Dr. Caitlin Adams, a psychiatrist at Massachusetts General Hospital, specializes in functional neurological disorders (FND). She breaks down the complexities of FND and debunks misconceptions about voluntary control over symptoms like functional weakness. Dr. Adams emphasizes the importance of effective communication and reducing stigma in treatment. The discussion includes key diagnostic signs, the biopsychosocial model, and therapeutic strategies such as cognitive behavioral therapy and specialized physical therapy, all aimed at enhancing patient engagement and recovery.
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insights INSIGHT
FND as Brain Connectivity Issue
Functional neurological disorders are characterized by brain connectivity issues resembling "software" rather than hardware problems.
This explains the difficulty in identifying specific structural brain lesions despite real symptoms.
insights INSIGHT
FND Prevalence and Commonality
FND is common and often underdiagnosed, with incidence comparable to Parkinson's.
It is the second most common reason for outpatient neurology visits after headaches.
volunteer_activism ADVICE
Use Positive Signs to Diagnose
Diagnose FND using positive clinical signs instead of excluding other conditions.
Look for physical exam signs like Hoover's sign and tremor entrainment to rule in the disorder.
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Dr. Caitlin Adams, psychiatrist at Massachusetts General Hospital, provides an overview of functional neurological disorder (FND). This episode covers how to recognize, explain, and treat FND using a modern, evidence-based, and patient-centered approach.
We begin by defining FND and discussing nomenclature from hysteria through conversion disorder and into our current construct of FND. Dr. Adams directly addresses one of the most critical misconceptions in clinical practice: whether symptoms like functional weakness or psychogenic non-epileptic seizures (PNES) are under voluntary control. We explore what current neuroscience tells us about the pathophysiology of FND and how this can support compassionate and effective care.
The episode outlines how to positively diagnose FND—including key physical exam findings such as Hoover’s sign, tremor variability, and features that distinguish PNES from epileptic seizures. We also review how to communicate the diagnosis to patients, reduce stigma, and improve treatment engagement.
Dr. Adams describes the biopsychosocial model of FND, including common predisposing, precipitating, and perpetuating factors. We discuss the central role of cognitive behavioral therapy (CBT), the benefits of specialized physical therapy for functional movement symptoms, and additional psychotherapeutic approaches such as mindfulness and psychodynamic therapy. Finally, we address how to manage chronic or treatment-resistant FND, and when to re-evaluate the diagnosis.
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