eprintid: 10087248 rev_number: 23 eprint_status: archive userid: 608 dir: disk0/10/08/72/48 datestamp: 2019-12-05 16:50:45 lastmod: 2021-09-20 22:33:28 status_changed: 2019-12-05 16:50:45 type: article metadata_visibility: show creators_name: Jones, A creators_name: O'Connell, N creators_name: David, AS creators_name: Chalder, T title: Functional Stroke Symptoms: A Narrative Review and Conceptual Model ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D79 keywords: Functional Symptoms, Model and Intervention, Narrative Review, Stroke note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: Stroke services have been reconfigured in recent years to facilitate early intervention. Throughout stroke settings, some patients present with functional symptoms that cannot be attributed to a structural cause. Emphasis on fast diagnosis and treatment means that a proportion of patients entering the care pathway present with functional symptoms that mimic stroke or have functional symptoms in addition to vascular stroke. There is limited understanding of mechanisms underlying functional stroke symptoms, how the treatment of such patients should be managed, and no referral pathway or treatment. Predisposing factors vary between individuals, and symptoms are heterogeneous: onset can be acute or insidious, and duration can be short-lived or chronic in the context of new or recurrent illness cognitions and behaviors. This article proposes a conceptual model of functional symptoms identified in stroke services and some hypotheses based on a narrative review of the functional neurological disorder literature. Predisposing factors may include illness experiences, stressors, and chronic autonomic nervous system arousal. Following the onset of distressing symptoms, perpetuating factors may include implicit cognitive processes, classical and operant conditioning, illness beliefs, and behavioral responses, which could form the basis of treatment targets. The proposed model will inform the development of theory-based interventions as well as a functional stroke care pathway. date: 2020 date_type: published official_url: https://doi.org/10.1176/appi.neuropsych.19030075 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1719874 doi: 10.1176/appi.neuropsych.19030075 lyricists_name: David, Anthony lyricists_id: ADDAV87 actors_name: David, Anthony actors_id: ADDAV87 actors_role: owner full_text_status: public publication: The Journal of Neuropsychiatry and Clinical Neurosciences volume: 32 number: 1 pagerange: 14-23 event_location: United States issn: 0895-0172 citation: Jones, A; O'Connell, N; David, AS; Chalder, T; (2020) Functional Stroke Symptoms: A Narrative Review and Conceptual Model. The Journal of Neuropsychiatry and Clinical Neurosciences , 32 (1) pp. 14-23. 10.1176/appi.neuropsych.19030075 <https://doi.org/10.1176/appi.neuropsych.19030075>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10087248/3/David_Functional%20Stroke%20Symptoms.%20A%20Narrative%20Review%20and%20Conceptual%20Model_AAM.pdf