Kathleen McKee1, Sean Glass2, Caitlin Adams3, Christopher D Stephen1, Franklin King4, Kristin Parlman5, David L Perez6, Nicholas Kontos7. 1. Movement Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 2. Neuropsychiatry Unit, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Cognitive Behavioral Neurology Unit, Department of Neurology, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Consultation Liaison Psychiatry Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 3. Cognitive Behavioral Neurology Unit, Department of Neurology, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Consultation Liaison Psychiatry Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry, Inpatient Psychiatry Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 4. Department of Psychiatry, Consultation Liaison Psychiatry Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 5. Department of Physical Therapy, Massachusetts General Hospital, Boston, MA. 6. Neuropsychiatry Unit, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Cognitive Behavioral Neurology Unit, Department of Neurology, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: dlperez@nmr.mgh.harvard.edu. 7. Department of Psychiatry, Consultation Liaison Psychiatry Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: nkontos@mgh.harvard.edu.
Abstract
BACKGROUND: Motor functional neurologic disorders (FND)-previously termed "hysteria" and later "conversion disorder"-are exceedingly common and frequently encountered in the acute hospital setting. Despite their high prevalence, patients with motor FND can be challenging to diagnose accurately and manage effectively. To date, there is limited guidance on the inpatient approach to the neuropsychiatric evaluation of patients with functional (psychogenic) neurologic symptoms. OBJECTIVE: The authors outline an inpatient multidisciplinary approach, involving neurology, psychiatry, and physical therapy, for the assessment and acute inpatient management of motor FND. METHODS: A vignette of a patient with motor FND is presented followed by a discussion of general assessment principles. Thereafter, a detailed description of the neurologic and psychiatric assessments is outlined. Delivery of a "rule-in" diagnosis is emphasized and specific guidance for what can be accomplished postdiagnosis in the hospital is suggested. DISCUSSION: We encourage an interdisciplinary approach beginning at the early stages of the diagnostic assessment once an individual is suspected of having motor FND. CONCLUSIONS: Practical suggestions for the inpatient assessment of motor FND are presented. It is also important to individualize the diagnostic assessment. Future research should be conducted to test best practices for motor FND management in the acute inpatient hospital setting.
BACKGROUND:Motor functional neurologic disorders (FND)-previously termed "hysteria" and later "conversion disorder"-are exceedingly common and frequently encountered in the acute hospital setting. Despite their high prevalence, patients with motor FND can be challenging to diagnose accurately and manage effectively. To date, there is limited guidance on the inpatient approach to the neuropsychiatric evaluation of patients with functional (psychogenic) neurologic symptoms. OBJECTIVE: The authors outline an inpatient multidisciplinary approach, involving neurology, psychiatry, and physical therapy, for the assessment and acute inpatient management of motor FND. METHODS: A vignette of a patient with motor FND is presented followed by a discussion of general assessment principles. Thereafter, a detailed description of the neurologic and psychiatric assessments is outlined. Delivery of a "rule-in" diagnosis is emphasized and specific guidance for what can be accomplished postdiagnosis in the hospital is suggested. DISCUSSION: We encourage an interdisciplinary approach beginning at the early stages of the diagnostic assessment once an individual is suspected of having motor FND. CONCLUSIONS: Practical suggestions for the inpatient assessment of motor FND are presented. It is also important to individualize the diagnostic assessment. Future research should be conducted to test best practices for motor FND management in the acute inpatient hospital setting.