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Functional Stroke Symptoms: A Narrative Review and Conceptual Model

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. Green open access

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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.

Type: Article
Title: Functional Stroke Symptoms: A Narrative Review and Conceptual Model
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1176/appi.neuropsych.19030075
Publisher version: https://doi.org/10.1176/appi.neuropsych.19030075
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Functional Symptoms, Model and Intervention, Narrative Review, Stroke
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/10087248
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