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Functional symptoms in neurology: questions and answers

¹ Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
² Department of Liaison Psychiatry, Brandon Mental Health Unit, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
³ Department of Neurology, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK
⁴ Department of Liaison Psychiatry, Sheffield Care Trust, Longley Centre, Norwood Grange Drive, Sheffield S5 7JT, UK

Correspondence to:
Correspondence to:
Markus Reuber
Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK; markus.reuber{at}sth.nhs.uk

Between 10 and 30% of patients seen by neurologists have symptoms for which there is no current pathophysiological explanation. The objective of this review is to answer questions many neurologists have about disorders characterised by unexplained symptoms (functional disorders) by conducting a multidisciplinary review based on published reports and clinical experience. Current concepts explain functional symptoms as resulting from auto-suggestion, innate coping styles, disorders of volition or attention. Predisposing, precipitating, and perpetuating aetiological factors can be identified and contribute to a therapeutic formulation. The sympathetic communication of the diagnosis by the neurologist is important and all patients should be screened for psychiatric or psychological symptoms because up to two thirds have symptomatic psychiatric comorbidity. Treatment programmes are likely to be most successful if there is close collaboration between neurologists, (liaison) psychiatrists, psychologists, and general practitioners. Long term, symptoms persist in over 50% of patients and many patients remain dependent on financial help from the government. Neurologists can acquire the skills needed to engage patients in psychological treatment but would benefit from closer working relationships with liaison psychiatry or psychology.

Abbreviations: DSM-IV, Diagnostic and Statistical Manual of Mental Disorder, 4th edition; ICD-10, International Statistical Classification of Diseases, 10th revision

Keywords: dissociative disorder; functional symptoms; neurology; psychotherapy; somatoform disorder

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