Functional Neurological Symptoms Referral

Our service is modelled on the stepped care approach recommended in the 2012 document “Stepped Care for Functional Neurological Symptoms” by Health Improvement Scotland. For more information visit
hwww.healthcareimprovementscotland.org/our_work/long_term_conditions/neurological_health_services/neurological_symptoms_report.aspx
Our current pathway is:

Step 1: Diagnosis and explanation made by a local neurologist, patient education material provided
Step 2: Brief intervention by local services as able e.g. liaison psychiatry team, IAPT, physiotherapy
Step 3: Chronic symptoms following steps 1 and 2: Referral to outpatient neuropsychiatry for assessment and guidance +/- CBT.
Step 4: MDT inpatient programme.

A succinct summary presentation on FND commissioning is available from the Northern England Strategic Clinical Networks at
hwww.necn.nhs.uk/wp-content/uploads/2015/02/Functional-Commissioning-FINAL-August-2015.pdf

Outcomes

We currently use the outcome measures from the liaison psychiatry PLAN protocol for our inpatient program, namely the CGI (Clinician Rated) and the CORE 10 (Patient rated)
For 68 consecutive cases in 2017-2018 our outcomes were as follows:

CORE 10 (Patient rated outcome measure):

  • Mean 4.7/10 at admission, Mean 2.0/10 at discharge.
  • Effect size (Cohens d, no control group) = 2.1.

CGI (Clinician rated outcome measure):

  • Mean 19.9 at admission, 11.1 at discharge.
  • Effect size (Cohens d, no control group) = 1.2.