title: Symptom severity in patients with functional motor symptoms: Patient's perception and doctor's clinical assessment.
abstract: BACKGROUND
  Beliefs and expectations about symptoms and an abnormal direction of attention towards the body have been proposed as important mechanistic factors in the pathophysiology of functional motor symptoms (FMS). We therefore aimed to evaluate patients' awareness/perception of the presence and severity of their own symptoms before and while watching themselves in a video and to compare this with doctors' assessment of the presence and severity of FMS, based on video evaluation.
  
  
  METHODS
  We evaluated 16 patients affected by FMS. Patients were invited to give a "subjective evaluation" of their symptoms. Afterwards, patients were invited to watch a video of themselves and to judge the presence of symptoms in the different body parts and, if so, to rate the severity. Patients' videos were also assessed by a rater with expertise in FMS.
  
  
  RESULTS
  Patients judged their symptoms to be more severe on subjective evaluation than when viewing a video of themselves (p = 0.002; t = 3.656). Subjective evaluation of symptom severity by patients was higher than that of raters viewing a video of the patient (p < 0.001, t = 4.860), but there was only a trend towards a difference between video ratings of severity by patients and independent raters (p = 0.017, t = 2.962 with p set at 0.016 according to Bonferroni correction).
  
  
  CONCLUSIONS
  Our study shows that patients with FMS tend to overestimate the severity of their symptoms compared independent rating. However, when viewing a video of themselves they rated their symptoms as less severe and closer to those of independent raters.
authors.affiliation: Sobell Department, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
authors.forename: L
authors.initials: L
authors.lastname: Ricciardi
authors.affiliation: Department of Psychiatry, San Paolo Hospital and University of Milan, Milan, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Demartini
authors.affiliation: Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Morgante
authors.affiliation: Sobell Department, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
authors.forename: I
authors.initials: I
authors.lastname: Parees
authors.affiliation: Sobell Department, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
authors.forename: G
authors.initials: G
authors.lastname: Nielsen
authors.affiliation: Sobell Department, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK. Electronic address: m.j.edwards@ucl.ac.uk.
authors.forename: M J
authors.initials: MJ
authors.lastname: Edwards
mesh_terms: D000328:Adult; D000368:Aged; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068079:Motor Disorders / Q000175:diagnosis* / Q000523:psychology; D010775:Photic Stimulation / Q000379:methods; D010819:Physician's Role / Q000523:psychology; D012720:Severity of Illness Index; D014741:Video Recording / Q000379:methods; D014796:Visual Perception / Q000502:physiology*; D055815:Young Adult
keywords: Awareness; Conversion disorders; Functional motor symptoms; Perception; Video