Abstract
AimWe report results from a 5-week MDT treatment programme, with individualised sessions, for a selected group of patients with FNSD, delivered in a neuropsychiatric outpatient setting. Primary aims were to (1) reduce symptoms, (2) improve functional performance and (3) improve health status.MethodsTreatment involved individual sessions of neuropsychiatry, cognitive behavioural therapy, physiotherapy, occupational-therapy, education and family meetings. Outcome measures collected at the beginning and end of treatment and at 6 months, were patient and clinician reported. Aims were assessed by the following: symptom reduction (PHQ15, PHQ9, GAD7, SPIN, Rosenberg); health and social functioning (HONOS, WSAS); functional performance (COPM); health status (EQ-5D-5L) and patient-rated perception of improvement (CGI).ResultsAnalyses of 78 patients completing the programme and attending a 6-month review revealed high-baseline levels of disability compared to EQ-5DL population norms and high rates of disability and psychopathology as indicated by the WSAS and mental health indices (PHQ9, GAD7, SPIN, Rosenberg’s self-esteem). At baseline, 92.3% met the IAPT caseness threshold for depression and 71% met the IAPT caseness threshold for anxiety. A Friedman ANOVA over the three time points and Dunn-Bonferroni post hoc tests indicated statistically significant improvements from admission to discharge and admission to 6-month follow-up. Sustained improvements were seen in somatic symptoms (PHQ15), depression (PHQ9), anxiety (GAD7), health and social functioning (HONOS), functionality (COPM), health status (EQ-5D-5L) and patient-rated clinical global improvement (CGI).ConclusionAn MDT can effectively deliver an outpatient programme for FNSD which can serve as an alternative to costlier inpatient programmes. Early identification and treatment of co-morbidities is advised.
Highlights
Functional neurological symptom disorders (FNSD) [1] encompass symptoms seemingly manifested through the nervous system, but which are not caused by a physical neurological disease
We aimed to assess whether a 5-week outpatient-based multidisciplinary team (MDT) treatment programme for FNSD (including neuropsychiatry, cognitive behavioural therapy (CBT), physiotherapy, occupational therapy (OT), previously shown to have sustained long-term benefit when delivered as an inpatient programme [21], could be delivered effectively in an outpatient setting and demonstrate sustained improvements
This study focuses on a selected group of FNSD patients who were: referred to a tertiary service, motivated to attend, ready and suitable to participate in a neuropsychiatry-led programme and had completed outcome measures on admission, discharge and 6-month review
Summary
Functional neurological symptom disorders (FNSD) [1] encompass symptoms seemingly manifested through the nervous system, but which are not caused by a physical neurological disease. Psychosomatic, somatization, medically unexplained symptoms and conversion disorder. The current preference, following the DSM-5 adoption of the term functional is intended to be causally neutral [2]. The requirement to identify an associated psychological factor was removed from the criteria in DSM-5, the importance of exploring psychological stressors continued to be emphasised in the accompanying text [3]. Journal of Neurology (2020) 267:2655–2666 it is referred to as dissociative neurological symptom disorder [4]. FNSD accounts for approximately 6% of neurology outpatient contacts and community incidence rates of 4–12 per 100,000 per annum [5]. The diagnosis is considered reliable, with revision rates less than 5% [5]
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