Setting up Functional Neurological Disorder Treatment Services

Finkelstein, Sara A.; Carson, Alan; Edwards, Mark J.; Kozlowska, Kasia; Lidstone, Sarah C.; Perez, David L.; Polich, Ginger; Stone, Jon; Aybek, Selma

doi:10.1016/j.ncl.2023.04.002

Cited by 5 publications

(6 citation statements)

References 35 publications

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“…Indeed, as our understanding of FMD evolves, it is becoming evident that long‐term recovery relies on self‐management of modifiable perpetuating factors rather than exclusive focus on the surface neurological symptoms 30 . Triage to no therapy does not mean no therapy at all; rather, suitability for rehabilitation is based on a fit between the patient's priority symptoms and concerns, health care provider assessment, and the skill set of the treatment team 31 . There is no “one size fits all” in FMD, and pragmatic treatment plans must meet the patient where they are, and target what is important with the resources available.…”

Section: Discussionmentioning

confidence: 99%

“… 30 Triage to no therapy does not mean no therapy at all; rather, suitability for rehabilitation is based on a fit between the patient's priority symptoms and concerns, health care provider assessment, and the skill set of the treatment team. 31 There is no “one size fits all” in FMD, and pragmatic treatment plans must meet the patient where they are, and target what is important with the resources available.…”

Section: Discussionmentioning

confidence: 99%

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Factors Influencing Triage to Rehabilitation in Functional Movement Disorder

Gilmour,

Langer,

Bhatt

et al. 2024

Movement Disord Clin Pract

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BackgroundTreatment of functional movement disorder (FMD) should be individualized, yet factors determining rehabilitation engagement have not been evaluated. Subspecialty FMD clinics are uniquely poised to explore factors influencing treatment suitability and triage.ObjectivesTo describe our approach and explore factors associated with triage to FMD rehabilitation.MethodsWe conducted a retrospective chart review of 158 consecutive patients with FMD seen for integrated assessment by movement disorders neurology and psychiatry, with the purpose of triage to rehabilitation. Demographic and clinical variables were compared between patients triaged to therapy versus no therapy, and logistic regression was used to explore factors predictive of triage outcome. Change in primary outcome scores were analyzed.ResultsSixty‐six patients (42%) were triaged to FMD therapy from July 2019 to December 2021. Patients triaged to therapy were more likely to have a constant movement disorder, gait disorder and/or tremor, hyperarousal, readiness for change, and people pleasing traits. Patients triaged to no therapy demonstrated persistent diagnostic disagreement, an inability to appreciate motor symptom inconsistency, low self‐agency, a propensity to dissociate, and cluster B traits. 90% of patients triaged to rehabilitation had improved outcomes.ConclusionsThe ability to “opt‐in” to FMD rehabilitation relies on different factors than those relevant to establishing a diagnosis. Unlike many other neurological disorders, a triage and treatment planning step is recommended to identify those likely to meaningfully engage at that time. Holistic assessment through a transdisciplinary lens, and working collaboratively with the patient is essential to prioritize symptoms, determine engagement, and identify treatment targets.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors Influencing Triage to Rehabilitation in Functional Movement Disorder

Gilmour,

Langer,

Bhatt

et al. 2024

Movement Disord Clin Pract

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“…3 4 24 Furthermore, patients still often find themselves in between the fields of psychiatry and neurology, and FND does not have a 'home within healthcare systems', as Finkelstein et al put Open access it. 24 Regardless of precise causal grounds of the disease, the lack of coherent concepts likely perpetuates and maintains the disorder, which often shows chronicity. 16 36 In clinical practice, patients often report being puzzled by explanations that there is 'nothing wrong' with them.…”

Section: Discussionmentioning

confidence: 99%

“…26 In this context, educational aspects of medical personnel (including students in the various professions) to become acquainted with functional disorders and learn from each other in multidisciplinary teams are essential. 24 McLaren et al recently pointed out, that self-identification, that is, that symptoms are understood as a disorder, is relevant for help-seeking behaviour in depressive illness, in addition to openness for a biopsychosocial model. 10 Balint stressed the importance of initial contacts with patients with somatoform disorders in general practice.…”

Section: Discussionmentioning

confidence: 99%

“…22 23 In sum, on the one hand, there is limited data on illness perception in FND, which is of importance in particular at the beginning of diagnostic and treatment processes; on the other hand, there has been a surge of interest and scientific study of the disorder over the last two decades. 24 As specific therapeutic concepts are rarely implemented in general neurological practice (apart from centres acquainted with the disorder), 24 patients often remain unable to develop coherent illness models and respective coping strategies. This likely impacts on management and prognosis, including adherence and self-efficacy.…”

Section: What This Study Addsmentioning

confidence: 99%

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Illness perception in functional neurological disorder: low illness coherence and personal control

Joos,

Popkirov,

Lahmann

et al. 2024

BMJ Neurol Open

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IntroductionIllness perception refers to patients’ subjective representations and appraisals of somatic and mental symptoms. These are relevant for self-management and outcome. In clinical practice, patients with functional neurological disorder (FND) often encounter a fragmented biomedical attitude, which leaves them without clear concepts. In this context, illness perception is relevant.MethodsIllness perception was assessed in FND patients and compared with samples of psychosomatic patients (PSM) as well as poststroke patients (STR). The three samples (FND, n=87; PSM, n=97 and STR, n=92) were almost all in inpatient treatment or rehabilitation. Illness perception was assessed with the revised German version of the Illness Perception Questionnaire (IPQ-R). For assessments of correlations, depressive symptoms were tested with the Patient Health Questionnaire-9, dissociative and functional neurological symptoms by the German adaption of the Dissociative Experiences Scale and biopsychosocial complexity by the INTERMED Self-Assessment questionnaire.ResultsApart from the chronicity subscale, all dimensions of the IPQ-R differed between groups. FND patients perceived lower illness coherence and personal control than both other groups and attributed their illness more to chance than to behavioural risk factors. PSM patients had the strongest emotional representations. There were only few correlations with dissociative scores and biopsychosocial complexity.ConclusionIllness perception is an important issue in patients with FND with particular emphasis on low illness coherence and personal control. Missing associations with biopsychosocial complexity suggest that subjective illness perception is an important complementary but separate issue, which likely influences therapeutic alliance and self-management in FND. Future studies should assess its influences on outcome.Trial registration numberDRKS00024685; German Clinical Trials Register;www.drks.de.

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Lessons from a Neurologist After 25 Years of Functional Neurological Disorder Subspeciality Practice

Stone

2023

Neurologic Clinics

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Setting up Functional Neurological Disorder Treatment Services

Cited by 5 publications

References 35 publications

Factors Influencing Triage to Rehabilitation in Functional Movement Disorder

Factors Influencing Triage to Rehabilitation in Functional Movement Disorder

Illness perception in functional neurological disorder: low illness coherence and personal control

Lessons from a Neurologist After 25 Years of Functional Neurological Disorder Subspeciality Practice

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