Neuropsychiatric Factors Linked to Adherence and Short-Term Outcome in a U.S. Functional Neurological Disorders Clinic: A Retrospective Cohort Study

Sean P Glass; Nassim Matin; Benjamin Williams; Julie Mello; Christopher D Stephen; Sigrid S Young; Janet Callahan; W Curt LaFrance Jr; David L Perez

doi:10.1176/appi.neuropsych.17060117

Neuropsychiatric Factors Linked to Adherence and Short-Term Outcome in a U.S. Functional Neurological Disorders Clinic: A Retrospective Cohort Study

J Neuropsychiatry Clin Neurosci. 2018 Spring;30(2):152-159. doi: 10.1176/appi.neuropsych.17060117. Epub 2017 Nov 14.

Authors

Sean P Glass¹, Nassim Matin¹, Benjamin Williams¹, Julie Mello¹, Christopher D Stephen¹, Sigrid S Young¹, Janet Callahan¹, W Curt LaFrance Jr¹, David L Perez¹

Affiliation

¹ From the Department of Neurology, Cognitive Behavioral Neurology Unit, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston (SPG, NM, BW, SSY, DLP); the Department of Psychiatry, Neuropsychiatry Unit, Massachusetts General Hospital, Harvard Medical School, Boston (SPG, DLP); the Department of Physical Therapy, Massachusetts General Hospital, Harvard Medical School, Boston (JM, JC); the Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (CDS); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Alpert Medical School, Providence, R.I. (WCL).

PMID: 29132273
DOI: 10.1176/appi.neuropsych.17060117

Abstract

Despite advancements in the assessment and management of functional neurological disorder (FND), the feasibility of implementing a new standard of care remains unclear. Chart reviews were performed for 100 patients with motor FND to investigate factors related to treatment adherence and clinical improvement over an average follow-up of 7 months. Of 81 patients who returned for follow-up, a history of chronic pain disorder inversely correlated with improvement. Of the 50 individuals newly referred for treatment, adherence correlated with improvement, while having abnormal neuroimaging inversely correlated with improvement. This study supports the feasibility of applying a new standard of care for FND.

Keywords: Behavioral Therapy (Neuropsychiatric Aspects); Somatoform Disorders.

MeSH terms

Chronic Pain / psychology
Cohort Studies
Comorbidity
Follow-Up Studies
Humans
Motor Disorders / diagnosis
Motor Disorders / therapy*
Nervous System Diseases / diagnosis
Nervous System Diseases / therapy
Neuropsychiatry
Prognosis
Psychology, Social
Retrospective Studies
Standard of Care*
Symptom Assessment
Treatment Adherence and Compliance*
Treatment Outcome