PsychEd Episode 71: Functional Neurological Disorder with Dr. Patricia Rosebush

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.

This episode covers Functional Neurological Disorder with Dr. Patricia Rosebush. Dr. Rosebush is a Professor in the Department of Psychiatry & Behavioural Neurosciences at McMaster University. She is the distinguished author of numerous articles on clinical neuroscience, including considerable work on mitochondrial disorders in mental illness and over 30 papers on catatonia, and practices consultation-liaison psychiatry at St. Joseph’s Healthcare Hamilton.

The learning objectives for this episode are as follows:

1. Provide a definition and conceptual approach to FND

2. Identify clinical signs and patient histories relevant to a diagnosis of FND

3. Describe an approach to the treatment of FND

4. Understand the special challenges of communication and collaboration in this illness

Guest: Dr. Patricia Rosebush

Hosts: Dr. Alastair Morrison, Dr. Kate Braithwaite

Audio editing: Dr. Alastair Morrison

Show notes: Dr. Kate Braithwaite

Interview content:

(02:39) Learning objectives

(03:09) Conceptualization of FND

(08:30) Underlying psychological processes

(09:35) Difference between FND and factitious disorder/malingering

(14:54) Alexithymia

(16:51) Common symptomatic presentations

(18:00) Types of underlying stressors

(19:17) Other risk factors for FND

(22:12) Communicating with patients to address stigma

(24:32) Psychotherapy in FND

(29:36) Referral pathways for patients with FND

(31:15) Prognosis of FND

(33:09) Social media and FND

Resources:

• Functional Neurological Disorder Society. Functional Neurological Disorder Society (FNDS). Includes a podcast and courses for physicians

• Functional Neurological Disorder (FND) – A Patient's Guide to FND

References:

• Hull, M., & Parnes, M. (2021). Tics and TikTok: Functional Tics Spread Through Social Media. Movement disorders clinical practice, 8(8), 1248–1252. https://doi.org/10.1002/mdc3.13267

• National Institute for Neurological Disorders and Stroke. (2024, July.) Functional Neurological Disorder.  U.S. Department of Health and Human Services, National Institutes of Health. Functional Neurologic Disorder | National Institute of Neurological Disorders and Stroke

• PsychDB. (2024, April). Conversion Disorder (Functional Neurological Disorder. Conversion Disorder (Functional Neurological Disorder) - PsychDB

• Rosebush, P. I., & Mazurek, M. F. (2011). Treatment of conversion disorder in the 21st century: have we moved beyond the couch?. Current treatment options in neurology, 13(3), 255–266. https://doi.org/10.1007/s11940-011-0124-y

• Scamvougeras, A., & Castle, D. (2024). Functional Neurological Disorders: Challenging the Mainstream Agnostic Causative Position. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 69(7), 487–492. https://doi.org/10.1177/07067437241245957

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