JNNP: Systematic evaluation of psychotherapy for functional neurological disorders in adults

Functional neurological disorder (FND) is a common disabling disease that is often considered difficult to treat, especially in adults.
psychotherapy is often recommended for FND.
results of psychotherapy studies on FND have increased in recent years, but no systematic assessment has been carried out since 2005.
study aims to systematically review the evidence base of individual outpatient FND cognitive behavior and psychodynamic psychotherapy.
system search strategy is applied to three major online databases (MEDLINE, PsycINFO, and Embase) to determine all prospective therapy studies of adults of any FND subtype, with at least five participants participating in psychotherapy.
treatment must be psychotherapy for outpatients.
includes controlled and non-controlled studies.
the results must include at least one variable: physical symptoms, mental health symptoms, quality of life, function, treatment satisfaction, and health care use.
results are limited to English-language articles from 1 January 1980 (the year of publication of the third edition of the Handbook on diagnosis and statistics of mental disorders (DSM-III)) to 1 June 2020.
identified other studies from a reference list of identified studies and comments.
abstract is a prospective study of FND individual outpatient psychotherapy involving at least 5 adults, based on an uncertain criterion for determining whether the abstract meets the requirements of the abstract.
study uses standardized assessment tools for methodological quality assessment.
search strategy identified 131 studies, 19 of which met the criteria for selection: 12 for cognitive behavioral therapy (CBT) and 7 for psychodynamic therapy (PDT).
11 were pre- and post-studies and 8 were randomized controlled trials.
most studies are based on a single symptom subsype, not all manifestations of FND.
CBT and PDT showed medium-sized benefits in terms of physical symptoms, mental health, well-being, function and resource use.
While the lack of high-quality PDT controlled trials is a significant limitation, the results of the two treatment types are largely comparative, and the lack of long-term follow-up data in most identified CBT trials is also an important limitation.
compared to the control group, CBT was statistically significant in terms of the longest period of free seizures, psychosocial function, global changes in self-assessment and clinician assessment, and health care satisfaction.
Because of the non-normal distribution of the measurements used, it is not possible to calculate the size of the main result effect, however, in the secondary measurements of physiological symptoms, the beneficial effect was medium to large compared to the control group and small to medium in terms of the reported severity and irritability of seizures.
in terms of mental health, well-being and function, the beneficial effects were small to moderate compared to before and after treatment, but the differences between groups decreased slightly over time.
most CBT studies have shown significant statistical significance in measuring physical symptoms, but not consistent in other measurements.
can be calculated that the impact is mainly the medium to large physical symptoms, while the measurement of mental health, function and quality of life is small to medium.
at the end of treatment, the median before and after CBT efficacy was 0.49, ranging from 0.03 to 2.12, and in the final follow-up (excluding the end of treatment), the median was 0.33, ranging from 0.08 to 0.71.
At the end of treatment, the median effect size between the CBT groups was 0.67, ranging from 0.19 to 1.99, and at the end of the final follow-up (excluding the end of treatment), the median was 0.32, ranging from 0.13 to 0.64.
comparing the pre-postms of the combined effect size at the end of treatment with follow-up, the medium effect size of PDT was 0.69 and 0.49, respectively, while the medium effect size of CBT was 0.49 and 0.33, respectively.
, however, when comparing the treatment group with the control group, the situation was very different, with the combined meso-effect sizes of PDT at the end of treatment and the end of follow-up being being -0.03 and 0.11, respectively, and PDT at 0.67 and 0.32, respectively.
exclusion of non-computable and non-numerical results has a significant impact on the size of the intergroup effect of PDT, which limits the utility of this comparison.
potential positive effects of CBT and PDT, more high-quality therapeutic studies are needed to confirm the efficacy of PDT.
Gutkin M, McLean L, Brown R, et al System review of psychotherapy for adults with functional neurological disorder Journal of Neurology, Neurosurgery and Psython Published Online First: 05 November 2020. doi: 10.1136/jnnp-2019 -321926MedSci Original Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Mets Medicine" or "Source: MedSci Originals" are owned by Mets Medical and are not authorized to reproduce by any media, website or individual, and are authorized to be reproduced with the words "Source: Mets Medicine".
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