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

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

Document Type

Article

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.

Medical Subject Headings

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

Publication Date

1-1-2018

Publication Title

The Journal of neuropsychiatry and clinical neurosciences

E-ISSN

1545-7222

Volume

30

Issue

2

First Page

152

Last Page

159

PubMed ID

29132273

Digital Object Identifier (DOI)

10.1176/appi.neuropsych.17060117

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