22 Psychiatric co-morbidity of patients referred to a neuropsychiatry clinic with functional neurological symptoms

Abstract

Objective Functional neurological disorders are common in neurology outpatient clinics and subsequently may be referred for follow-up to other specialists in neurology, neuropsychology and neuropsychiatry. The main aim of this study was to examine the prevalence of mental health problems in a group of patients referred to neuropsychiatry with functional neurological symptoms Method The case notes of fifty consecutive patients with a functional disorder seen at a neuropsychiatry clinic were reviewed. Frequency of associated psychiatric co-morbidity, previous self-harming, and other variables was reviewed. Results The most common form of functional neurological disorder reviewed at clinic were blackouts/non-epileptic attacks followed by functional movement disorders. However, a wide variety of other functional symptoms were observed including functional forms of speech problems, tics, blindness, and fugues. Rates of previous deliberate self-harm was high with 60% having a history of either self-harming or suicide attempts. The most common diagnoses was post-traumatic stress disorder which was seen in almost a third. Less than 10% had no evidence of any Axis One disorder. Over a third had co-morbid borderline personality disorder or significant traits of emotionally unstable personality disorder. Over 90% of individuals had a history of experiencing some significant emotional trauma- the majority of such traumas had occurred decades earlier in childhood with only a few reporting more recent stresses. Conclusion Severe enduring psychiatric problems are very commonly seen in a cohort of individuals referred to a neuropsychiatric clinic with functional neurological symptoms. Rates of previous self-harming are especially high. This study shows the importance of neuropsychiatry within the multidisciplinary management of functional neurological symptoms.