37 Outpatient cognitive behavioural therapy for ‘functional’ and ‘organic’ neuropsychiatric disorders: a retrospective case control comparison

Objectives There is no gold standard treatment for functional neurological disorder, motor type (mFND). Cognitive behavioural therapy (CBT) is effective in the treatment of certain somatoform disorders. This study aims to evaluate the characteristics and outcomes of mFND patients receiving CBT in a neuropsychiatry outpatient clinic. Method We utilise a large psychiatric register to assess all mFND patients receiving outpatient CBT in a neuropsychiatric clinic between 2006 and 2011. We assess socio-demographic characteristics, changes in physical and psychological outcomes using standardised rating scales, and rates of CBT uptake and dropout. We compare mFND patients to patients with psychiatric and behavioural manifestations of organic neuropsychiatric diseases treated in the same clinic (ONP patients). Results The most common reasons for patients not accepting a CBT referral were referral to the Trust’s inpatient neuropsychiatry ward, or non-attendance at assessment or treatment sessions. We identified a total of 98 patients with mFND and 76 ONP patients treated with CBT. 56.1% of mFND and 56.6% of ONP patients attended all sessions offered. There were no socio-demographic characteristics associated with mFND patients who completed all therapy sessions versus those who dropped out early. Compared to controls, mFND patients were more likely to be female (72.4% v. 44.7%, χ2: 13.6, 95% CI: 12.2–41.9, p=0.001), unemployed (52.6% versus 35.5%, χ2: 5, 95% CI: 2.2–30.8, p=0.03), to have a carer (27.6% versus 14.3%, χ2: 4.4, 95% CI: 0.9–24.7, p=0.04) and to have experienced child sexual abuse (23.8% v 8.2%, χ2: 7.3, p=0.01). The most common mFND symptom was weakness (26.9%), most frequently in the leg or entire body. Both mFND and ONP patients showed significant improvements in measures of psychological functioning (measured with the CORE-OM, HoNOS-ABI, and PHQ-9), with physical symptoms improving in 49.4% of mFND patients. A logistic regression showed acceptance of psychological formulations prior to CBT (p Conclusions mFND patients treated in a specialist CBT clinic show similar improvements in physical and psychological functioning to ONP patients with positive effects on motor symptoms, distress, depression, general health and social functioning. With little evidence on the effectiveness of CBT in treating motor variants of FND, this study could help inform the design of a pilot RCT.