Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide

Abstract

There is a growing body of knowledge regarding management of functional neurological disorder (FND). The aim of this article is to guide the clinician through FND clinical management, from delivery of the diagnosis, to creation of a biopsychosocially-informed treatment plan, to troubleshooting common issues that arise throughout longitudinal care. We review the evidence and core principles of both rehabilitative therapies (physical therapy, occupational therapy, and speech and language therapy) and psychological therapies for the treatment of FND, and discuss the benefits of engaging a multidisciplinary and interdisciplinary team. The optimal timing of specific therapeutic interventions is also discussed, emphasizing a patient-centered perspective. Resources for further reading, for both patients and clinicians, are provided throughout. Additional research is needed to further optimize the therapeutic approach to patients with FND, including the need to develop novel treatments for those that do not positively respond to currently available interventions.

Lessons Learned in Outpatient Physical Therapy for Motor Functional Neurological Disorder

“…The biopsychosocial formulation, a dynamic and interactive model, is a prevailing perspective through which to conceptualize mFND 23,24. Although the viewpoint put forth in this article leverages the biopsychosocial formulation consistent with our programmatic philosophy, it is important to note that there are other multifaceted perspectives such as those developed in the chronic pain literature that offer alternative framings (eg, the enactive approach) 25,26…”

“…23,24 Although the viewpoint put forth in this article leverages the biopsychosocial formulation consistent with our programmatic philosophy, it is important to note that there are other multifaceted perspectives such as those developed in the chronic pain literature that offer alternative framings (eg, the enactive approach). 25,26 In mFND, the biopsychosocial model identifies relevant biological, psychological, and social factors that act as predisposing vulnerabilities, acute precipitants, and perpetuating factors for a given patient. 27 Consensus recommendations by Nielsen et al 15 outline the use of the biopsychosocial model as a framework for personalizing PT interventions by considering a range of factors and how they relate to the patient's presentation.…”

“…In our program, patients have access to time-limited cognitive behavioral therapy, OT, speech and language pathology, and/or PT, driven by their symptoms and clinical formulation 19,43. An initial evaluation in our outpatient FND program is performed by a neurologist or neuropsychiatrist who following diagnostic confirmation aims to develop an individualized (biopsychosocial-informed) treatment plan, referring to PT and other physical rehabilitation disciplines based on clinical phenotype and concurrently to psychotherapy in most cases 26. Our group participates in monthly FND clinical rounds to discuss patients—emphasizing challenging cases to problem solve; we also use this setting to discuss clinical successes to consolidate positive therapeutic approaches.…”

“…19,43 An initial evaluation in our outpatient FND program is performed by a neurologist or neuropsychiatrist who following diagnostic confirmation aims to develop an individualized (biopsychosocial-informed) treatment plan, referring to PT and other physical rehabilitation disciplines based on clinical phenotype and concurrently to psychotherapy in most cases. 26 Our group participates in monthly FND clinical rounds to discuss patients-emphasizing challenging cases to problem solve; we also use this setting to discuss clinical successes to consolidate positive therapeutic approaches. Our program also allows for a more modular approach, attempting to tailor treatments to individual patients.…”

Neuropsychiatric Treatments for Epilepsy: Nonpharmacological Approaches

“…Specific themes related to functional (psychogenic nonepileptic) seizures are not covered in this article, as this topic is covered elsewhere in this issue. 17 Thus, the term “seizure” refers to epileptic seizures throughout this article.…”