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Functional neurological disorder (FND) represents a broad group of motor and sensory clinical symptoms which cannot be explained by other neurological diagnoses. Dissociation is considered a key mechanism in their development and maintenance. Despite psychological therapy being the recommended choice of treatment for FND, evidence for its effectiveness is in its infancy. This study explored the dissociative profile of forty-seven patients with FND and evaluated whether individual psychological therapy improved dissociative symptoms, psychological distress and general functioning among twenty-five adults with FND. Patients completed the Multiscale Dissociation Inventory, the EuroQol five-dimensional descriptive system, the General Anxiety Disorder-7 scale and the Patient Health Questionnaire-9. Our sample showed high levels of disengagement, depersonalization and memory disturbance at baseline. Treatment was associated with significant improvements in general functioning, and symptoms of dissociation and anxiety. Improvements in dissociative experiences were found to be possibly due to reduction in anxiety. Improvements in depression were the strongest predictor of improvements in general functioning. Limitations and areas for further research are discussed. [ABSTRACT FROM AUTHOR]

This study aimed to provide a preliminary assessment of objective and subjective neurocognitive functioning in individuals with functional motor symptoms (FMS) and/or functional seizures (FS). We tested the hypotheses that the FMS/FS group would display poorer objective attentional and executive functioning, altered social cognition, and reduced metacognitive accuracy. Individuals with FMS/FS (n = 16) and healthy controls (HCs, n = 17) completed an abbreviated CANTAB battery, and measures of intellectual functioning, subjective cognitive complaints, performance validity, and comorbid symptoms. Subjective performance ratings were obtained to assess local metacognitive accuracy. The groups were comparable in age (p = 0.45), sex (p = 0.62), IQ (p = 0.57), and performance validity (p-values = 0.10–0.91). We observed no impairment on any CANTAB test in this FMS/FS sample compared to HCs, although the FMS/FS group displayed shorter reaction times on the Emotional Bias task (anger) (p = 0.01, np2 = 0.20). The groups did not differ in subjective performance ratings (p-values 0.15). Whilst CANTAB attentional set-shifting performance (total trials/errors) correlated with subjective performance ratings in HCs (p-values<0.005, rs = −0.85), these correlations were non-significant in the FMS/FS sample (p-values = 0.10–0.13, rs-values = −0.46–0.50). The FMS/FS group reported more daily cognitive complaints than HCs (p = 0.006, g = 0.92), which were associated with subjective performance ratings on CANTAB sustained attention (p = 0.001, rs = −0.74) and working memory tests (p < 0.001, rs = −0.75), and with depression (p = 0.003, rs = 0.70), and somatoform (p = 0.003, rs = 0.70) and psychological dissociation (p-values<0.005, rs-values = 0.67–0.85). These results suggest a discordance between objective and subjective neurocognitive functioning in this FMS/FS sample, reflecting intact test performance alongside poorer subjective cognitive functioning. Further investigation of neurocognitive functioning in FND subgroups is necessary. [ABSTRACT FROM AUTHOR]

Background and purpose: Functional neurological disorder (FND) is common, and symptoms can be severe. There have been no international large‐scale studies of patient experiences of FND. Methods: A patient questionnaire was created to assess FND patient characteristics, symptom comorbidities and illness perceptions. Respondents were recruited internationally through an open access questionnaire via social media and patient groups over a month‐long period. Results: In total, 1048 respondents from 16 countries participated. Mean age was 42 years (86% female). Median FND symptom duration was 5 years, and median time from first symptom to diagnosis was 2 years. Mean number of current symptoms (core FND and associated) was 9.9. Many respondents had associated symptoms, for example fatigue (93%), memory difficulties (80%) and headache (70%). Self‐reported psychiatric comorbidities were relatively common (depression, 43%; anxiety, 51%; panic, 20%; and post‐traumatic stress disorder, 22%). Most respondents reported that FND had multiple causes, including physical and psychological. Conclusions: This large survey adds further evidence that people with FND typically have high levels of multiple symptom comorbidity with resultant distress. It also supports the notion that associated physical symptoms are of particular clinical significance in FND patients. Dualistic ideas of FND were not supported by respondents, who generally preferred to conceptualize the disorder as one at the interface of mind and brain. The need for a broad approach to this poorly served patient group is highlighted. Potential selection and response biases due to distribution of the survey online, mostly via FND patient groups, are a key limitation. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to identify existing outcome measures for functional neurological disorder (FND), to inform the development of recommendations and to guide future research on FND outcomes.Methods: A systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previous treatment studies. Searches of Embase, MEDLINE and PsycINFO were conducted between January 1965 and June 2019. The findings were discussed during two international meetings of the FND-Core Outcome Measures group.Results: Five FND-specific measures were identified-three clinician-rated and two patient-rated-but their measurement properties have not been rigorously evaluated. No single measure was identified for use across the range of FND symptoms in adults. Across randomised controlled trials (k=40) and observational treatment studies (k=40), outcome measures most often assessed core FND symptom change. Other domains measured commonly were additional physical and psychological symptoms, life impact (ie, quality of life, disability and general functioning) and health economics/cost-utility (eg, healthcare resource use and quality-adjusted life years).Conclusions: There are few well-validated FND-specific outcome measures. Thus, at present, we recommend that existing outcome measures, known to be reliable, valid and responsive in FND or closely related populations, are used to capture key outcome domains. Increased consistency in outcome measurement will facilitate comparison of treatment effects across FND symptom types and treatment modalities. Future work needs to more rigorously validate outcome measures used in this population. [ABSTRACT FROM AUTHOR]

Functional neurological disorder (FND) is a common and highly disabling disorder, but its aetiology remains enigmatic. Conceptually, there has been reduced emphasis on the role of psychosocial stressors in recent years, with a corresponding increase in neurobiological explanations. However, a wealth of evidence supports the role of psychosocial adversities (eg, stressful life events, interpersonal difficulties) as important risk factors for FND. Therefore, there is a need to integrate psychosocial (environmental) and neurobiological factors (eg, sensorimotor and cognitive functions) in contemporary models of FND. Altered emotional processing may represent a key link between psychosocial risk factors and core features of FND. Here, we summarise and critically appraise experimental studies of emotional processing in FND using behavioural, psychophysiological and/or neuroimaging measures in conjunction with affective processing tasks. We propose that enhanced preconscious (implicit) processing of emotionally salient stimuli, associated with elevated limbic reactivity (eg, amygdala), may contribute to the initiation of basic affective/defensive responses via hypothalamic and brainstem pathways (eg, periaqueductal grey). In parallel, affect-related brain areas may simultaneously exert a disruptive influence on neurocircuits involved in voluntary motor control, awareness and emotional regulation (eg, sensorimotor, salience, central executive networks). Limbic-paralimbic disturbances in patients with FND may represent one of several neurobiological adaptations linked to early, severe and/or prolonged psychosocial adversity. This perspective integrates neurobiological and psychosocial factors in FND and proposes a research agenda, highlighting the need for replication of existing findings, multimodal sampling across emotional response domains and further examination of emotional influences on sensorimotor and cognitive functions in FND populations. [ABSTRACT FROM AUTHOR]

People with dissociative seizures (DS) report a range of difficulties in emotional functioning and exhibit altered responding to emotional facial expressions in experimental tasks. We extended this research by investigating subjective and autonomic reactivity (ratings of emotional valence, arousal and skin conductance responses [SCRs]) to general emotional images in 39 people with DS relative to 42 healthy control participants, whilst controlling for anxiety, depression, cognitive functioning and, where relevant, medication use. It was predicted that greater subjective negativity and arousal and increased SCRs in response to the affective pictures would be observed in the DS group. The DS group as a whole did not differ from controls in their subjective responses of valence and arousal. However, SCR amplitudes were greater in ‘autonomic responders’ with DS relative to ‘autonomic responders’ in the control group. A positive correlation was also observed between SCRs for highly arousing negative pictures and self‐reported ictal autonomic arousal, in DS ‘autonomic responders’. In the DS subgroup of autonomic ‘non‐responders’, differences in subjective responses were observed for some conditions, compared to control ‘non‐responders’. The findings indicate unaffected subjective responses to emotional images in people with DS overall. However, within the group of people with DS, there may be subgroups characterized by differences in emotional responding. One subgroup (i.e., ‘autonomic responders’) exhibit heightened autonomic responses but intact subjective emotional experience, whilst another subgroup (i.e., ‘autonomic non‐responders’) seem to experience greater subjective negativity and arousal for some emotional stimuli, despite less frequent autonomic reactions. The current results suggest that therapeutic interventions targeting awareness and regulation of physiological arousal and subjective emotional experience could be of value in some people with this disorder. [ABSTRACT FROM AUTHOR]

This study sought to extend knowledge about the previously reported preconscious attentional bias (AB) for facial emotion in patients with dissociative seizures (DS) by exploring whether the finding could be replicated, while controlling for concurrent anxiety, depression, and potentially relevant cognitive impairments. Patients diagnosed with DS (n = 38) were compared with healthy controls (n = 43) on a pictorial emotional Stroop test, in which backwardly masked emotional faces (angry, happy, neutral) were processed implicitly. The group with DS displayed a significantly greater AB to facial emotion relative to controls; however, the bias was not specific to negative or positive emotions. The group effect could not be explained by performance on standardized cognitive tests or self-reported depression/anxiety. The study provides additional evidence of a disproportionate and automatic allocation of attention to facial affect in patients with DS, including both positive and negative facial expressions. Such a tendency could act as a predisposing factor for developing DS initially, or may contribute to triggering individuals' seizures on an ongoing basis. Psychological interventions such as Cognitive Behavioral Therapy (CBT) or AB modification might be suitable approaches to target this bias in clinical practice. [ABSTRACT FROM AUTHOR]

Identification of clinical features that might distinguish psychogenic nonepileptic seizures (PNES) from epileptic seizures (ES) is of value for diagnosis, management, and understanding of both conditions. Previous studies have shown that patients' descriptions of their seizures reflect differences in content and delivery. We aimed to compare verbal descriptions of PNES and ES using a mixed-methods approach. We analyzed data from semi-structured interviews in which patients with video-electroencephalography (EEG)-confirmed ES (n = 30) or PNES (n = 10) described their seizures. Two masked raters independently coded the transcripts for relevant psychological categories and discrepancies that were noted and resolved. Additional analyses were conducted using the Linguistic Inquiry and Word Count system. The identified phenomena were descriptively compared, and inferential analyses assessed group differences in frequencies. A logistic regression analysis examined the predictive power of the most distinctive phenomena for diagnosis. As compared with ES, PNES reported longer seizures, more preseizure negative emotions (e.g., fear), anxiety symptoms (e.g., arousal, hyperventilation), altered vision/olfaction, and automatic behaviors. During seizures, PNES reported more fear, altered breathing, and dissociative phenomena (depersonalization, impaired time perception). Epileptic seizures reported more self-injurious behavior. Postseizure, PNES reported more fear and weeping and ES more amnesia and aches. The predictive power when including these variables was 97.5%. None of the single predictor variables was significant. The few but consistent linguistic differences related to the use of some pronouns and references to family. Although no single clinical feature definitively distinguishes PNES from ES, several features may be suggestive of a PNES diagnosis, including longer duration, negative emotion (i.e., fear) throughout the events, preseizure anxiety, ictal dissociation, and postseizure weeping. Fewer reports of ictal self-injury and postseizure amnesia and aches may also indicate the possibility of PNES. • No single feature distinguished PNES from ES. • Psychogenic nonepileptic seizures reported longer seizures, more negative emotions, and anxiety. • Epileptic seizures reported more ictal self-injury, postseizure amnesia, and aches. • Epileptic seizures used more words related to "he/she," "they," and "family." [ABSTRACT FROM AUTHOR]

Altered interoception may be a pathophysiological mechanism in functional neurological disorder (FND). However, findings have been inconsistent across interoceptive dimensions in FND including functional motor symptoms (FMS) and seizures (FS). Here, individuals with FMS/FS (n = 17) and healthy controls (HC, n = 17) completed measures of interoceptive accuracy and insight (adapted heartbeat tracking task [HTT] with confidence ratings), a time estimation control task (TET) and the Multidimensional Assessment of Interoceptive Awareness–2 (MAIA-2) to assess interoceptive sensibility. The groups did not differ in interoceptive accuracy (p = 1.00, g = 0.00) or confidence (p =.99, g = 0.004), although the FMS/FS group displayed lower scores on the "Not-Distracting" (p <.001, g = 1.42) and "Trusting" (p =.005, g = 1.17) MAIA-2 subscales, relative to HCs. The groups did not differ in TET performance (p =.82, g = 0.08). There was a positive relationship between HTT accuracy and confidence (insight) in HCs (r =.61, p =.016) but not in FMS/FS (r = 0.11, p =.69). HTT confidence was positively correlated with MAIA-2 "Self-Regulation" (r = 0.77, p =.002) and negatively correlated with FND symptom severity (r = −0.84, p <.001) and impact (r = −0.86, p <.001) in FMS/FS. Impaired interoceptive accuracy may not be a core feature in FMS/FS, but reduced insight and altered sensibility may be relevant. Reduced certainty in self-evaluations of bodily experiences may contribute to the pathogenesis of FND symptoms. • Intact interoceptive accuracy in functional motor symptoms/seizures (FMS/FS). • Potentially reduced interoceptive insight in FMS/FS versus healthy controls (HC). • Lower levels of "Trusting" and "Not-Distracting" in FMS/FS compared to HC. • Elevated "Self-regulation" positively related to interoceptive confidence in FMS/FS. • Elevated symptom severity/impact negatively related to interoceptive confidence. [ABSTRACT FROM AUTHOR]