Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series

McFarlane, Fiona; Allcott-Watson, Hannah; Hadjimichael, Maria; McAllister, Eve; Stark, Daniel; Reilly, Colin; Bennett, Sophie; McWillliams, Andrew; Heyman, Isobel

doi:10.1016/j.ejpn.2018.12.002

Cited by 29 publications

(23 citation statements)

References 41 publications

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“…No reliable predictors of long-term remission were identified. Although there is some accumulating evidence for the effectiveness of psychological treatments for paediatric FND,29 30 our data are of limited value in adding to this evidence base. Access to CAMHS support in this series was at clinician discretion, and given CAMHS resource, limitations probably reflected recognition of more severe or persistent symptoms.…”

Section: Discussionmentioning

confidence: 83%

Long-term outcomes of functional neurological disorder in children

et al. 2019

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ObjectivesTo establish the incidence and long-term outcomes (up to 21 years) of children presenting to a University hospital paediatric neurology service with symptoms due to functional neurological disorder (FND) with particular reference to occurrence of FND or similar symptoms in adulthood.MethodsRetrospective chart review to determine characteristics of the original paediatric FND presentation plus record-linkage with providers of Child and Adolescent Mental Health Services. Chart review of adult medical records for documentation of functional symptoms in adulthood.Results124 individuals (56% female) met entry criteria. The most common presentations were seizures (18%), sensory loss (18%) and motor symptoms (16%). Frequency gradually increased with age of onset with an incidence in paediatric neurological services of 6 per 100 000 children under 16. In up to 21 years’ follow-up (median 8.3 years), 114/124 attained their 16th birthdays by the study census date and were thus eligible for inclusion in an analysis of symptom persistence/recurrence in adulthood. 26/114 (23%) showed evidence of FND in adulthood of sufficient significance to be recorded in medical records.ConclusionPaediatric FND is commoner than previous estimates. Even in this selected population of children reaching specialist paediatric neurology services, a high long-term remission rate is observed.

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Section: Discussionmentioning

confidence: 83%

Long-term outcomes of functional neurological disorder in children

et al. 2019

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“…Patients who suffer from comorbid anxiety-depressive disorders need to be treated with antidepressants and anxiolytics [7,12]. In addition, cognitive-behavioral therapy is an effective intervention for patients with cognitive impairments, which can change the outcome of dissociative (conversion) disorders [40,41].…”

Section: Logistic Regression For Variables Predicting Prognosismentioning

confidence: 99%

Characteristics and outcomes of children with dissociative (conversion) disorders in western China: a retrospective study

Fang

Xie

et al. 2021

BMC Psychiatry

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Background Dissociative (conversion) disorder in children is a complex biopsychosocial disorder with high rates of medical and psychiatric comorbidities. We sought to identify the characteristics and outcomes of children with dissociative (conversion) disorders in western China. Methods We conducted a retrospective cohort study of 66 children admitted with dissociative (conversion) disorders from January 2017 to July 2019, and analyzed their clinical characteristics, socio-cultural environmental variables, and personality and psychiatric/psychological characteristics. Binary logistic regression was used to analyze the variables associated with clinical efficacy. Results Of these 66 patients, 38 (57.6%) were male and 28 (42.4%) were female, 46 (69.7%) had an antecedent stressor, 30 (45.5%) were left-behind adolescents, and 16 (24.2%) were from single-parent families. In addition, 30 patients (45.5%) were not close to their parents, 38 patients (59.4%) had an introverted personality, and 34 (53.1%) had unstable emotions. Thirteen families (19.7%) were uncooperative with the treatment. Patients who had cormorbid anxiety or depression exhibited significantly lower cognitive ability (P < 0.01). Logistic regression found that better treatment outcomes were positively associated with having a close relationship with parents, parental cooperation with treatment, and having a father with a lower level of education (i.e., less than junior college or higher). Conclusions The characteristics and outcomes of children with dissociative (conversion) disorders are related to socio-cultural environmental variables and psychiatric/psychological factors. Timely recognition and effective treatment of dissociative (conversion) disorders are important.

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“…Treatment should be multidisciplinary and include the mental health professional, the child, parents, school, and a pediatrician/ pediatric neurologist [19,[43][44][45]. The first step of treatment is providing psychoeducation regar-ding PNES to the family and school [19,44]. Many children diagnosed with PNES have a decrease in their daily functioning.…”

Section: Treatmentmentioning

confidence: 99%

“…to return to previous level of activity and functioning is recommended. In order to increase the patient's success in school, accommodations should be implemented to minimize school absences [44]. Both the school and the parents should be taught selective attention (ignoring the episodes) and be given specific instructions of how to react to the episodes.…”

Section: Treatmentmentioning

confidence: 99%

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Psychogenic Nonepileptic Seizures in Children and Adolescents

2021

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Though psychogenic non-epileptic seizures (PNES) are seen commonly during evaluation of children and adolescents with epilepsy, the literature regarding developmental changes in PNES is limited. Evidence Acquisition: Literature search was conducted in PubMed. Key search terms included: Pseudoseizure* OR PNES OR [(non-epileptic or nonepileptic or psychogenic or non-epileptic attack disorder) AND (seizure*)], resulting in 3,236 articles. Filters included human, ages 1-18 years, English language and last 15 years (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019), resulting in 533 articles. We reviewed 33 articles, which included 19 articles that involved children (1-18 years), with 10 or more children with PNES in their study group. 21 articles obtained in cross references that were outside the filter setting (including time frame and age range) were also reviewed, for a total of 54 articles. Results: Majority of the studies were retrospective. We detail clinical features, predisposing factors and appropriate workup for children and adolescents with possible PNES. There is no consensus regarding frequency of psychiatric comorbidities in children with PNES. No controlled trials of treatment of PNES in children are available, but cognitive behavioral therapy is the consensus for adult PNES. Outcome appears to be better in children with PNES. Conclusions: There is a need for be long-term prospective studies to document various clinical features and outcome of pediatric and adolescent PNES, and also the comorbid conditions.

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Cognitive-behavioural treatment of functional neurological symptoms (conversion disorder) in children and adolescents: A case series

Cited by 29 publications

References 41 publications

Long-term outcomes of functional neurological disorder in children

Long-term outcomes of functional neurological disorder in children

Characteristics and outcomes of children with dissociative (conversion) disorders in western China: a retrospective study

Psychogenic Nonepileptic Seizures in Children and Adolescents

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