Overcoming Functional Neurological Symptoms: A Five Areas Approach

Williams, Christopher; Carson, Alan; Smith, Sharon; Sharpe, Michael; Cavanagh, Jonathan; Kent, Catriona

doi:10.1201/b13567

Cited by 25 publications

(26 citation statements)

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“…The use of a selfguided CBT booklet has been shown to reduce symptom burden at 3 and 6 months, and the difference between this treatment benefit and standard medical care was found to be statistically significant (57). CBT treatment workbooks that have been validated in randomized clinical trials can be recommended to help patients (and mental health providers) understand the diagnosis and develop the necessary skills to overcome their symptoms (57,58). CBT is the preferred treatment modality for patients with episodic symptoms, such as psychogenic nonepileptic seizures.…”

Section: Cognitive-behavioral Therapymentioning

confidence: 96%

“…Randomized pilot studies have shown efficacy for CBT in the treatment of psychogenic nonepileptic seizures (55,56). The use of a selfguided CBT booklet has been shown to reduce symptom burden at 3 and 6 months, and the difference between this treatment benefit and standard medical care was found to be statistically significant (57). CBT treatment workbooks that have been validated in randomized clinical trials can be recommended to help patients (and mental health providers) understand the diagnosis and develop the necessary skills to overcome their symptoms (57,58).…”

Section: Cognitive-behavioral Therapymentioning

confidence: 99%

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Treatment for Patients With a Functional Neurological Disorder (Conversion Disorder): An Integrated Approach

O’Neal

Baslet

2018

AJP

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The care of patients with functional neurological disorders overlaps both the neurology and psychiatry specialties. It is often the case that neither provider thinks that he or she should be the treating clinician, and as a result, this patient group can suffer a substantial gap in care. Here, we illustrate a practical approach toward integration of care to appropriately treat patients with functional neurological disorders. DEFINITIONSThe chapter on somatic symptoms and related disorders in DSM-5 encompasses several psychiatric disorders for which the primary feature is a symptom related to a physical or health-related complaint. The diagnostic criteria for somatic symptom disorder require that the patient have one or more Which of the following reflects a DSM-5 criterion for conversion disorder (functional neurologic symptom disorder)?A. Symptoms of altered voluntary motor, cognitive, or sensory function. B. Clinical findings compatible with a recognized neurologic condition. C. Symptom onset following an identified stressor. D. Evidence of intentional production of neurologic symptoms. "Ms. A," a 29-year-old woman, was referred for a second neurologic opinion. Several months earlier, she woke with a pins-and-needles sensation involving both legs from the knees to the toes. The following day, she could not move her legs without help from her fiancé. Several hours later, she developed transient numbness of the left arm. Alarmed by her increasing symptoms, she presented to the emergency department. A brain and cervical MRI with gadolinium contrast showed no abnormalities. The patient was discharged with neurologic follow-up. Results of an electromyogram and nerve conduction study of the upper and lower extremities were normal. Later, because of increasing back and diffuse leg pain, the patient underwent a lumbar MRI, which also showed no abnormalities. She continued to experience lower extremity weakness and paresthesias as well as back and leg pain. No diagnosis was made. The patient had been unable to work since her symptoms began.Ms. A had a history of posttraumatic stress disorder related to a rape in college. She still endorsed presence of frequent nightmares and flashbacks related to the experience. She denied hypervigilance or avoidance related to her trauma. She denied any history of depression or other anxiety symptoms.On examination the patient had diffuse lower extremity weakness with variability of effort (the strength of her lower extremities did not consistently show the same response, as would be expected in a physiological motor deficit). Her reflexes were normal and there were no pathological reflexes. Sensation to pinprick was decreased in both legs without a sensory level or a dermatomal pattern (if a patient has a spinal cord abnormality, a sensory level would be an expected finding, or if there were cauda equina involvement, the sensory loss should conform to that of multiple sensory dermatomes). The patient's vibratory sense was diminished over the thoracic but not the lumbar vertebrae or in...

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Section: Cognitive-behavioral Therapymentioning

confidence: 96%

Section: Cognitive-behavioral Therapymentioning

confidence: 99%

Treatment for Patients With a Functional Neurological Disorder (Conversion Disorder): An Integrated Approach

O’Neal

Baslet

2018

AJP

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“…Patients also meet with a psychologist every day for a 1-hour session. Psychologists work with cognitive behavioral based materials according to a validated treatment manual for FMDs [29].…”

Section: Interventionmentioning

confidence: 99%

Motor Retraining (MoRe) for Functional Movement Disorders: Outcomes From a 1‐Week Multidisciplinary Rehabilitation Program

Jacob

Kaelin

Roach

et al. 2018

PM&R

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“…For patients with isolated PNES, individuals were commonly referred to the workbook "Taking Control of Your Seizures: Workbook" 26 in the context of individual psychotherapy with a therapist familiar with CBT, who was also referred to the workbook "Treating Nonepileptic Seizures: Therapist Guide." 27 For those with other motor FND semiologies (including PNES with mixed symptoms), the guided self-help CBT workbook "Overcoming Functional Neurological Symptoms: A Five Area Approach," 28 based on the clinical trial by Sharpe and colleagues, 18 was frequently recommended, either to be used during the course of individual psychotherapy sessions or to be used by the patient on his or her own in the context of longitudinal FND clinic follow-up. All MGH/outside psychotherapists were encouraged to contact MGH FND clinic providers after their initial outpatient assessment to ensure proficiency in using CBT treatments for FND.…”

Section: Patient Cohort and Interventionsmentioning

confidence: 99%

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

Glass

Matin

Williams

et al. 2018

JNP

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Despite advancements in the assessment and management of functional neurological disorder (FND), the feasibility of implementing a new standard of care remains unclear. Chart reviews were performed for 100 patients with motor FND to investigate factors related to treatment adherence and clinical improvement over an average follow-up of 7 months. Of 81 patients who returned for follow-up, a history of chronic pain disorder inversely correlated with improvement. Of the 50 individuals newly referred for treatment, adherence correlated with improvement, while having abnormal neuroimaging inversely correlated with improvement. This study supports the feasibility of applying a new standard of care for FND.

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Overcoming Functional Neurological Symptoms: A Five Areas Approach

Cited by 25 publications

References 0 publications

Treatment for Patients With a Functional Neurological Disorder (Conversion Disorder): An Integrated Approach

Treatment for Patients With a Functional Neurological Disorder (Conversion Disorder): An Integrated Approach

Motor Retraining (MoRe) for Functional Movement Disorders: Outcomes From a 1‐Week Multidisciplinary Rehabilitation Program

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

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