Cummins Rynagh, Hawkes Clare, Longworth Judy, Scher Stephen, Kozlowska Kasia
Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Center School of Psychological Sciences, University of Tasmania, Launceston, TAS, Australia.
Front Psychiatry. 2025 Jul 17;16:1560873. doi: 10.3389/fpsyt.2025.1560873. eCollection 2025.
Rehabilitation for children with functional neurological disorder (FND) requires a biopsychosocial intervention: physiotherapy, psychotherapy, pharmacotherapy, school attendance, and family work. This study documents the pharmacotherapeutic element and its rationale.
Medication use was documented in 158 children with FND (41 boys, 117 girls, aged 8.50-17.58; mean 13.78) admitted into the Mind-Body Program.
On presentation, children with FND had high levels of functional impairment, school loss, and comorbid psychiatric, functional, and medical disorders. On admission, 63% (n=95) were on medications. During admission, 130 (82.3%) children had pharmacotherapy interventions: dose adjustment, initiation, or discontinuation. 88.6% (n=140) were discharged on medications. Pharmacotherapy targets included: antidepressants for anxiety/depression (n=111; 70.3%); antipsychotics for extreme anxiety/arousal (n=73; 46.2%); melatonin for sleep (n=64; 40.5%); α agonists and β blockers, for arousal, sleep initiation, and trauma-related nightmares (n=58; 36.7%); iron/vitamin supplementation (n=30; 19.0%); and medications for functional gut symptoms (n=28; 17.7%) and comorbid pain (n=20; 12.7%).
Pharmacotherapy is used as an adjunct in paediatric FND to down-regulate the stress system, reset the circadian clock, manage pain, and treat comorbid disorders. Pharmacotherapy and its concomitant placebo effects scaffold the child to enable engagement in all components of the therapeutic process and return to healthy function.
功能性神经系统疾病（FND）患儿的康复需要生物心理社会干预：物理治疗、心理治疗、药物治疗、上学以及家庭干预。本研究记录了药物治疗部分及其基本原理。
对纳入身心项目的158名FND患儿（41名男孩，117名女孩，年龄8.50 - 17.58岁；平均13.78岁）的用药情况进行记录。
初诊时，FND患儿存在高度的功能障碍、缺课情况，以及合并的精神、功能和医学疾病。入院时，63%（n = 95）的患儿正在服药。住院期间，130名（82.3%）患儿接受了药物治疗干预：剂量调整、开始用药或停药。88.6%（n = 140）的患儿出院时仍在服药。药物治疗的目标包括：用于焦虑/抑郁的抗抑郁药（n = 111；70.3%）；用于极度焦虑/唤醒的抗精神病药（n = 73；46.2%）；用于睡眠的褪黑素（n = 64；40.5%）；用于唤醒、入睡困难和创伤相关噩梦的α激动剂和β阻滞剂（n = 58；36.7%）；铁/维生素补充剂（n = 30；19.0%）；以及用于功能性肠道症状的药物（n = 28；17.7%）和合并疼痛的药物（n = 20；12.7%）。
药物治疗在儿科FND中用作辅助手段，以下调应激系统、重置生物钟、管理疼痛并治疗合并疾病。药物治疗及其伴随的安慰剂效应为患儿提供支持，使其能够参与治疗过程的各个环节并恢复健康功能。
