Psych · Consultation-liaison psychiatry
Functional neurological disorder in the medical setting
Also known as FND consultation-liaison · Functional neurological disorder ward · Conversion disorder medical setting · Functional seizures ED · Dissociative seizures hospital · PNES inpatient · Functional weakness ward · Neuropsychiatry liaison FND
Exam-exhaustive C-L fellowship leaf on functional neurological disorder in the medical setting — liaison role, positive rule-in diagnosis, bedside explanation as first treatment, ward and ED management of functional seizures and weakness, staff countertransference, stopping iatrogenesis, MDT discharge planning, dual pathology, and deliberate distinction from the general-adult FND clinic leaf. FRANZCP-primary, globally tagged.
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10 MCQs with explanations
Target exams
Red flags
Meet the patient
A 29-year-old teacher is on the acute stroke unit, day two. She woke with a dense right leg weakness. Thrombolysis was withheld, the CT and MRI were normal, and the physiotherapist noted the leg moved differently when she was distracted. Overnight she had two prolonged shaking episodes with her eyes closed.[4][19]
The referral arrives at four in the afternoon and says: psychiatric review, medically cleared. The chart already contains the word "?genuine". The nurse tells you the patient has stopped eating because she thinks nobody believes her.[4][10]
Two questions decide this admission and both belong to you: what is the positive evidence for the diagnosis? and who is going to say it to her, in what words? Everything below answers those two.[1][4]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.
References19Show ledgerHide ledger
- [1]Espay AJ, Aybek S, Carson A, et al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders JAMA Neurol, 2018.PMID 29868890
- [2]Hallett M, Aybek S, Dworetzky BA, et al. Functional neurological disorder: new subtypes and shared mechanisms Lancet Neurol, 2022.PMID 35430029
- [3]Aybek S, Perez DL Diagnosis and management of functional neurological disorder BMJ, 2022.PMID 35074803
- [4]Stone J, Burton C, Carson A Recognising and explaining functional neurological disorder BMJ, 2020.PMID 33087335
- [5]Daum C, Hubschmid M, Aybek S The value of 'positive' clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review J Neurol Neurosurg Psychiatry, 2014.PMID 23467417
- [6]Daum C, Gheorghita F, Spatola M, et al. Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study J Neurol Neurosurg Psychiatry, 2015.PMID 24994927
- [7]Edwards MJ, Adams RA, Brown H, Pareés I, Friston KJ A Bayesian account of 'hysteria' Brain, 2012.PMID 22641838
- [8]Maurer CW, LaFaver K, Ameli R, et al. Impaired self-agency in functional movement disorders: A resting-state fMRI study Neurology, 2016.PMID 27385746
- [9]Stone J, Carson A, Duncan R, et al. Symptoms 'unexplained by organic disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain, 2009.PMID 19737842
- [10]Carson A, Stone J, Hibberd C, et al. Disability, distress and unemployment in neurology outpatients with symptoms 'unexplained by organic disease' J Neurol Neurosurg Psychiatry, 2011.PMID 21257981
- [11]Carson A, Lehn A Epidemiology Handb Clin Neurol, 2016.PMID 27719864
- [12]Ludwig L, Pasman JA, Nicholson T, et al. Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies Lancet Psychiatry, 2018.PMID 29526521
- [13]Nielsen G, Stone J, Matthews A, et al. Physiotherapy for functional motor disorders: a consensus recommendation J Neurol Neurosurg Psychiatry, 2015.PMID 25433033
- [14]Nielsen G, Stone J, Lee TC, et al. Specialist physiotherapy for functional motor disorder in England and Scotland (Physio4FMD): a pragmatic, multicentre, phase 3 randomised controlled trial Lancet Neurol, 2024.PMID 38768621
- [15]LaFrance WC Jr, Baird GL, Barry JJ, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial JAMA Psychiatry, 2014.PMID 24989152
- [16]Goldstein LH, Robinson EJ, Mellers JDC, et al. Cognitive behavioural therapy for adults with dissociative seizures (CODES): a pragmatic, multicentre, randomised controlled trial Lancet Psychiatry, 2020.PMID 32445688
- [17]Gelauff J, Stone J Prognosis of functional neurologic disorders Handb Clin Neurol, 2016.PMID 27719869
- [18]Gelauff JM, Carson A, Ludwig L, Tijssen MAJ, Stone J The prognosis of functional limb weakness: a 14-year case-control study Brain, 2019.PMID 31167232
- [19]Bennett K, Diamond C, Hoeritzauer I, et al. A practical review of functional neurological disorder (FND) for the general physician Clin Med (Lond), 2021.PMID 33479065