Tailored psychotherapy for patients with functional neurological symptoms: a pilot study

J Psychosom Res. 2007 Dec;63(6):625-32. doi: 10.1016/j.jpsychores.2007.06.013. Epub 2007 Aug 1.


Objective: The objective of this study was to assess whether individually tailored psychotherapy for patients with functional neurological symptoms is associated with improvements in patient-centered measures of emotional well-being, quality of life, as well as somatic symptoms and whether this treatment modality is likely to be cost-effective.

Methods: We conducted an uncontrolled prospective pilot study of consecutive patients with functional symptoms referred from neurology outpatient clinics to a single psychotherapist using validated questionnaires [Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), Short Function (SF)-36 Health Survey, and Patient Health Questionnaire (PHQ)-15]. Patients had a median of 6 treatment sessions (range=1-24). Ninety-one patients completed questionnaires at referral, 63 did at the end of treatment, and 34 did at follow-up after 6 months. Significant improvements were seen on all measures and were maintained at follow-up (CORE-OM, P=.003; SF-36, P<.001; PHQ-15, P=.001). Significance was not lost in an intention-to-treat analysis. Of all the patients, 49.2% improved by at least 1 S.D. in at least one of the measures. The number of patients needed to be treated to see an improvement of at least 1 S.D. in one of the three outcome measures was 2; that in two measures, 3.9; and that in all measures, 7. The mean cost of the intervention was pound231; the cost per quality-adjusted life year was estimated as pound5,328.

Results: Psychotherapy was associated with significant improvements in patient-centered measures, which seemed to be achieved at a comparatively low cost.

Conclusions: The results indicate that psychotherapy may be a cost-effective intervention for patients presenting with functional neurological symptoms. The findings warrant further assessment of this treatment with a randomized and controlled trial.

MeSH terms

  • Adult
  • Affect*
  • Aged
  • Cognition Disorders / economics
  • Cognition Disorders / therapy*
  • Cost-Benefit Analysis
  • Dissociative Disorders / economics
  • Dissociative Disorders / psychology*
  • Dissociative Disorders / therapy*
  • Fatigue / economics
  • Fatigue / therapy*
  • Female
  • Follow-Up Studies
  • Gait Disorders, Neurologic / economics
  • Gait Disorders, Neurologic / therapy*
  • Health Status
  • Humans
  • Intention
  • Male
  • Middle Aged
  • Pain / economics
  • Pain Management*
  • Pilot Projects
  • Prospective Studies
  • Psychotherapy / economics
  • Psychotherapy / standards*
  • Surveys and Questionnaires
  • Treatment Outcome