Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective

Aneeta Saxena,1,2 Ellen Godena,1 Julie Maggio,1,3 David L Perez1,4 1Functional Neurological Disorder Clinical and Research Program, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 2Epilepsy Division, Department of...

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Autores principales:	Saxena A, Godena E, Maggio J, Perez DL
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	functional movement disorder dissociative seizures conversion disorder psychogenic treatment neuropsychiatry Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/85dead446b924c55b3ac23cd00d18a3e
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spelling	oai:doaj.org-article:85dead446b924c55b3ac23cd00d18a3e2021-12-02T03:36:27ZTowards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective1178-2021https://doaj.org/article/85dead446b924c55b3ac23cd00d18a3e2020-09-01T00:00:00Zhttps://www.dovepress.com/towards-an-outpatient-model-of-care-for-motor-functional-neurological--peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Aneeta Saxena,1,2 Ellen Godena,1 Julie Maggio,1,3 David L Perez1,4 1Functional Neurological Disorder Clinical and Research Program, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 2Epilepsy Division, Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; 3Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA; 4Division of Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USACorrespondence: Aneeta SaxenaMassachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA 02114, USAEmail asaxena7@mgh.harvard.eduAbstract: 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.Keywords: functional movement disorder, dissociative seizures, conversion disorder, psychogenic, treatment, neuropsychiatrySaxena AGodena EMaggio JPerez DLDove Medical Pressarticlefunctional movement disorderdissociative seizuresconversion disorderpsychogenictreatmentneuropsychiatryNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 16, Pp 2119-2134 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	functional movement disorder dissociative seizures conversion disorder psychogenic treatment neuropsychiatry Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	functional movement disorder dissociative seizures conversion disorder psychogenic treatment neuropsychiatry Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Saxena A Godena E Maggio J Perez DL Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective
description	Aneeta Saxena,1,2 Ellen Godena,1 Julie Maggio,1,3 David L Perez1,4 1Functional Neurological Disorder Clinical and Research Program, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 2Epilepsy Division, Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; 3Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA; 4Division of Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USACorrespondence: Aneeta SaxenaMassachusetts General Hospital, Department of Neurology, 55 Fruit Street, Boston, MA 02114, USAEmail asaxena7@mgh.harvard.eduAbstract: 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.Keywords: functional movement disorder, dissociative seizures, conversion disorder, psychogenic, treatment, neuropsychiatry
format	article
author	Saxena A Godena E Maggio J Perez DL
author_facet	Saxena A Godena E Maggio J Perez DL
author_sort	Saxena A
title	Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective
title_short	Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective
title_full	Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective
title_fullStr	Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective
title_full_unstemmed	Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective
title_sort	towards an outpatient model of care for motor functional neurological disorders: a neuropsychiatric perspective
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/85dead446b924c55b3ac23cd00d18a3e
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Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective

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