Functional Neurological Disorder (FND)
FNDs are complex and often misunderstood conditions that present with a range of neurological symptoms, which cannot be attributed to a specific structural or biochemical abnormality in the nervous system. However, it is a problem that is REAL and due to a problem going on in the brain at a level that people CAN’T control—just like migraine. One of the big problems patients with functional and dissociative neurological symptoms experience is a feeling that they are not being believed. This is partly because many doctors are not trained well in functional disorders, including FND, and people have only begun researching them properly in recent years.
As a psychiatrist with experience in diagnosing and treating FNDs, I am committed to providing compassionate care and effective treatment options to my patients and their families.
Diagnosis of Functional Neurological Disorders
FNDs can be challenging to diagnose due to their diverse symptoms and the absence of clear neurological abnormalities. I take a thorough and multidisciplinary approach to the diagnostic process, which may include:
- Detailed patient history: A comprehensive assessment of the patient’s medical, psychiatric, and social history is essential in identifying potential factors contributing to FND symptoms.
- Physical examination: A careful neurological examination can help rule out other neurological conditions and identify signs consistent with FND.
- Diagnostic tests: While there are no specific tests for FNDs, neuroimaging, electrophysiological tests, and laboratory tests may be used to exclude other possible causes of the symptoms and provide evidence for positive clinical signs as part of the diagnostic criteria for FND.
- Collaboration with other specialists: I will consult with neurologists, psychologists, or other healthcare professionals to gather additional information and ensure an accurate diagnosis.
Treatment of Functional Neurological Disorders
Once a diagnosis of FND is established, I work closely with the patient and their family to develop a personalized treatment plan. Treatment options may include:
- Psychotherapy: Cognitive-behavioral therapy (CBT) or other forms of therapy can help patients understand and manage their symptoms, address emotional triggers, and develop coping strategies. Other therapies that have been shown to be helpful for FND include dialectical behavior therapy, psychodynamic psychotherapy, or mindfulness-based therapy. Hypnotherapy has also been shown to be helpful in FND but I do not provide this at this time.
- Physical and occupational therapy: These therapies aim to improve patients’ motor function, coordination, and daily living skills, helping them regain independence. For FND, the severity of the symptoms can vary over time and the goal of these therapies is to restore the quality of movements. I often work with these therapists to advise on techniques and skills that can be helpful in improve FND symptoms.
- Medication: There is no medication that works to treat FND directly. However, depending on the individual’s specific symptoms and coexisting conditions, I may prescribe a medication to manage symptoms such as pain, anxiety, or depression. When the co-occurring conditions are treated, this can often indirectly help make FND better.
- Education and support: I provide patients and their families with information about FNDs and available resources to help them better understand the condition and build a supportive network.
- Multidisciplinary approach: I may collaborate with other healthcare professionals, such as neurologists, psychologists, and physiotherapists, to ensure comprehensive care for the patient.
I understand the challenges and complexities associated with Functional Neurological Disorders and am dedicated to providing the highest quality care for my patients and their families. Through accurate diagnosis and personalized treatment plans, I aim to improve the lives of those affected by FNDs and help them regain control over their symptoms. If you or a loved one is experiencing symptoms suggestive of an FND, please fill out a brief consultation request to get started.
Educational Materials:
Overcoming Functional Neurological Symptoms: A Five Areas Approach by Christopher Williams, MD and Alan Carson, MD.
This self-help book utilizes the evidence-based cognitive-behavioral therapy (CBT) five areas approach to help individuals with FND understand and manage their symptoms. The book is practical and easy to follow, providing tools and techniques for overcoming functional neurological symptoms.
Psychogenic Non-Epileptic Seizures: A Guide by Lorna Myers, PhD.
This book offers valuable insights into the diagnosis, treatment, and management of PNES. It provides both patients, loved ones, and healthcare professionals with a comprehensive understanding of this condition and practical guidance for addressing it.
Taking Control of Your Seizures: Workbook by Joel M. Reiter, MD, Donna K. Andrews, PhD, and Charlotte E. Reiter, MD.
This workbook offers practical guidance for individuals experiencing seizures, including those with functional neurological disorders. The book provides exercises and strategies to help patients better understand and manage their seizures, empowering them to take control of their lives. There is also an accompanying therapist guide book, which can be helpful to give to your therapist if they are unsure about how to help you with your symptoms.
In Our Own Words: Stories of those living with, learning from and overcoming the challenges of psychogenic non-epileptic seizures (PNES) by Mary Martiros, M.Ed., Lorna Myers Ph.D.
A collection of personal stories from individuals living with PNES, a misunderstood functional neurological disorder. The book offers valuable insights and inspiration through the authentic experiences of those affected by PNES.
Lowering the Shield – Overcoming Psychogenic Nonepileptic Seizures by John Dougherty.
Told from the story of a husband who helped his wife recover from PNES. Both of them offer practical advice, their personal experiences, exploring its causes which for this wife was rooted in trauma, and expert guidance in how to overcome the challenges associated with PNES.
60-minute training for school nurses for PNES:
https://learn.epilepsy.com/courses/seizure-training-for-school-nurses-caring-for-students-with-psychogenic-seizures
Online Resources:
Neurosymptoms – a website for patients and their families to understand more about the symptoms, causes, and treatment of each FND type from a world-renowned neurologist who studies FND.
FND Hope – an international patient-run registered charity for patients with functional neurological disorders. It has a large and growing amount of material for patients with functional neurological disorders, especially symptoms like movement disorder and weakness.
FND Society – a professional society of clinicians, scientists, other
healthcare professionals, students, and members of the lay public who are interested in functional neurological disorders.
Traumatic Brain Injury (TBI)
As a psychiatrist, I recognize the profound impact that a traumatic brain injury (TBI) can have on an individual’s mental health and overall well-being. TBIs can lead to a range of emotional, cognitive, and behavioral changes, which is why I am committed to providing comprehensive and compassionate care for my patients who have experienced a TBI. This includes mild TBIs such as concussions to more severe TBIs that can lead to coma.
In my practice, I take a personalized approach to diagnosing and treating TBI-related symptoms. I work closely with patients and their families to assess the extent of the injury and identify specific challenges they face. This may involve screening for common TBI-related mental health conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), memory and concentration problems, apathy, agitation, psychosis, mania, irritability, and substance use disorders.
After a thorough assessment, I develop a tailored treatment plan that addresses the unique needs of each individual. This plan may include a combination of the following treatment options:
- Psychotherapy: I can provide cognitive-behavioral therapy (CBT), executive functioning skills coaching, and family therapy, all of which can help patients process their trauma, manage emotional responses, develop coping strategies, and help address relationship issues and emotional impact of the injury on the family system. It is important to note that the effectiveness of these therapies can depend on various factors, such as the severity of the injury, the specific symptoms experienced, and the patient’s individual needs.
- Medication: There are FDA approved no medications to treat the chronic symptoms as a result of TBI. Depending on the specific symptoms and coexisting conditions, medications may be prescribed to manage issues such as mood swings, anxiety, sleep disturbances, or attention deficits.
- Cognitive rehabilitation: Working with a neuropsychologist or an occupational therapist, I may incorporate cognitive rehabilitation to help patients improve cognitive functions like memory, attention, and problem-solving.
- Support services: I can connect patients and their families with support groups, community resources, and educational materials to help them better understand the challenges of TBI and build a strong support network.
My goal is to help patients with TBI regain their sense of self, improve their quality of life, and achieve the best possible outcomes on their road to recovery. Not only is it important to identify the deficits from the TBI, but it is equally if not more important to identify preserved functions and strengths. Over the years I have been treating TBI, I have learned that knowing the full extent of a patient’s strengths is invaluable.
If you or a loved one has experienced a TBI and is struggling with emotional, cognitive, or behavioral issues, please fill out a brief consultation request to get started. Together, we can navigate the challenges of TBI and work towards healing and recovery.
Psychiatric Manifestations of Neurological Disease
Neurological diseases often have complex and wide-ranging effects on an individual’s mental health and overall well-being. Psychiatric symptoms are common in patients with epilepsy, brain tumors, neurogenetic diseases such as tuberous sclerosis, after a stroke, autoimmune encephalitis, multiple sclerosis, Parkinson’s Disease, cerebral palsy, and neurosurgical resections of parts of the brain.
As a psychiatrist with expertise in recognizing and managing psychiatric manifestations of neurological conditions, I assess the impact of the neurological disease on mood, anxiety, behavior, thoughts, memory, cognition, perception, impulse control, attention, and motivation. I work closely with neurologists to determine which medications are the best to treat both the neurological and psychiatric conditions. I also provide psychotherapy for those who are struggling with the impact of their neurological disease.
If you or a loved one is experiencing symptoms related to a neurological disease, please fill out a brief consultation request to get started.
Catatonia
Catatonia is a syndrome of motor, behavior, and affect resulting in difficulty interacting with one’s surroundings. It presents with a diverse range of symptoms, from immobility and mutism to agitation and peculiar behaviors. It is critical to understand that these symptoms can have considerable overlap with other conditions, hence, the need for expert assessment. As a syndrome, it is crucial to investigate the underlying cause of catatonia, whether it is a medical condition or a psychiatric one such as autism, bipolar, or schizophrenia. I review laboratory tests, brain imaging, neurophysiological testing such as electroencephalograms, and conduct my own physical and neurological examination of patients to ensure we are catching the underlying cause.
There is considerable overlap between catatonia and autism spectrum disorders (ASD). Symptoms of social indifference, mannerisms, and echolalia are common to both catatonia and ASD. Diagnosis of catatonia in ASD might result in difficulties in its identification due to the overlap in symptoms between these two conditions. Because I have seen many patients with catatonia, autism, or both, I have experience in the subtle findings in diagnosing catatonia in autistic patients where it may otherwise be missed by those without this expertise.
Often times, catatonia is diagnosed in the hospital, treatment is started with lorazepam, and finding outpatient treatment is difficult as many psychiatrists and primary care physicians are uncomfortable prescribing high doses of benzodiazepines. If you or a loved one is currently in the hospital and have been diagnosed with catatonia, please reach out to me and connect as soon as possible for an urgent appointment after discharge. The goal is to achieve complete remission from as quickly as possible and to avoid recurrence afterwards.
Leveraging my extensive expertise and the latest advancements in the field, I am well-equipped to conduct thorough evaluations, including the use of standard rating scales like the Bush-Francis Catatonia Rating Scale (BFCRS), to ensure precise diagnoses. I utilize the Harvard Standardized Catatonia Examination to examine for and score the severity of catatonia, as well as to track progress during our treatment.
Upon confirming a diagnosis, my treatment approach is rooted in established guidelines, focusing primarily on the administration of benzodiazepines or augmenting agents should higher doses of benzodiazepines be intolerable or does not provide complete resolution of symptoms. There are no FDA approved medication for the treatment of catatonia and much of the treatment comes from clinical experience and expertise. I’ve become familiar with many different medications that I’ve found highly effective in treating catatonia. The goal is to achieve complete remission of symptoms as quickly as possible. I offer personalized care plans tailored to the unique needs and circumstances of each patient, with the objective of rapidly alleviating catatonic symptoms and addressing the underlying disorder, thereby improving the overall quality of life.
My commitment extends beyond direct treatment. I work closely with families and caregivers, offering support and guidance through this challenging period. I also firmly believe in the value of patient education, providing resources and guidance to equip patients and their loved ones with the understanding and skills needed to manage their condition more effectively.
At my practice, I am dedicated to delivering compassionate, scientifically-grounded, and patient-centered psychiatric care. If you or a loved one may be experiencing symptoms of catatonia, I invite you to reach out to begin the journey towards healing and recovery.
Education:
