Functional neurological disorder (FND) (conversion disorder) is a group of common involuntary disorders in which there is a dysfunction of the nervous system and how the brain and body send and receive signals. Sigmund Freud thought it to be a “conversion disorder” as he considered it a psychological disorder converted into a neurological one.
It is not associated with an organic disease.
F>M; More common onset between ages 35-50; affects 4–12/100,000 people.
Aetiology is largely unknown. Early childhood trauma may increase the risk.
Clinical features:
The symptoms have no underlying structural cause and include balance issues; fainting; limb weakness or paralysis; tremors; cognitive disturbances; loss of vision or double vision; bladder and bowel issues; sensory changes; speech changes; fatigue; disassociation (blackouts/seizures); depression and anxiety
Hoover’s sign (weakness of hip extension, which becomes normal with contralateral hip flexion)
Differential: multiple sclerosis, Guillain-Barré syndrome, health ‘anxiety’, stroke
The Diagnostic and Statistical Manual of Mental Illness (DSM-5) diagnostic criteria for functional neurological disorder:
- One or more symptoms of altered voluntary motor or sensory function.
- Clinical findings can provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
- Another medical or mental disorder does not better explain the symptom or deficit.
- The symptom or deficit results in clinically significant distress or impairment in social, occupational, or other vital areas of functioning or warrants medical evaluation
Management:
Education
Psychotherapy
Physiotherapy to help elicit normal movements
Occupational therapy
Medication for pain, anxiety, depression and insomnia
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