Favourable outcome without psychotherapy in patients with functional neurologic disorder. (January 2020)

• Record Type: Journal Article
• Authors: Vermeulen, Marinus; de Haan, Rob J.
• Is Part Of: Journal of clinical neuroscience. Volume 71(2020)
• Page Start: 141
• Page End: 143
• Publication Date: 2020-01
• Subjects: Functional neurologic disorders -- Conversion disorder -- Psychogenic symptoms -- Psychotherapy -- Physiotherapy; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2019.08.100
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Many neurologists experience difficulties with referral of patients with FND to psychiatrists/psychologists as these patients perceive somatic symptoms and mostly therefore do not see the medical relevance of this referral. In a retrospective study it was shown that even if symptoms exist for several months about 60% of the patients with FND improved, none had been treated with any form of psychotherapy. Of all 193 participants of our prospective study only 31% had been referred for psychotherapy. Multivariable logistic regression showed that psychotherapy had no independent significant impact on outcome. Participants with a high level of somatisation were less likely to improve. Abstract: Objective: To investigate whether patients with functional neurologic disorder (FND) may improve without psychotherapy as was suggested by a retrospective study. Methods: We prospectively studied patients with newly diagnosed FND. At baseline and at 12 months participants filled out a set of self-reported health questionnaires. During the one-year follow up we recorded the use of psychotherapy. Results: The study group consisted of 193 included participants. After 12 months 60 participants (60/193 = 31.1%) perceived a favourable outcome. Sixty participants (60/191 = 31.4%) were referred for psychotherapy. Multivariable logistic regression showed that participants with a high level of somatisation were less likely to have a favourable outcome (adjusted OR = 0.55; 95% CI: 0.29 to 1.04; p = 0.07). We could not demonstrate an independent significant impact of the use of psychotherapy on favourable outcome (adjusted OR = 0.65; 95% CI: 0.33 to 1.30; p = 0.22). Conclusion: Our study confirms the results of the retrospective study. The association between a high level of somatisation and a less favourable outcome suggests that neurologists should pay more attention to symptoms other than the neurological, but this does not necessarily mean referral for a psychological intervention.