Treatment of Functional Movement Disorders With Psychotherapy
Condition: Movement Disorders
MeSH terms: Movement Disorders; Conversion Disorder; Hysteria
Study type: Interventional

Summary: 
      Background:

      - Functional movement disorder (FMD) is a form of conversion disorder (CD). CD is a disorder
      in which a person has neurological symptoms that do not have a neurological cause. These
      symptoms can include pain, weakness, dizziness, and fatigue. Some thoughts on CD suggest that
      it may come from feelings of anxiety that are converted into physical symptoms. Treatment for
      FMD usually involves stress reduction, family help, and regular doctor s appointments.
      Therapy interventions, however, have not been well studied. Researchers want to see if people
      with FMD get better with psychotherapy. They will study two different types of psychotherapy:
      group therapy and a self-help manual.

      Objectives:

      - To test two different types of therapy treatments for FMD.

      Eligibility:

      - Individuals at least 18 years of age who have been diagnosed with FMD by a neurologist.

      Design:

        -  Participants will be screened with a physical exam and medical history. They will also
           have a psychological exam, and answer questions about their mood and symptoms.

        -  Participants will be separated into three groups. One group will have group therapy.
           Another will use a self-help workbook designed for people with FMD, and have individual
           therapy sessions. A third group will just have standard care. During the study,
           participants will continue to see their regular doctor.

        -  Group therapy participants will meet once a week for 6 months at the National Institutes
           of Health clinical center. There will be 8 to 10 people per group. Sessions will last 75
           minutes. These sessions will work on methods for treating FMD.

        -  Self-help workbook participants will have six individual therapy sessions over 3 to 4
           months. They will use the workbooks to learn about and practice methods for treating
           FMD.

        -  All participants will be evaluated at 3, 6, and 12 months during the study.

        -  At the end of the study, participants will have a final follow-up session with exams and
           questions similar to the screening exam. They will return to the care of their regular
           doctor.
    

Detailed description: 
      Objectives:

      This is an exploratory study of two options for treating functional movement disorders (FMD):

        -  Group psychotherapy

        -  Cognitive behavioral therapy (CBT)-based guided self-help.

      Study population:

      We intend to study adult patients with diagnoses of FMD seen by the Human Motor Control
      Section Clinic (HMCS) and who live in the Washington-Baltimore metropolitan area for group
      psychotherapy as well as patients who live out of the area for CBT-based guided self-help.

      Design:

      Patients will be screened for participation through protocol 07-N-0190 ( Neurobiology of
      Psychogenic Movement Disorder and Non-Epileptic Seizures ). Those who meet the inclusion
      criteria and who live locally will be invited to participate in a treatment study of group
      psychotherapy. The duration of the study for each patient is one year. Local patients who
      meet the inclusion criteria will be divided into two groups of 10 patients each. Accrual will
      be gradual. All 10 patients in each group will start simultaneously. All participants will
      undergo an initial assessment, followed by an assessment at 3, 6, and 12 months. The primary
      endpoint will be assessed at 6 months. At the end of the study, all subjects will undergo the
      same MRI studies they completed as part of protocol 07-N-0190 baseline assessment. Patients
      will be evaluated with the scales described below.

      Those who meet the inclusion criteria and who live locally will be invited to participate in
      a treatment study of group psychotherapy. Local patients who meet the inclusion criteria will
      be divided into two groups of 10 patients each. Accrual will be gradual. All 10 patients in
      each group will start simultaneously. All group participants will be asked to sign a therapy
      contract , a nonbinding group therapy conduct guideline.

      Patients who are out-of-town and meet the inclusion/exclusion criteria will be invited to
      join the CBT-based guided self-help arm. They will be randomized in two groups of 20 patients
      each. One group will undergo CBT-based guided self-help; the other will be randomized to
      standard of care. Standard of care is defined as pharmacological or other treatment
      modalities excluding CBT or group psychotherapy (the studied modalities). Subjects will be
      included on a rolling basis, and therapy will be delivered approximately once every two weeks
      for a total of six sessions. Participants will be instructed in the use of CBT-based
      self-help workbooks aimed at treating functional neurological symptoms (Overcoming
      unexplained neurological symptoms: a five areas approach by Dr. Chris Williams, 2011, Hodder
      and Arnold). Total duration of the intervention will be about 6 months. Subjects will undergo
      the same assessments as patients in the group psychotherapy arm of the study at the same time
      points. Only participants in the standard of care arm who successfully complete the whole
      study will be offered the CBT-based guided self-help therapy after study completion.

      Outcome measures:

      Primary Outcome measure

      -Ability to participate in social roles and activities (Neuro-QOL Item Bank) at 6 months
      after initiation of therapy.

      Secondary Outcome Measures

        -  Clinical global impression of severity (CGI).

        -  Subjective and objective depressive and anxiety symptoms, measured with the Beck
           Depression Inventory (BDI), Hamilton Depression Rating Scale-17, State Trait Anxiety
           Inventory (STAI) and Hamilton Anxiety Scale.

        -  Patient and physician rated assessment of disease severity (5 point Likert scales).

        -  Somatic symptoms (SCL-90).

        -  Insight, measures with the Brown Assessment of Beliefs Scale (BABS)

        -  Similar measures at 12 months after initiation of therapy.

        -  MRI studies (resting state BOLD fMRI, DTI, VBM) comparison between baseline (protocol
           07-N-0190) and 6 months after initiation of therapy.
    

Intervention name(s): Group Psychotherapy; Cognitive behavior therapy based on self help
Intervention type(s): Other; Other
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Psychogenic Movement Disorders