Diagnosis and management of functional neurological symptoms: The Dutch experience

Functional neurological symptoms (FNS) were considered as a psychiatric disorder at the beginning of the 20th century (conversion disorder). Psychiatrists performed diagnosis and treatment throughout most of the past century in the Netherlands, but in the latest decades patients were usually firstly referred to neurologists. The aim of this study was to investigate the opinions of today's neurologists, psychiatrists and rehabilitation physicians in the Netherlands, regarding pathogenesis, diagnosis and treatment of FNS.

An electronic questionnaire was sent to all neurologists registered with the Dutch Society for Neurology and to the members of the Department for Consultation-liaison and General Hospital Psychiatry.

343 of 780 neurologists, 64 of 197 psychiatrists and 47 of 750 rehabilitation physicians completed the questionnaire. 60% of neurologists and 67% of psychiatrists considered disordered brain functioning together with psychogenic factors responsible for FNS. 29% of neurologists and 88% of psychiatrists felt a psychiatrist was needed for diagnosis. 55% of neurologists and 88% of psychiatrists preferred combined treatment consisting of explaining FNS to patients, psychotherapy and physiotherapy provided by a therapist trained in FNS. 15% of neurologists preferred only physiotherapy.

Most neurologists and psychiatrists did not consider FNS as a mere psychiatric disorder, but counted disordered brain functioning together with psychogenic factors responsible for FNS. Subsequently, according to the majority of neurologists and psychiatrists FNS should not be solely diagnosed and treated by psychiatrists. These results can help to formulate treatment strategies.