Functional Neurologic Disorders

 
 
Academic Press
  • 1. Auflage
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  • erschienen am 6. Oktober 2016
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  • 680 Seiten
 
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978-0-12-801849-1 (ISBN)
 

Functional Neurologic Disorders, the latest volume in the Handbook of Clinical Neurology series, summarizes state-of-the-art research findings and clinical practice on this class of disorders at the interface between neurology and psychiatry. This 51-chapter volume offers an historical introduction, chapters on epidemiology and pathophysiolology, a large section on the clinical features of different type of functional neurologic symptoms and disorders (including functional movement disorders, non-epileptic seizures, dizziness, vision, hearing, speech and cognitive symptoms), and then concluding with approaches to therapy.

This group of internationally acclaimed experts in neurology, psychiatry, and neuroscience represent a broad spectrum of areas of expertise, chosen for their ability to write clearly and concisely with an eye toward a clinical audience. This HCN volume sets a new landmark standard for a comprehensive, multi-authored work dealing with functional neurologic disorders (also described as psychogenic, dissociative or conversion disorders).


  • Offers a comprehensive interdisciplinary approach for the care of patients with functional disorders seen in neurologic practice, leading to more efficient prevention, management, and treatment
  • Provides a synthesis of research efforts incorporating clinical, brain imaging and neurophysiological studies
  • Fills an existing gap between traditional neurology and traditional psychiatry
  • Contents include coverage of history, epidemiology, clinical presentations, and therapy
  • Edited work with chapters authored by leaders in the field, the broadest, most expert coverage available
0072-9752
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  • Niederlande
Elsevier Science
  • 41,24 MB
978-0-12-801849-1 (9780128018491)
0128018496 (0128018496)
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  • Front Cover
  • Functional Neurologic Disorders
  • Copyright
  • Handbook of Clinical Neurology 3rd Series
  • Foreword
  • Preface
  • References
  • Contributors
  • Contents
  • Section 1: History
  • Chapter 1: A brief history of hysteria: From the ancient to the modern
  • Introduction
  • Babylon and assyria
  • Ancient egypt
  • Greece and rome
  • Middle Ages
  • Mass hysteria
  • Willis (1621-1675) and the beginnings of neurology
  • 18th and 19th centuries
  • Conclusions
  • References
  • Chapter 2: Charcot, hysteria, and simulated disorders
  • Introduction
  • The protagonist
  • Charcot's nosology: organic diseases and the névroses
  • Charcot and the cause of neurologic diseases
  • Charcot and hysteria
  • Hysteria and psychologic influences: the role of suggestion
  • Charcot and Freud: the mentor's never-sated obsession
  • Simulation
  • Charcot in a modern context
  • References
  • Chapter 3: Neurologic approaches to hysteria, psychogenic and functional disorders from the late 19th century onwards
  • Introduction
  • Neurologic approaches to hysteria from charcot to world war I
  • Babinski
  • Janet
  • UK neurology before World War I
  • US neurology
  • Oppenheim and traumatic neurosis
  • World war I
  • The 1920S to the 1960S
  • St. Louis ``hysteria´´ and the systematization of symptoms
  • 1970S to 1990S
  • Developments since 2000 and the future
  • Conclusions
  • Acknowledgments
  • References
  • Chapter 4: Freud´s hysteria and its legacy
  • Introduction
  • Freuds hysteria
  • Repression
  • Conversion
  • The third ingredient
  • Shell shock and psychosomatics
  • Scientists and philosophers
  • Hysteria is dead
  • long live functional neurologic symptoms
  • References
  • Section 2: Epidemiology, etiology, and mechanism
  • Chapter 5: Epidemiology
  • Introduction: which diagnosis in which population?
  • A technical barrier to epidemiologic research
  • Incidence
  • Prevalence
  • Frequency in neurology settings
  • Age and sex
  • Geographic and historic epidemiology
  • Onset
  • Physical symptom and disease comorbidity
  • Disability
  • Psychologic comorbidity
  • Outcome: misdiagnosis
  • Risk factors
  • Predisposing factors
  • Precipitating factors
  • Perpetuating factors
  • Epidemiology of functional neurologic disorder subtypes: lumping or splitting?
  • Patient outcomes and mortality
  • Economics
  • Conclusion
  • References
  • Chapter 6: Neurophysiologic studies of functional neurologic disorders
  • Introduction
  • Functional weakness and paralysis
  • Interpretation
  • Functional sensory loss
  • Somatic sensation
  • Vision
  • Audition
  • Interpretation
  • Functional movement disorders
  • Functional myoclonus
  • Interpretation
  • Functional tremor
  • Interpretation
  • Functional dystonia
  • Interpretation
  • Other functional movement disorders
  • Functional seizures (psychogenic nonepileptic seizures: PNES)
  • Interpretation
  • Synthesis
  • Acknowledgment
  • References
  • Chapter 7: Imaging studies of functional neurologic disorders
  • Background
  • Are functional symptoms simulated?
  • How are functional neurologic symptoms produced?
  • Why are functional neurologic symptoms produced?
  • Linking the how and why: a role for medial prefrontal areas?
  • Structural Imaging
  • Resting-state imaging
  • Summary
  • Acknowledgments
  • References
  • Chapter 8: Dissociation and functional neurologic disorders
  • Introduction
  • Psychiatric classification and the dissociative experiences scale
  • ``Trait dissociation´´ and functional neurologic symptoms
  • Physical symptoms in patients with dissociative disorders
  • ``Psychoform´´ dissociative symptoms in patients with nonepileptic seizures
  • ``Psychoform´´ dissociative symptoms in patients with functional motor symptoms
  • Is comorbidity evidence for a dissociative mechanism in FND?
  • ``State´´ dissociation and functional neurologic symptoms
  • Compartmentalization and FND
  • Compartmentalization due to a monitoring problem
  • Compartmentalization due to a control problem
  • The Integrative Cognitive Model
  • Evidence for compartmentalization in functional neurologic disorders
  • Trauma and functional neurologic disorders
  • Summary, implications, and future developments
  • References
  • Chapter 9: Hypnosis as a model of functional neurologic disorders
  • Hypnosis as a model
  • Introduction
  • Hypnosis and suggestibility
  • Explanatory models in scientific explanation
  • The initial construction of hypnosis as a model for hysteria
  • Contemporary versions of hypnosis as a model for functional symptoms
  • Neuroimaging studies
  • Limb paralysis
  • Functional amnesia
  • Loss of agency and awareness
  • Nonepileptic seizures, involuntary movement, and loss of awareness
  • Dissociative identity changes
  • Complex automatisms and loss of awareness
  • Integrative models of functional and suggested phenomena
  • Relationships between functional symptoms, suggestive processes, and hypnosis
  • Conclusion
  • References
  • Chapter 10: Psychologic theories in functional neurologic disorders
  • Introduction
  • Psychodynamic theories
  • Transference and countertransference
  • Primary and secondary gain
  • Sexual theories
  • Symbolism
  • Object relations theory and attachment theory
  • The social model
  • Illness behavior
  • Abnormal illness behavior
  • Diagnostic operationalization
  • Learning theories
  • Classic conditioning
  • Operant conditioning
  • Social learning theory
  • Self-regulation theory
  • Cognitive-behavioral therapy
  • Mindfulness
  • Conclusions
  • References
  • Chapter 11: Voluntary or involuntary? A neurophysiologic approach to functional movement disorders
  • Introduction
  • What are we aware of when we act?
  • Neurophysiology of action awareness
  • Action awareness and agency in functional movement disorders
  • Expected and experienced control
  • Generation of ``involuntary´´ movements in fmd
  • Conclusions and research agenda
  • References
  • Chapter 12: Neurobiologic theories of functional neurologic disorders
  • Introduction
  • Historic neurobiologic theories
  • 20th-century neurobiologic theories
  • 21st-century neurobiologic models
  • Co-occurrence of symptoms
  • Attention
  • Beliefs/expectations
  • Agency
  • Concluding remarks
  • References
  • Chapter 13: Stress, childhood trauma, and cognitive functions in functional neurologic disorders
  • Introduction
  • Trauma and life events in conversion disorder: a literature review
  • Trauma rates in conversion disorder
  • Physical abuse
  • Sexual abuse
  • Emotional abuse or neglect
  • Life events
  • Other vulnerability factors
  • Explanatory models
  • Historic models of conversion and dissociation
  • Cognitive hierarchic models
  • Neurobiologic stress models
  • Cognitive dysfunction in CD: empiric support
  • Stress and cognitive function in CD
  • Towards an integration
  • Associative learning leads to altered mental representations
  • Life events lead to alterations in neurobiologic stress systems
  • Summary and research agenda
  • Acknowledgments
  • References
  • Chapter 14: Do (epi)genetics impact the brain in functional neurologic disorders?
  • Introduction
  • Environmental effects
  • Link between environmental factors like stress and the brain systems
  • Genetics
  • Studies in conversion disorders
  • Studies in somatoform disorders
  • Environment-gene interactions and epigenetics
  • Conclusions
  • References
  • Section 3: Symptoms (including signs and investigations)
  • Chapter 15: Assessment of patients with functional neurologic disorders
  • Introduction
  • Preparation and start of the consultation
  • Setting
  • Preparation
  • Beginning a consultation
  • The assessment of physical symptoms in the history
  • Make a list of physical symptoms
  • Typical day and disability
  • Onset and course
  • Dissociative symptoms
  • Exploring the patient's beliefs
  • The psychologic assessment of patients with functional disorders
  • Asking about depression, anxiety, and other common psychologic symptoms
  • Family history, childhood, and recent stress
  • Dealing with anger and excessive praise
  • Exaggeration
  • Mental state examination
  • La belle indifférence
  • Physical examination
  • Principles of diagnosis and diagnostic pitfalls
  • Reaching a diagnosis
  • Eight shades of diagnostic change
  • Diagnostic pitfalls - general considerations
  • ``This patient is anxious/recently stressed/has a personality disorder,´´ so must have funct
  • ``The patient is too normal/nice/stoic/male/young/old/intelligent/muchlike me,´´ so must have a ne
  • ``I've made a diagnosis
  • there is no need for another one´´: the problem of comorbidity
  • Overreliance on and poor interpretation of neuroimaging
  • Diagnostic pitfalls in dissociative (nonepileptic) attacks
  • Diagnostic pitfalls in functional motor disorders
  • Conclusion
  • References
  • Chapter 16: The classification of conversion disorder (functional neurologic symptom disorder) in ICD and DSM
  • Introduction
  • Conversion disorder in the international classification of diseases (ICD)
  • Conversion disorder in the DSM, 1952-2000
  • Conversion disorder in DSM-5
  • Name
  • Feigning
  • Stressors
  • Incompatibility with organic disease
  • Specifiers
  • References
  • Chapter 17: Neurologic diagnostic criteria for functional neurologic disorders
  • Introduction
  • Functional motor, sensory, and gait disorders
  • Reliable clinical signs and diagnostic criteria
  • Positive signs for functional weakness, sensory and gait disorders
  • Suggested signs and their reliability
  • Weakness (Table 17.2)
  • Sensory disorders (Table 17.3)
  • Gait disorders (Table 17.4)
  • Less investigated signs (Table 17.5)
  • Rating scales and their reliability
  • Psychogenic nonepileptic seizures
  • Reliable clinical signs
  • Diagnostic criteria
  • Rating scales and their reliability
  • Functional movement disorders
  • Diagnostic criteria and their degree of certainty
  • Diagnostic criteria focused on the different types of movement disorders
  • Rating scales for severity of functional movement disorders
  • Concluding remarks
  • References
  • Chapter 18: Functional limb weakness and paralysis
  • Introduction
  • Historic descriptions
  • Gowers
  • Late 19th- and early 20th-century descriptions
  • Mid to late 20th century
  • Epidemiology
  • Prevalence and incidence
  • Population-based
  • Secondary care settings
  • Age of onset and gender
  • Clinical features in the history
  • Subjective experience
  • Distribution and laterality
  • Onset
  • Other functional disorders and symptoms
  • Neurologic and other disease
  • Physical signs of functional limb weakness
  • General signs of functional limb weakness
  • Global pattern of weakness
  • Give-way weakness
  • Co-contraction
  • Motor inconsistency
  • Inverse pyramidal weakness
  • Signs of functional weakness in the face, neck, and arms
  • Functional facial spasm
  • Sternocleidomastoid test
  • Drift without pronation
  • Monrad-Krohn's cough test
  • Double crossed-arm pull test
  • Finger abduction
  • The elbow flex-ex test
  • ``Make a fist´´ test
  • Arm drop
  • Bowlus maneuver
  • Signs of functional weakness in the trunk and legs
  • Hoover's sign
  • Hip abductor sign
  • Dragging monoplegic gait (Figs18.1 and 18.2)
  • Trunk-thigh test
  • Spinal Injuries Center test
  • BarrÉ sign (manoeuvre de la jambe)
  • Additional clinical findings in functional limb weakness
  • Neurophysiologic tests of functional limb weakness
  • Mechanism, etiology, and treatment
  • Conclusion
  • References
  • Chapter 19: Functional tremor
  • Introduction
  • Symptoms and signs
  • Supportive ancillary examinations
  • References
  • Chapter 20: Functional dystonia
  • Introduction
  • Historic background
  • Diagnosis of functional dystonia
  • Regional functional dystonia phenotypes
  • Craniofacial region
  • Cervical region
  • Foot
  • Hand
  • Psychopathology
  • Pathophysiology
  • Cortical and spinal excitability
  • Somatosensory processing
  • Cortical plasticity
  • Functional neuroimaging
  • Prognosis
  • Management
  • General therapeutic principles
  • Cognitive behavioral therapy
  • Psychodynamic psychotherapy
  • Physical therapy
  • Motor reprogramming physiotherapy
  • FD-specific anecdotal experience
  • Conclusions and future steps
  • References
  • Chapter 21: Functional jerks, tics, and paroxysmal movement disorders
  • Introduction
  • Epidemiology and clinical picture
  • Functional jerks
  • Epidemiology
  • Clinical picture
  • Tics in the scope of Tourette's disorder
  • Epidemiology
  • Clinical picture
  • Myoclonus
  • Epidemiology
  • Clinical picture
  • Cortical myoclonus
  • Subcortical myoclonus
  • Spinal myoclonus
  • Paroxysmal movement disorders
  • Epidemiology
  • Clinical picture
  • Psychiatric comorbidity and psychopathology
  • Functional jerks
  • Differential diagnosis with tics and myoclonus based on psychiatric comorbidity
  • Pathophysiology of functional jerks
  • The neurophysiologic examination
  • Summary and conclusion
  • References
  • Chapter 22: Psychogenic (functional) parkinsonism
  • Introduction
  • Epidemiology
  • Clinical history
  • Clinical signs
  • Ancillary testing
  • Future directions
  • References
  • Chapter 23: Functional gait disorder
  • Introduction
  • Normal gait
  • Characteristics of some classic organic gaits
  • Characteristics of some complex organic gaits
  • Isolated dystonic gait
  • Gait in combined dystonia
  • Frontal ataxia
  • Psychogenic gait
  • History
  • Examination of gait (phenomenology)
  • Associated neurologic signs
  • Syndromes
  • Movement disorder mimics
  • Neurologic (nonmovement disorder) mimics
  • Musculoskeletal or biomechanical mimics
  • Isolated disequilibrium or balance disorders
  • Management
  • Conclusions
  • References
  • Chapter 24: Functional sensory symptoms
  • Introduction
  • Historic background
  • Epidemiology
  • Hypoesthesia/sensory loss
  • Nature of symptoms
  • Distribution of symptoms
  • Physical signs of functional sensory loss
  • Hyperesthesia/paresthesia and pain
  • Unusual (but nonfunctional) sensory symptoms
  • Synesthesia
  • Cenesthesias
  • Allesthesia or allochiria
  • Pathophysiology
  • Treatment specific for sensory symptoms
  • Acknowledgment
  • References
  • Chapter 25: Nonepileptic seizures - subjective phenomena
  • Introduction
  • Methodologic considerations
  • Temporal characteristics of subjective symptoms associated with PNES
  • PNES triggers
  • PNES warnings
  • Ictal symptoms
  • Postictal symptoms
  • Interictal symptoms
  • Impairment of consciousness
  • Clinical significance of subjective PNES experience
  • Diagnostic implications
  • Links with etiology
  • Treatment implications
  • Prognostic implications
  • Conclusion
  • References
  • Chapter 26: Nonepileptic seizures - objective phenomena
  • Introduction
  • Diagnosis
  • Semiology
  • Classification
  • Other characteristics to help clinicians differentiate PNES from ES
  • Conclusions
  • References
  • Chapter 27: Psychogenic nonepileptic seizures: EEG and investigation
  • Introduction
  • Inpatient video-EEG monitoring
  • Simple partial seizures
  • Hypermotor frontal-lobe seizures
  • ``Swoon´´-type events
  • Tilt table testing
  • The need to capture habitual events
  • The use of video-EEG in practice
  • Short-duration outpatient video-EEG monitoring
  • Home video monitoring
  • Ambulatory EEG monitoring
  • Serum prolactin estimation
  • Postictal EEG recording
  • Additional epilepsy: using EEG as a screening test
  • Additional epilepsy - using EEG to exclude it
  • Overinterpretation of nonepileptiform interictal EEG abnormalities
  • The value of medium-term residential monitoring
  • Conclusions
  • References
  • Chapter 28: Functional coma
  • Introduction
  • Terminology, assessment, and differential diagnosis
  • Functional stupor and coma (including ``nonepileptic pseudostatus´´)
  • Stupor in psychiatric disorders, such as depression, mania, and catatonia
  • Factitious unresponsiveness
  • Functional coma: clinical features and review of published cases
  • Diagnostic classification
  • Etiology
  • Prevalence
  • Diagnosis
  • (Positive) clinical signs
  • EEG
  • Treatment and prognosis
  • Conclusion
  • References
  • Chapter 29: Functional and simulated visual loss
  • Introduction
  • Nonorganic visual loss
  • Evaluation
  • Monocular vision loss
  • Binocular vision loss
  • Visual field loss
  • Imaging and ancillary testing
  • Management
  • Conclusions
  • Disclosures
  • References
  • Chapter 30: Functional eye movement disorders
  • Introduction
  • The eye movement examination
  • Epidemiology
  • Functional eye movement syndromes
  • Functional convergence spasm
  • Functional convergence paralysis
  • Functional limitation of gaze
  • Functional eye oscillations
  • Functional opsoclonus
  • Functional tonic eye deviation (oculogyric crisis)
  • Functional diplopia
  • Management options
  • References
  • Chapter 31: Functional facial and tongue movement disorders
  • Introduction
  • Epidemiology
  • Clinical features
  • Bilateral involvement of orbicularis oculis
  • Unilateral involvement of orbicularis oculis and/or oris
  • Bilateral involvement of orbicularis oris
  • Tongue involvement
  • Palate involvement
  • Associated conditions
  • Diagnosis
  • Differential diagnosis
  • Management
  • References
  • Chapter 32: Functional auditory disorders
  • Introduction
  • Nonorganic hearing loss
  • Definition
  • Demographics
  • Investigations
  • Is it functional?
  • Treatment strategies
  • Disorders of auditory processing
  • Definition
  • Demographics
  • Investigations
  • Is it functional?
  • Treatment strategies
  • Tinnitus
  • Definition
  • Demographics
  • Investigations
  • Is it functional?
  • Treatment strategies
  • Musical hallucination (MH)
  • Definition
  • Demographics
  • Investigations
  • Is it functional?
  • Treatment strategies
  • Low-frequency noise complaint
  • Definition
  • Demographics
  • Investigations
  • Is it functional?
  • Treatment strategies
  • Disorders of loudness perception
  • Definition
  • Demographics
  • Investigations
  • Is it functional?
  • Treatment strategies
  • Misophonia
  • Definition
  • Demographics
  • Investigations
  • Is it functional?
  • Treatment strategies
  • Acoustic shock
  • Definition
  • Demographics
  • Investigations
  • Is it functional?
  • Treatment strategies
  • Conclusion
  • References
  • Chapter 33: Functional speech disorders: clinical manifestations, diagnosis, and management
  • Introduction
  • The spectrum of functional speech disorders
  • Prevalence
  • Examination and differential diagnosis
  • Can the abnormal speech pattern be classified neurologically?
  • Are observations of the oral mechanism consistent with the speech and/or oral mechanism abnormalities typically associat
  • Is the speech deficit consistent?
  • Is the speech deficit suggestible or subject to distractibility?
  • Does speech fatigue in a lawful manner?
  • Is the speech deficit reversible?
  • Broad categories of functional speech disorders
  • Stuttering
  • Foreign-accent syndrome and other prosodic disturbances
  • Other manifestations of functional speech disorders
  • Articulation abnormalities
  • Resonance abnormalities
  • Mixed and related abnormalities
  • Management
  • Conclusion
  • References
  • Chapter 34: Functional voice disorders: clinical presentations and differential diagnosis
  • Introduction
  • Complexities of laryngeal function
  • Other vital roles of the laryngeal valve
  • Communicative role of the voice and as a reflection of personal identity
  • Voice as an indicator of physical and mental health
  • Terminologies and diagnostic classification
  • Clinical voice evaluation and differential diagnosis
  • Laryngeal and functional assessment of the voice
  • Muscle tension voice disorders - clinical features
  • Subtypes within the MTVD classification
  • Clinical features of MTVD
  • Initial observation
  • Laryngoscopic examination
  • Perception of MTVD
  • Related signs
  • Co-occurrence of MTVD
  • Normal or improved phonation
  • Prognosis
  • Psychogenic voice disorders - clinical features
  • Subtypes within the PVD classification
  • Clinical features of PVD
  • Onset of PVD
  • Symptom incongruity and reversibility
  • Symptom incongruity
  • Symptom reversibility
  • Perception of PVD
  • Signs and symptoms of PVD
  • Co-occurrence of PVD
  • Normal or improved phonation
  • Prognosis of PVD
  • Etiology
  • Prevalence
  • Prevalence in relation to gender and age
  • Biographic details for individuals with functional voice disorders
  • Diagnostic dilemmas between functional and neurologic voice disorders
  • Functional voice disorders versus neurologic voice disorders
  • Example 1
  • Example 2
  • Example 3
  • Example 4
  • Example 5
  • Management
  • Conclusion
  • References
  • Chapter 35: Psychologic/functional forms of memory disorder
  • Introduction
  • Memory clinics
  • Existing studies of memory clinics
  • Patients in memory clinics - a range of different disorders
  • Neurologic causes of memory symptoms other than dementia
  • Diseases other than dementia causing memory disorders
  • Memory symptoms secondary to alcohol/substance abuse or prescribed medication
  • Patients with psychiatric symptoms who actually go on to develop dementia
  • Psychological/functional causes of memory symptoms
  • Memory symptoms as part of depression/anxiety
  • ``Normal´´ memory symptoms that become the focus of attention or anxiety
  • Health anxiety about dementia/memory
  • Memory symptoms as part of another functional disorder
  • Psychogenic memory disorder as an isolated symptom
  • Exaggeration/malingering of memory symptoms
  • Approaches to assessment
  • Approaches to treatment
  • Conclusion and future directions
  • References
  • Chapter 36: Functional (dissociative) retrograde amnesia
  • Introduction
  • Content-based memory systems
  • Measurement problems of retrograde amnesia
  • Retrograde amnesia: organic or psychogenic?
  • Short review of retrograde amnesia after structural brain damage
  • Brain infarcts and vascular brain damage
  • Degenerative and metabolic brain diseases
  • Hypoxia
  • Traumatic brain injury/minor head trauma
  • Cases with severe amnesia after major TBI - relation to functional amnesia?
  • Dissociative amnesia with and without tbi
  • The puzzle of retrograde amnesia occurrence
  • Inability of access hypothesis
  • How can recovery occur?
  • Why is anterograde learning of autobiographic episodes usually unimpaired or much less impaired than retrograde memo
  • Conclusions
  • References
  • Chapter 37: Functional (psychogenic) dizziness
  • Introduction
  • Functional causes of vestibular symptoms
  • Phobic postural vertigo
  • Clinical aspects and course of the illness
  • Differential diagnosis
  • Pathophysiologic mechanisms
  • Pragmatic therapy
  • Chronic subjective dizziness
  • Clinical aspects and course of the illness
  • Differential diagnosis
  • Pathophysiologic mechanisms
  • Treatment
  • Persistent postural-perceptual dizziness
  • Additional functional vestibular presentations
  • Psychiatric causes of vestibular symptoms
  • Detecting functional and psychiatric disorders - importance of patient history
  • Treatment of psychiatric vestibular disorders
  • References
  • Chapter 38: Urologic symptoms and functional neurologic disorders
  • Introduction
  • Lower urinary tract functions in health
  • Current models of the brain-bladder axis
  • Assessment of functional urologic disorders
  • Psychogenic urinary retention
  • Fowler's syndrome
  • Paruresis
  • Dysfunctional voiding and Hinman-Allen syndrome
  • Overactive bladder
  • Interstitial cystitis/bladder pain syndrome and functional somatic syndromes
  • Frequency of urologic symptoms in functional/psychogenic disorders
  • Opiate use and LUT dysfunction
  • Is there an association between LUT dysfunction and functional disorders?
  • Patients with one functional syndrome frequently meet diagnostic criteria for other syndromes
  • Sex
  • Emotional problems
  • Physiology
  • History of childhood abuse or neglect
  • Acknowledgments
  • References
  • Chapter 39: Functional disorders of swallowing
  • Introduction
  • Swallowing
  • Anatomy
  • Physiology
  • Dysphagia
  • Etiology
  • Diagnosis
  • Functional dysphagia
  • Definition
  • Diagnosis
  • Pathophysiology
  • Treatment
  • Globus sensation
  • Conclusion
  • References
  • Chapter 40: Pediatric functional neurologic symptoms
  • Pediatric functional neurologic symptoms
  • How common are pediatric functional neurologic symptoms?
  • How do children with functional neurologic disorders present?
  • Historic features
  • Epidemiology
  • The predicament of the child
  • The provocation of an FND by minor injury or illness
  • Controversies over the cause
  • The difficulty in separating organic disease from FND
  • Malingering
  • Treatment of the symptom or the underlying cause?
  • Treatment difficulties and the tendency of families to seek alternative methods
  • Prognosis
  • Diagnosis of functional neurological disorders
  • Are functional neurologic disorders psychogenic?
  • Informing the child and family of the diagnosis
  • Treatment of functional neurologic disorders
  • Prognosis
  • Functional or psychogenic?
  • References
  • Chapter 41: Posttraumatic functional movement disorders
  • Peripheral trauma and movement disorders - evolution of a concept
  • Distinct phenotypes of movement disorders following peripheral trauma and their overlap with functional movement disorders
  • Peripheral trauma-induced fixed limb dystonia
  • Posttraumatic painful torticollis
  • Other movement disorders induced by peripheral trauma
  • Pathophysiologic considerations
  • Management of movement disorders induced by peripheral trauma
  • Conclusion
  • References
  • Chapter 42: Factitious disorders and malingering in relation to functional neurologic disorders
  • Introduction
  • Historic context
  • Diagnosis of simulated illness
  • Growing interest in illness deception
  • Psychosocial context
  • Factitious disorders
  • Definition
  • Epidemiology
  • Factitious disorders: clinical features
  • Management
  • Course and prognosis
  • Malingering
  • Conceptual and definitional problems
  • Epidemiology
  • Assessment
  • Special investigations
  • Psychologic approaches
  • Clinical presentations relating to neuropsychiatric practice
  • Malingered cognitive deficit (e.g., postconcussional syndrome)
  • Somatoform and dissociative disorders
  • Psychogenic nonepileptic seizures
  • Complex regional pain syndrome
  • Prognosis and outcome
  • Conclusions
  • References
  • Section 4: Treatment
  • Chapter 43: Prognosis of functional neurologic disorders
  • Introduction
  • Methodologic issues
  • Heterogeneity
  • Diagnostic suspicion bias
  • Secondary and tertiary care referral bias
  • Study size and design
  • Follow-up rates
  • Assessing natural history vs. treatment studies
  • Measuring outcome
  • Literature review bias
  • Symptom outcome
  • Motor symptoms
  • Dissociative (nonepileptic) seizures
  • Sensory symptoms
  • Visual symptoms
  • Hearing loss
  • Mixed studies
  • Quality of life and functioning at follow-up
  • Working status
  • Cross-over
  • Prognostic factors
  • Gender
  • Age at onset
  • Health-related benefits
  • Employment and educational status
  • Comorbidity
  • Duration of symptoms
  • Early diagnosis and confidence in the diagnosis
  • Misdiagnosis
  • Pediatric studies
  • Conclusion
  • References
  • Chapter 44: Explanation as treatment for functional neurologic disorders
  • Introduction
  • Evidence for the importance of good communication / explanation
  • Barriers to explanation
  • Barriers to successful explanation from health professionals
  • Lack of interest/negative attitudes
  • Lack of education
  • The issue of malingering
  • Uncertainty over which model / terminology is correct
  • Alteration of the normal order of explanation
  • Lack of diagnostic certainty
  • Lack of diagnostic codes
  • Barriers to successful explanation from patients
  • Lack of public awareness
  • Lack of supporting radiologic or laboratory abnormalities
  • Strong views of alternative diagnoses
  • Societal unacceptability of psychologic factors/psychosomatic concepts
  • Individual sensitivity regarding psychologic factors
  • Evidence about explanations in clinical practice
  • Patient experiences of diagnosis and predictors of outcome
  • Can training health professionals improve patient satisfaction with communication?
  • Evidence about explaining and arranging investigations
  • A consensus of core features of explanation
  • Psychogenic or functional?
  • Improving evidence for explanation
  • References
  • Chapter 45: Physical treatment of functional neurologic disorders
  • Introduction
  • Pathophysiologic Model and Rationale for Physical Treatment
  • Evidence for Physical Rehabilitation
  • Referral to Physical Treatment
  • Assessment
  • Treatment Agreement
  • Components of Treatment
  • Education
  • Movement retraining
  • Addressing belief and expectation by demonstrating normal movement
  • Strategies to retrain movement (with redirected attention)
  • Applying principles of motor learning
  • Supporting self-management
  • Precipitating and perpetuating factors relevant to physical treatment
  • Components of Physical Treatment and Therapeutic Adjuncts
  • Mirror and video feedback
  • Nonspecific exercise
  • Electrotherapies
  • Other treatment adjuncts
  • Addressing pain and fatigue
  • Falls prevention in symptoms affecting mobility
  • Adaptive Aids, Equipment, and Environmental Modifications
  • Setting Intensity and Duration
  • Measuring Outcome
  • Discharge
  • Symptom-Specific Treatment Approaches
  • Lower-limb weakness
  • Tremor
  • The special case of fixed functional dystonia and joint contractures
  • Conclusions
  • Financial disclosures
  • Acknowledgment
  • References
  • Chapter 46: Psychologic treatment of functional neurologic disorders
  • Introduction
  • Functional model
  • Dissociative model
  • ``Psych´´: what to leave in?
  • What is the treatment evidence base?
  • Psychologic interventions
  • Early reviews of interventions
  • More recent reviews of interventions for somatoform disorders
  • Specific nonmotor conversion disorders
  • Chronic pain
  • Dizziness
  • Psychotherapeutic and psychoeducational interventions for dissociative (nonepileptic) seizures
  • Self-management approaches for functional neurologic symptoms (not specifically dissociative seizures)
  • Multidisciplinary approaches
  • Abreaction/sedative interviews (see Chapter 50)
  • Implications of treatment studies
  • References
  • Chapter 47: Hypnosis as therapy for functional neurologic disorders
  • Introduction
  • Suggestion, hypnosis, and functional symptoms: a brief history
  • Hypnosis and treatment of functional symptoms in the 20th century to the present
  • Assessment and treatment approaches employing hypnotic techniques
  • Symptom-oriented techniques
  • Motor symptoms such as paralysis, contractures, and uncontrollable movements
  • Making use of the present rest capacity with flaccid paralysis
  • The nonaffected limb helps the affected one
  • Relaxation and imagination
  • Imagination of normal functioning in the past
  • During sleep the symptoms are absent
  • Letting go
  • Somatosensory symptoms
  • Making use of visual and auditory imagination in functional blindness or deafness
  • Seizures or convulsions
  • Hypnotic self-control procedures
  • Prescribing the symptom as a self-controlled procedure
  • Expressive techniques
  • Future directions
  • Conclusions
  • References
  • Chapter 48: Nature of the placebo and nocebo effect in relation to functional neurologic disorders
  • Definition
  • Characterization of the neurobiologic underpinnings
  • Disruption of placebo effects
  • Beyond the healing context
  • What is the difference between placebos and drugs?
  • Duration of action
  • Variability of effect
  • Magnitude of effect
  • Conclusions
  • Acknowledgments
  • References
  • Chapter 49: The role of placebo in the diagnosis and treatment of functional neurologic disorders
  • Evolving controversy over therapeutic placebo
  • Placebo for psychogenic disorders
  • For diagnosis
  • For treatment
  • Conceptualizations of disease and medicine
  • Ethical and legal concerns
  • Deception and protecting patient autonomy
  • Beneficence and nonmaleficence
  • Legal considerations
  • Future directions
  • Clinical research and therapeutic discovery
  • Education of healthcare providers
  • Conclusions
  • References
  • Chapter 50: Transcranial magnetic stimulation and sedation as treatment for functional neurologic disorders
  • Introduction
  • Transcranial magnetic stimulation
  • Something old, something new - electric stimulation for FND
  • Evidence for the efficacy of TMS
  • Case series
  • Controlled trials
  • Potential mechanism(s) of action
  • Placebo
  • ``Possibility of symptom improvement´´
  • Neuromodulation
  • Future directions
  • Randomized controlled trials of TMS
  • Other stimulation methods
  • Conclusion
  • Sedation
  • Abreaction
  • Rehabilitation
  • Conclusion
  • Acknowledgments and Funding
  • References
  • Chapter 51: Inpatient treatment for functional neurologic disorders
  • Pioneering inpatient treatment of psychogenic (functional) movement disorders (PMDs)
  • A rehabilitation model for conversion paralysis
  • Strategic intervention in inpatient rehabilitation of severe functional/factitious disorders
  • A multimodal program-based inpatient approach
  • A neuropsychiatry-led multimodal intervention
  • A unique randomized trial of inpatient physical rehabilitation therapies
  • An exemplar of a very brief multidisciplinary inpatient rehabilitation program
  • Principles of therapy within the MoRe program
  • Pediatric inpatient services
  • A move to day-patient treatment?
  • Some considerations on psychogenic nonepileptic seizures (PNES)
  • Formal psychiatric assessment by a psychiatrist familiar with the management of PNES should be arranged and performed
  • Predisposing, precipitating, and perpetuating factors should be explored as a prelude to delineating appropriate psychotherape
  • Psychotherapy should be implemented when possible
  • Pharmacologic treatment of patients
  • Initiate psychopharmacologic agents to treat comorbid mood, anxiety, obsessive compulsive disorder, or psychotic disorders
  • The interdigitating roles of the neurologist and mental health practitioner (MHP) in diagnostic assessment and treatment
  • Conclusions
  • References
  • Errata
  • Index
  • Back Cover

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