Cristina Bleier, Ellen J Godena, Daniel Millstein, Andrew Guthrie, Caitlin Adams, Margaret Tuttle, Bruce Price, Sara A Finkelstein, David L Perez
{"title":"功能性神经障碍技能心理治疗结果的预测因素：一项回顾性队列研究。","authors":"Cristina Bleier, Ellen J Godena, Daniel Millstein, Andrew Guthrie, Caitlin Adams, Margaret Tuttle, Bruce Price, Sara A Finkelstein, David L Perez","doi":"10.1176/appi.neuropsych.20250011","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Skills-based psychotherapy is an evidence-based treatment for functional neurological disorder (FND). However, evidence supporting its real-world efficacy is limited, and no consensus exists on optimal treatment duration. The authors examined how baseline neuropsychiatric characteristics are related to outcomes among patients with FND who were receiving psychotherapy.</p><p><strong>Methods: </strong>This retrospective cohort included 97 patients with FND who received outpatient skills-based psychotherapy between 2019 and 2023. FND symptoms included motor (79%), seizure (32%), and speech (24%) presentations. Baseline characteristics and clinician-estimated outcomes were extracted from medical records. Univariate screenings were followed by multivariate regression analyses to identify predictors of improvement.</p><p><strong>Results: </strong>At the end of treatment (mean±SD number of sessions=20.0 ± 17.1), 64 patients (66%) had chart-documented evidence of improvement; 20 had complete or near-complete symptom resolution. In a logistic regression, improvement was positively associated with full-time employment and negatively associated with being in a concurrent psychotherapy. After adjustment of analyses for baseline demographic factors and FND subtypes, the number of sessions attended positively correlated with improvement. Of 43 patients who received >16 sessions, 56% showed additional improvement with more treatment. Factors associated with continued improvement in univariate screenings were longer illness duration, cognitive symptoms at baseline, and not being in concurrent psychotherapy, the latter independently predicting continued improvement in prolonged treatment.</p><p><strong>Conclusions: </strong>These findings indicate that skills-based psychotherapy is effective for some patients with FND in real-world outpatient settings. Prolonged treatment benefits a subgroup of patients with FND, highlighting the need for prospective studies to refine and individualize psychotherapy protocols.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"appineuropsych20250011"},"PeriodicalIF":2.9000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictors of Skills-Based Psychotherapy Outcomes for Functional Neurological Disorder: A Retrospective Cohort Study.\",\"authors\":\"Cristina Bleier, Ellen J Godena, Daniel Millstein, Andrew Guthrie, Caitlin Adams, Margaret Tuttle, Bruce Price, Sara A Finkelstein, David L Perez\",\"doi\":\"10.1176/appi.neuropsych.20250011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Skills-based psychotherapy is an evidence-based treatment for functional neurological disorder (FND). However, evidence supporting its real-world efficacy is limited, and no consensus exists on optimal treatment duration. The authors examined how baseline neuropsychiatric characteristics are related to outcomes among patients with FND who were receiving psychotherapy.</p><p><strong>Methods: </strong>This retrospective cohort included 97 patients with FND who received outpatient skills-based psychotherapy between 2019 and 2023. FND symptoms included motor (79%), seizure (32%), and speech (24%) presentations. Baseline characteristics and clinician-estimated outcomes were extracted from medical records. Univariate screenings were followed by multivariate regression analyses to identify predictors of improvement.</p><p><strong>Results: </strong>At the end of treatment (mean±SD number of sessions=20.0 ± 17.1), 64 patients (66%) had chart-documented evidence of improvement; 20 had complete or near-complete symptom resolution. In a logistic regression, improvement was positively associated with full-time employment and negatively associated with being in a concurrent psychotherapy. After adjustment of analyses for baseline demographic factors and FND subtypes, the number of sessions attended positively correlated with improvement. Of 43 patients who received >16 sessions, 56% showed additional improvement with more treatment. Factors associated with continued improvement in univariate screenings were longer illness duration, cognitive symptoms at baseline, and not being in concurrent psychotherapy, the latter independently predicting continued improvement in prolonged treatment.</p><p><strong>Conclusions: </strong>These findings indicate that skills-based psychotherapy is effective for some patients with FND in real-world outpatient settings. Prolonged treatment benefits a subgroup of patients with FND, highlighting the need for prospective studies to refine and individualize psychotherapy protocols.</p>\",\"PeriodicalId\":16559,\"journal\":{\"name\":\"Journal of Neuropsychiatry and Clinical Neurosciences\",\"volume\":\" \",\"pages\":\"appineuropsych20250011\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-10-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Neuropsychiatry and Clinical Neurosciences\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1176/appi.neuropsych.20250011\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Neuropsychiatry and Clinical Neurosciences","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1176/appi.neuropsych.20250011","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Predictors of Skills-Based Psychotherapy Outcomes for Functional Neurological Disorder: A Retrospective Cohort Study.
Objective: Skills-based psychotherapy is an evidence-based treatment for functional neurological disorder (FND). However, evidence supporting its real-world efficacy is limited, and no consensus exists on optimal treatment duration. The authors examined how baseline neuropsychiatric characteristics are related to outcomes among patients with FND who were receiving psychotherapy.
Methods: This retrospective cohort included 97 patients with FND who received outpatient skills-based psychotherapy between 2019 and 2023. FND symptoms included motor (79%), seizure (32%), and speech (24%) presentations. Baseline characteristics and clinician-estimated outcomes were extracted from medical records. Univariate screenings were followed by multivariate regression analyses to identify predictors of improvement.
Results: At the end of treatment (mean±SD number of sessions=20.0 ± 17.1), 64 patients (66%) had chart-documented evidence of improvement; 20 had complete or near-complete symptom resolution. In a logistic regression, improvement was positively associated with full-time employment and negatively associated with being in a concurrent psychotherapy. After adjustment of analyses for baseline demographic factors and FND subtypes, the number of sessions attended positively correlated with improvement. Of 43 patients who received >16 sessions, 56% showed additional improvement with more treatment. Factors associated with continued improvement in univariate screenings were longer illness duration, cognitive symptoms at baseline, and not being in concurrent psychotherapy, the latter independently predicting continued improvement in prolonged treatment.
Conclusions: These findings indicate that skills-based psychotherapy is effective for some patients with FND in real-world outpatient settings. Prolonged treatment benefits a subgroup of patients with FND, highlighting the need for prospective studies to refine and individualize psychotherapy protocols.
期刊介绍：
As the official Journal of the American Neuropsychiatric Association, the premier North American organization of clinicians, scientists, and educators specializing in behavioral neurology & neuropsychiatry, neuropsychology, and the clinical neurosciences, the Journal of Neuropsychiatry and Clinical Neurosciences (JNCN) aims to publish works that advance the science of brain-behavior relationships, the care of persons and families affected by neurodevelopmental, acquired neurological, and neurodegenerative conditions, and education and training in behavioral neurology & neuropsychiatry. JNCN publishes peer-reviewed articles on the cognitive, emotional, and behavioral manifestations of neurological conditions, the structural and functional neuroanatomy of idiopathic psychiatric disorders, and the clinical and educational applications and public health implications of scientific advances in these areas. The Journal features systematic reviews and meta-analyses, narrative reviews, original research articles, scholarly considerations of treatment and educational challenges in behavioral neurology & neuropsychiatry, analyses and commentaries on advances and emerging trends in the field, international perspectives on neuropsychiatry, opinions and introspections, case reports that inform on the structural and functional bases of neuropsychiatric conditions, and classic pieces from the field’s rich history.
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