Open Access<p>Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective</p>
Author(s) -
Aneeta Saxena,
Ellen Godena,
Julie Maggio,
David L. Perez
Publication year - 2020
Publication title -
neuropsychiatric disease and treatment
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.819
H-Index - 67
eISSN - 1178-2021
pISSN - 1176-6328
DOI - 10.2147/ndt.s247119
Subject(s) - medicine , conversion disorder , psychogenic disease , neuropsychiatry , psychosocial , neurology , psychiatry , movement disorders , neurological examination , physical medicine and rehabilitation , physical therapy , pathology , disease
Functional neurological disorder (FND), a condition at the intersection of neurology and psychiatry, is a common and disabling outpatient referral to neurology and neuropsychiatry clinics. In this perspective article, we focus on the motor spectrum of FND (mFND), including individuals with functional movement disorders (FND-movt), functional limb weakness/paresis (FND-par) and functional [psychogenic non-epileptic/dissociative] seizures (FND-seiz). Over the past several decades, there have been dedicated efforts within the neurologic and psychiatric communities to create "rule-in" diagnostic criteria, as well as thoughtful approaches to the clinical interview, delivery of the diagnosis and the development of a patient-centered treatment plan. These advances allow the promotion of good clinical practices in the outpatient assessment and management of mFND. Informed by the literature and our prior clinical experiences, we provide suggestions on how to evaluate individuals with suspected functional motor symptoms - including conducting sensitive psychiatric and psychosocial screenings. Additional sections discuss common "rule-in" neurological examination and semiologic signs of motor FND, as well as approaches to deliver the diagnosis and formulate a treatment plan based on individual patient needs. To aid the development of shared (partially overlapping) expertise that catalyzes an interdisciplinary approach to mFND, the use of physiotherapy for therapeutic motor retraining and cognitive behavioral therapy to examine relationships between symptoms, thoughts, behaviors and emotions are also discussed. Additional clinical research is needed to further refine and operationalize the assessment and management of mFND, across clinics, healthcare settings and countries.