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27 Functional neurological presentation: a psychological intervention
  1. Vanessa Owen,
  2. Christine Mortimer

Abstract

Objective To reduce a significant functional tremor for a patient who has been diagnosed with a trauma response to life events, who’s medical conditions are exacerbated by the extreme and persistent nature of the tremor and the complex psychological vulnerability of JM.

Intentions of Neuropsychology Services

• Improve well-being;

• Reduction in functional movement;

• Reduction in associated pain;

• Reduction in presentation to clinical services;

• Reduction in annual cost of services used by patients:

• Greater engagement and functioning in society;

• Improved QOL.

Attendance 1. Education Day for JM and his partner, and one other friend or family member completed

Clinicians at the education day will include an 8 c Clinical Psychologist and an 8b Counselling Psychologist.

JM, his partner, and family member attended a course/workshop lasting one session/two hours

They are offered prescriptive education around the evidence for cause and treatment of Functional Neurological Presentations. This included prevalence rates, theories and evidence, the process of diagnosis e.g., how the person came to be in the Neuropsychology Service, investigations that were carried out by the specialists involved, and the individual formulation for JM was provided and explored and was presented to JM and others. Questions and answers and discussion points were informally discussed and shared.

Therapy part two *A therapeutic package of 10–14 sessions was offered

*liaison with family is on-going over the period of therapy

JM and others indicated that they wished to explore the formulation through therapy

• Outcome measures were completed

2. Therapy consultation

Formulation discussion

JM has a consultation with a psychologist and a counselling psychologist/hypnotherapist and an agreement was made regarding their be-spoke service:

Psychodynamic therapy

Or

CBT/solution focused interpersonal therapy/hypnotherapy

*JM and others explored and agreed an approach CBT/Hypnotherapy in addition to the education sessions

Therapy part three 3. Treatment sessions

Treatment sessions will be carried out by the 8 c Clinical Psychologist and the Counselling Psychologist in unison at JM home in West Sussex.

Following Two DNAs whether cancelled sessions or non-attended sessions will result JMs discharge, unless there are clear and exceptional circumstances. The 8 c will make a decision on each individual case.

Each session will be taped to aid memory, for reflection and homework over the we.

Therapy part four: end of therapy *Penultimate session:

• Outcome measures to be completed

• Satisfaction questionnaire completed

• Consent to audit financial elements of care

Last session

• Exit Meeting

Following last session

• Discharge report

*the approach may or may not involve other friends or family.

*the approach has an end of therapy exit meeting attached to the last 30 min of the final session.

OUTCOME MEASURES may include:

Consent Forms

Equality and Diversity forms

Risk assessment

BICRO-39 Well-being questionnaire

QOL questionnaire

DASS42 (mood measure)

Beck measures (where needed)

Self-esteem measures (where needed)

PTSD measures (where needed)

Consent for Audit data collection (clinical and financial)

Behavioural data

Video data of movement Measure of pain

Measure of pain

Results We are at session 4 and will have the end of therapeutic contract meeting in January. The outcome of this therapeutic approach will be evaluated at this time.

Conclusion Conclusions as to the effectiveness of the intervention will be evaluated via the behavioural data and the outcome measures. We will also seek feedback from the treating Neuropsychiatric Team at St Georges in London.

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