Abstract
AbstractObjectiveFunctional neurological symptoms (FNS) are disabling symptoms without macro‐structural cause. While inpatient treatment confers important benefits, it is resource‐intensive, and hence, it is important to optimise its efficiency.MethodsWe developed a brief, Internet‐based preparatory therapy based on psychoeducation and CBT, termed the Queen Square Guided Self‐help (QGSH), to maximise the efficacy of the inpatient FNS treatment at the National Hospital for Neurology and Neurosurgery.ResultsThe QGSH aims to ensure that prior to admission, the patient understands (a) the diagnosis of FNS, (b) the five‐areas CBT model and (c) the use of goal setting in rehabilitation. It has now run since 2017, and 191 patients have taken part in the inpatient FNS programme, with 122 of these having participated in the QGSH. It runs for up to 12 weeks and includes original videos and patient worksheets, as well as signposting to existing published resources. Information is sent weekly by email, and content is delivered in the form of 11 modules built around online video sessions.ConclusionWe believe that the set of materials used in QGSH has the potential to benefit patients with FNS and can support clinicians wishing to develop their expertise. It could help with the development of new FNS services, and we are in the process of developing it into a stand‐alone service. We hope that the experience of the Queen Square team can be used to help patients and clinicians to improve the provision of FNS services.
Highlights
Functional neurological symptoms (FNS) are disabling symptoms without macro-structural cause (American Psychiatric Association, 2013)
An important subtype of FNS is non-epileptic attack disorder (NEADs), known as dissociative or psychogenic seizures, which present with episodes of disrupted consciousness without EEG evidence of epileptic brain activity (American Psychiatric Association, 2013)
In order to improve the Queen Square Guided Self-h elp (QGSH), we developed an ongoing evaluation system based on a Patient-provided Routine Outcome Measure (PROM) and a complementary Clinician-provided Routine Outcome Measure (CROM)
Summary
Functional neurological symptoms (FNS) are disabling symptoms without macro-structural cause (American Psychiatric Association, 2013). These symptoms have been described using a range of terms including ‘hysterical’, ‘conversion’ and ‘somatisation’, each with implications about the underlying mechanism. The diagnosis is based on a pattern of positive signs and symptoms that are characteristic of functional disease and that vary with time or attention (Carson et al, 2016). This is reflected in the DSM-5 and ICD-10 criteria (see Appendix 2). An important subtype of FNS is non-epileptic attack disorder (NEADs), known as dissociative or psychogenic seizures, which present with episodes of disrupted consciousness without EEG evidence of epileptic brain activity (American Psychiatric Association, 2013)
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