Oral Papers: Neuropsychiatry
Background/Significance: Multidisciplinary inpatient rehabilitation with psychiatry, neurology, and physiatry collaboration is effective for patients with functional movement disorders in the short-term (Czarnecki et al, 2012; Jacob et al, 2018). However, little is known about the long-term course of depression, anxiety, and somatization in treated cohorts.
Methods: We performed an exploratory observational study to investigate the efficacy of a multidisciplinary inpatient rehabilitation protocol consisting of active psychotropic drug management, intensive psychotherapy, and motor retraining. We recruited participants who were diagnosed with functional movement disorders based on expert consensus after review of video recordings of abnormal movements. The study was approved by our Institutional Review Board. Baseline and follow-up measures included: Clinical Global Impression (severity and change, CGI-s and CGI-c), Patient Health Questionnaire-9 (PHQ-9), DSM-5 PTSD check list (PCL-5), Generalized Anxiety Disorder-7 (GAD-7), and Depression and Somatic Symptom Scale (DSSS). Participants who completed the protocol were followed for one year after discharge.
Results: Seventeen patients (14 women, 3 men) successfully completed the rehabilitation program (median stay = 7.5 days). Median CGI-s score at study entry was 5, indicating moderate disease severity. Median CGI-c score at discharge was 2 with corresponding decreases in depression, anxiety, and somatic symptoms (PHQ-9 Wilcoxon Z = -3.42, p < 0.001; GAD-7 Wilcoxon Z = -3.01, p < 0.002; DSSS Wilcoxon Z = -2.91, p < 0.004). No significant change in PCL-5 scores was noted (Wilcoxon Z = -1.51, p > 0.05). Thirteen patients completed one year follow-up, and 54% showed sustained improvement in their movement disorder (median CGI-c = 3). Improvement was not maintained for GAD-7, PHQ-9, and DSSS. When comparing patients who maintained improvement in their movement disorder (CGI-c 3 or lower, N=7) to those who did not (CGI-c 4 or higher, N=6), GAD-7 was significantly lower in the improved versus the non-improved cohorts at one year (GAD-7 Wilcoxon = 31, p < 0.010).
Discussion: Previous treatments of functional movement disorders have focused on aggressive management of psychiatric comorbidity. This pilot study indicates a possible positive relationship between the improvement of anxiety symptoms and sustained improvement in functional movement disorders. Additional studies with larger cohorts are needed to better understand these findings.
Conclusion/Implications: Multidisciplinary inpatient rehabilitation is effective for functional movement disorders. Further investigation is needed to understand the relationship between the maintenance of long term improvement of functional movement disorders and suboptimal treatment of anxiety.
Czarnecki K, Thompson JM, Seime R, Geda YE, Duffy JR: Functional movement disorders: Successful treatment with a physical therapy rehabilitation protocol. Parkinsonism and Related Disorders 2012; 18:247-251.
Jacob AE, Kaelin DL, Roach AR, Ziegler CH, LaFaver K. Motor retraining (MoRe) for functional movement disorders: outcomes from a 1-week multidisciplinary rehabilitation program. 2018 PMR; 10:1164-1172.