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Review
Systematic review of psychotherapy for adults with functional neurological disorder
  1. Myles Gutkin1,2,
  2. Loyola McLean3,4,
  3. Richard Brown5,6,
  4. Richard A Kanaan1
  1. 1Department of Psychiatry, The University of Melbourne, Austin Health, Heidelberg, Victoria, Australia
  2. 2Consultation–Liaison Psychiatry Department, Royal North Shore Hospital, Saint Leonards, New South Wales, Australia
  3. 3Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
  4. 4Westmead Psychotherapy Program for Complex Traumatic Disorders, Cumberland Hospital, North Paramatta, New South Wales, Australia
  5. 5Division of Psychology and Mental Health, The University of Manchester, Manchester, UK
  6. 6Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Myles Gutkin, Consultation–Liaison Psychiatry Department, Royal North Shore Hospital, Saint Leonards NSW 2065, New South Wales, Australia; myles.gutkin{at}unimelb.edu.au

Abstract

Functional neurological disorder (FND) is a common and disabling disorder that is often considered difficult to treat, particularly in adults. Psychological therapies are often recommended for FND. Outcome research on psychological therapies for FND has grown in recent years but has not been systematically evaluated since 2005. This study aims to build on that by systematically reviewing the evidence-base for individual outpatient cognitive behavioural and psychodynamic psychotherapies for FND. Medical databases were systematically searched for prospective studies of individual outpatient psychotherapy for FND with at least five adult participants. Studies were assessed for methodological quality using a standardised assessment tool. Results were synthesised, and effect sizes calculated for illustrative purposes. The search strategy identified 131 relevant studies, of which 19 were eligible for inclusion: 12 examining cognitive behavioural therapy (CBT) and 7 investigating psychodynamic therapy (PDT). Eleven were pre–post studies and eight were randomised controlled trials. Most studies recruited a single symptom-based subtype rather than all presentations of FND. Effect sizes, where calculable, showed generally medium-sized benefits for physical symptoms, mental health, well-being, function and resource use for both CBT and PDT. Outcomes were broadly comparable across the two therapy types, although a lack of high-quality controlled trials of PDT is a significant limitation, as is the lack of long-term follow-up data in the majority of identified CBT trials. In conclusion, both CBT and PDT appear to potentially offer some benefit for FND, although better quality studies are needed.

  • conversion disorder
  • functional neurological disorder
  • neuropsychiatry
  • somatisation disorder
  • psychology
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Footnotes

  • Twitter @mjgutkin

  • Contributors MG planned the review, carried out the analysis, wrote the first draft and modified all subsequent drafts. LM contributed to all drafts of the manuscript. RB contributed to the interpretation of the data and to all drafts of the manuscript. RK contributed to the interpretation of the data and to all drafts of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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