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Van Patten R, Mordecai K, LaFrance WC. The role of neuropsychology in the care of patients with functional neurological symptom disorder. J Int Neuropsychol Soc 2024:1-8. [PMID: 38813659 DOI: 10.1017/s1355617724000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Functional neurological symptom disorder (FNSD) is a neuropsychiatric condition characterized by signs/symptoms associated with brain network dysfunction. FNSDs are common and are associated with high healthcare costs. FNSDs are relevant to neuropsychologists, as they frequently present with chronic neuropsychiatric symptoms, subjective cognitive concerns, and/or low neuropsychological test scores, with associated disability and reduced quality of life. However, neuropsychologists in some settings are not involved in care of patients with FNSDs. This review summarizes relevant FNSD literature with a focus on the role of neuropsychologists. METHODS A brief review of the literature is provided with respect to epidemiology, public health impact, symptomatology, pathophysiology, and treatment. RESULTS Two primary areas of focus for this review are the following: (1) increasing neuropsychologists' training in FNSDs, and (2) increasing neuropsychologists' role in assessment and treatment of FNSD patients. CONCLUSIONS Patients with FNSD would benefit from increased involvement of neuropsychologists in their care.
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Affiliation(s)
- Ryan Van Patten
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | | | - W Curt LaFrance
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
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Cavanna AE, Purpura G, Riva A, Nacinovich R, Seri S. Functional tics: Expanding the phenotypes of functional movement disorders? Eur J Neurol 2023; 30:3353-3356. [PMID: 37410535 DOI: 10.1111/ene.15967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND AND PURPOSE Until the outbreak reported during the COVID-19 pandemic, functional tics were considered to be a relatively rare clinical phenotype, as opposed to other functional movement disorders such as functional tremor and dystonia. To better characterize this phenotype, we compared the demographic and clinical characteristics of patients who developed functional tics during the pandemic and those of patients with other functional movement disorders. METHODS Data from 110 patients were collected at the same neuropsychiatry centre: 66 consecutive patients who developed functional tics without other functional motor symptoms or neurodevelopmental tics and 44 patients with a mix of functional dystonia, tremor, gait, and myoclonus. RESULTS Both groups were characterized by female sex preponderance (70%-80%) and (sub)acute onset of functional symptoms (~80%). However, patients with functional tics had a significantly earlier age at onset of functional symptoms (21 vs. 39 years). Exposure to relevant social media content was reported by almost half of the patients with functional tics, but by none of the patients with other functional movement disorders. Comorbidity profiles were similar, with relatively high rates of anxiety/affective symptoms and other functional neurological symptoms (nonepileptic attacks). CONCLUSIONS Patients who developed functional tics during the pandemic represent a phenotypic variant of the wider group of patients with functional movement disorders, associated with younger age at onset and influenced by pandemic-related factors, including increased exposure to specific social media content. Diagnostic protocols and treatment interventions should be tailored to address the specific features of this newly defined phenotype.
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Affiliation(s)
- Andrea E Cavanna
- Department of Neuropsychiatry, BSMHFT and University of Birmingham, Birmingham, UK
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology and University College London, London, UK
- School of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giulia Purpura
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Anna Riva
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Renata Nacinovich
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Child Neuropsychiatry, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Stefano Seri
- School of Health and Life Sciences, Aston Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
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Marotta A, Lasalvia A, Fiorio M, Zanalda E, Di Sciascio G, Palumbo C, Papola D, Barbui C, Tinazzi M. Psychiatrists' attitudes towards functional neurological disorders: results from a national survey. Front Psychiatry 2023; 14:1216756. [PMID: 37520227 PMCID: PMC10375048 DOI: 10.3389/fpsyt.2023.1216756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Functional neurological disorder (FND) presents motor, sensory, and cognitive symptoms characterized by clinical signs incongruent with known neurological disease. Together with other health professionals, like neurologists, psychiatrists can play an essential role in diagnosing and managing these disorders. Hence, understanding their opinion and clinical experience with FND is of utmost importance to catch potential educational needs and improve healthcare services for patients. This study aims at assessing the knowledge, opinion, and clinical approach of Italian psychiatrists to FND. Methods Members of the Italian Society of Psychiatry completed a 14-item web-based survey investigating their approach to FND. Results. Overall, 174 questionnaires were completed. Our main findings suggest that Italian psychiatrists have a psychogenetic conceptualization of FND. "Conversion disorders", in fact, is the term most frequently used by Italian psychiatrists to refer to FND, thus implying a psychological etiology of these disorders. Congruently with this view, psychotherapy associated with pharmacological therapy is considered the most appropriate treatment by psychiatrists, while physiotherapy is an under-recognized treatment option for FND. Discussion The present study highlights that a psychogenetic view of FND dominates among Italian psychiatrists. This could be due to out-of-date knowledge about the pathophysiology of this group of disorders. Promoting education about novel approaches to FND would be of crucial importance to improving care for patients suffering from this condition.
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Affiliation(s)
- Angela Marotta
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Enrico Zanalda
- Department of Mental Health ASL TO3 and AOU San Luigi Gonzaga, Collegno, Italy
| | | | | | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Kerr WT, Tatekawa H, Lee JK, Karimi AH, Sreenivasan SS, O'Neill J, Smith JM, Hickman LB, Savic I, Nasrullah N, Espinoza R, Narr K, Salamon N, Beimer NJ, Hadjiiski LM, Eliashiv DS, Stacey WC, Engel J, Feusner JD, Stern JM. Clinical MRI morphological analysis of functional seizures compared to seizure-naïve and psychiatric controls. Epilepsy Behav 2022; 134:108858. [PMID: 35933959 DOI: 10.1016/j.yebeh.2022.108858] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/26/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE Functional seizures (FS), also known as psychogenic nonepileptic seizures (PNES), are physical manifestations of acute or chronic psychological distress. Functional and structural neuroimaging have identified objective signs of this disorder. We evaluated whether magnetic resonance imaging (MRI) morphometry differed between patients with FS and clinically relevant comparison populations. METHODS Quality-screened clinical-grade MRIs were acquired from 666 patients from 2006 to 2020. Morphometric features were quantified with FreeSurfer v6. Mixed-effects linear regression compared the volume, thickness, and surface area within 201 regions-of-interest for 90 patients with FS, compared to seizure-naïve patients with depression (n = 243), anxiety (n = 68), and obsessive-compulsive disorder (OCD, n = 41), respectively, and to other seizure-naïve controls with similar quality MRIs, accounting for the influence of multiple confounds including depression and anxiety based on chart review. These comparison populations were obtained through review of clinical records plus research studies obtained on similar scanners. RESULTS After Bonferroni-Holm correction, patients with FS compared with seizure-naïve controls exhibited thinner bilateral superior temporal cortex (left 0.053 mm, p = 0.014; right 0.071 mm, p = 0.00006), thicker left lateral occipital cortex (0.052 mm, p = 0.0035), and greater left cerebellar white-matter volume (1085 mm3, p = 0.0065). These findings were not accounted for by lower MRI quality in patients with FS. CONCLUSIONS These results reinforce prior indications of structural neuroimaging correlates of FS and, in particular, distinguish brain morphology in FS from that in depression, anxiety, and OCD. Future work may entail comparisons with other psychiatric disorders including bipolar and schizophrenia, as well as exploration of brain structural heterogeneity within FS.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Hiroyuki Tatekawa
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - John K Lee
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amir H Karimi
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Siddhika S Sreenivasan
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Jane & Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Jena M Smith
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - L Brian Hickman
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ivanka Savic
- Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Nilab Nasrullah
- Department of Women's and Children's Health, Karolinska Institute and Neurology Clinic, Karolinksa University Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine Narr
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nicholas J Beimer
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Lubomir M Hadjiiski
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Dawn S Eliashiv
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - William C Stacey
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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