None listed
Conditions
Brief summary
Adults diagnosed by a Neurologist with Functional Neurological Symptom Disorder with residual symptoms despite diagnosis and treatment as usual will be seen for four two hour sessions of psychodynamic therapy with a Psychiatrist incorporating a comprehensive psychiatric history and formulation followed by management recommendations. Family and carers will be invited to join the planning component of sessions. At the final session a personalised "farewell" letter will be given to participants and a medical letter will be sent to referring and other treating doctors incorporating managment recommendations. All participants will complete a questionnaire in person before each interview and again three months after the last session by phone. A clinician administered measure of dissociation will be completed in the first appointment and again at the final session and during the follow up phone call. A modified adult attachment interview (AAI) will be incorporated into the first session for subsequent analysis. The assessments will be voice recorded for later assessment of interaction and adjherence to protocol by a supervisor and will be transcribed externally for thematic analysis and production of a case series. The clinician will also complete a HoNOS measure about the patient after each session and after the follow up phone call three months after the last session.. Statistical analysis will compare measures from before the first and last sessions as well as the measures at follow-up. The therapeutic interactions and patient narratives will be explored for themes. Rates and nature of additional psychiatric diagnoses in this population will be described. Modified Adult Attachment Interviews and Shutdown Dissociation interviews will be scored to indicate rates of each attachment style and rates of dissociation. Collaborative formulations which are agreed upon with the participants will be used to produce a case series.
Interventions
Patients diagnosed by a Neurologist with Functional Neurological Symptom Disorder with residual symptoms despite diagnosis and treatment as usual will have four sessions of psychodynamic therapy incorporating individualised formulation and management advice based on assessment of history and mental state examination.
All participants will be directed to the www.neurosymptoms.org website, and an individualised farewell letter will be provided to all participants at the final session. No other m
Patients diagnosed by a Neurologist with Functional Neurological Symptom Disorder with residual symptoms despite diagnosis and treatment as usual will have four sessions of psychodynamic therapy incorporating individualised formulation and management advice based on assessment of history and mental state examination. All participants will be directed to the www.neurosymptoms.org website, and an individualised farewell letter will be provided to all participants at the final session. No other materials will be provided. The procedure will be face to face psychotherapy administered by talking and listening with attention to both spoken and unspoken communication. This will be administered by a single clinician, Dr Myles Gutkin and will occur four times with one month between each session. Each session will last two hours, but if considered necessary and appropriate by the clinician, the first session may last as long as three hours and subsequent sessions may be as short as one hour. All interventions will occur in the Academic and Liaison Psychiatry Department at Royal North Shore Hospital. Voice recordings of sessions will be used to assess adherence to the protocol by A/Prof. Loyola McLean at fortnightly supervision sessions when directions will be given to ensure adherence to protocol as necessary. All participants will complete a questionnaire before each interview and again several months after the last contact during a follow up phone call. A clinician administered measure of dissociation will be completed in the first appointment and again during the follow up phone call. A modified adult attachment interview (AAI) will be incorporated into the first session for subsequent analysis. The voice recordings will be transcribed externally for thematic analysis and production of a case series.
Sponsors
Health Education Training Institute Higher Education
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients diagnosed by a Neurologist with Functional Neurological Symptom Disorder with residual symptoms despite a clear diagnosis and treatment as usual. Over 16 years old and able to consent. Able to speak and understand English or a language for which translation services are readily available.
Exclusion criteria
Age under 18 or unable to consent.
Outcome results
None listed