Functional neurologic disorders, also called psychogenic, nonorganic, conversion, and dissociative disorders, are among the most common problems in neurologic practice. This article presents a practical guide to clinical assessment and treatment, incorporating emerging research evidence. This article places an emphasis on encouraging neurologists to use the assessment as treatment, take an active role in educating and treating the patient, and work in a multidisciplinary way with psychiatry, psychology, and physical therapy.
Classification of functional neurologic disorders now emphasizes the importance of positive diagnosis based on physical signs, not psychological features. Studies of mechanism have produced new clinical and neurobiological ways of thinking about these disorders. Evidence has emerged to support the use of physical therapy for functional movement disorders and psychotherapy for dissociative (nonepileptic) attacks.
The diagnosis and management of functional neurologic disorders has entered a new evidence-based era and deserves a standard place in the neurologic curriculum.