The Biopsychosocial Formulation for Functional Movement Disorder

MacGillivray, Lindsey; Lidstone, Sarah C.

doi:10.1007/978-3-030-86495-8_3

Cited by 4 publications

(3 citation statements)

References 51 publications

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“…If there is co-morbid anxiety or symptoms are worse with stress, relaxation techniques including mindfulness, breathing exercises, and sensory grounding can be helpful. 96…”

Section: Comparing Neurological Assessment and Dedicated Specialist F...mentioning

confidence: 99%

Moving Beyond Movement: Diagnosing Functional Movement Disorder

Gilmour

Lidstone

2023

Semin Neurol

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Functional movement disorder (FMD) is a complex neuropsychiatric syndrome, encompassing abnormal movements and weakness, and is a common cause of potentially disabling neurological symptoms. It is vital to recognize that FMD is a syndrome, with nonmotor manifestations negatively affecting a patient's quality of life. This review highlights a diagnostic algorithm, where a history suggestive of FMD is combined with the presence of positive signs on examination and appropriate investigations to make the diagnosis. Positive signs indicate internal inconsistency such as variability and distractibility, and clinical findings that are incongruent with other known neurological disease. Importantly, the clinical assessment acts as the first opportunity to allow patients to understand FMD as the cause for their symptoms. Accurate and early diagnosis of FMD is necessary given that it is a treatable and potentially reversible cause of disability, with significant risk of iatrogenic harm associated with misdiagnosis.

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“…If there is co-morbid anxiety or symptoms are worse with stress, relaxation techniques including mindfulness, breathing exercises, and sensory grounding can be helpful. 96…”

Section: Comparing Neurological Assessment and Dedicated Specialist F...mentioning

confidence: 99%

Moving Beyond Movement: Diagnosing Functional Movement Disorder

Gilmour

Lidstone

2023

Semin Neurol

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“…2 FMD is best conceptualized using a biopsychosocial framework, with identifiable risk factors and triggering events that are relevant for functional symptom onset, and perpetuating factors that are relevant for symptom maintenance. 3 Growing evidence exists for various treatments for FMD including motor retraining/specialist physiotherapy (PT), occupational therapy, speech-language therapy, multidisciplinary or integrated rehabilitation, and specialist cognitive behavioral therapy or psychotherapy. [4][5][6][7][8] Across most studies, two-thirds of patients demonstrate improvements in physical function and quality of life.…”

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confidence: 99%

“…Patients with FMD have a motor‐dominant presentation, frequently with combinations of multiple motor and non‐motor symptoms 2 . FMD is best conceptualized using a biopsychosocial framework, with identifiable risk factors and triggering events that are relevant for functional symptom onset, and perpetuating factors that are relevant for symptom maintenance 3 …”

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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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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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