FND in the medical setting — C-L ward MEQ

(i) Formulation. Working diagnosis: functional neurological symptom disorder (FND) with mixed motor features (weakness, tremor) and seizure-like events, acute presentation in the medical setting. Justification is rule-in: Hoover’s sign, give-way, tremor entrainment/internal inconsistency — not merely normal CT. Symptoms are real and involuntary; this is not malingering by default. A stressor/panic context supports formulation but is not required for DSM-5-era diagnosis. Joint neurology–C-L ownership rather than “psych take-over.”^[1][3][7]

(ii) Explanation and staff language. Structure bedside explanation: name FND; affirm symptoms are real and not feigned; show how positive signs mean pathways can still work; offer a careful function/software metaphor; give hope and a plan; invite questions; provide written information. With staff: reframe pejorative “attention-seeking” as harmful and inaccurate; model non-stigmatising documentation; align one team story before multi-voice conversations.^[2][7][8]

(iii) Acute-to-discharge plan. (1) Shared diagnostic letter. (2) Attack plan: protect, time, calm environment; avoid automatic AED escalation without neurology indication. (3) Specialist physiotherapy per Nielsen consensus; cite Physio4FMD as phase 3 specialist physio context for functional motor disorder. (4) Psychological pathway (CBT-informed; for seizures, LaFrance/CODES evidence base with honest endpoints). (5) Treat mood/anxiety comorbidity if present. (6) Stop non-indicated tests; safety-net red flags. (7) Booked outpatient FND/neuropsychiatry follow-up — do not discharge without a plan.^{[4][5][6][7][8]}

(iv) Red flags / dual pathology. Hyperacute stroke features, progressive UMN signs, encephalopathy, fever, first atypical seizures without adequate epilepsy consideration, sphincter failure, or evolving inconsistency with pure FND — reopen organic work-up. Dual pathology (FND plus epilepsy/MS) remains possible. Capacity and suicide risk still assessed as in any C-L consult.^[1][7][8]