The spectrum of functional neurological disorders: A retrospective analysis at a tertiary hospital in South Africa

South African Journal of Psychiatry

Field Value
Title The spectrum of functional neurological disorders: A retrospective analysis at a tertiary hospital in South Africa
Creator Naidoo, Lavanya Bhigjee, Ahmed I.
Subject Neurology, Psychiatry, Neuropsychiatry functional neurological disorders; conversion disorder; somatisation disorder; psychiatric diagnosis; African ethnicity
Description Background: Functional neurological disorders (FNDs) are commonly encountered in practice; however, there is a paucity of data in Africa.Aim: To identify and describe the clinical profile of patients presenting with FNDs, underlying medical and psychiatric diagnoses and review the investigation and management of these patients.Setting: Inkosi Albert Luthuli Central Hospital (IALCH), a tertiary-level hospital in Durban, South Africa.Methods: A retrospective chart review and descriptive analysis were performed over a 14-year period (2003–2017) on cases meeting the study criteria.Results: Of 158 subjects, the majority were female (72.8%), had a mean age of 32.8 years, were single (63.3%), unemployed (56.3%) and of black African ethnicity (64.6%). The most common clinical presentation was sensory impairment (57%) followed by weakness (53.2%) and seizures (38.6%). Inconsistency was the most frequent examination finding (16.5%). Medical conditions were identified in half of the study population (51.3%), with hypertension (22.2%) and human immunodeficiency virus (HIV) (17.2%) being most common. Of patients with a psychiatric diagnosis (55.1%), 25.3% had depression. Magnetic resonance imaging (MRI) was the most frequently performed investigation (36.1%). The majority of patients received psychotherapy (72%) and most had not shown improvement (55.3%) at a median follow-up of 2 months, whilst 17% had deteriorated.Conclusion: Functional neurological disorders were most frequently diagnosed in young unmarried females, of black African ethnicity. Family history, personal exposure to a neurological illness and certain socioeconomic factors may be potential risk factors. Sensory impairment was the most common clinical phenotype. Further studies are needed to better understand and manage FNDs in the South African context.
Publisher AOSIS
Date 2021-04-19
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Retrospective chart review
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajpsychiatry.v27i0.1607
Source South African Journal of Psychiatry; Vol 27 (2021); 9 pages 2078-6786 1608-9685
Language eng
Coverage South Africa 2003-2017 Demographic data, clinical presentation, examination findings, organic disease, psychiatric illness if known or diagnosed during admission, investigations performed, management and follow-up.
Rights Copyright (c) 2021 Lavanya Naidoo, Ahmed I. Bhigjee