Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-10T09:58:28.465Z Has data issue: false hasContentIssue false
  • English
  • Français

Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case–control study

Published online by Cambridge University Press:  18 February 2019

N. O'Connell ,
T. R. Nicholson Open the ORCID record for T. R. Nicholson [Opens in a new window] ,
S. Wessely Open the ORCID record for S. Wessely [Opens in a new window]  and
A. S. David Open the ORCID record for A. S. David [Opens in a new window]
N. O'Connell*
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
T. R. Nicholson
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
S. Wessely
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
A. S. David
Affiliation:
UCL Institute of Mental Health Studies, University College London, London, UK
*
Author for correspondence: N. O'Connell, E-mail: nicola.k.o'connell@kcl.ac.uk; noconne@tcd.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Functional neurological disorder (FND), previously known as conversion disorder, is common and often results in substantial distress and disability. Previous research lacks large sample sizes and clinical surveys are most commonly derived from neurological settings, limiting our understanding of the disorder and its associations in other contexts. We sought to address this by analysing a large anonymised electronic psychiatric health record dataset.

Methods

Data were obtained from 322 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who had an ICD-10 diagnosis of motor FND (mFND) (limb weakness or disorders of movement or gait) between 1 January 2006 and 31 December 2016. Data were collected on a range of socio-demographic and clinical factors and compared to 644 psychiatric control patients from the same register.

Results

Weakness was the most commonly occurring functional symptom. mFND patients were more likely to be female, British, married, employed pre-morbidly, to have a carer and a physical health condition, but less likely to have had an inpatient psychiatric admission or to receive benefits. No differences in self-reported sexual or physical abuse rates were observed between groups, although mFND patients were more likely to experience life events linked to inter-personal difficulties.

Conclusions

mFND patients have distinct demographic characteristics compared with psychiatric controls. Experiences of abuse appear to be equally prevalent across psychiatric patient groups. This study establishes the socio-demographic and life experience profile of this understudied patient group and may be used to guide future therapeutic interventions designed specifically for mFND.

Keywords

Conversion disorderfunctional motor disorderfunctional neurological disorder
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 3 , February 2020 , pp. 446 - 455
Copyright
Copyright © Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahmad, O and Ahmad, KE (2016) Functional neurological disorders in outpatient practice: an Australian cohort. Journal of Clinical Neuroscience 28, 93–96.CrossRefGoogle Scholar
Akagi, H and House, A (2001) The epidemiology of hysterical conversion. In Halligan, PW, Bass, C and Marshall, JC (eds), Contemporary Approaches to the Study of Hysteria: Clinical and Theoretical Perspectives. Oxford: Oxford University Press, pp. 73–87.Google Scholar
Akyuz, F, Gokalp, PG, Erdiman, S, Oflaz, S and Karsidag, Ç (2017) Conversion disorder comorbidity and childhood trauma. Archives of Neuropsychiatry 54, 15–20.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.Google Scholar
Bebbington, PE, Jonas, S, Brugha, T, Meltzer, H, Jenkins, R, Cooper, C, King, M and Mcmanus, S (2011) Child sexual abuse reported by an English national sample: characteristics and demography. Social Psychiatry and Psychiatric Epidemiology 46, 255–262.CrossRefGoogle ScholarPubMed
Bell, V, Marshall, C, Kanji, Z, Wilkinson, S, Halligan, P and Deeley, Q (2018) Uncovering Capgras delusion using a large-scale medical records database. British Journal of Psychiatry 3, 179–185.Google Scholar
Bermingham, SL, Cohen, A, Hague, J and Parsonage, M (2010) The cost of somatisation among the working-age population in England for the year 2008–2009. Mental Health in Family Medicine 7, 71–84.Google ScholarPubMed
Binzer, M, Andersen, PM and Kullgren, G (1997) Clinical characteristics of patients with motor disability due to conversion disorder: a prospective control group study. Journal of Neurology, Neurosurgery, and Psychiatry 63, 83–88.CrossRefGoogle ScholarPubMed
Brown, RJ and Lewis-Fernández, R (2011) Culture and conversion disorder: implications for DSM-5. Psychiatry: Interpersonal and Biological Processes 74, 187–206.CrossRefGoogle ScholarPubMed
Carson, A and Lehn, A (2016) Epidemiology. In Hallett, M, Stone, J and Carson, A (eds), Functional Neurological Disorders. New York: Elsevier, pp. 47–60.CrossRefGoogle Scholar
Carson, A, Stone, J, Hibberd, C, Murray, G, Duncan, R, Coleman, R, Warlow, C, Roberts, R, Pelosi, A, Cavanagh, J, Matthews, K, Goldbeck, R, Hansen, C and Sharpe, M (2011) Disability, distress and unemployment in neurology outpatients with symptoms ‘unexplained by organic disease’. Journal of Neurology, Neurosurgery and Psychiatry 82, 810–813.CrossRefGoogle ScholarPubMed
Crimlisk, HL, Bhatia, K, Cope, H, David, A, Marsden, CD and Ron, MA (1998) Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. British Medical Journal 316, 582–586.CrossRefGoogle ScholarPubMed
Deka, K, Chaudhury, PK, Bora, K and Kalita, P (2007) A study of clinical correlates and socio-demographic profile in conversion disorder. Indian Journal of Psychiatry 49, 205–207.CrossRefGoogle ScholarPubMed
Demartini, B, Petrochilos, P, Ricciardi, L, Price, G, Edwards, MJ and Joyce, E (2014) The role of alexithymia in the development of functional motor symptoms (conversion disorder). Journal of Neurology, Neurosurgery & Psychiatry 85, 1132–1137.CrossRefGoogle Scholar
Dirkzwager, AJ and Verhaak, PF (2007) Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care. BMC Family Practice 8, 33.CrossRefGoogle ScholarPubMed
Ertan, S, Derya, U, Özekmekçi, S, Kiziltan, G, Ertan, T, Yalçinkaya, C and Özkara, Ç (2009) Clinical characteristics of 49 patients with psychogenic movement disorders in a tertiary clinic in Turkey. Movement Disorders 24, 759–762.CrossRefGoogle Scholar
Espay, AJ, Aybek, S, Carson, A, Edwards, MJ, Goldstein, LH, Hallett, M, Lafaver, K, Curt Lafrance, W, Lang, AE, Nicholson, T, Nielsen, G, Reuber, M, Voon, V, Stone, J and Morgante, F (2018) Current concepts in diagnosis and treatment of Functional Neurological Disorders. JAMA Neurology 74, 1132–1141.CrossRefGoogle Scholar
Factor, SA, Podskalny, GD and Molho, ES (1995) Psychogenic movement disorders: frequency, clinical profile, and characteristics. Journal of Neurology, Neurosurgery, and Psychiatry 59, 406–412.CrossRefGoogle ScholarPubMed
Farooq, A and Yousaf, A (2016) Childhood trauma and alexithymia in patients with conversion disorder. Journal of the College of Physicians and Surgeons Pakistan 26, 606–610.Google ScholarPubMed
Garcin, B (2018) Motor functional neurological disorders: an update. Revue Neurologique 174, 203–211.CrossRefGoogle ScholarPubMed
Gargalas, S, Weeks, R, Khan-Bourne, N, Shotbolt, P, Simblett, S, Ashraf, L, Doyle, C, Bancroft, V and David, AS (2015) Incidence and outcome of functional stroke mimics admitted to a hyperacute stroke unit. Journal of Neurology Neurosurgery and Psychiatry 0, 1–5.Google ScholarPubMed
Gorey, KM and Leslie, DR (1997) The prevalence of child sexual abuse: Integrative review adjustment for potential response and measurement biases. Child Abuse & Neglect 21, 391–398.CrossRefGoogle ScholarPubMed
Health and Social Care Information Centre (2015) Statistics on Smoking, England. London: NHS England.Google Scholar
Hinson, VK and Haren, WB (2006) Psychogenic movement disorders. The Lancet Neurology 5, 695–700.CrossRefGoogle ScholarPubMed
Hotopf, M, Wilson-Jones, C, Mayou, R, Wadsworth, M and Wessely, S (2018) Childhood predictors of adult medically unexplained hospitalisations: results from a national birth cohort study. British Journal of Psychiatry 176, 273–280.CrossRefGoogle Scholar
Kenney, C, Diamond, A, Mejia, N, Davidson, A, Hunter, C and Jankovic, J (2007) Distinguishing psychogenic and essential tremor. Journal of the Neurological Sciences 263, 94–99.CrossRefGoogle ScholarPubMed
Kleinman, A (1982) Neurasthenia and depression: a study of somatization and culture in China. Culture, Medicine and Psychiatry 6, 117–190.CrossRefGoogle Scholar
Kleinman, AM (1980) Patients and Healers in the Context of Culture. Berkeley: University of California Press.Google Scholar
Kranick, S, Ekanayake, V, Martinez, V, Ameli, R, Hallett, M and Voon, V (2011) Psychopathology and psychogenic movement disorders. Movement Disorders 26, 1844–1850.CrossRefGoogle ScholarPubMed
Lambo, TA (1956) Neuropsychiatric observations in the western region of Nigeria. British Medical Journal 2, 1388–1394.CrossRefGoogle ScholarPubMed
Li, SH and Graham, BM (2017) Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? The potential role of sex hormones. The Lancet Psychiatry 4, 73–82.CrossRefGoogle ScholarPubMed
Ludwig, L, Pasman, JA, Nicholson, T, Aybek, S, David, AS, Tuck, S, Kanaan, RA, Roelofs, K, Carson, A and Stone, J (2018) Stressful life events and maltreatment in conversion (functional neurological) disorder: systematic review and meta-analysis of case-control studies. The Lancet Psychiatry 5, 307–320.CrossRefGoogle ScholarPubMed
Mccormack, R, Moriarty, J, Mellers, J, Shotbolt, P, Pastena, R, Landes, N, Goldstein, L, Fleminger, S and David, AS (2014) Specialist inpatient treatment for severe motor conversion disorder: a retrospective comparative study. Journal of Neurology, Neurosurgery & Psychiatry 85, 895–900.CrossRefGoogle ScholarPubMed
Mccrae, RR, Costa, PT Jr., Ostendorf, F, Angleitner, A, Hřebíčková, M, Avia, MD, Sanz, J, Sánchez-Bernardos, ML, Kusdil, ME, Woodfield, R, Saunders, PR and Smith, PB (2000) Nature over nurture: Temperament, personality, and life span development. Journal of Personality and Social Psychology 78, 173–186.CrossRefGoogle ScholarPubMed
Mechanic, D (1972) Social psychologic factors affecting the presentation of bodily complaints. New England Journal of Medicine 286, 1132–1139.CrossRefGoogle ScholarPubMed
Molnar, BE, Buka, SL and Kessler, RC (2001) Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health 91, 753–760.Google ScholarPubMed
Nathanson, CA (1977) Sex, illness, and medical care: a review of data, theory, and method. Social Science & Medicine 11, 13–25.CrossRefGoogle ScholarPubMed
Nicholson, TR, Aybek, S, Craig, T, Harris, T, Wojcik, W, David, AS and Kanaan, RA (2016) Life events and escape in conversion disorder. Psychological Medicine 46, 2617–2626.CrossRefGoogle ScholarPubMed
Office for National Statistics (2011) Census Data. London: Office for National Statistics.Google Scholar
Office for National Statistics (2016) Crime Survey for England and Wales, Year Ending March 2016. London: Office For National Statistics.Google Scholar
Park, JE (2018) Clinical characteristics of functional movement disorders: a clinic-based study. Tremor and Other Hyperkinetic Movements 2, 504.Google Scholar
Perera, G, Broadbent, M, Callard, F, Chang, C, Downs, J, Dutta, R, Fernandes, A, Hayes, RD, Henderson, M, Jackson, R, Jewell, A, Kadra, G, Little, R, Pritchard, M, Shetty, H, Tulloch, A and Stewart, R (2016) Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register: current status and recent enhancement of an Electronic Mental Health Record-derived data resource. British Medical Journal 6, e008721.Google ScholarPubMed
Perry, CG, Holmes, KG, Gruber-Baldini, AL, Anderson, KE, Shulman, LM, Weiner, WJ and Reich, SG (2017) Are patients with psychogenic movement disorders more likely to be healthcare workers? Movement Disorders Clinical Practice 4, 62–67.CrossRefGoogle ScholarPubMed
Roelofs, K, Keijsers, G, Hoogduin, K, Näring, G and Moene, F (2002) Childhood abuse in patients with conversion disorder. American Journal of Psychiatry 159, 1908–1913.CrossRefGoogle ScholarPubMed
Roelofs, K, Spinhoven, P, Sandijck, P, Moene, FC and Hoogduin, K (2005 a) The impact of early trauma and recent life-events on symptom severity in patients with conversion disorder. The Journal of Nervous and Mental Disease 193, 508–514.CrossRefGoogle ScholarPubMed
Roelofs, K, Spinhoven, P, Sandijck, P, Moene, FC and Hoogduin, KA (2005 b) The impact of early trauma and recent life-events on symptom severity in patients with conversion disorder. Journal of Nervous and Mental Disorders 193, 508–514.CrossRefGoogle ScholarPubMed
Sar, V, Akyuz, G, Kundakc, T, Kiziltan, E and Dogan, O (2004) Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. American Journal of Psychiatry 161, 2271–2276.CrossRefGoogle ScholarPubMed
Schrag, A, Trimble, M, Quinn, N and Bhatia, K (2004) The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 127, 2360–2372.CrossRefGoogle ScholarPubMed
Sharpe, D and Faye, C (2006) Non-epileptic seizures and child sexual abuse: a critical review of the literature. Clinical Psychology Review 26, 1020–1040.CrossRefGoogle ScholarPubMed
Shill, H and Gerber, P (2006) Evaluation of clinical diagnostic criteria for psychogenic movement disorders. Movement Disorders 21, 1163–1168.CrossRefGoogle ScholarPubMed
Stefansson, JG, Messina, JA and Meyerowitz, S (1976) Hysterical neurosis, conversion type: clinical and epidemiological considerations. Acta Psychiatrica Scandinavica 53, 119–138.CrossRefGoogle ScholarPubMed
Stone, J, Sharpe, M and Binzer, M (2004) Motor conversion symptoms and pseudoseizures: a comparison of clinical characteristics. Psychosomatics 45, 492–499.CrossRefGoogle ScholarPubMed
Stone, J, Carson, A, Duncan, R, Coleman, R, Roberts, R, Warlow, C, Hibberd, C, Murray, G, Cull, R, Pelosi, A, Cavanagh, J, Matthews, K, Goldbeck, R, Smyth, R, Walker, J, Macmahon, AD and Sharpe, M (2009) Symptoms ‘unexplained by organic disease’ in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain 132, 2878–2888.CrossRefGoogle ScholarPubMed
Stone, J, Carson, A, Duncan, R, Roberts, R, Warlow, C, Hibberd, C, Coleman, R, Cull, R, Murray, G, Pelosi, A, Cavanagh, J, Matthews, K, Goldbeck, R, Smyth, R, Walker, J and Sharpe, M (2010 a) Who is referred to neurology clinics? The diagnoses made in 3781 new patients. Clinical Neurology and Neurosurgery 112, 747–751.CrossRefGoogle ScholarPubMed
Stone, J, Warlow, C and Sharpe, M (2010 b) The symptom of functional weakness: a controlled study of 107 patients. Brain 133, 1537–1551.CrossRefGoogle ScholarPubMed
Van Der Hoeven, RM, Broersma, M, Pijnenborg, GHM, Koops, EA, Van Laar, T, Stone, J and Van Beilen, M (2015) Functional (psychogenic) movement disorders associated with normal scores in psychological questionnaires: a case control study. Journal of Psychosomatic Research 79, 190–194.CrossRefGoogle ScholarPubMed
Villain, N, Mesrati, F, Naccache, L, Marie, V, Roze, E, Bertrand, D and Garcin, B (2017) Clinical and demographic characteristics of patients with functional motor disorder. Neurological Review 173, S178.Google Scholar
Waller, E and Scheidt, CE (2006) Somatoform disorders as disorders of affect regulation: a development perspective. International Review of Psychiatry 18, 13–24.CrossRefGoogle ScholarPubMed
Warner, CD (1995) Somatic awareness and coronary artery disease in women with chest pain. Heart & Lung: The Journal of Acute and Critical Care 24, 436–443.CrossRefGoogle ScholarPubMed
Yar, M, Dix, D and Bajekal, M (2006) Socio-demographic characteristics of the healthcare workforce in England and Wales – results from the 2001 Census. Health Statistics Quarterly 32, 44–56.Google Scholar
Supplementary material: File

O'Connell et al. supplementary material

O'Connell et al. supplementary material 1

Download O'Connell et al. supplementary material(File)
File 14.8 KB