From the Guidelines
Conversion disorder and functional neurological symptom disorder are actually the same condition, with the term "functional neurological symptom disorder" being the current terminology used in the DSM-5 diagnostic manual, as stated in the study by 1. The condition involves neurological symptoms (such as weakness, abnormal movements, seizures, or sensory changes) that cannot be fully explained by medical or neurological disease, despite being genuine and causing significant distress. Diagnosis requires a thorough neurological examination and sometimes tests to rule out organic causes, as noted in the study by 1. Treatment typically involves a multidisciplinary approach including psychotherapy (particularly cognitive behavioral therapy), physical therapy, and sometimes medications to address comorbid anxiety or depression if present, as recommended in the study by 1. Patient education about the diagnosis is crucial, emphasizing that symptoms are real but represent a functional problem in how the nervous system works rather than structural damage, as emphasized in the study by 1. Early intervention generally leads to better outcomes, with approximately two-thirds of patients showing improvement with appropriate treatment, as reported in the study by 1. Some key factors to consider when engaging with treatment include a reasonable degree of understanding and agreement with the diagnosis, motivation, and agreement to treatment, as outlined in the study by 1. Overall, a comprehensive and multidisciplinary approach to treatment, combined with patient education and support, is essential for managing functional neurological symptom disorder and improving patient outcomes, as highlighted in the study by 1.
From the Research
Definition and Diagnosis
- Functional Neurological Symptom Disorder (FNSD) is a neuropsychiatric disorder characterized by the presence of neurological symptoms in the absence of any neurological abnormality that can be linked to a known pathology 2.
- FNSD is also known as Conversion Disorder, and the term FNSD or Functional Neurological Disorder (FND) is now preferred, as Conversion Disorder is not an etiologically neutral term 3.
- Diagnosis of FNSD is often a diagnosis of exclusion, which means that patients may undergo many tests before receiving a diagnosis 2.
Clinical Presentation and Treatment
- FNSD can present with a variety of symptoms, including paroxysmal functional speech and gait disorder symptoms 4.
- Psychotherapy is an emerging first-line intervention for FNSD, and the biopsychosocial model is the prevailing model through which to guide longitudinal treatment 4.
- Cognitive-behavioral therapy (CBT) has been shown to be effective in the rehabilitation of young patients with FNSD 5.
- Management of FNSD should comprise honest disclosure, reassurance of recovery, and reinforcement of alternative coping strategies 3.
Etiology and Triggers
- FNSD can be triggered by various factors, including procedures involving anesthesia 3.
- The occurrence of FNSD in the postoperative period is increasingly being attributed to the effects of anesthesia, including abreactive or dissociative effects of anesthetic agents 3.
- Psychiatric co-morbidities, such as anxiety and depression, may be seen in patients with FNSD 3.
Pediatric FNSD
- Pediatric FNSD is an often misunderstood but treatable condition that frequently presents in medical settings with unexplained symptoms 6.
- The role of pediatric psychologists may include consultation, assessment, treatment, program development, and providing education to patients, families, and healthcare colleagues in various disciplines 6.
- CBT has been shown to be effective in the treatment of pediatric FNSD, with significant improvements in clinical outcomes 5.