We take a closer look at Functional Neurological Disorder this week, as well as a report on the effectiveness of aripiprazole, and the challenges of menstrual psychosis.
New Review Outlines Diagnosis, Treatment Strategies
For years, clinicians have dismissed functional neurological disorder (FND) as something that’s “all in the patient’s head.” Today, we recognize it as a common, disabling condition that lurks at the crossroads of neurology and psychiatry.
A new review in The Primary Care Companion for CNS Disorders outlines how clinicians can diagnose and manage the disorder with clarity and compassion.
Unlike traditional neurological disorders, FND’s symptoms (such as weakness, tremors, seizures, speech problems, or sensory loss) are real. But they can’t be explained by structural damage. Risk factors include female sex, midlife onset, prior trauma, psychiatric comorbidities, and even existing neurological illness.
Historically viewed as a “diagnosis of exclusion,” FND can now be ruled in with legitimate bedside signs, such as the Hoover maneuver for leg weakness or tremor entrainment tests.
Neuroimaging studies show disruptions in circuits tied to agency, attention, and emotion processing, bolstering its biological basis.
Treatment begins with a clear explanation that validates symptoms while emphasizing reversibility. Effective care is multidisciplinary: physical therapy to retrain movement, occupational therapy for daily functioning, speech therapy for communication or cognition, and cognitive-behavioral therapy for seizures or mood symptoms.
Early intervention improves outcomes, though prognosis can vary dramatically. While medications still don’t treat FND itself, they might help manage comorbid depression, anxiety, or PTSD. The authors also stress the importance of destigmatization, patient education, and provider support.
“Clear, empathic communication can transform patient engagement and recovery,” they conclude, urging clinicians to see FND as both real and treatable.
IN OTHER PSYCHIATRY AND NEUROLOGY NEWS
- The Journal of Clinical Psychiatry documents aripiprazole, a safe, effective long-term treatment option for maintaining stability in adults with bipolar I disorder.
- PCC presents two cases of menstrual psychosis, which can pose a challenge to clinicians due to its lack of inclusion in any existing nosological system.
- JCP has also published a response from Postpartum Support International expressing concern about the July 2025 FDA panel discussion on SSRIs in pregnancy.
- Another PCC case study illustrates the need for timely screening and treatment of Lyme disease and other tick-borne co-infections in patients with neuropsychiatric symptoms in tick-endemic areas.
- And, finally, our news department reports on the surprising benefits of ADHD meds.
