Tailored psychotherapy for patients with functional neurological symptoms: A pilot study

Reuber, Markus; Burness, Christine; Howlett, Stephanie; Brazier, John; Grünewald, Richard

doi:10.1016/j.jpsychores.2007.06.013

« Previous Next »Journal of Psychosomatic Research
Volume 63, Issue 6 , Pages 625-632, December 2007

Tailored psychotherapy for patients with functional neurological symptoms: A pilot study☆

Markus Reuber
- Academic Unit of Neurology, Division of Genomic Medicine, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
- Corresponding author. Academic Unit of Neurology, Division of Genomic Medicine, University of Sheffield, Royal Hallamshire Hospital, Glossop Road, S10 2JF Sheffield, United Kingdom. Tel.: +44 0114 2268763; fax: +44 0114 2713684.
Christine Burness
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
Stephanie Howlett
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
John Brazier
- School of Health and Related Research, Regent Court, Sheffield, United Kingdom
Richard Grünewald
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom

Received 2 February 2007; received in revised form 14 May 2007; accepted 19 June 2007. published online 28 July 2007.

Abstract

Objective

The objective of this study was to assess whether individually tailored psychotherapy for patients with functional neurological symptoms is associated with improvements in patient-centered measures of emotional well-being, quality of life, as well as somatic symptoms and whether this treatment modality is likely to be cost-effective.

Methods

We conducted an uncontrolled prospective pilot study of consecutive patients with functional symptoms referred from neurology outpatient clinics to a single psychotherapist using validated questionnaires [Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), Short Function (SF)-36 Health Survey, and Patient Health Questionnaire (PHQ)-15]. Patients had a median of 6 treatment sessions (range=1–24). Ninety-one patients completed questionnaires at referral, 63 did at the end of treatment, and 34 did at follow-up after 6 months. Significant improvements were seen on all measures and were maintained at follow-up (CORE-OM, P=.003; SF-36, P<.001; PHQ-15, P=.001). Significance was not lost in an intention-to-treat analysis. Of all the patients, 49.2% improved by at least 1 S.D. in at least one of the measures. The number of patients needed to be treated to see an improvement of at least 1 S.D. in one of the three outcome measures was 2; that in two measures, 3.9; and that in all measures, 7. The mean cost of the intervention was £231; the cost per quality-adjusted life year was estimated as £5,328.

Results

Psychotherapy was associated with significant improvements in patient-centered measures, which seemed to be achieved at a comparatively low cost.

Conclusions

The results indicate that psychotherapy may be a cost-effective intervention for patients presenting with functional neurological symptoms. The findings warrant further assessment of this treatment with a randomized and controlled trial.

Keywords: Functional symptoms, Dissociative disorder, Neurology, Nonepileptic seizures, Psychotherapy, Somatoform disorder