Treatment of functional neurological disorders by example of a patient with cardiac neurosis, tension headache, musculoskeletal pain and insomnia

Abstract

The article presents a clinical case of a patient with cardioneurosis, frequent episodic tension headaches involving the pericranial muscles, chronic musculoskeletal cervicalgia, thoracalgia, chronic insomnia and increased anxiety. The above disorders are listed among the most common reasons for seeking outpatient care from a neurologist. The majority of patients with these disorders are young people of working and reproductive age. For this reason, it is important to consider an effective, modern approach to the treatment of such patients in outpatient neurological settings. Treatment of this category of patients is quite a challenge that requires the expert knowledge, experience and attentive attitude of the doctor towards the patient. Difficulties in treating such patients are associated with the fact that they have misconceptions about their disease, catastrophic thinking about their symptoms, avoidance behaviours, unhealthy lifestyle and distress for a long time, increased emotional sensitivity to current events, and stressful events that preceded their disease. Despite the increased level of anxiety and the psychosomatic nature of the complaints, many patients refuse to consult a psychiatrist and take antidepressants in real neurological practice.  The Sechenov University Clinic of Nervous Diseases offered the patient a comprehensive approach to the treatment that comprises awareness conversations, recommendations on sleep hygiene and lifestyle, the short-term use of Valocordin, cognitive-behavioural therapy, relaxation and mindfulness, and kinesiotherapy. The detailed clinical conversations with the patient and examination data allowed to identify all factors that provoked and supported cardioneurosis, pain syndromes, insomnia that was caused by stressful events in the anamnesis, misconceptions about her condition and treatment methods, catastrophizing of symptoms, erroneous strategies for overcoming pain, anxiety and insomnia, physical inactivity, prolonged static load. The treatment process included therapeutic dealing with all of the listed factors. The complex treatment resulted in a decrease in patient’s pain and cardioneurotic symptoms, improvement of her sleep and emotional state, and returning to her previous active lifestyle.