Functional neurological disorders

2020 ◽  
pp. 267-276
Author(s):  
Mark Edwards ◽  
Sarah R. Cope ◽  
Niruj Agrawal
Keyword(s):  
Neurological Disorders ◽  
Controlled Trial ◽  
Treatment Options ◽  
Behavioural Therapy ◽  
Cognitive Disorder ◽  
Motor Disorder ◽  
Interpersonal Therapy ◽  
Treatment Services ◽  
Cognitive Behavioural ◽  
Functional Neurological Disorders

Referred to by the ancient Greeks as ‘Hysteria’, functional neurological disorders (FNDs) are one of the most prevalent diagnoses made in neurology clinics. Nonetheless, in part, due to the uncertainty regarding the potential voluntariness of such conditions, diagnostic and treatment services for FNDs are underdeveloped by comparison to those for other causes of neurological symptoms. This chapter discusses historical approaches to the classification and approach to FNDs, before moving on to contemporary treatments for it. Various treatments are then described with regard to certain forms of FNDs, such as the effects of cognitive behavioural therapy (CBT) and psychodynamic interpersonal therapy on functional non-epileptic attacks and multidisciplinary inpatient treatment, physiotherapy, and hypnosis on functional motor disorder. Finally, the relative lack of treatment options for functional cognitive disorder (FCD) is discussed, along with the initial findings of a pilot randomized controlled trial for it.

scholarly journals #3121 Adapting the queen square guided self help (QGSH) for functional neurological disorders as a stand-alone intervention: an exonian pilot study

2021 ◽  
Vol 92 (8) ◽  
pp. A17.2-A17
Author(s):  
Jasjeet Sachdeva ◽  
Caroline Selai ◽  
Michael Moutoussis
Keyword(s):  
Neurological Disorders ◽  
Behavioural Therapy ◽  
Post Intervention ◽  
Patient Feedback ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Before And After ◽  
Significant Disability ◽  
The Impact ◽  
Functional Neurological Disorders

AimFunctional neurological disorders (FND) are one of the most common presentation in neurology clinics, causing a significant disability and economic burden. Cognitive behavioural therapy (CBT) has one of the best available evidence in managing FND, although access remains limited. Queen Square, London neuropsychiatry experts have established an excellent model for a CBT based, Guided Self Help (GSH) programme, which is preparatory to a multidisciplinary inpatient treatment. It has been shown to have good outcomes. This study was designed to ascertain the feasibility and acceptance of this QGSH model, in an Exonian cohort of FND patients, whilst piloting its stand-alone version, without the inpatient component. Additionally, the study explores the need and types of modifications required for the stand-alone adaptation of QGSH.MethodConsecutive patients referred to Exeter FND Service, between February to June 2020, who had internet access, were offered the QGSH pilot. Patients with a primary mental disorder concurrent drug/alcohol misuse or risk of self-harm or suicide were excluded. Ethics approval was not required. The QGSH intervention constitutes of 11 modules focussing on specific elements crucial to FND management along with homework tasks, delivered by the author, under supervision by QGSH experts. Patients completed Pre and Post-intervention questionnaires as well as structured feedback.ResultsThree successive patients with varied FND symptoms were recruited to the pilot between February and June 2020. The baseline health status of these patients was worse as compared to EQ-5D-5L population norms with significant baseline psychiatric comorbidity. Outcome measures used before and after QGSH intervention included PHQ 9, GAD 7, EQ-5D-5L and a locally devised symptom severity questionnaire. Necessary modifications were made to the program based on the patients informal feedback and structured formal feedback was sought in the end.ConclusionAll patients derived some benefit from QGSH and certain modifications were suggested in patient feedback to improve engagement. Despite study limitations, especially small size and the impact of Covid 19 pandemic during the intervention; QGSH model appears acceptable and feasible in an Exonian cohort, however, some modifications are recommended for the stand-alone version to succeed. The recommendations will be presented.

scholarly journals Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness

2017 ◽  
Vol 18 (1) ◽  
pp. 5-13 ◽  
Author(s):  
Stoyan Popkirov ◽  
Jeffrey P Staab ◽  
Jon Stone
Keyword(s):  
Neurological Disorders ◽  
Treatment Strategies ◽  
Behavioural Therapy ◽  
Phobic Postural Vertigo ◽  
Cognitive Behavioural ◽  
Chronic Dizziness ◽  
Vestibular Symptoms ◽  
Functional Gait ◽  
Functional Neurological Disorders

Persistent postural-perceptual dizziness (PPPD) is a newly defined diagnostic syndrome that unifies key features of chronic subjective dizziness, phobic postural vertigo and related disorders. It describes a common chronic dysfunction of the vestibular system and brain that produces persistent dizziness, non-spinning vertigo and/or unsteadiness. The disorder constitutes a long-term maladaptation to a neuro-otological, medical or psychological event that triggered vestibular symptoms, and is usefully considered within the spectrum of other functional neurological disorders. While diagnostic tests and conventional imaging usually remain negative, patients with PPPD present in a characteristic way that maps on to positive diagnostic criteria. Patients often develop secondary functional gait disorder, anxiety, avoidance behaviour and severe disability. Once recognised, PPPD can be managed with effective communication and tailored treatment strategies, including specialised physical therapy (vestibular rehabilitation), serotonergic medications and cognitive-behavioural therapy.

scholarly journals Low-Intensity Guided Help Through Mindfulness (LIGHTMIND): Study protocol for a randomised controlled trial comparing supported Mindfulness-Based Cognitive Therapy self-help to supported Cognitive Behavioural Therapy self-help for adults experiencing depression

2020 ◽  
Author(s):  
Clara Strauss ◽  
Amy Arbon ◽  
Michael Barkham ◽  
Sarah Byford ◽  
Rebecca Crane ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Cognitive Therapy ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Treatment Options ◽  
Behavioural Therapy ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Complete Treatment ◽  
Randomised Controlled

Abstract Background: Depression has serious personal, family and economic consequences. It is estimated that it will cost £12.15 billion to the economy each year in England by 2026. Improving Access to Psychological Therapies (IAPT) is the National Health Service talking therapies service in England for adults experiencing anxiety or depression. Over 1 million people are referred to IAPT every year, over half experiencing depression. Where symptoms of depression are mild/moderate, people are typically offered Cognitive Behavioural Therapy (CBT) self-help supported by a psychological wellbeing practitioner (PWP). The problem is that over half of people who complete treatment for depression in IAPT remain depressed despite receiving National Institute of Health and Care Excellent (NICE) recommended treatment. Furthermore, less than half of IAPT service users complete treatment. This study seeks to investigate the effectiveness of an alternative to CBT self-help. Mindfulness-based cognitive therapy differs from CBT in focus, approach and practice and may be more effective with a higher number of treatment completions. Methods/Design: This is a definitive randomised controlled trial comparing supported mindfulness-based cognitive therapy self-help (MBCT-SH) with supported cognitive behavioural therapy self-help (CBT-SH) for adults experiencing mild/moderate depression being treated in IAPT services. Four hundred and ten participants experiencing mild/moderate depression will be recruited from IAPT services and randomised to receive either an MBCT-based self-help workbook or a CBT-based self-help workbook. Participants will be asked to complete their workbook within 16 weeks, with six support sessions with a PWP. The primary outcome is depression symptom severity upon treatment completion. Secondary outcomes are treatment completion rates and measures of generalized anxiety, wellbeing, functioning and mindfulness. An exploratory non-inferiority analysis will be conducted in the event the primary hypothesis is not supported. A semi-structured interview with participants will guide understanding of change processes.Discussion: If the findings from this randomised controlled trial demonstrate that MBCT-SH is more effective than CBT-SH for adults experiencing depression, this will provide evidence for policy makers and lead to changes to clinical practice in IAPT services, leading to greater choice of self-help treatment options and better outcomes for service users. If the exploratory non-inferiority analysis is conducted and this indicates non-inferiority of MBCT-SH in comparison to CBT-SH this will also be of interest to policy makers when seeking to increase service user choice of self-help treatment options for depression. Trial registration: Current Controlled Trial registration number ISRCTN 13495752. Registered on 31 August 2017 (www.isrctn.com/ISRCTN13495752).Protocol Version: Version 1 (18 January 2020)Date first participant randomised: 24 November 2017Trial Sponsor: Sussex Partnership NHS Foundation Trust ([email protected])

scholarly journals Low-Intensity Guided Help Through Mindfulness (LIGHTMIND): Study protocol for a randomised controlled trial comparing supported Mindfulness-Based Cognitive Therapy self-help to supported Cognitive Behavioural Therapy self-help for adults experiencing depression

2020 ◽  
Author(s):  
Clara Strauss ◽  
Amy Arbon ◽  
Michael Barkham ◽  
Sarah Byford ◽  
Rebecca Crane ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Cognitive Therapy ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Treatment Options ◽  
Behavioural Therapy ◽  
Self Help ◽  
Cognitive Behavioural ◽  
Complete Treatment ◽  
Randomised Controlled

Abstract Background Depression has serious personal, family and economic consequences. It is estimated that it will cost £12.15 billion to the economy each year in England by 2026. Improving Access to Psychological Therapies (IAPT) is the National Health Service talking therapies service in England for adults experiencing anxiety or depression. Over 1 million people are referred to IAPT every year, over half experiencing depression. Where symptoms of depression are mild/moderate, people are typically offered Cognitive Behavioural Therapy (CBT) self-help supported by a psychological wellbeing practitioner (PWP). The problem is that over half of people who complete treatment for depression in IAPT remain depressed despite receiving National Institute of Health and Care Excellent (NICE) recommended treatment. Furthermore, less than half of IAPT service users complete treatment. This study seeks to investigate the effectiveness of an alternative to CBT self-help. Mindfulness-based cognitive therapy differs from CBT in focus, approach and practice and may be more effective with a higher number of treatment completions. Methods/Design This is a definitive randomised controlled trial comparing supported mindfulness-based cognitive therapy self-help (MBCT-SH) with supported cognitive behavioural therapy self-help (CBT-SH) for adults experiencing mild/moderate depression being treated in IAPT services. Four hundred and ten participants experiencing mild/moderate depression will be recruited from IAPT services and randomised to receive either an MBCT-based self-help workbook or a CBT-based self-help workbook. Participants will be asked to complete their workbook within 16 weeks, with six support sessions with a PWP. The primary outcome is depression symptom severity upon treatment completion. Secondary outcomes are treatment completion rates and measures of generalized anxiety, wellbeing, functioning and mindfulness. An exploratory non-inferiority analysis will be conducted in the event the primary hypothesis is not supported. A semi-structured interview with participants will guide understanding of change processes. Discussion If the findings from this randomised controlled trial demonstrate that MBCT-SH is more effective than CBT-SH for adults experiencing depression, this will provide evidence for policy makers and lead to changes to clinical practice in IAPT services, leading to greater choice of self-help treatment options and better outcomes for service users. If the exploratory non-inferiority analysis is conducted and this indicates non-inferiority of MBCT-SH in comparison to CBT-SH this will also be of interest to policy makers when seeking to increase service user choice of self-help treatment options for depression.

scholarly journals Digital cognitive–behavioural therapy for insomnia compared with digital patient education about insomnia in individuals referred to secondary mental health services in Norway: protocol for a multicentre randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e050661
Author(s):  
Håvard Kallestad ◽  
Simen Saksvik ◽  
Øystein Vedaa ◽  
Knut Langsrud ◽  
Gunnar Morken ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomised Controlled Trial ◽  
Patient Education ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Group Differences ◽  
Post Intervention ◽  
Cognitive Behavioural ◽  
Randomised Controlled

IntroductionInsomnia is highly prevalent in outpatients receiving treatment for mental disorders. Cognitive–behavioural therapy for insomnia (CBT-I) is a recommended first-line intervention. However, access is limited and most patients with insomnia who are receiving mental healthcare services are treated using medication. This multicentre randomised controlled trial (RCT) examines additional benefits of a digital adaptation of CBT-I (dCBT-I), compared with an online control intervention of patient education about insomnia (PE), in individuals referred to secondary mental health clinics.Methods and analysisA parallel group, superiority RCT with a target sample of 800 participants recruited from treatment waiting lists at Norwegian psychiatric services. Individuals awaiting treatment will receive an invitation to the RCT, with potential participants undertaking online screening and consent procedures. Eligible outpatients will be randomised to dCBT-I or PE in a 1:1 ratio. Assessments will be performed at baseline, 9 weeks after completion of baseline assessments (post-intervention assessment), 33 weeks after baseline (6 months after the post-intervention assessment) and 61 weeks after baseline (12 months after the post-intervention assessment). The primary outcome is between-group difference in insomnia severity 9 weeks after baseline. Secondary outcomes include between-group differences in levels of psychopathology, and measures of health and functioning 9 weeks after baseline. Additionally, we will test between-group differences at 6-month and 12-month follow-up, and examine any negative effects of the intervention, any changes in mental health resource use, and/or in functioning and prescription of medications across the duration of the study. Other exploratory analyses are planned.Ethics and disseminationThe study protocol has been approved by the Regional Committee for Medical and Health Research Ethics in Norway (Ref: 125068). Findings from the RCT will be disseminated via peer-reviewed publications, conference presentations, and advocacy and stakeholder groups. Exploratory analyses, including potential mediators and moderators, will be reported separately from main outcomes.Trial registration numberClinicalTrials.gov Registry (NCT04621643); Pre-results.

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