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Baer Jr Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100001479","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["K23MH111983-04"],"award-info":[{"award-number":["K23MH111983-04"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Massachusetts General Hospital Physician-Scientist Career Development Program"},{"name":"Swiss National Research Foundation","award":["PP00P3_176985"],"award-info":[{"award-number":["PP00P3_176985"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>With the creation of the Somatic Symptom and Related Disorders category of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition in 2013, the functional neurological (symptom) disorder diagnostic criteria underwent transformative changes. These included an emphasis on \u2018rule-in\u2019 physical examination signs\/semiological features guiding diagnosis and the removal of a required proximal psychological stressor to be linked to symptoms. In addition, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder, somatoform pain disorder and undifferentiated somatoform disorder conditions were eliminated and collapsed into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition somatic symptom disorder diagnosis. With somatic symptom disorder, emphasis was placed on a cognitive-behavioural (psychological) formulation as the basis for diagnosis in individuals reporting distressing bodily symptoms such as pain and\/or fatigue; the need for bodily symptoms to be \u2018medically unexplained\u2019 was removed, and the overall utility of this diagnostic criteria remains debated. A consequence of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition restructuring is that the diagnosis of somatization disorder that encompassed individuals with functional neurological (sensorimotor) symptoms and prominent other bodily symptoms, including pain, was eliminated. This change negatively impacts clinical and research efforts because many patients with functional neurological disorder experience pain, supporting that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition would benefit from an integrated diagnosis at this intersection. We seek to revisit this with modifications, particularly since pain (and a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder comorbidity, more specifically) is associated with poor clinical prognosis in functional neurological disorder. As a first step, we systematically reviewed the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder literature to detail epidemiologic, healthcare utilization, demographic, diagnostic, medical and psychiatric comorbidity, psychosocial, neurobiological and treatment data. Thereafter, we propose a preliminary revision to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition allowing for the specifier functional neurological disorder \u2018with prominent pain\u2019. To meet this criterion, core functional neurological symptoms (e.g. limb weakness, gait difficulties, seizures, non-dermatomal sensory loss and\/or blindness) would have \u2018rule-in\u2019 signs and pain (&amp;gt;6\u2009months) impairing social and\/or occupational functioning would also be present. Two optional secondary specifiers assist in characterizing individuals with cognitive-behavioural (psychological) features recognized to amplify or perpetuate pain and documenting if there is a pain-related comorbidity. The specifier of \u2018with prominent pain\u2019 is etiologically neutral, while secondary specifiers provide additional clarification. We advocate for a similar approach to contextualize fatigue and mixed somatic symptoms in functional neurological disorder. While this preliminary proposal requires prospective data and additional discussion, these revisions offer the potential benefit to readily identify important functional neurological disorder subgroups\u2014resulting in diagnostic, treatment and pathophysiology implications.<\/jats:p>","DOI":"10.1093\/braincomms\/fcaa156","type":"journal-article","created":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T16:24:36Z","timestamp":1600878276000},"source":"Crossref","is-referenced-by-count":43,"title":["Briquet syndrome revisited: implications for functional neurological disorder"],"prefix":"10.1093","volume":"2","author":[{"given":"Julie","family":"Maggio","sequence":"first","affiliation":[{"name":"Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"},{"name":"Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka R","family":"Alluri","sequence":"additional","affiliation":[{"name":"Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Paredes-Echeverri","sequence":"additional","affiliation":[{"name":"Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna G","family":"Larson","sequence":"additional","affiliation":[{"name":"Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petr","family":"Sojka","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University Hospital Brno, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce H","family":"Price","sequence":"additional","affiliation":[{"name":"Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"},{"name":"Department of Neurology, McLean Hospital, Belmont, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selma","family":"Aybek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inselspital University Hospital Bern and Clinical Neurosciences Bern, Bern University, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2721-583X","authenticated-orcid":false,"given":"David L","family":"Perez","sequence":"additional","affiliation":[{"name":"Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"},{"name":"Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,9,23]]},"reference":[{"key":"2021010507000399600_fcaa156-B1","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1001\/archinte.166.14.1512","article-title":"Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial","volume":"166","author":"Allen","year":"2006","journal-title":"Arch Intern Med"},{"key":"2021010507000399600_fcaa156-B2","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0005-7916(01)00020-9","article-title":"Cognitive behavior therapy for somatization disorder: A preliminary investigation","volume":"32","author":"Allen","year":"2001","journal-title":"J Behav Ther Exp Psychiatry"},{"key":"2021010507000399600_fcaa156-B3","volume-title":"Text Revision (DSM-IV-TR);","author":"American Psychiatric Association","year":"2000","edition":"4th edn."},{"key":"2021010507000399600_fcaa156-B4","author":"American Psychiatric Association","year":"2013","edition":"5th edn."},{"key":"2021010507000399600_fcaa156-B5","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1176\/appi.neuropsych.19040083","article-title":"What is the role of a specialist assessment clinic for FND? 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