Outcomes of a 5-week individualised MDT outpatient (day-patient) treatment programme for functional neurological symptom disorder (FNSD)

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Abstract

Aim

We report results from a 5-week MDT treatment programme, with individualised sessions, for a selected group of patients with FNSD, delivered in a neuropsychiatric outpatient setting. Primary aims were to (1) reduce symptoms, (2) improve functional performance and (3) improve health status.

Methods

Treatment involved individual sessions of neuropsychiatry, cognitive behavioural therapy, physiotherapy, occupational-therapy, education and family meetings. Outcome measures collected at the beginning and end of treatment and at 6 months, were patient and clinician reported. Aims were assessed by the following: symptom reduction (PHQ15, PHQ9, GAD7, SPIN, Rosenberg); health and social functioning (HONOS, WSAS); functional performance (COPM); health status (EQ-5D-5L) and patient-rated perception of improvement (CGI).

Results

Analyses of 78 patients completing the programme and attending a 6-month review revealed high-baseline levels of disability compared to EQ-5DL population norms and high rates of disability and psychopathology as indicated by the WSAS and mental health indices (PHQ9, GAD7, SPIN, Rosenberg’s self-esteem). At baseline, 92.3% met the IAPT caseness threshold for depression and 71% met the IAPT caseness threshold for anxiety. A Friedman ANOVA over the three time points and Dunn-Bonferroni post hoc tests indicated statistically significant improvements from admission to discharge and admission to 6-month follow-up. Sustained improvements were seen in somatic symptoms (PHQ15), depression (PHQ9), anxiety (GAD7), health and social functioning (HONOS), functionality (COPM), health status (EQ-5D-5L) and patient-rated clinical global improvement (CGI).

Conclusion

An MDT can effectively deliver an outpatient programme for FNSD which can serve as an alternative to costlier inpatient programmes. Early identification and treatment of co-morbidities is advised.

Electronic supplementary material

The online version of this article (10.1007/s00415-020-09874-5) contains supplementary material, which is available to authorized users.

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Most cited references 18

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Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care.

Isobel Cameron, John R Crawford, Kenneth Lawton … (2008)

The 2004 National Institute for Health and Clinical Excellence (NICE) guidelines highlight the importance of assessing severity of depression in primary care. To assess the psychometric properties of the Patient Health Questionnaire (PHQ-9) and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) for measuring depression severity in primary care. Psychometric assessment. Thirty-two general practices in Grampian, Scotland. Consecutive patients referred to a primary care mental health worker completed the PHQ-9 and HADS at baseline (n = 1063) and at the end of treatment (n = 544). Data were analysed to assess reliability, robustness of factor structure, convergent/discriminant validity, convergence of severity banding, and responsiveness to change. Both scales demonstrated high internal consistency at baseline and end of treatment (PHQ-9 alpha = 0.83 and 0.92; HADS-D alpha = 0.84 and 0.89). One factor emerged each for the PHQ-9 (explaining 42% of variance) and HADS-D (explaining 52% of variance). Both scales converged more with each other than with the HADS anxiety (HADS-A) subscale at baseline (P<0.001) and at end of treatment (P = 0.01). Responsiveness to change was similar: effect size for PHQ-9 = 0.99 and for the HADS-D = 1. The HADS-D and PHQ-9 differed significantly in categorising severity of depression, with the PHQ-9 categorising a greater proportion of patients with moderate/severe depression (P<0.001). The HADS-D and PHQ-9 demonstrated reliability, convergent/discriminant validity, and responsiveness to change. However, they differed considerably in how they catergorised severity. Given that treatment decisions are made on the basis of severity, further work is needed to assess the validity of the scales' severity cut-off bands.

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Health of the Nation Outcome Scales (HoNOS). Research and development.

A Beevor, Jeffrey Curtis, Mary-Anne A. Burns … (1997)

An instrument was required to quantify and thus potentially measure progress towards a Health of the Nation target, set by the Department of Health, "to improve significantly the health and social functioning of mentally ill people". A first draft was created in consultation with experts and on the basis of literature review. This version was improved during four stages of testing: two preliminary stages, a large field trial involving 2706 patients (rated by 492 clinicians) and tests of the final Health of the Nation Outcome Scales (HoNOS), which included an independent study (n = 197) of reliability and relationship to other instruments. The resulting 12-item instrument is simple to use, covers clinical problems and social functioning with reasonable adequacy, has been generally acceptable to clinicians who have used it, is sensitive to change or the lack of it, showed good reliability in independent trials and compared reasonably well with equivalent items in the Brief Psychiatric Rating Scales and Role Functioning Scales. The key test for HoNOS is that clinicians should want to use it for their own purposes. In general, it has passed that test. A further possibility, that HoNOS data collected routinely as part of a minimum data set, for example for the Care Programme Approach, could also be useful in anonymized and aggregated form for public health purposes, is therefore testable but has not yet been tested.

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The Canadian Occupational Performance Measure: An Outcome Measure for Occupational Therapy

Mary Law, Sue Baptiste, MaryAnn McColl … (2016)

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Author and article information

Contributors

Panayiota Petrochilos:

ORCID: http://orcid.org/0000-0002-3880-8799

p.petrochilos@ucl.ac.uk

Journal

Journal ID (nlm-ta): J Neurol

Journal ID (iso-abbrev): J. Neurol

Title: Journal of Neurology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0340-5354

ISSN (Electronic): 1432-1459

Publication date (Electronic): 14 May 2020

Publication date PMC-release: 14 May 2020

Publication date (Print): 2020

Volume: 267

Issue: 9

Pages: 2655-2666

Affiliations

[1 ]GRID grid.436283.8, ISNI 0000 0004 0612 2631, Department of Neuropsychiatry, , National Hospital for Neurology and Neurosurgery, ; Queen Square, Box 19, London, WC1N 3BG UK

[2 ]GRID grid.83440.3b, ISNI 0000000121901201, Department of Clinical and Movement Neurosciences, National Hospital for Neurology and Neurosurgery, , UCL Queen Square Institute of Neurology, ; Queen Square, Box 95, London, WC1N 3BG UK

[3 ]GRID grid.436283.8, ISNI 0000 0004 0612 2631, Therapies Services Department, National Hospital for Neurology and Neurosurgery, ; Queen Square, London, WC1N 3BG UK

Author information

Panayiota Petrochilos http://orcid.org/0000-0002-3880-8799

Article

Publisher ID: 9874

DOI: 10.1007/s00415-020-09874-5

PMC ID: 7419475

PubMed ID: 32410018

SO-VID: 8e3426b0-6c70-4a2c-9fff-c3e30de10491

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 20 February 2020

Date revision received : 27 April 2020

Date accepted : 29 April 2020

Custom metadata

ScienceOpen disciplines: Neurology

Keywords: functional neurological symptom disorder,functional neurological disorders,conversion disorder,psychogenic,dissociative disorders,multidisciplinary team,therapy,outpatient

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ScienceOpen disciplines: Neurology

Keywords: functional neurological symptom disorder, functional neurological disorders, conversion disorder, psychogenic, dissociative disorders, multidisciplinary team, therapy, outpatient

Outcomes of a 5-week individualised MDT outpatient (day-patient) treatment programme for functional neurological symptom disorder (FNSD)

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Most cited references 18

Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care.

Health of the Nation Outcome Scales (HoNOS). Research and development.

The Canadian Occupational Performance Measure: An Outcome Measure for Occupational Therapy

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