The prognosis of functional (psychogenic) motor symptoms: a systematic review

Gelauff, Jeannette M.; Stone, Jon; Edwards, Mark J.; Carson, Alan

doi:10.1136/jnnp-2013-305321

Cited by 284 publications

(253 citation statements)

References 40 publications

(122 reference statements)

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“…However, patients with FMD are generally reported to have poor outcome, with persistent symptoms reported in 65-95 % patients [2][3][4]. Such reports, most of which are based in tertiary referral centers may overstate poor outcome, but a recent systematic review of outcome in patients with functional motor symptoms, in general, also found outcome, in general, to be poor, with most studies finding at least 50 % of patients to still be symptomatic at long-term follow-up [5].…”

Section: Introductionmentioning

confidence: 97%

Treatment of Functional (Psychogenic) Movement Disorders

Ricciardi

Edwards

2014

Neurotherapeutics

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Functional (psychogenic) movement disorders are a common source of disability and distress. Despite this, little systematic evidence is available to guide treatment decisions. This situation is likely to have been influenced by the "no man's land" that such patients occupy between neurologists and psychiatrists, often with neither side feeling a clear responsibility or ability to direct management. The aim of this narrative review is to provide an overview of the current state of the evidence regarding management of functional movement disorders. This reveals that there is some evidence to support the use of specific forms of cognitive behavioral therapy and physiotherapy. Such treatments may be facilitated in selected patients with the use of antidepressant medication, and may be more effective for those with severe symptoms when given as part of inpatient multidisciplinary rehabilitation. Other treatments, for example hypnosis and transcranial magnetic stimulation, are of interest, but further evidence is required regarding mechanism of effect and long-term benefit. Though prognosis is poor in general, improvement in symptoms is possible in patients with functional movement disorders, and there is a clear challenge to clinicians and therapists involved in their care to conduct and advocate for high-quality clinical trials.

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Section: Introductionmentioning

confidence: 97%

Treatment of Functional (Psychogenic) Movement Disorders

Ricciardi

Edwards

2014

Neurotherapeutics

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“…3 Given the frequency, consequences, prognosis, and burden, FND has been called a "crisis for neurology." 4 Despite this, FND is poorly understood.…”

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confidence: 99%

Functional Neuroanatomy and Neurophysiology of Functional Neurological Disorders (Conversion Disorder)

Voon¹,

Cavanna²,

Coburn³

et al. 2016

JNP

131

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Much is known regarding the physical characteristics, comorbid symptoms, psychological makeup, and neuropsychological performance of patients with functional neurological disorders (FNDs)/conversion disorders. Gross neurostructural deficits do not account for the patients' deficits or symptoms. This review describes the literature focusing on potential neurobiological (i.e. functional neuroanatomic/neurophysiological) findings among individuals with FND, examining neuroimaging and neurophysiological studies of patients with the various forms of motor and sensory FND. In summary, neural networks and neurophysiologic mechanisms may mediate "functional" symptoms, reflecting neurobiological and intrapsychic processes. J Neuropsychiatry Clin Neurosci 2016; 28:168-190; doi: 10.1176/appi.neuropsych.14090217 Functional neurological disorders (FNDs; or psychogenic neurological symptoms), also known as conversion disorder, are a classic neuropsychiatric disorder, existing in the border between neurology and psychiatry. Unexplained neurological symptoms are common, occurring in up to one-third of patients in neurological outpatient clinics.1 Relative to disorders such as Parkinson's disease, FND is associated with similar levels of disability and physical quality of life with poorer mental health quality of life. 2 The prognosis is poor, with a recent reviewshowing that up to 40% of patients with FND report similar or worse outcomes at 7-year follow-up. 3 Given the frequency, consequences, prognosis, and burden, FND has been called a "crisis for neurology." 4 Despite this, FND is poorly understood. In the last decade, an increasing number of studies have focused on underlying neurobiological mechanisms. FND is defined in DSM-5 as the presence of one or more symptoms of altered voluntary or sensory function, with clinical findings providing evidence of incompatibility between the symptom and recognized neurological or medical conditions.5 The DSM-5 diagnosis differs from that of the DSM-IV diagnosis of conversion disorder by adding the criterion of incorporating physical diagnostic features and by relegating to the accompanying text the criteria requiring (a) an association with psychological stressors and (b) the exclusion of malingering or factitious disorder to make the diagnosis. DSM-5 FND diagnosis criteria now allow for potential greater interrater reliability, making them appropriate for research studies and greater compatibility with specialtyspecific diagnoses including psychogenic movement disorder (PMD) and psychogenic nonepileptic seizures (PNES). 6The putative biopsychosocial mechanisms underlying FND are complex and have been extensively reviewed.7 Our review focuses on the physiological mechanisms that may underlie FND and does not specifically focus on the extensive literature on the antecedents of early childhood experiences and temperament (Figure 1). At the outset, regarding the proposed model, we acknowledge that predisposing factors for functional neurological symptoms are not limited to genetics, te...

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“…Compared with patients suffering from disease pathology, patients with functional disorders suffer from more distress and disability, more social isolation and are more likely to be receiving disability-related state financial benefits [3,4]. Although functional disorders can remit spontaneously, the prognosis is often poor [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Functional neurological disorders: mechanisms and treatment

et al. 2015

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Functional neurological disorders are common problems in neurologic practice. In the past decade there has been an increasing interest in this group of disorders both from a clinical as well as research point of view. In this review, we highlight some of the most salient and exciting publications from recent years focusing especially on new findings illuminating mechanism and studies examining treatment.

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The prognosis of functional (psychogenic) motor symptoms: a systematic review

Cited by 284 publications

References 40 publications

Treatment of Functional (Psychogenic) Movement Disorders

Treatment of Functional (Psychogenic) Movement Disorders

Functional Neuroanatomy and Neurophysiology of Functional Neurological Disorders (Conversion Disorder)

Functional neurological disorders: mechanisms and treatment

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