Guided self-help for functional (psychogenic) symptoms

Abstract

Objectives: Functional (psychogenic or somatoform) symptoms are common in neurology clinics.Cognitive-behavioral therapy (CBT) can be an effective treatment, but there are major obstacles to its provision in practice. We tested the hypothesis that adding CBT-based guided self-help (GSH) to the usual care (UC) received by patients improves outcomes. Methods:We conducted a randomized trial in 2 neurology services in the United Kingdom. Outpatients with functional symptoms (rated by the neurologist as "not at all" or only "somewhat" explained by organic disease) were randomly allocated to UC or UC plus GSH. GSH comprised a self-help manual and 4 half-hour guidance sessions. The primary outcome was self-rated health on a 5-point clinical global improvement scale (CGI) at 3 months. Secondary outcomes were measured at 3 and 6 months. Results:In this trial, 127 participants were enrolled, and primary outcome data were collected for 125. Participants allocated to GSH reported greater improvement on the primary outcome (adjusted common odds ratio on the CGI 2.36 [95% confidence interval 1.17-4.74; p ϭ 0.016]). The absolute difference in proportion "better" or "much better" was 13% (number needed to treat was 8). At 6 months the treatment effect was no longer statistically significant on the CGI but was apparent in symptom improvement and in physical functioning. Conclusions: CBT-based GSH is feasible to implement and efficacious. Further evaluation is indicated. Classification of evidence:This study provides Class III evidence that CBT-based GSH therapy improves self-reported general health, as measured by the CGI, in patients with functional neurologic symptoms. Neurology ® 2011;77:564-572 GLOSSARY CBT ϭ cognitive-behavioral therapy; CGI ϭ clinical global improvement scale; CPS ϭ change in presenting symptoms scale; GSH ϭ guided self-help; NNT ϭ number needed to treat; OR ϭ odds ratio; SF-12 ϭ Medical Outcomes Short Form 12-Item Scale; UC ϭ usual care.

Treatment of Functional (Psychogenic) Movement Disorders

“…Sharpe et al [27] conducted a RCT of patients with functional neurologic symptoms, including some patients with motor symptoms using a CBT-based self-help workbook and a very limited number of face-to-face sessions to explain its use and to give support. This support was given by a nurse rather than a trained psychologist.…”

Efficacy of brief interdisciplinary psychotherapeutic intervention for motor conversion disorder and nonepileptic attacks

“…The prognosis is globally unfavorable, with long-lasting symptoms as shown by a recent review (globally only 50% improving) [5][6][7] leading to early work retirement (30% do not work anymore at an average age of 44) [6]. A number of treatment strategies have been proposed ranging from psychologically derived hypothesis using hypnosis [8], abreaction [9], cognitive-behavioral approaches [10][11][12] to more physically based approaches using physiotherapy [13], transcranial magnetic stimulation [14] or drugs (antidepressants) [15]. A recent Cochrane review of treatments for nonepileptic attacks concluded that the evidence was scarce for any psychological or behavioral intervention and that there is a lack of randomized controlled trials [16].…”

Functional neurological disorders: mechanisms and treatment

“…A RCT of the effect of liaison psychiatry input on patients with a wide spectrum of functional neurological disorders in 23 patients found promising results both on symptoms and hospital visits encouraging more research and investment in interdisciplinary working [73]. Finally, an RCT of brief (4 9 30 min) guided self-help based on CBT in 127 patients with a range of functional symptoms and disorders in a neurology outpatient setting showed benefits (odds ratio 2.4 for improved outcome p = 0.02) [74]. Given the numbers of patients with these disorders, brief and costeffective interventions are required to properly support neurology services.…”