Functional neurological disorder (FND) most often presents in women of childbearing age, but little is known about its course and outcomes during pregnancy, labour and postpartum (the perinatal period). We searched MEDLINE, PsycInfo and Embase combining search terms for FND and the perinatal period. We extracted data on patient demographics, subtype of FND, timing of symptom onset, comorbidities, medications, type of delivery, investigations, treatment, pregnancy outcomes and FND symptoms at follow-up.

We included 36 studies (34 case reports and 2 case series) describing 43 patients. Six subtypes of FND were identified: functional (dissociative) seizures, motor weakness, movement disorder, dissociative amnesia, speech disorders and visual symptoms. New onset of perinatal FND was more common in the third trimester and onwards. Some women with functional seizures were exposed to unnecessary anti-seizure prescriptions and intensive care admissions.

Prospective studies are urgently needed to explore how FND interacts with women's health in the perinatal period.

Functional neurological symptom disorder (FNSD) is a neuropsychiatric condition characterized by signs/symptoms associated with brain network dysfunction. FNSDs are common and are associated with high healthcare costs. FNSDs are relevant to neuropsychologists, as they frequently present with chronic neuropsychiatric symptoms, subjective cognitive concerns, and/or low neuropsychological test scores, with associated disability and reduced quality of life. However, neuropsychologists in some settings are not involved in care of patients with FNSDs. This review summarizes relevant FNSD literature with a focus on the role of neuropsychologists.

A brief review of the literature is provided with respect to epidemiology, public health impact, symptomatology, pathophysiology, and treatment.

Two primary areas of focus for this review are the following: (1) increasing neuropsychologists’ training in FNSDs, and (2) increasing neuropsychologists’ role in assessment and treatment of FNSD patients.

Patients with FNSD would benefit from increased involvement of neuropsychologists in their care.

Functional movement disorder (FMD), the motor-dominant subtype of functional neurological disorder, is a complex neuropsychiatric condition. Patients with FMD also manifest non-motor symptoms. Given that patients with FMD are diagnosed based on motor phenotype, the contribution of non-motor features to the neuropsychiatric syndrome is not well characterized. The objective of this hypothesis-generating study was to explore potential novel, neuropsychiatric FMD phenotypes by combining movement disorder presentations with non-motor comorbidities including somatic symptoms, psychiatric diagnoses, and psychological traits.

This retrospective chart review evaluated 158 consecutive patients with a diagnosis of FMD who underwent deep phenotyping across neurological and psychiatric domains. Demographic, clinical, and self-report features were analyzed. A data-driven approach using cluster analysis was performed to detect patterns when combining the movement disorder presentation with somatic symptoms, psychiatric diagnoses, and psychological factors. These new neuropsychiatric FMD phenotypes were then tested using logistic regression models.

Distinct neuropsychiatric FMD phenotypes emerged when stratifying by episodic vs. constant motor symptoms. Episodic FMD was associated with hyperkinetic movements, hyperarousal, anxiety, and history of trauma. In contrast, constant FMD was associated with weakness, gait disorders, fixed dystonia, activity avoidance, and low self-agency. Pain, fatigue, somatic preoccupation, and health anxiety were common across all phenotypes.

This study found patterns spanning the neurological-psychiatric interface that indicate that FMD is part of a broader neuropsychiatric syndrome. Adopting a transdisciplinary view of illness reveals readily identifiable clinical factors that are relevant for the development and maintenance of FMD.

Studies have reported elevated rates of dissociative symptoms and comorbid dissociative disorders in functional neurological disorder (FND); however, a comprehensive review is lacking.

To systematically review the severity of dissociative symptoms and prevalence of comorbid dissociative disorders in FND and summarise their biological and clinical associations.

We searched Embase, PsycInfo and MEDLINE up to June 2021, combining terms for FND and dissociation. Studies were eligible if reporting dissociative symptom scores or rates of comorbid dissociative disorder in FND samples. Risk of bias was appraised using modified Newcastle–Ottawa criteria. The findings were synthesised qualitatively and dissociative symptom scores were included in a meta-analysis (PROSPERO CRD42020173263).

Seventy-five studies were eligible (FND n = 3940; control n = 3073), most commonly prospective case–control studies (k = 54). Dissociative disorders were frequently comorbid in FND. Psychoform dissociation was elevated in FND compared with healthy (g = 0.90, 95% CI 0.66–1.14, I2 = 70%) and neurological controls (g = 0.56, 95% CI 0.19–0.92, I2 = 67%). Greater psychoform dissociation was observed in FND samples with seizure symptoms versus healthy controls (g = 0.94, 95% CI 0.65–1.22, I2 = 42%) and FND samples with motor symptoms (g = 0.40, 95% CI −0.18 to 1.00, I2 = 54%). Somatoform dissociation was elevated in FND versus healthy controls (g = 1.80, 95% CI 1.25–2.34, I2 = 75%). Dissociation in FND was associated with more severe functional symptoms, worse quality of life and brain alterations.

Our findings highlight the potential clinical utility of assessing patients with FND for dissociative symptomatology. However, fewer studies investigated FND samples with motor symptoms and heterogeneity between studies and risk of bias were high. Rigorous investigation of the prevalence, features and mechanistic relevance of dissociation in FND is needed.

Since before the time of “Anna O”, the functional neurologic symptom disorder (FNSD) has captivated psychiatry. While the definitive psychopathological mechanism for this phenomenon remains elusive, it is nevertheless of great value for patients and clinicians alike to develop a more nuanced understanding of FNSD. It is necessary to make an enquiry into the mechanism by bridging the psychoanalytic and neurobiological theories.

1.Elucidate psychoanalytic concepts to FNSD 2.Elucidate neuroscientific aspects of FNSD 3.Reconcile the chasm between the two concepts

Comprehensive review of literature at the interface of psychoanalytic and neuroscientific theories of FNSD

Emerging evidence have found putative explanations to account for FNSD. Orbitofrontal cortex, anterior cingulate gyrus, dorsolateral prefrontal cortex and striatothalamocortical circuits have been implicated. Number of total studies remain small with each study having few participants. This necessitates a degree of caution in interpreting results. Thus far, mechanisms such as signal rerouting or hypoactivation of specific frontal regions appears to play a material role in FNSD. Neuroscience may be approaching to providing evidence that psychological defenses may have neurobiological correlates that can be measured in certain conditions. However, a definitive answer remains elusive.

The expanding narrative of a relatively nascent dialogue between neuroscience and psychoanalysis remains not only clinically relevant, but also promotes a holistic view of patients with psychiatric illnesses. Through our discussion, psychoanalytic theory is woven into the current neurobiological framework for FNSD, which we believe will assist clinicians provide empathic care and help patients develop a more adaptive and meaningful explanatory paradigm of their lived experience.

No significant relationships.

Conversion disorder (CD) is largely managed by primary care physician. A good knowledge of this disorder and a mastery of adequate therapeutic means will allow patients to recover promptly and reduce recurrences.

To evaluate the management of CD by primary care physicians.

This cross-sectional and descriptive study involved 90 primary care physicians in the region of Sfax (Tunisia). We submitted a self-administered anonymous questionnaire to physicians to explore their practice towards patients with CD.

Among the 90 doctors contacted, 54 (60%) responded to our questionnaire. Their age ranged from 25 to 70 years, with a median of 41 years. The sex ratio was 0.92. The average number of years of practice was 15 years (SD = 9.7). Half of the physicians reported that the consultation of a patient with CD lasted between 15 and 30 minutes. Faced with a first episode of CD, 61.1% of the doctors decided to treat the patient alone and 18.5% preferred to take the advice of a psychiatrist. In the case of a recurrence, 59.2% chose to refer the patient immediately to a psychiatrist. The use of pharmacological treatment was indicated by 64.8% of participants. Half of the doctors stated that they had difficulties in managing patients with CD.

According to our results, the management of CD by primary care physicians remained restrictive and difficult. It is therefore necessary to encourage primary care physicians to express the difficulties they encounter and to turn to their psychiatric colleagues for help.

No significant relationships.

Since there is no objective criteria, unique clinical symptom or laboratory test to make the diagnosis of conversion disorder; its diagnosis and treatment is challenging which leads to a poor prognosis.

The aim of this study is to investigate the brain metabolic activity of patients with conversion disorder with PET/MRI.

12 conversion disorder patients were included. Somatosensory Amplification Scale, Somatoform Dissociation Scale, Patient Health Questionnaire-15, Toronto Alexithymia Scale were filled in by the participants. Neurological, mental status examinations, Wechsler Adult Intelligence Scale-Revised Form (WAIS-R) and brain F18-FDG-PET/MRI were performed. Structured Clinical Interview for DSM-5, Hamilton Depression and Anxiety Scales were administered.

83% of the patients were female, the mean age was 33 years and average education period was 10,2 years. WAIS-R total scores were consistent with low avarage intelligence level.Cerebral hypermetabolism was detected in the primary visual cortex. Average regional brain metabolic activity had a tendency to increase in bilateral prefrontal, right sensorimotor (SM),cingulate,right inferior parietal,occipital lateral,right temporal lateral cortices and cerebellum. Each region was metabolically correlated with the homologous contralateral regions. Significant correlations in the same direction was found between frontal and occipital lateral & primary visual cortices; cerebellum and left sensorimotor cortex; anterior cingulate cortex(ACC) and superior parietal cortex & cerebellum. No correlations were found between ACC and left SM cortex.

Findings of our study indicate that there are moderate changes in regional brain metabolic activities and inter-regional correlations in patients with conversion disorder. In order to confirm these findings, furter functional neuroimaging studies are needed.

No significant relationships.

Primary care physicians tend to examine patients with conversion disorder (CD) first. A good knowledge of this disorder will allow an early diagnosis and avoid unnecessary investigations for the patient.

To assess the knowledge of primary care physicians about patients with CD.

We conducted a cross-sectional and descriptive study among 90 primary care physicians in Sfax (Tunisia). We used an anonymous self-questionnaire for data collection.

The response rate to our questionnaire was 60%. The participants’ age ranged from 25 to 70 years, with a median of 41 years. The sex ratio (M/F) was 0.92. The majority of physicians (75.9%) have practiced in the public sector. Among the respondents, 75.9% had theoretical training in CD, 14.8% had continuing medical education (CME), and 42.6% had hospital experience in a psychiatric department. The overall proportion of correct answers was 71.8%. The most recognised symptoms of CD were: dysphonia-aphonia, paresthesia or paresis. All doctors mentioned at least one criterion to distinguish CD from epileptic seizures and loss of consciousness.

There are some gaps in primary care physicians’ knowledge of CD. Thus, we propose to reconsider the conduct of CME, to favour small group training workshops with role-playing and to improve the collaboration between the psychiatrist and the primary care physician.

No significant relationships.

. Autoimmune encephalitis is a difficult-to-recognize, complex disease that can present with various neuropsychiatric symptoms. N-methyl-D-aspartate receptor (NMDA-r) and anti-leucine-rich glioma-inactivated 1 protein (LGI-1) subtypes of autoimmune encephalitis may present with psychiatric symptoms.

We would like to present an autoimmune encephalitis case that can be confused with conversion disorder.

A 54-year-old, female patient started to have forgetfulness ten months ago, and convulsions started five months ago. The patient had disorganized behaviors and contractions in the extremities. Diffusion MRI and brain CT images were normal. The patient had low blood sodium level. In the follow-up, her orientation was impaired and she could hardly make eye contact. As the patient’s contractions were evaluated as conversion in the first stage, 50mg/day sertraline was added to the treatment.

After cranial MRI and EEG recordings were completed, the patient was referred to the neurology department due to the suspicion of autoimmune encephalitis. In the cerebrospinal fluid examination anti-LGI-1 and anti-yo antibodies were positive. Thereupon, IV pulse steroid was given. After that her orientation and disorganized behavior improved. Then, the patient was referred to oncology department.

Limbic encephalitis may manifest as sleep disorders, short-term memory loss, conversion disorder, disorganized behaviors, slurred speech, non-epileptic seizures, sensory and motor defects. Delay in diagnosis may worsen the prognosis of possible malignancy. It should be kept in mind that the patient with a suspected conversion disorder may have limbic encephalitis.

No significant relationships.

Patients with functional neurological disorders (FND) often present with multiple motor, sensory, psychological and cognitive symptoms. In order to explore the relationship between these common symptoms, we performed a detailed clinical assessment of motor, non-motor symptoms, health-related quality of life (HRQoL) and disability in a large cohort of patients with motor FND. To understand the clinical heterogeneity, cluster analysis was used to search for subgroups within the cohort.

One hundred fifty-two patients with a clinically established diagnosis of motor FND were assessed for motor symptom severity using the Simplified Functional Movement Disorder Rating Scale (S-FMDRS), the number of different motor phenotypes (i.e. tremor, dystonia, gait disorder, myoclonus, and weakness), gait severity and postural instability. All patients then evaluated each motor symptom type severity on a Likert scale and completed questionnaires for depression, anxiety, pain, fatigue, cognitive complaints and HRQoL.

Significant correlations were found among the self-reported and all objective motor symptoms severity measures. All self-reported measures including HRQoL correlated strongly with each other. S-FMDRS weakly correlated with HRQoL. Hierarchical cluster analysis supplemented with gap statistics revealed a homogenous patient sample which could not be separated into subgroups.

We interpret the lack of evidence of clusters along with a high degree of correlation between all self-reported and objective measures of motor or non-motor symptoms and HRQoL within current neurobiological models as evidence to support a unified pathophysiology of ‘functional’ symptoms. Our results support the unification of functional and somatic syndromes in classification schemes and for future mechanistic and therapeutic research.

Clinicians who recognize functional neurological disorders (FND) may not share that diagnosis with patients. Poor communication delays treatment and contributes to substantial disability in FND. Diagnostic (ICD-10) coding, one form of medical communication, offers an insight into clinicians’ face-to-face communication. Therefore, quantifying the phenomenon of noncoding, and identifying beliefs and practice habits that reduce coding, may suggest routes to improve medical communication in FND.

We reviewed all pediatric neurology consultations in our hospital from 2017 to 2020, selecting those in which neurologists explicitly stated an FND-related diagnosis (N = 57). We identified the neurological symptoms and ICD-10 codes assigned for each consultation. In parallel, we reviewed all encounters that utilized FND-related codes to determine whether insurers paid for this care. Finally, we assessed beliefs and practices that influence FND-related coding through a nationwide survey of pediatric neurologists (N = 460).

After diagnosing FND, neurologists selected FND-related ICD-10 codes in only 22.8% of consultations. 96.2% of neurologists estimated that they would code for non-epileptic seizure when substantiated by electroencephalography; in practice, they coded for 36.7% of such consultations. For other FND manifestations, neurologists coded in only 13.3% of cases. When presented with FND and non-FND scenarios with equal levels of information, neurologists coded for FND 41% less often. The strongest predictor of noncoding was the outdated belief that FND is a diagnosis of exclusion. Coding for FND never resulted in insurance nonpayment.

Noncoding for FND is common. Most factors that amplify noncoding also hinder face-to-face communication. Research based on ICD-10 coding (eg, prevalence and cost) may underestimate the impact of FND by >fourfold.

Conversion Disorder is a condition defined by the sudden appearance of neurologic symptoms without an identifiable organic cause, often thought to be associated with psychological triggers. This disorder can lead to severe distress and loss of functionality which, without appropriate treatment, can be made permanent.

To raise awareness for this unexplained and often misunderstood disorder using a clinical case as background.

Clinical history, organic evaluation, psychological evaluation and literature review.

28-year-old female, single, with two children, working from home as a call-centre operator. Previously followed and medicated for depression. Presents to the ER due to sudden loss of consciousness while working, after which her speech became hindered by stuttering. Neurologic evaluation was unremarkable and she was referred for Psychiatric assessment, resulting in a diagnosis of Conversion Disorder. Speech was at first understandable but in the following weeks became progressively worse and eventually led to aphonia, while written communication remained normal and was the patient’s method of choice.

Once a favourite of Psychiatrists, little is yet known about the underlying mechanisms behind this disorder. Experts disagree on whether to classify it as a dissociative disorder, a somatoform disorder, or its own category. Patients presenting with this condition are often mistaken for malingering and thus subject to unhelpful or outright discriminatory practices. Broadened awareness is required to ensure patients get early access to the best possible care and thus improve their quality of life.

Amongst different subtypes of Conversion Disorder (CD), DSM-V lists the Psychogenic Non-epileptic seizures (PNES). PNES are defined as episodes that visually resemble epileptic seizures but, etiologically, they are not due to electrical discharges in the brain.

Our study aims to explore the differences between PNES and other CDs. In particular, we studied the suicidality and its correlations with dissociation and alexithymia.

Patients, recruited from the Psychiatry and Clinical Psychology Unit of the Fondazione Policlinico Tor Vergata, Rome, Italy, were diagnosed with PNES (n=22) and CD (n=16) using the DSM-5 criteria. Patients underwent the following clinical assessments: HAM-D, BDI, DES, BHS, TAS, CTQ.

PNES showed significantly higher scores than CD in all assessments, except for BDI-somatic (p=0.39), BHS-feeling (p=0.86), and the presence of childhood trauma. PNES also showed significantly higher suicidality (p = 0.003). By controlling for the confounding factor “depression”, in PNES suicidality (and in particular the BHS-loss of motivation) appears to be correlated with DES-total score (p = 0.008), DES-amnesia (p = 0.002) and DES -derealization-depersonalization (p = 0.003). On the other hand, in CDs, the BHS-total score shows a correlation with the TAS-total score (p = 0.03) and BHS-Feelings with TAS-Externally-Oriented Thinking (p = 0.035), while only the BHS-Loss of motivation appears correlated with DES-Absorption (p = 0.011).

Our study shows significant differences between PNES and CD, in several symptomatologic dimensions, including suicidality. Indeed, in PNES suicidality appears to be related to dissociation, while in CDs it appears mainly to be correlated with alexithymia.

To describe a case of conversion disorder in a pre-school girl, affecting the sensory functions.

The authors revise the specific characteristics of this disorder in pre-school children and highlight its differences from adult's common pictures. With that purpose they describe a case of a 5 year's old girl who attended the ER with sudden blindness complaints. She was admitted for observation and investigation. All possible organic causes where excluded. She was then referred to Child and Adolescent Psychiatry emergency consultation. She was diagnosed with Conversion Disorder triggered by a familiar stressful situation and was medicated with diazepam. Her vision recovered suddenly within a few hours.

Although common among adolescents and older children, conversion disorder is a rare entity among pre-school children. The affected function in this age group is usually the motor function, but in rare cases it can affect the sensory functions causing deafness or blindness. This seems to be associated with stressful events but also has a strong familiar component, where imitation of adult's behaviors and familiar gains take major roles.