Saunders Chloe, Bawa Hetashi, Aslanyan Daron, Coleman Frances, Jinadu Helen, Sigala Natasha, Medford Nick
Department of Neuropsychiatry, South London and Maudsley NHS Foundation Trust, London, UK.
Aarhus University Hospital, Aarhus, Denmark.
BMJ Neurol Open. 2024 Jul 2;6(2):e000675. doi: 10.1136/bmjno-2024-000675. eCollection 2024.
Functional neurological disorder (FND) is a heterogeneous condition; severe forms can be disabling. Multidisciplinary treatment and rehabilitation are recommended for severe FND, but there remains a lack of evidence for its efficacy and lack of understanding of the predictors and components of recovery.
We report clinical outcome data for an inpatient cohort with severe FND. Clinical Global Impression Improvement with treatment is the primary outcome measure. Admission and discharge measures (Euroqol quality of life measures, Beck Depression Inventory, Spielberger Trait Anxiety Inventory, Cambridge Depersonalisation Scale, Illness Perception Questionnaire (Revised) and Functional Mobility Scale) are reported as secondary outcomes.
We describe an FND cohort (n=52) with chronic illness (mean symptom duration 9.7 years). At admission, there were clinically relevant levels of depression, anxiety and depersonalisation derealisation. At the time of discharge, most (43/52) patients' global condition had improved. Measures of mobility, depression and quality of life also significantly improved while at discharge, symptoms were experienced as more understandable and less distressing than at admission. An admission measure of patient confidence in treatment was predictive of eventual clinical outcome.
The most frequent outcome of inpatient rehabilitation is global improvement, even when symptoms are chronic and severe, reflected in measurable changes in both physical and psychological functioning. Significant levels of depersonalisation derealisation seen in this patient group suggest that routine enquiry into such experiences could help personalise FND treatment approaches. Patient confidence in treatment is key in determining clinical outcomes.
功能性神经障碍（FND）是一种异质性疾病；严重形式可能会导致残疾。对于重度FND，推荐采用多学科治疗和康复方法，但目前仍缺乏其疗效的证据，且对康复的预测因素和组成部分也缺乏了解。
我们报告了一组重度FND住院患者的临床结局数据。治疗后的临床总体印象改善是主要结局指标。入院和出院时的测量指标（欧洲生活质量量表、贝克抑郁量表、斯皮尔伯格特质焦虑量表、剑桥人格解体量表、疾病认知问卷（修订版）和功能活动量表）作为次要结局指标进行报告。
我们描述了一个患有慢性疾病（平均症状持续时间9.7年）的FND队列（n = 52）。入院时，存在具有临床意义的抑郁、焦虑和人格解体-现实解体水平。出院时，大多数（43/52）患者的总体状况有所改善。活动能力、抑郁和生活质量指标在出院时也有显著改善，同时与入院时相比，症状变得更容易理解且痛苦减轻。入院时患者对治疗的信心这一测量指标可预测最终的临床结局。
住院康复最常见的结局是总体改善，即使症状是慢性且严重的，这体现在身体和心理功能的可测量变化上。该患者组中出现的显著水平的人格解体-现实解体表明，对此类经历进行常规询问有助于使FND治疗方法个性化。患者对治疗的信心是决定临床结局的关键。
