A Novel Treatment Protocol (Nocebo Hypothesis Cognitive Behavioural Therapy; NH-CBT) for Functional Neurological Symptom Disorder/Conversion Disorder: A Retrospective Consecutive Case Series

2018 ◽  
Vol 46 (4) ◽  
pp. 497-503 ◽  
Author(s):  
Matt Richardson ◽  
Gina Isbister ◽  
Brad Nicholson
Keyword(s):  
Neurological Symptom ◽  
Treatment Protocol ◽  
Case Series ◽  
Conversion Disorder ◽  
Functional Independence ◽  
Interdisciplinary Treatment ◽  
Controlled Study ◽  
Consecutive Case ◽  
Symptom Remission ◽  
Functional Neurological Symptom Disorder

Background: Theories concerning the aetiology of functional neurological symptom disorder (FNSD; also known as conversion disorder) have historically inferred that psychological factors or dissociative states underlie patients’ symptoms. Current psychological models of functional neurological symptoms suggest that some type of ‘top-down’ representations/beliefs are activated automatically (without conscious awareness), leading to symptoms. It is assumed that these representations or beliefs are similar to the idea ‘I am neurologically damaged’, as in our clinical experience, almost all patients have some reason to doubt the integrity of their neurological system. Aims: It was hypothesized that FNSD arises from a belief of being neurologically damaged (via a mechanism akin to a nocebo response), and an interdisciplinary treatment protocol was developed consistent with this hypothesis, transparently sharing this theory with participants. Method: A retrospective consecutive case series design was utilized, measuring functional independence and symptom remission. Results: Of the 13 episodes of care, 12 resulted in complete or almost complete symptom remission. Length of stay in rehabilitation was also reduced compared with previous treatment attempts. Conclusions: It appears as if the treatment protocol may be very effective, and further controlled study appears warranted.

scholarly journals Functional Neurological Symptom Disorder in a Patient with Parkinson’s Disease and Psychotic Features: A Case Report

2020 ◽  
Vol 24 (4) ◽  
Author(s):  
Seyed Abolfazl Ghoreishi ◽  
Hoda As'adi
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Neurological Symptom ◽  
Diagnostic Category ◽  
Conversion Disorder ◽  
Primary Treatment ◽  
Classification Systems ◽  
Wearing Off ◽  
Psychotic Features ◽  
Functional Neurological Symptom Disorder

: The conversion disorder (CD) or functional neurological symptom disorder is a diagnostic category used in some psychiatric classification systems, which often refers to the patients presenting with neurological symptoms. Parkinson’s disease (PD) essentially affects non-motor and motor functions. The chronic use of levodopa, which is the primary treatment in this regard, has been reported to cause complications such as the wearing-off phenomenon. This problem may also increase the disease symptoms, as well as the patients’ need to receive higher doses of the drug to remain symptom-free for a longer period. This case study aimed to describe a 47-year-old male patient with PD and psychotic features, the symptoms of which had progressed in a conversional setup relating to particular visitation times. According to the examinations, CD was the main problem, which simulated the features of PD.

scholarly journals Post-operative functional neurological symptom disorder after anesthesia

2020 ◽  
Author(s):  
Ryan S D'Souza ◽  
Matthew NP Vogt ◽  
Edwin Rho
Keyword(s):  
Neurological Symptom ◽  
Past History ◽  
Significant Proportion ◽  
Case Series ◽  
Pharmacologic Therapy ◽  
Prior History ◽  
General Anesthetic ◽  
Tertiary Referral Hospital ◽  
History Of ◽  
Functional Neurological Symptom Disorder

A rare manifestation during the post-anesthetic period may include the occurrence of functional neurological symptom disorder (FNSD). FNSD is described as neurological symptoms that are not consistently explained by neurological or medical conditions. We report a case series consisting of six patients who underwent a general anesthetic at a tertiary referral hospital and experienced FNSD in the immediate post-anesthetic period. Life-threatening causes were excluded based on benign physical exam findings and knowledge of past history. Five of six cases manifested with FNSD only in the immediate post-operative setting after exposure to anesthesia, and never otherwise experienced these symptoms during their normal daily lives. MEDLINE and Google Scholar were searched through October 2019 using a highly-sensitive search strategy and identified 38 published cases of post-anesthetic FNSD. Meta-analysis of pooled clinical data revealed that a significant proportion of patients were females (86%), reported a history of psychiatric illness (49%), reported a prior history of FNSD (53%), and underwent general anesthesia as the primary anesthetic (93%). The majority of patients were exposed to diagnostic studies (66% received radiographic tests and 52% received electroencephalogram) as well as pharmacologic therapy (57%). While no deaths occurred, many patients had unanticipated admission to the hospital (53%) or to the intensive care unit (25%). These data may help inform the anesthesia literature on presentation, risk factors, and treatment outcomes of FNSD in the context of anesthetic administration. We contemplate whether anesthetic agents may predispose a vulnerable brain to manifest with involuntary motor and sensory control seen in FNSD.

Functional neurological symptom disorder (conversion disorder)

2020 ◽  
pp. 1350-1360
Author(s):  
Jon Stone ◽  
Michael Sharpe
Keyword(s):  
Neurological Symptom ◽  
Neurological Disease ◽  
Visual Loss ◽  
Psychological Treatment ◽  
Initial Step ◽  
Conversion Disorder ◽  
Physical Symptom ◽  
Limb Weakness ◽  
Depression Disorders ◽  
Functional Neurological Symptom Disorder

Conversion disorder (now also called functional neurological symptom disorder) describes symptoms (of motor and sensory dysfunction such as limb weakness, tremor, visual loss, with or without ‘blackouts’), which can be positively identified as being inconsistent with neurological disease. The disorder is common in neurological services and frequently seen by psychiatrists working in such settings. It is often associated with chronic severe disability. The diagnosis previously hinged on the neurologist’s demonstration of the lack of disease and the psychiatrist’s hypothesis of a ‘conversion’ of stress into a physical symptom. It is now based on positive findings on neurological assessment supplemented by a psychiatric assessment to confirm the diagnosis. Comorbid anxiety and depression disorders are common. Treatment is multi-disciplinary. Explanation of the condition to the patient is a crucial initial step supplemented, where necessary, by psychological treatment (especially for dissociative or non-epileptic attacks) and physiotherapy for functional motor symptoms. The prognosis without treatment is poor once the disability is established.

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