Neuropsychiatric Factors Linked to Adherence and Short-Term Outcome in a U.S. Functional Neurological Disorders Clinic: A Retrospective Cohort Study

Glass, Sean; Matin, Nassim; Williams, Benjamin; Mello, Julie; Stephen, Christopher D.; Young, Steven; Callahan, Janet; LaFrance, W. Curt; Perez, David L.

doi:10.1176/appi.neuropsych.17060117

Cited by 31 publications

(25 citation statements)

References 57 publications

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“…Once a patient and the immediate family are receptive to the diagnosis, the core components of treatment for functional dystonia and related functional motor symptoms include physical interventions (e.g., physical therapy, occupational therapy), [28][29][30] psychological interventions (including a component of cognitive-behavioral therapy [CBT] to explore the interactions between functional neurological symptoms, thoughts, behaviors, emotions, and psychosocial factors), 31,32 and management of comorbid psychiatric and somatic (e.g., pain, fatigue) symptoms that may have prognostic implications. [33][34][35] While the above components are core aspects of treatment, the identification of patient-specific predisposing vulnerabilities, acute precipitants, and perpetuating factors should be elucidated to help individualize treatments with these factors in mind. 36 In this case, predisposing vulnerabilities included early-life separation anxiety, dyslexia with academic difficulties, bullying at school, tendency to not verbalize stress and affective symptoms to supports, and the concurrent presence of another functional somatic disorder (irritable bowel syndrome).…”

Section: Questions To the Consultantsmentioning

confidence: 99%

Twisted in Pain: The Multidisciplinary Treatment Approach to Functional Dystonia

Khachane

Kozlowska

Savage

et al. 2019

Harv Rev Psychiatry

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Section: Questions To the Consultantsmentioning

confidence: 99%

Twisted in Pain: The Multidisciplinary Treatment Approach to Functional Dystonia

Khachane

Kozlowska

Savage

et al. 2019

Harv Rev Psychiatry

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“… 21 , 22 Here, we provide a framework for the initial assessment and management of mFND modeled in part after the example of the Massachusetts General Hospital FND Clinic. 6 , 23 – 26 Using the approach detailed below, Glass et al previously reported in 81 consecutive patients with at least one follow-up that 42% noted some degree of clinical improvement at 7 months. 23 While emphasis on neurological examination and semiological features aids the neurologist’s role in diagnosis, a comprehensive assessment guiding the development of a patient-centered treatment plan benefits from interdisciplinary neurologic, psychiatric, allied mental health and rehabilitation perspectives.…”

Section: Introductionmentioning

confidence: 99%

“… 6 , 23 – 26 Using the approach detailed below, Glass et al previously reported in 81 consecutive patients with at least one follow-up that 42% noted some degree of clinical improvement at 7 months. 23 While emphasis on neurological examination and semiological features aids the neurologist’s role in diagnosis, a comprehensive assessment guiding the development of a patient-centered treatment plan benefits from interdisciplinary neurologic, psychiatric, allied mental health and rehabilitation perspectives. 14 Sections of this article outline the neuropsychiatric history, physical examination, delivery of the diagnosis, treatment planning, physical rehabilitation, and psychological treatments.…”

Section: Introductionmentioning

confidence: 99%

<p>Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective</p>

Saxena¹,

Godena²,

Maggio³

et al. 2020

NDT

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Functional neurological disorder (FND), a condition at the intersection of neurology and psychiatry, is a common and disabling outpatient referral to neurology and neuropsychiatry clinics. In this perspective article, we focus on the motor spectrum of FND (mFND), including individuals with functional movement disorders (FND-movt), functional limb weakness/paresis (FND-par) and functional [psychogenic non-epileptic/dissociative] seizures (FND-seiz). Over the past several decades, there have been dedicated efforts within the neurologic and psychiatric communities to create “rule-in” diagnostic criteria, as well as thoughtful approaches to the clinical interview, delivery of the diagnosis and the development of a patient-centered treatment plan. These advances allow the promotion of good clinical practices in the outpatient assessment and management of mFND. Informed by the literature and our prior clinical experiences, we provide suggestions on how to evaluate individuals with suspected functional motor symptoms - including conducting sensitive psychiatric and psychosocial screenings. Additional sections discuss common “rule-in” neurological examination and semiologic signs of motor FND, as well as approaches to deliver the diagnosis and formulate a treatment plan based on individual patient needs. To aid the development of shared (partially overlapping) expertise that catalyzes an interdisciplinary approach to mFND, the use of physiotherapy for therapeutic motor retraining and cognitive behavioral therapy to examine relationships between symptoms, thoughts, behaviors and emotions are also discussed. Additional clinical research is needed to further refine and operationalize the assessment and management of mFND, across clinics, healthcare settings and countries.

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“…female predominance, high rates of depression-anxiety and adverse life event burden (Guz et al, 2004; Paras et al, 2009; Taylor, 2003)) further raising the possibility of a partially overlapping biology. Comorbid somatic symptoms in patients with FND also negatively impact healthcare utilization and prognosis (Ettinger et al, 1999; Glass et al, 2018; Ibrahim et al, 2009; Salinsky et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Structural alterations in functional neurological disorder and related conditions: a software and hardware problem?

Bègue

Adams

Stone

et al. 2019

NeuroImage: Clinical

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Functional neurological (conversion) disorder (FND) is a condition at the interface of neurology and psychiatry. A “software” vs. “hardware” analogy describes abnormal neurobiological mechanisms occurring in the context of intact macroscopic brain structure. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders (SSD) as defined in DSM-IV (somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article) raises the possibility of a partially overlapping pathophysiology. In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders. Future directions that could accelerate the characterization of the pathophysiology of FND and DSM-5 SSD are outlined, including “disease staging” discussions to contextualize subgroups with or without structural changes. Emerging neuroimaging evidence suggests that some individuals with FND and SSD may have a “software” and “hardware” problem, although if structural alterations are present the neural mechanisms of functional disorders remain distinct from lesional neurological conditions. Furthermore, it remains unclear whether structural alterations relate to predisposing vulnerabilities or consequences of the disorder.

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Neuropsychiatric Factors Linked to Adherence and Short-Term Outcome in a U.S. Functional Neurological Disorders Clinic: A Retrospective Cohort Study

Cited by 31 publications

References 57 publications

Twisted in Pain: The Multidisciplinary Treatment Approach to Functional Dystonia

Twisted in Pain: The Multidisciplinary Treatment Approach to Functional Dystonia

<p>Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective</p>

Structural alterations in functional neurological disorder and related conditions: a software and hardware problem?

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