W10 - Advances in the Diagnosis and Treatment of Functional Neurological Disorder, Illness Anxiety, and Somatization
Saturday, 24 October
11:15 – 12:45 (1.5 hrs)
Mohamed Gheis*, MRCPsych, FRCPC, MBA; Karen Kit, PhD; Lindsay Millala, BA, RPN; Michelle Van Den Eng, CCFP, FRCPC
Supported by the Neuropsychiatry Section
At the end of this session, participants will be able to: 1) Recognize the characteristics of the new functional neurological disorder (FND)-conversion disorder model and how it differs from prior models; 2) Understand how the new model explains the overlaps and differences between FND-conversion and illness anxiety; and 3) Assimilate current evidence in the triage and treatment of patients with FND-conversion disorder.
Conversion disorder (CD) or functional neurological disorder (FND), is a prevalent and costly condition. It accounts for more than 15 percent of presentations to neurology clinics. Patients with this condition are referred to psychiatric services for ongoing care. Through decades of psychiatric care, limited guidelines were developed into the diagnosis and treatment of this condition. In 2013, this diagnosis underwent a significant review by the American Psychiatric Association. A new approach to the diagnosis was presented in the DSM-5 and a new explanatory model started to emerge; research interest increased.
Findings: Literature points to many limitations in the understanding and treatment of FND and patients tend to receive limited interventions beyond a diagnosis. (2) The diagnosis tends to be poorly delivered. Patients are offered excessive investigation and interventions with iatrogenic consequences. They receive limited effective therapies. There is a lack of treatment ambition for this condition and recent developments in FND research place the disciplines of clinical neuroscience at an ethical turning point, with a pressing need to develop triage methods and deliver effective therapies.
This workshop covers the following: 1) Characteristics of the new FND model, integrating concepts from neurophysiology, neuropsychology, and neurophilosophy; 2) Strategies to deliver and explain the diagnosis of FND to patients; 3) Triage methods (explained and applied to case vignettes); and 4) Current resources for patients with FND and recommendations for developing FND treatment services.
Espay AJ, Aybek S, Carson A, et al. Current concepts in diagnosis and treatment of functional neurological disorders. JAMA Neurol 2018;75:1132.
Edwards MJ. Functional neurological disorder: an ethical turning point for neuroscience. Brain 2019;142:1855–7.