PIONEERING AN INTEGRATED TREATMENT APPROACH FOR FUNCTIONAL NEUROLOGICAL SYMPTOM DISORDER: A RANDOMISED CONTROLLED TRIAL

DR JUMANA HASEEN S,DR LAVANYA,DR SHANTHI NAMBI

Background: Functional Neurological Symptom Disorder (FNSD), previously referred to as conversion disorder, presents with neurological symptoms that are inconsistent with structural neurological disease and are often associated with significant psychosocial distress and disability. Traditional treatment approaches have shown limited success due to the complexity of the disorder’s biopsychosocial etiology. Cognitive Behavioural Therapy (CBT) has demonstrated efficacy in managing FNSD, and when combined with appropriate pharmacotherapy, may offer superior outcomes by addressing both cognitive-emotional and neurochemical dysregulation. However, integrated treatment models have not been widely tested in controlled trials.

Objectives

To evaluate the efficacy of an integrated treatment approach (CBT + pharmacotherapy) in reducing symptom severity in patients with Functional Neurological Symptom Disorder.

To assess improvements in functional outcomes and quality of life compared to standard care.

Methods: A single-center randomized controlled trial was conducted among 44 adult patients (aged 18–60 years) diagnosed with FNSD according to DSM-5 criteria. Participants were randomized into two groups:

Intervention Group (n = 22): Received an 8-week structured CBT protocol alongside pharmacotherapy tailored to symptom profile.

Control Group (n = 22): Received standard care as per clinical practice guidelines.

Baseline assessments included the PHQ-9, WHOQOL-BREF, and Sheehan Disability Scale (SDS). Follow-up assessments were conducted at 8 and 10 weeks. Data were analyzed using repeated measures ANOVA and independent t-tests.

Results: The intervention group showed significant improvements in symptom severity, quality of life, and functioning at both 8 and 10 weeks. PHQ-9 scores reduced by an average of 8.3 points in the intervention group versus 3.2 in the control group (p < 0.001). WHOQOL-BREF domains showed marked enhancement in physical and psychological well-being (p < 0.01). SDS scores indicated greater improvement in work, social, and family functioning among intervention participants (p < 0.001).

Conclusion: The integrated treatment approach combining CBT and pharmacotherapy was significantly more effective than standard care in reducing symptom burden and improving overall functioning in patients with FNSD. These findings support the implementation of structured, multidisciplinary interventions in the routine management of functional neurological disorders.