physically unexplained symptoms, non-epileptic seizures do not always have a psychological cause. One of the reasons behind the change from conversion disorder to functional neurological disorder was because there were patients where no underlying psychological problems could be found. These patients would get batted from neurology and psychiatry (and still often do)
Out of interest what non-psychological causes have been found?
My experience is neurology admits and reviews patient first, rules out any obvious or serious neurological cause, then refers to psychiatry for further investigation. It’s common for psychiatry inpatients to have ongoing out-patient neurology appointments or attend repeat MRI scans etc. They are often under psychiatry and neurology at the same time.
IME there is no organic cause found for pseudo seizures, hence the name. No abnormal electrical patterns, no loss of bowel/bladder control, no post ichytal phase, no tongue biting. Often these non epileptic seizures occur when a patient is distressed (almost like a panic attack), or feels neglected/lonely/seeking comfort and attention from staff on a busy ward, when staff can’t give that psychological support due to other situations going on.
I’ve never come across patients who suffer pseudo seizures in the absence of any MH condition though I’m sure there must be some rare cases.
As for FND, I had a patient who was admitted to psychiatry in an electric wheelchair, having had her house fully kitted out with adaptive equipment. Claimed to be unable to weight bare yet managed to transfer independently WB when she thought staff weren’t watching, and somehow got from one side of a bathroom with a wet floor to the other without getting her jeans wet (despite claiming she’d crawled). A specialist FND placement was unsuccessful as she refused to engage with physiotherapy.
A different patient claimed she couldn’t walk, had used a wheelchair for years, yet suddenly got up and walked about independently. So had clearly been walking in secret or her muscles would have wasted.
It’s frustrating for staff, because of course there COULD be something physically wrong, or symptoms could be trauma related, but often it feels like the patient is inventing symptoms; sometimes they do have a motivation, like claiming higher rate PIP or receiving more input and resources from services.