Functional neurological disorders: The neurological assessment as treatment
Open accessAbstract
The neurologist's role in patients with functional disorders has traditionally been limited to making the diagnosis, excluding a ‘disease’ and pronouncing the symptoms to be ‘non-organic’ or ‘psychogenic’. In this article, I argue that there are multiple opportunities during routine assessment of a patient with a functional disorder for the neurologist to take the lead with treatment. These opportunities occur throughout history taking, during the examination and, with greatest potential for treatment, at the end of the consultation. Elements of the neurologist's discussion that may be most useful include (a) emphasis that symptoms are genuine, common and potentially reversible; (b) explanation of the positive nature of the diagnosis (ie, not a diagnosis of exclusion); (c) simple advice about distraction techniques, self-help techniques and sources of information; (d) referral on to appropriate physiotherapy and/or psychological services; and (e) offering outpatient review. I also discuss how new diagnostic criteria for Diagnostic and Statistical Manual of Mental Disorders-5 and changes proposed for International Classification of Diseases may facilitate changes that allow neurologists to bring their management of patients with functional disorders in line with other multidisciplinary neurological disorders in the outpatient clinic.
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In FND, symptoms amplify with attention.
“symptoms amplify with attention, and they diminish when attention is drawn away from them (and toward something else) [19,51,53].”
From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [53]
In FND, symptoms diminish when attention is drawn away from them.
“symptoms amplify with attention, and they diminish when attention is drawn away from them (and toward something else) [19,51,53].”
From Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder (2023) · cites this paper as [53]
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Treatment of Persistent Postural-Perceptual Dizziness (PPPD)
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“In FND, however, once the medical assessment has been undertaken and a positive diagnosis provided, further attention to the symptoms is unhelpful—symptoms amplify with attention, and they diminish when attention is drawn away from them (and toward something else) [19,51,53].”
BackgroundFunctional neurological disorders: an Australian interdisciplinary perspective
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Functional neurological symptoms: welcome to the new normal
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Neurological examinations for psychiatric patients: A systematic review
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- Authors
- Stone, J.
- Affiliations
- Western General Hospital (GB)
- Corresponding author
- Stone, Jon
- ORCID
- Stone, Jon
- Venue
- Practical Neurology
- Publisher
- BMJ
- Published
- 2015-12-29
- Volume
- 16
- Issue
- 1
- Pages
- 7-17
- ISSN
- 1474-7758 (ISSN-L)
- 1474-7766
- OpenAlex
- W2230375827
- Cited by
- 157
- References
- 54
- Citations by year
- 2026: 17 · 2025: 14 · 2024: 9 · 2023: 21 · 2022: 19 · 2021: 23 · 2020: 15 · 2019: 13 · 2018: 7 · 2017: 12 · 2016: 7
- FWCI
- 1.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Practical Neurology (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- NHS Health Scotland
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- conversion disorder, neurological assessment, diagnosis of exclusion, patient education, distraction techniques, self-help, referral to physiotherapy, DSM-5 diagnostic criteria, multidisciplinary management
- MeSH terms
- Humans, Nervous System Diseases, Neurologic Examination
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