Kemuel Philbrick, MD¹; Wolfgang Söllner, MD²; Friedrich Stiefel, MD³; Ewa Bieber, MD⁴

 

¹Mayo Clinic, Rochester MN, USA; ²Dept. of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany; ³Service of Consultation-Liaison Psychiatry, University of Lausanne, Switzerland; ⁴Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago IL, USA.

 

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A.G. Lever (PhD), psychologist

L.M. Tak (MD, PhD), psychiatrist

Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands

Abstract:
Functional neurological disorder (FND) is a prevalent, potentially disabling condition that benefits from early diagnosis and treatment, such as physiotherapy or psychotherapy. However, not all patients benefit from those treatments and not all treatments are easy accessible, therefore there is a need for more options. A technique that is increasingly used in the Netherlands to treat motor symptoms of FND is tactile-induced catalepsy. Catalepsy refers to a condition characterized by muscular rigidity, which can be used to retrain normal bodily movement and control. Patients may experience how to calm or ‘reset’ the body (in case of tremors or uncoordinated body movements), stabilize their body (in case of balance problems), or relearn standing or walking (in case of paresis, paralysis and various gait disorders). This technique is still quite unknown among neurologists, psychologists and physiotherapists worldwide in research and clinical practice.

In this workshop, we introduce the theoretical background of catalepsy and we provide a practical description of the technique itself. Our aim is to raise awareness of this technique, so scientific and clinical interest may be increased.

We use video-material to show how to induce catalepsy and show patients with FND to whom this technique has been applied. Also, we are going to practice with participants of this workshop to induce and experience catalepsy.

 

Psychiatrist. Director of Mental Health and Addiction Services, Hospital Universitari de Santa Maria de Lleida / Gestió de Serveis Sanitaris

Department of Psychiatry and Psychology, Hospital Clinic of Barcelona
Associate Professor, University of Barcelona

 

Per Fink 1,3, MD, PhD, DMSc. Professor and head of department.

Majbritt Mostrup Pedersen 2, MSc, PhD. Clinical psychologist experienced in psychotherapy and multidisciplinary pain treatment.

Lise Kirstine Gormsen 1,2, MD, PhD. Experienced clinician, educator and researcher in FSD and pain.

 

Pain is a common symptom in functional somatic disorders (FSDs). Most of the conditions included in the ICD-11 under the diagnosis of primary pain may thus as well be diagnosed as FSD.

 

The Pain Clinic at Arhus University Hospital was established in 2014 as a partnership between the Department of Neurology and The Research Clinic for Functional Disorders and Psychosomatics.

 

The Pain Clinic has two treatment tracks: one for patients with FSD and one for patients with neuropathic pain.

 

After triage, the patients are referred to a clinical examination. The diagnostic interview includes a meticulous review of their medical records and electronic questionaries' completed by the patients prior to the appointment. If relevant, a physical examination, blood screening and/or referral to scanning are included. Medical conferences are held regularly to present and discuss the patient's diagnosis and treatment plan. If the diagnosis single-organ musculoskeletal FSD is established, the patient will be offered treatment such as a brief psychoeducational intervention, medical treatment (e.g., low-dose antidepressant), graded exercise program, and extensive psychotherapy in either an individual- or group-based format. Patients with FSD multisystemic type can be referred to The Research Clinic for Functional Disorders and Psychosomatics.

 

In this workshop, we will present the organizational structure of the pain clinic and how we diagnose and treat patients with FSD/primary pain in a multidisciplinary setting. Furthermore, the challenges in using FSD diagnoses instead of or in combination with pain disorder diagnoses will be addressed as well as patients' reactions to their diagnoses and the resulting influence on illness beliefs and adherence to treatment.

 

The workshop will be interactive, with time for questions, reflections and discussions. You will learn how do diagnose and treat patients with FSD/primary pain.