Biopsychosocial complexity in functional neurological disorder.

Area of Science:

• Neurology
• Psychiatry
• Psychosomatic Medicine

Background:

• Functional Neurological Disorder (FND) is increasingly recognized as a complex biopsychosocial condition, often with chronic implications.
• Over 50% of FND cases experience long-term challenges, necessitating comprehensive assessment tools.
• The INTERMED Self-Assessment Questionnaire (IMSA) is designed to evaluate biopsychosocial complexity across various patient groups.

Purpose of the Study:

• To compare the biopsychosocial complexity of Functional Neurological Disorder (FND) patients with psychosomatic (PSM) and post-stroke patient cohorts.
• To evaluate the utility of the INTERMED Self-Assessment Questionnaire (IMSA) in assessing FND patients.
• To investigate affective burden, somatoform symptoms, dissociation, and quality of life in these patient groups.

Main Methods:

• A cross-sectional study involving 287 patients across three groups: FND, PSM, and post-stroke.
• Participants underwent psychotherapeutic or neurological rehabilitation.
• The IMSA was administered, alongside validated scales for anxiety (GAD-7), depression (PHQ-9), somatoform symptoms (PHQ-15), dissociation (FDS), and quality of life (SF-12).

Main Results:

• Functional Neurological Disorder (FND) and psychosomatic (PSM) patients exhibited high biopsychosocial complexity scores (≥70%) via the IMSA, significantly more than post-stroke patients (15%).
• Elevated levels of affective symptoms, somatoform symptoms, and dissociation were observed in both FND and PSM groups.
• FND and PSM patients reported lower mental and somatic quality of life compared to post-stroke patients.

Conclusions:

• Functional Neurological Disorder (FND) patients experience substantial biopsychosocial strain, comparable to severely affected psychosomatic patients and exceeding that of post-stroke patients.
• These findings underscore the importance of adopting a biopsychosocial perspective for evaluating and managing FND.
• The INTERMED Self-Assessment Questionnaire (IMSA) appears to be a valuable tool for assessing biopsychosocial complexity in FND, warranting further longitudinal validation.