of the negative Pell equation $$20478302982^2-397\times 1027776565^2=-1$$
Getting the second convergent of this type $$\frac{838721786045180184649}{42094239791738433660}=[19;1,12,3,4,9,1,2,1,2,1,1,2,1,2,1,9,4,3,12,1,38,1,12,3,4,9,1,2,1,2,1,1,2,1,2,1,9,4,3,12,1]$$
Gives the fundamental solution to the positive Pell equation
$$838721786045180184649^2-397\times 42094239791738433660^2=1$$
It is hard not to prove by induction that the convergents of this form alternate between generating solutions to the positive and negative equations, although very laborious. I have also proven this for the first 20 naturals, 61, and 92. So that's a bit of computational evidence. Heuristically it seems far too unlikely that the conjecture isn't true.
If the conjecture is true then the numbers for which the negative Pell equation has a solution are those with an even number of numbers in their period, in particular primes congruent to 1 mod 4.
If $$ u^2 - n v^2 = -1, $$ then $$ (u^2 + n v^2 )^2 - n (2uv)^2 = 1. $$
The bit about the continued fraction "digits" being palindromic is true. Known to Lagrange, explicit in some things by Galois. The relationship with $x^2 - n y^2 = -1$ comes down to this: if it is possible, it happens at the end of one, umm, cycle. Another cycle takes us back to $x^2 - n y^2 = 1.$ A short proof that this is always possible for primes $n \equiv 1 \pmod 4$ is in Mordell, Diophantine Equations. The same proof applies when $n = pq,$ primes $p \equiv q \equiv 1 \pmod 4,$ AND Legendre symbol $(p|q) = (q|p) = -1,$ that is, they are mutual quadratic non-residues. Howeve, look at $n = 205$ or $n = 221,$ for which $x^2 - n y^2 = -1$ is impossible: