"schema mode therapy for disorders in the borderline between psychiatry and neurology (functional neurological disorders)"
hot topic by samantha flores
Objective: Functional neurological symptom disorders refer to medically unexplained symptoms and signs affecting voluntary motor or sensory function. There is enough empirical evidence for schema therapy and mode work in a range of difficult to treat psychiatric disorders. Although schema mode therapy has not been evaluated for the treatment of these disorders, it may be well suited as it targets underlying psychopathological vulnerabilities as poor recognition and management of emotions and behaviors/modes associated to triggered schemas; so feasibility and efficacy of schema mode therapy for the treatment of these disorders is researched.
Method:Prospective three-adult-patient case series. One patient suffered gait disturbances, two presented psychogenic non-epileptic seizures (PNES). Treatment focused on identification of schemas and modes; disorder and schema model psychoeducation; cognitive and behavioral challenging of schemas and modes; emotional and therapy relationship based techniques. Primary outcome measures were weekly PNES count and functional independence measurements of ambulation. Psychopharmacological interventions were kept minimal.
Results: Patients´ symptoms showed a declined from baseline. PNES: median of 10 weekly events at baseline, by session 10 a median of 6.2 events, by session 20 a median of 1.5 events maintained at follow up. Gait disturbance went from 30 minutes to walk 500 meters to walking 2 kilometers in 45 minutes and from depending on a walker to using a walking cane and finally to walking independently, which maintained at follow up.
Conclusion: Schema mode therapy may be effective for the treatment of functional neurological disorders since it appears to provide a clinical significant improvement of symptoms.
Samantha Flores Bio:
I am a physician specialized in neuropsychiatry. I have a master´s degree in cognitive behavioral therapy and I am currently in the international certification training in schema therapy in the New Jersey Schema Therapy Institute.
I currently run a private practice in psychiatry and psychotherapy. I work with a variety of diagnoses of psychiatric and neuropsychiatric patients through medication and psychotherapy. I have a special interest in patients who suffer functional neurologic disorders. I am the academic director at the “Instituto Jalisciense de Psicoterapia Cognitivo Conductual” (Cognitive Behavior Psychotjerapy Intitute of Jalisco) in Guadalajara, Jalisco, Mexico where I run my private practice, teach cognitive-behavior psychotherapy, basics of schema therapy included and where I have started to do research in Schema therapy. I also teach behavioral science to medical students at the Universidad Autonoma de Guadalajara.
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