You've made the diagnosis of functional neurological disorder: now what?

Practical Neurology
Caitlin AdamsDavid L Perez

Abstract

Patients with functional neurological disorders (FND)/conversion disorder commonly present to outpatient clinics. FND is now a 'rule in' diagnosis based on neurological examination findings and semiological features. While neurologists may be more comfortable diagnosing patients with FND, there is only limited guidance as to how to conduct follow-up outpatient visits. Using clinical vignettes, we provide practical suggestions that may help guide clinical encounters including how to: (1) explore illness beliefs openly; (2) enquire longitudinally about predisposing vulnerabilities, acute precipitants and perpetuating factors that may be further elucidated over time; (3) facilitate psychotherapy engagement by actively listening for potentially unhelpful or maladaptive patterns of thoughts, behaviours, fears or psychosocial stressors that can be reflected back to the patient and (4) enquire about the fidelity of individual treatments and educate other providers who may be less familiar with FND. These suggestions, while important to individualise, provide a blueprint for follow-up FND clinical care.

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Citations

Oct 12, 2018·Journal of Child and Adolescent Psychopharmacology·Timothy RiceBarbara Coffey
Oct 30, 2019·Academic Psychiatry : the Journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry·Michel MedinaJoseph J Cooper
Aug 12, 2020·Brain : a Journal of Neurology·Denise LinDiego Kaski
Sep 29, 2020·Neuropsychiatric Disease and Treatment·Aneeta SaxenaDavid L Perez
Mar 27, 2020·BMJ : British Medical Journal·Jan CoeberghTim Nicholson
Sep 5, 2020·Neuropsychiatric Disease and Treatment·Benjamin DentRichard A Kanaan
Jan 8, 2021·Disability and Rehabilitation·Caroline BarnettSarah Tyson
Apr 14, 2020·Neurologic Clinics·Kathrin LaFaver
Mar 9, 2021·BMJ Neurology Open·Alexander LehnPaul Pun
Aug 26, 2021·Sociology of Health & Illness·Jennifer C H Sebring
Sep 16, 2021·CNS Spectrums·Lorena DoVal HerbertJeff L Waugh

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