27 Functional neurological presentation: a psychological intervention

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Abstract

Objective

To reduce a significant functional tremor for a patient who has been diagnosed with a trauma response to life events, who’s medical conditions are exacerbated by the extreme and persistent nature of the tremor and the complex psychological vulnerability of JM.

Objective

Intentions of Neuropsychology Services

Objective

• Improve well-being;

Objective

• Reduction in functional movement;

Objective

• Reduction in associated pain;

Objective

• Reduction in presentation to clinical services;

Objective

• Reduction in annual cost of services used by patients:

Objective

• Greater engagement and functioning in society;

Objective

• Improved QOL.

Method

Therapy part one

Attendance

1. Education Day for JM and his partner, and one other friend or family member completed

Attendance

Clinicians at the education day will include an 8 c Clinical Psychologist and an 8b Counselling Psychologist.

Attendance

JM, his partner, and family member attended a course/workshop lasting one session/two hours

Attendance

They are offered prescriptive education around the evidence for cause and treatment of Functional Neurological Presentations. This included prevalence rates, theories and evidence, the process of diagnosis e.g., how the person came to be in the Neuropsychology Service, investigations that were carried out by the specialists involved, and the individual formulation for JM was provided and explored and was presented to JM and others. Questions and answers and discussion points were informally discussed and shared.

Therapy part two

*A therapeutic package of 10–14 sessions was offered

Therapy part two

*liaison with family is on-going over the period of therapy

Therapy part two

JM and others indicated that they wished to explore the formulation through therapy

Therapy part two

• Outcome measures were completed

Therapy part two

2. Therapy consultation

Therapy part two

Formulation discussion

Therapy part two

JM has a consultation with a psychologist and a counselling psychologist/hypnotherapist and an agreement was made regarding their be-spoke service:

Therapy part two

Psychodynamic therapy

Therapy part two

Or

Therapy part two

CBT/solution focused interpersonal therapy/hypnotherapy

Therapy part two

*JM and others explored and agreed an approach CBT/Hypnotherapy in addition to the education sessions

Therapy part three

3. Treatment sessions

Therapy part three

Treatment sessions will be carried out by the 8 c Clinical Psychologist and the Counselling Psychologist in unison at JM home in West Sussex.

Therapy part three

Following Two DNAs whether cancelled sessions or non-attended sessions will result JMs discharge, unless there are clear and exceptional circumstances. The 8 c will make a decision on each individual case.

Therapy part three

Each session will be taped to aid memory, for reflection and homework over the we.

Therapy part four: end of therapy

*Penultimate session:

Therapy part four: end of therapy

• Outcome measures to be completed

Therapy part four: end of therapy

• Satisfaction questionnaire completed

Therapy part four: end of therapy

• Consent to audit financial elements of care

Therapy part four: end of therapy

Last session

Therapy part four: end of therapy

• Exit Meeting

Therapy part four: end of therapy

Following last session

Therapy part four: end of therapy

• Discharge report

Therapy part four: end of therapy

*the approach may or may not involve other friends or family.

Therapy part four: end of therapy

*the approach has an end of therapy exit meeting attached to the last 30 min of the final session.

Therapy part four: end of therapy

OUTCOME MEASURES may include:

Therapy part four: end of therapy

Consent Forms

Therapy part four: end of therapy

Equality and Diversity forms

Therapy part four: end of therapy

Risk assessment

Therapy part four: end of therapy

BICRO-39 Well-being questionnaire

Therapy part four: end of therapy

QOL questionnaire

Therapy part four: end of therapy

DASS42 (mood measure)

Therapy part four: end of therapy

Beck measures (where needed)

Therapy part four: end of therapy

Self-esteem measures (where needed)

Therapy part four: end of therapy

PTSD measures (where needed)

Therapy part four: end of therapy

Consent for Audit data collection (clinical and financial)

Therapy part four: end of therapy

Behavioural data

Therapy part four: end of therapy

Video data of movement Measure of pain

Therapy part four: end of therapy

Measure of pain

Results

We are at session 4 and will have the end of therapeutic contract meeting in January. The outcome of this therapeutic approach will be evaluated at this time.

Conclusion

Conclusions as to the effectiveness of the intervention will be evaluated via the behavioural data and the outcome measures. We will also seek feedback from the treating Neuropsychiatric Team at St Georges in London.

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