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FNSD Treatment Approach — MRCPsych Paper B MCQ

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ModerateLiaison PsychiatryFNSD Treatment ApproachMRCPsych Paper B

A 32-year-old woman has an 8-month history of intermittent right-leg weakness and tremor. A neurologist demonstrates a positive Hoover sign and marked improvement of the tremor with distraction. Appropriate investigations have excluded a structural neurological disorder. The diagnosis of functional neurological disorder has been explained positively, and she accepts it and wishes to engage in treatment. Anxiety, symptom-focused attention and avoidance of activity appear to perpetuate her disability. Which management approach is most appropriate?

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Correct answer: E — Offer FND-specific education, goal-based physiotherapy and adapted CBT within coordinated multidisciplinary care

The correct answer is E. Functional neurological disorder should be explained as a genuine, potentially reversible disorder of nervous-system functioning, supported by positive clinical signs such as Hoover’s sign and tremor distractibility. Treatment is individualised and commonly multidisciplinary. Functional motor symptoms are addressed with FND-specific physiotherapy and movement retraining; adapted CBT is appropriate here because anxiety, symptom-focused attention and avoidance are perpetuating factors. Occupational therapy and treatment of relevant comorbidity may also be required. Antiseizure medication does not treat functional motor symptoms and should not be used without epilepsy. Confrontation is stigmatising and undermines engagement. Ignoring symptoms or withdrawing follow-up constitutes therapeutic neglect rather than structured reduction of maladaptive reinforcement. Sedation and bed rest impede rehabilitation and may worsen disability.

Reference: University College London Hospitals NHS Foundation Trust. Functional Neurological Disorder Rehabilitation Service: therapeutic approaches. Current page accessed 19 August 2026. https://www.uclh.nhs.uk/our-services/find-service/neurology-and-neurosurgery/neuropsychiatry/functional-neurological-disorder-fnd-rehabilitation-service