Letter to the Editor – Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective [Letter]

Abstract

Lars de Vroege, 1, 2 Anne Vergeest, 1, 2 Willem Johan Kop 1, 3 1Clinical Center of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands; 2Tilburg School of Behavioral and Social Sciences, Tranzo Department, Tilburg University, Tilburg, the Netherlands; 3Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the NetherlandsCorrespondence: Lars de Vroege Lage Witsiebaan 4, Tilburg, 5042 DA, the NetherlandsTel [phone]Fax [phone]Email [email protected] We have read the article written by Saxena et al “Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective” with great interest. The authors address relevant information and provide a sound outpatient model.1 However, some significant issues concerning patients with functional neurological disorders (FND) may be missing in their model which we want to discuss in more detail. The authors focus on patients with FND, especially the spectrum of motor FND (mFND). They introduce a practical guide and refer to this guide as a neuropsychiatric approach to the assessment and management of mFND with “[…] a comprehensive assessment guiding the development of a patient-centered treatment plan benefits from interdisciplinary neurologic, psychiatric, allied mental health and rehabilitation perspectives.” Furthermore, they state that specialized tertiary care centers as well as community-based care have to be included in this approach to offer the aforementioned patient-centered care. The authors thus provide an approach that is very useful for clinicians in which the value of stateof-the-art diagnostics including neuropsychiatric screening and a “rule-in” neurological examination is emphasized. Also, they provide assistance in how to deliver the diagnosis of (m)FND and offer an overview of several psychotherapy modalities for mFND. Therefore, their perspective paper is of substantial importance for clinicians working in the field of FND. However one pivotal clinical characteristic of patients with (m)FND, cognitive impairments, is only marginally addressed and should, in our opinion, play a more central role in the neuropsychiatric evaluation and treatment of (m)FND.   View the original paper by Saxena and colleagues

Keywords

• functional neurological disorder neuropsychiatry cognitive symptoms