Functional disorders

Abstract

Functional disorders in neurology: Changing a negative to a positiveFunctional symptoms and disorders (also called psychogenic, non-organic and conversion disorders) are a common cause of distress and disability and account for around 1 in 6 new referrals to the neurology clinic. In the last 10-15 advances in understanding, diagnosis and treatment of patients with functional disorders have changed the clinical landscape1. These are turning traditionally negative views in to a more positive approach which brings these disorders back within standard neurological practice.In this lecture I will discuss: 1) The importance of making the diagnosis, not on psychosocial grounds or as a diagnosis of exclusion, but using positive diagnostic clinical signs, such as Hoover’s sign of functional leg weakness or the entrainment test of functional tremor; 2) The central role of the neurologist in providing explanation, information (for example www.neurosymptoms.org), and triage of treatment (with some practical examples); 3) Increasing recognition of the evidence base for physiotherapy2 as well as psychological therapy3; 4) Changes in the model that we use to think about the mechanism and aetiology of these problems which now incorporate biological as well as psychological factors4.1. Stone, J. & Carson, A. Functional Neurologic Disorders. Continuum. 21, 818–837 (2015).2. Nielsen, G. et al. Physiotherapy for functional motor disorders. JNNP (2015). doi:10.1136/jnnp-2014-3092553. Goldstein, L. H. et al. Cognitive-behavioral therapy for psychogenic nonepileptic seizures: A pilot RCT. Neurology 74, 1986–1994 (2010).4. Edwards, M. J., et al A Bayesian account of ‘hysteria’. Brain 135, 3495–512 (2012). Functional disorders in neurology: Changing a negative to a positive Functional symptoms and disorders (also called psychogenic, non-organic and conversion disorders) are a common cause of distress and disability and account for around 1 in 6 new referrals to the neurology clinic. In the last 10-15 advances in understanding, diagnosis and treatment of patients with functional disorders have changed the clinical landscape1. These are turning traditionally negative views in to a more positive approach which brings these disorders back within standard neurological practice. In this lecture I will discuss: 1) The importance of making the diagnosis, not on psychosocial grounds or as a diagnosis of exclusion, but using positive diagnostic clinical signs, such as Hoover’s sign of functional leg weakness or the entrainment test of functional tremor; 2) The central role of the neurologist in providing explanation, information (for example www.neurosymptoms.org), and triage of treatment (with some practical examples); 3) Increasing recognition of the evidence base for physiotherapy2 as well as psychological therapy3; 4) Changes in the model that we use to think about the mechanism and aetiology of these problems which now incorporate biological as well as psychological factors4. 1. Stone, J. & Carson, A. Functional Neurologic Disorders. Continuum. 21, 818–837 (2015). 2. Nielsen, G. et al. Physiotherapy for functional motor disorders. JNNP (2015). doi:10.1136/jnnp-2014-309255 3. Goldstein, L. H. et al. Cognitive-behavioral therapy for psychogenic nonepileptic seizures: A pilot RCT. Neurology 74, 1986–1994 (2010). 4. Edwards, M. J., et al A Bayesian account of ‘hysteria’. Brain 135, 3495–512 (2012).