Tests
1st tests to order
laboratory testing
Test
At initial presentation, all patients should have laboratory testing to rule out potential medical or neurologic conditions. Repeat laboratory evaluations may be necessary when new symptoms arise.
In established functional neurologic and somatic symptom disorders, it is not necessary to repeat and exhaust all medical evaluations when there is clear evidence of ongoing functional neurologic or functional somatic disorder (and no other indication of neurologic conditions) on neurologic exam. Clinicians should nonetheless remain vigilant for the development of any new medical/neurologic comorbidity warranting additional evaluation.
Result
normal
electroencephalogram (EEG)
Test
Continuous video-EEG monitoring can be useful in establishing a diagnosis of functional seizures when typical spells are captured.
Result
normal; however, note that functional seizures and epileptic seizures may coexist in some people
Tests to consider
comprehensive neuropsychological testing
Test
Provides detailed evaluation of current cognitive abilities, comparison of abilities in reference to age-adjusted normal control groups, and information on cognitive strengths and weaknesses. Typical findings are either normal cognitive functioning or patterns of nonspecific cognitive abnormalities that differ from neurologic disease.[82] These may be related to multiple factors, including any relevant neurologic history (e.g., history of head injury, learning disability, attention-deficit disorder), psychopathology or psychological distress, medication effects, and even level of task engagement during the evaluation itself.[82][83][84]
Result
normal cognitive function or nonspecific cognitive abnormalities
standardized personality testing
Test
Provides descriptive information about specific personality features that may be helpful to target treatment and objectively measures presence or absence of psychopathology (e.g., depression, anxiety).
Personality assessment tools commonly used by psychologists include Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Personality Assessment Inventory (PAI), and Millon Clinical Multiaxial Inventory-III (MCMI-III).[85][86][87] These are self-report questionnaires completed by patients and interpreted by psychologists with training in standardized assessment. Such assessments complement comprehensive clinical psychiatric interview and other medical and historic information, as no indicator is 100% sensitive or 100% specific for functional neurologic or somatic symptom disorder.[88]
Result
mental illness trait, personality disorder trait, hypochondriasis, depression, hysteria, anxiety, somatization, pain disorder, or health concern
focused symptom inventories
Test
Designed to objectively capture specific psychological, cognitive, or physical symptoms or constructs. Include: Beck Depression Inventory-2 (BDI-2), Beck Anxiety Inventory (BAI), Toronto Alexithymia Scale (TAS), Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder Assessment (GAD)-7, PHQ-15.[77][78][79][80] These are brief self-report questionnaires designed to capture details of experiences of single psychological constructs, such as depression, anxiety, somatic focus, or alexithymia. The Levels of Emotional Awareness Scale (LEAS) is designed to measure a person's ability and capacity for emotional awareness.[81]
Result
may be features of co-occurring psychiatric illness/symptoms such as depression, anxiety, or alexithymia
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