title: Explanation as treatment for functional neurologic disorders.
abstract: There is widespread agreement that the way health professionals communicate the diagnosis of functional neurologic disorders (FND) has a central role in treatment, as it does arguably for most conditions. In this chapter we discuss barriers to effective diagnosis, different models of explanation and evidence regarding the importance of effective communication of the diagnosis in FND, especially movement disorders, and dissociative (nonepileptic) seizures. Debates and disagreements about how to go about this task often reflect different theoretic models held by health professionals rather than evidence. More evidence is required to know whether an initial emphasis on one model is more or less effective than another (e.g., a functional model vs. a psychologic model). We conclude, however, that there are a number of generic components to effective explanation shared by most authors on the topic that form the basis of a consensus. These include taking the patient seriously, giving the problem a diagnostic label, explaining the rationale for the diagnosis, some discussion of how the symptoms arise, emphasis on the potential for reversibility (rather than damage), and effective triage and referral for other treatment where appropriate. Although explanation can sometimes be therapeutic on its own, its role is probably more important as a facilitator to other therapy, including self-help, physical treatments, and psychotherapy.
authors.affiliation: Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. Electronic address: Jon.Stone@ed.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Stone
authors.affiliation: Departments of Clinical Neurosciences and of Rehabilitation Medicine, NHS Lothian and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: A
authors.initials: A
authors.lastname: Carson
authors.affiliation: Human Motor Control Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Hallett
mesh_terms: D003291:Conversion Disorder; D006801:Humans; D009422:Nervous System Diseases / Q000523:psychology*; D011369:Professional-Patient Relations; D011602:Psychophysiologic Disorders
keywords: communication; conversion disorder; explanation; functional neurologic symptoms; nonorganic; psychogenic