Tailored psychotherapy for patients with functional neurological symptoms: a pilot study.
OBJECTIVE
The objective of this study was to assess whether individually tailored psychotherapy for patients with functional neurological symptoms is associated with improvements in patient-centered measures of emotional well-being, quality of life, as well as somatic symptoms and whether this treatment modality is likely to be cost-effective.


METHODS
We conducted an uncontrolled prospective pilot study of consecutive patients with functional symptoms referred from neurology outpatient clinics to a single psychotherapist using validated questionnaires [Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), Short Function (SF)-36 Health Survey, and Patient Health Questionnaire (PHQ)-15]. Patients had a median of 6 treatment sessions (range=1-24). Ninety-one patients completed questionnaires at referral, 63 did at the end of treatment, and 34 did at follow-up after 6 months. Significant improvements were seen on all measures and were maintained at follow-up (CORE-OM, P=.003; SF-36, P<.001; PHQ-15, P=.001). Significance was not lost in an intention-to-treat analysis. Of all the patients, 49.2% improved by at least 1 S.D. in at least one of the measures. The number of patients needed to be treated to see an improvement of at least 1 S.D. in one of the three outcome measures was 2; that in two measures, 3.9; and that in all measures, 7. The mean cost of the intervention was pound231; the cost per quality-adjusted life year was estimated as pound5,328.


RESULTS
Psychotherapy was associated with significant improvements in patient-centered measures, which seemed to be achieved at a comparatively low cost.


CONCLUSIONS
The results indicate that psychotherapy may be a cost-effective intervention for patients presenting with functional neurological symptoms. The findings warrant further assessment of this treatment with a randomized and controlled trial.
Academic Unit of Neurology, Division of Genomic Medicine, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom. markus.reuber@sth.nhs.uk
Markus
M
Reuber
Christine
C
Burness
Stephanie
S
Howlett
John
J
Brazier
Richard
R
Grünewald
D000328:Adult; D000339:Affect; D000368:Aged; D003072:Cognition Disorders / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004213:Dissociative Disorders / Q000191:economics / Q000523:psychology* / Q000628:therapy*; D005221:Fatigue / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000191:economics / Q000628:therapy*; D006304:Health Status; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000191:economics; D059408:Pain Management; D010865:Pilot Projects; D011446:Prospective Studies; D011613:Psychotherapy / Q000191:economics / Q000592:standards*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome