A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders.

Perez, David L; Aybek, Selma; Popkirov, Stoyan; Kozlowska, Kasia; Stephen, Christopher D; Anderson, Jordan; Shura, Robert; Ducharme, Simon; Carson, Alan; Hallett, Mark; Nicholson, Timothy R; Stone, Jon; LaFrance, W Curt; Voon, Valerie (2021). A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders. The journal of neuropsychiatry and clinical neurosciences, 33(1), pp. 14-26. American Psychiatric Association 10.1176/appi.neuropsych.19120357

Text Perez, 2020, A Review and Expert Opinion on the Neuropsychiatric Assessment.pdf - Accepted Version Restricted to registered users only Available under License Publisher holds Copyright. Download (417kB)

Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of the initial neuropsychiatric assessment of functional movement disorders (FND-movt) and functional limb weakness/paresis (FND-par) have yet to be established. This is an important gap from both diagnostic and treatment planning perspectives. In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases. Although clinical history should not be used to make a FND diagnosis, characteristics such as acute onset, precipitating events (e.g., injury and surgery), and a waxing and waning course (including spontaneous remissions) are commonly reported. Active psychiatric symptoms (e.g., depression and anxiety) and ongoing psychosocial stressors also warrant evaluation. Positive physical examination signs (e.g., Hoover's sign and tremor entrainment) are key findings, as one of the DSM-5 diagnostic criteria. The neuropsychiatric assessment proposed emphasizes diagnosing FND by using "rule-in" physical signs while also considering psychiatric and psychosocial factors to aid in the development of a patient-centered treatment plan.

Interest & Impact

Downloads

2 since deposited on 13 Nov 2020
0 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item