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Semin Neurol 2019; 39(01): 102-114
DOI: 10.1055/s-0038-1676844
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Functional (Psychogenic) Neurological Disorders: Assessment and Acute Management in the Emergency Department

Jordan R. Anderson
1  Department of Neurology, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
2  Department of Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
,
Vihang Nakhate
3  Functional Neurology Research Group, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
,
Christopher D. Stephen
3  Functional Neurology Research Group, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
,
David L. Perez
3  Functional Neurology Research Group, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
4  Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations Funding D.L.P. was supported by the Sidney R. Baer Jr. Foundation and the Massachusetts General Hospital Physician-Scientist Career Development Award.
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Publication History

Publication Date:
11 February 2019 (online)

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Abstract

Functional neurological disorders (FND) are complex and prevalent neuropsychiatric conditions. Importantly, some patients with FND develop acute onset symptoms requiring emergency department (ED) evaluations. Historically, FND was a “rule-out” diagnosis, making assessment and management in the ED difficult. While the rapid triage of potential neurological emergencies remains the initial task, advancements have altered the approach to FND. FND is now a “rule-in” diagnosis based on validated neurological examination signs and semiological features. In this perspective article, we review signs and semiological features that can help guide the initial assessment of FND in the acute setting. Thereafter, we outline potential approaches to introduce a suspected diagnosis of FND to patients in the ED, while emphasizing the need for a comprehensive neurological evaluation. Physical and occupational therapy may be useful adjunct assessments in some individuals. Notably, clinicians in the ED setting are important members of the interdisciplinary approach to FND.

Keywords

conversion disorder - psychogenic nonepileptic seizures - functional movement disorders - functional paralysis