Treatment outcomes in the inpatient management of severe functional neurological disorder: a retrospective cohort study.
Journal article
Saunders, C., Bawa, Hetashi, Aslanyan, Daron, Coleman, Frances, Jinadu, Helen, Sigala, N. and Medford, N. 2024. Treatment outcomes in the inpatient management of severe functional neurological disorder: a retrospective cohort study. BMJ neurology open. 6 (2), p. e000675. https://doi.org/10.1136/bmjno-2024-000675
| Authors | Saunders, C., Bawa, Hetashi, Aslanyan, Daron, Coleman, Frances, Jinadu, Helen, Sigala, N. and Medford, N. |
|---|---|
| Abstract | Functional neurological disorder (FND) is a heterogeneous condition; severe forms can be disabling. Multidisciplinary treatment and rehabilitation are recommended for severe FND, but there remains a lack of evidence for its efficacy and lack of understanding of the predictors and components of recovery. We report clinical outcome data for an inpatient cohort with severe FND. Clinical Global Impression Improvement with treatment is the primary outcome measure. Admission and discharge measures (Euroqol quality of life measures, Beck Depression Inventory, Spielberger Trait Anxiety Inventory, Cambridge Depersonalisation Scale, Illness Perception Questionnaire (Revised) and Functional Mobility Scale) are reported as secondary outcomes. We describe an FND cohort (n=52) with chronic illness (mean symptom duration 9.7 years). At admission, there were clinically relevant levels of depression, anxiety and depersonalisation derealisation. At the time of discharge, most (43/52) patients' global condition had improved. Measures of mobility, depression and quality of life also significantly improved while at discharge, symptoms were experienced as more understandable and less distressing than at admission. An admission measure of patient confidence in treatment was predictive of eventual clinical outcome. The most frequent outcome of inpatient rehabilitation is global improvement, even when symptoms are chronic and severe, reflected in measurable changes in both physical and psychological functioning. Significant levels of depersonalisation derealisation seen in this patient group suggest that routine enquiry into such experiences could help personalise FND treatment approaches. Patient confidence in treatment is key in determining clinical outcomes. [Abstract copyright: © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.] |
| Keywords | REHABILITATION; NEUROPSYCHIATRY; FUNCTIONAL NEUROLOGICAL DISORDER |
| Year | 2024 |
| Journal | BMJ neurology open |
| Journal citation | 6 (2), p. e000675 |
| Publisher | BMJ Publishing Group |
| ISSN | 2632-6140 |
| Digital Object Identifier (DOI) | https://doi.org/10.1136/bmjno-2024-000675 |
| https://doi.org/bmjno-2024-000675 | |
| Official URL | https://neurologyopen.bmj.com/content/6/2/e000675 |
| Publication dates | |
| Online | 02 Jul 2024 |
| Publication process dates | |
| Deposited | 22 Jul 2024 |
| Accepted | 10 Jun 2024 |
| Publisher's version | License File Access Level Open |
| Output status | Published |
| Additional information | Publications router: Date 2024-06-10 of type 'accepted_date' included in notification. |
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https://repository.canterbury.ac.uk/item/98760/treatment-outcomes-in-the-inpatient-management-of-severe-functional-neurological-disorder-a-retrospective-cohort-study
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