Functional neurological and somatic symptom disorders

Functional neurological disorder

• Between 50% and 90% of patients with functional neurological disorder exhibit short-term resolution of symptoms after reassurance, but up to 25% of these responders relapse or develop new conversion symptoms over time.[161]Hafeiz HB. Hysterical conversion: a prognostic study. Br J Psychiatry. 1980 Jun;136:548-51. http://www.ncbi.nlm.nih.gov/pubmed/7388262?tool=bestpractice.com

• After the acute stressors resolve, some functional neurological disorder patients have a good prognosis.[162]Gelauff JM, Carson A, Ludwig L, et al. The prognosis of functional limb weakness: a 14-year case-control study. Brain. 2019 Jul 1;142(7):2137-48. https://academic.oup.com/brain/article/142/7/2137/5510175 http://www.ncbi.nlm.nih.gov/pubmed/31167232?tool=bestpractice.com

• Despite their reputation for being relatively treatment resistant, prognosis can be good when using the suggested approaches and tenacious care as is outlined in this topic.

• Favourable prognostic indicators for patients with functional neurological disorder include acute onset of symptoms, precipitation by a well-defined stressful event, good premorbid health, and absence of psychiatric or neurological comorbidities.

• Patients with personality disorders, concomitant somatic diseases, psychiatric comorbidity, subacute presentation, and tremor or functional seizures subtypes have a poorer prognosis.

Somatic symptom disorder

• Reported remission rates range from very low (<10%) to a 50% recovery within 1 year.[163]Robins LN, Regier DA, eds. Psychiatric disorders in America. New York, NY: Free Press; 1991:220-57.[164]Bass CM, Murphy MR. Somatization disorder: critique of the concept and suggestions for future research. In: Bass CM, ed. Somatization: physical symptoms and psychological illness. Oxford, UK: Blackwell; 1990.

• Patients with many somatic symptoms, anxiety or depression, and old age or marked impairment were more likely to have persistent symptoms.[164]Bass CM, Murphy MR. Somatization disorder: critique of the concept and suggestions for future research. In: Bass CM, ed. Somatization: physical symptoms and psychological illness. Oxford, UK: Blackwell; 1990.

Undiagnosed patients

Patients who remain undiagnosed may undergo excessive and unnecessary medical tests, procedures, or hospital admissions. They may also receive excessive and unnecessary medication and experience any adverse effects needlessly.

Non-adherent patients

Non-adherence to management strategies is a risk, including ambivalence towards mental health referral and failure to use psychotherapeutic treatments. If mental health referral is declined, the focus should be on supportive care, which limits tests and procedures and encourages rehabilitation, with attribution of symptoms to stress-related causes.

Long-term management

Long-term management involves interrupting perpetuating factors, minimising unnecessary tests and procedures, avoiding 'doctor shopping', and encouraging higher levels of emotional processing.