Hospital revisit rate after a diagnosis of conversion disorder

Merkler, Alexander E; Parikh, Neal S; Chaudhry, Simriti; Chait, Alanna; Allen, Nicole; Navi, Babak B.; Kamel, Hooman

doi:10.1136/jnnp-2014-310181

Cited by 17 publications

(9 citation statements)

References 24 publications

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“…Therefore, the interventions and any information or explanation received during inpatient admission did not reduce future acute healthcare utilization in our cohort. It is known that acute healthcare demand can respond sharply to appropriate explanation of the diagnosis of functional seizures [13,14], but this does not appear to have extrapolated to our cohort of patients with mixed FND, a finding consistent with behaviours in similar populations [15,16]. Lack of psychological support and intervention is a potential cause, even if the therapeutic effect of psychological interventions remains poorly understood (see below).…”

Section: Discussionmentioning

confidence: 78%

Functional neurological disorders presenting as emergencies to secondary care

Beharry

Palmer

et al. 2021

Euro J of Neurology

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Background Functional neurological disorders (FND) represent a significant proportion of presentations to outpatient adult neurology services. There is little information relating to patients presenting to acute inpatient care. Methods We identified patients presenting as acute admissions with FND to Christchurch Hospital, Christchurch, New Zealand, from 2016 to 2018. We analyzed relevant demographic and clinical data from electronic records and measured incidence of presentation to secondary care and healthcare utilization. Results One hundred sixty‐two patients presented on 173 occasions with FND, representing 9% of all admissions to the neurology service during the 3‐year study period. The mean age was 40 (SD 17) years, 111 (69%) patients were female and the median length of stay was 3 (IQR 2–4) days. A total of 92 computed tomography brain scans, 77 magnetic resonance imaging brain scans and 42 electroencephalograms were carried out. On 22 (13%) occasions, patients were referred for outpatient psychological therapy. In the 3 years prior to each patient's last presentation in the study period, these 162 patients had a total of 671 presentations to the emergency department. Healthcare demand did not decrease after the index admission. The rate of acute inpatient admission for FND was 10 per 100,000 per year for the total Christchurch Hospital catchment, 6/100,000/year in rural areas, and 11/100,000/year in urban areas. Conclusion FND represented almost 1 in 10 acute neurology admissions with significant inpatient healthcare resource utilization.

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Section: Discussionmentioning

confidence: 78%

Functional neurological disorders presenting as emergencies to secondary care

Beharry

Palmer

et al. 2021

Euro J of Neurology

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“…Approximately 20%–30% of patients at neurological clinics suffer from CD/FND (Stone et al, ; Aybek et al, ; Feinstein, ). CD/FND occurs mostly in the 2nd–4th decade and generally takes a protracted course with high limitations in general, social and work functioning in addition to high medical healthcare utilization (Merkler et al, ). Family members also feel a burden (Griffith, Polles, & Griffith, ) as patients with CD/FND often need long‐time intensive help, can become dependent on a wheelchair, and may need adaptations of their house and living arrangements.…”

Section: Introductionmentioning

confidence: 99%

“…As treatment may have relatively little to offer, family members often provide care. Patients with CD/FND visit neurological wards for diagnostic procedures (Stone & Vermeulen, 2016;Vermeulen & Willems, 2015), often with unsatisfactory results (Régny & Cathébras, 2016;Stone & Vermeulen, 2016;Sveinson, Stafánsson, & Hjaltason, 2009;Van der Feltz-Cornelis, 2015), and there is a high return rate of patients (Merkler et al, 2016). A 3-year follow-up study of 42 patients with CD/FND showed persistence in abnormal movements in more than 90% of the patients (Feinstein, Stergiopoulos, Fine, & Lang, 2001).…”

Section: Introductionmentioning

confidence: 99%

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Childhood sexual abuse predicts treatment outcome in conversion disorder/functional neurological disorder. An observational longitudinal study

2020

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Objective Explore trauma, stress, and other predictive factors for treatment outcome in conversion disorder/functional neurological disorder (CD/FND). Methods Prospective observational design. Clinical cohort study among consecutive outpatients with DSM‐IV CD/FND in a specialized mental health institution for somatic symptom disorders and related disorders (SSRD), presented between 1 February 2010 and 31 December 2017. Patient files were assessed for early childhood trauma, childhood sexual abuse, current stress, and other predictive factors. Patient‐related routine outcome monitoring (PROM) data were evaluated for treatment outcome at physical (Patient Health Questionnaire [PHQ15], Physical Symptoms Questionnaire [PSQ]) level as primary outcome, and depression (Patient Health Questionnaire [PHQ9]), anxiety (General Anxiety Disorder [GAD7]), general functioning (Short Form 36 Health Survey [SF36]), and pain (Brief Pain Inventory [BPI]) as secondary outcome. Results A total of 64 outpatients were included in the study. 70.3% of the sample reported childhood trauma and 64.1% a recent life event. Mean scores of patients proceeding to treatment improved. Sexual abuse in childhood (F(1, 28) = 30.068, β = 0.608 p < .001) was significantly associated with worse physical (PHQ15, PSQ) treatment outcome. 42.2% reported comorbid depression, and this was significantly associated with worse concomitant depressive (PHQ9) (F[1, 39] = 11.526, β = 0.478, p = .002) and anxiety (GAD7) (F[1,34] = 7.950, β = 0.435, p = .008) outcome. Conclusion Childhood sexual abuse is significantly associated with poor treatment outcome in CD/FND. Randomized clinical trials evaluating treatment models addressing childhood sexual abuse in CD are needed.

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“…Patients with FND may present acutely to the emergency department (ED) with symptoms similar to epileptic seizure, stroke, or other neurological conditions 2 . These patients often have a high return rate to the ED 3 and their symptoms have traditionally been seen as difficult to manage in the ED setting. Shorter time from symptom onset to diagnosis is an important positive prognostic factor, 4 demonstrating the importance of identifying these patients in an acute care setting.…”

Section: Introductionmentioning

confidence: 99%

Functional neurological disorder in the emergency department

Finkelstein

Cortel-LeBlanc

et al. 2021

Academic Emergency Medicine

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We provide a narrative review of functional neurological disorder (FND, or conversion disorder) for the emergency department (ED). Diagnosis of FND has shifted from a “rule‐out” disorder to one now based on the recognition of positive clinical signs, allowing the ED physician to make a suspected or likely diagnosis of FND. PubMed, Google Scholar, academic books, and a hand search through review article references were used to conduct a literature review. We review clinical features and diagnostic pitfalls for the most common functional neurologic presentations to the ED, including functional limb weakness, functional (nonepileptic) seizures, and functional movement disorders. We provide practical advice for discussing FND as a possible diagnosis and suggestions for initial steps in workup and management plans.

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Hospital revisit rate after a diagnosis of conversion disorder

Abstract: CD is associated with a substantial hospital revisit rate. Our findings suggest that CD is not an acute, time-limited response to stress, but rather that CD is a manifestation of a broader pattern of chronic neuropsychiatric disease.

Cited by 17 publications

References 24 publications

Functional neurological disorders presenting as emergencies to secondary care

Functional neurological disorders presenting as emergencies to secondary care

Childhood sexual abuse predicts treatment outcome in conversion disorder/functional neurological disorder. An observational longitudinal study

Functional neurological disorder in the emergency department

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