The Effect of Psychoeducational Diagnosis Communication on Perception of Illness, Satisfaction, and Behavioral Intentions Among Patients With Functional Neurological Movement Disorders

The Effect of Psychoeducational Diagnosis Communication on Perception of Illness, Satisfaction, and Behavioral Intentions in Patients With Functional Neurological Movement Disorders: An Intervention Study Using a Within-Subject Design

Functional neurological movement disorders are common conditions that can lead to significant limitations in daily life. They result from a functional disorder in the brain. A clear, understandable, and empathetic explanation of the diagnosis is a crucial first step in treatment. The purpose of this clinical study is to investigate how a clear and detailed explanation of the diagnosis of functional neurological movement disorders affects patients' understanding of their condition and their symptoms The investigators are interested in how well patients understand the diagnosis and the symptoms they experience as the disease progresses, as well as how the conversation between patient and doctor is experienced from both perspectives. In addition, as part of the study, a one-time examination using brain imaging (magnetic resonance imaging) will be conducted to better understand possible differences in brain function.

Study Overview

• Status: Recruiting
• Conditions: Functional Neurological Disorder; Functional Movement Disorder
• Intervention / Treatment: Behavioral: Psychoeducational communication guide for first-diagnosis of FND

Detailed Description

Functional neurological disorders (FNDs) are common neurological conditions associated with a significant reduction in quality of life and a poor prognosis if diagnosis is delayed. FNDs have multifactorial causes, including psychological stressors, psychiatric comorbidities, and past trauma. A characteristic feature of FNDs is their susceptibility to influence by attention: symptoms can be intensified by increased focus and alleviated by distraction. Despite the establishment of positive diagnostic criteria that position FNS as disorders to be actively diagnosed rather than merely excluded, communicating this in clinical practice remains a challenge. There is often a lack of clear, empathetic, and patient-centered communication of the diagnosis by physicians. Previous studies have shown that the way in which a diagnosis of functional disorders is communicated can have a decisive influence on understanding of the condition, acceptance of the diagnosis, willingness to undergo treatment, and long-term outcomes. In particular, psychoeducational intervention studies show positive effects; however, these have so far been investigated primarily within the context of complex group programs, which are potentially biased by participant self-selection. It remains unclear whether structured, empathetic, and guideline-based individual counseling provided during a regular doctor-patient consultation can achieve similar positive effects. In addition, many physicians report feeling uncertain about how to interact with patients with unexplained symptoms, which can negatively impact the quality of physician- patient communication and the physician-patient relationship. Patients are often simply told which other diseases have been ruled out, without receiving a comprehensible explanation for their symptoms-which can encourage repeated visits to other doctors ("doctor shopping"). Despite the recommendation for patient-centered, understandable, and empathetic explanation of the FNS diagnosis as the first step in treatment, there has been a lack of systematic research to date on the specific effectiveness of this explanation in the doctor-patient conversation. Against this backdrop, the planned study aims to investigate the impact of an empathetic, psychoeducational explanation of the diagnosis on patients newly diagnosed with a functional movement disorder (FMD). The focus is on changes in the perception of the condition and in symptom severity and burden, as well as confidence in the diagnosis of the functional movement disorder, the patients' communication experience and satisfaction with the physician who conveys the diagnosis, intentions regarding "doctor shopping," as well as remaining unanswered questions, individual preferences, and support needs following the diagnosis.

In addition, the self-efficacy of physicians in communicating the diagnosis will be assessed to identify potential correlations with patients' confidence in the diagnosis and the positive effect of the intervention on other variables.

As part of the study, magnetic resonance imaging (MRI) will also be used once as a supplementary imaging modality to assess anatomical and functional aspects of the brain and to make comparisons between participants who show improvements in symptoms and quality of life over the course of the study and those who do not, as well as with healthy control groups.

Study Design: The study follows a prospective intervention design with repeated measurements at four time points within the same participants (within-subject waitlist design). Following an initial baseline assessment (T0), all participants undergo a four-week waiting period without intervention, which serves as an intra-individual control condition.

The measurement time points following the baseline assessment (T0) occur before the diagnosis is made (T1), immediately afterward (T2), four weeks later (T3), and three months later (T4). A separate control group of individuals who do not receive an intervention is not included.

• Study Type: Interventional
• Enrollment (Estimated): 35
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Maria Schneller; Phone Number: 004331638580395; Email: maria.schneller@medunigraz.at

Study Locations

• Austria
  • Graz, Austria, 8036
    • Recruiting
    • Medical University of Graz
    • Contact: Maria Schneller, Master of Science; Phone Number: 0043/316/385/833 79; Email: maria.schneller@medunigraz.at
    • Contact: Petra Schwingenschuh, Professor; Phone Number: 004331638583379; Email: petra.schwingenschuh@medunigraz.at

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Presence of any of the following functional movement disorders:

  • Functional paralysis
  • Functional seizures
  • Functional tremor
  • Functional drop attacks
  • Functional dystonia
  • Functional twitching
  • Functional facial symptoms
  • Functional tics
  • Functional parkinsonism

Exclusion Criteria:

• The patient is unable to give informed consent.
• The patient is temporarily unable to give informed consent.
• The patient does not have sufficiently understand German language to answer the questionnaires (the questionnaires are available only in German).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Standardized FND Psychoeducation Guideline

Behavioral: Psychoeducational communication guide for first-diagnosis of FND; The intervention is a structured communication protocol used by physicians to provide a systematic, evidence-based explanation of the diagnosis to patients with Functional Movement Disorders (FMD). The primary goal is to foster a common understanding of the condition, validate the patient's experience, and establish a foundation for active rehabilitation. The psychoeducational session follows a 14-step framework designed to address the clinical, neurological, and psychological dimensions of the disorder

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Illness Perception	Revised Illness Perception Questionnaire (IPQ-R), Range (min, max scores) varies by subscale (typically 1-5 per item), Higher scores indicate more negative perceptions.	4 months (at each measurement point)
Trust in the diagnosis	3 questions whether participants trust the diagnosis	From immediately post-intervention to the last follow up
Doctor shopping intentions	Question on whether participants intent to consult other physicians regarding their diagnosis in the future	From post-intervention to the last follow up
Symptom Burden of functional movement disorders	Symptom-Functional Movement Disorder Rating Scale (S-FMDRS), Range: 0 - 60; higher scores mean greater symptom burden and severity	at baseline and the pre-intervention
Patient Global Impression of Severity / Change (PGI-S/C)	standardized instrument to assess the subjective impression of disease severity and change with 3 items, rated on a likert scale from 1-5. Range of the full scale: 3-15 (higher values indicate higher severity of the disease)	At baseline (severity), before the intervention (change), at the first follow up and at the second follow up)
Clinician Global Impression of Severity / Change (CGI-S/C)	standardized instrument for clinicians to assess the clinicians' impression of disease severity and change of the patient, with 3 items, rated on a likert scale from 1-5. Range of the full scale: 3-15 (higher values indicate higher severity of the disease)	At baseline (severity), before the intervention (change), at the first follow up and at the second follow up)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Functional comorbidities	measured with selected subscales of the PHQ-D , which is the German translation and validation of the "Patient Health Questionnaire (PHQ)" by Löwe et al., 1999. Higher values indicate higher scores indicate more severe symptoms of depression, anxiety, or somatization. Scores range from 0-3 per item.	at baseline
Patient-reported outcome measures of functional neurological disorders	PROM questionnaire by Michaelis et al. (2026) assessing the extent and the impact of the movement disorder on the patient. Self-reported measurement. Range: 16 to 80 with higher values indicating higher severity/impairment.	at baseline, pre-intervention, 1st and 2nd follow up
health-related quality of life	Assessed with the Short Form 36 Health Survey (SF36), a questionnaire of the patient's subjective quality of life, measured with 36 items rated on a likert scale, range of the total score goes from 0 to 100 with higher values indicating better health-related quality of life and function.	baseline, pre-intervention and at the 1st follow up
Remaining questions	assessing remaining open questions with regards to the FND diagnosis after the psychoeducation and diagnosis explanation , asked by the study team	immediately after the intervention and at the first follow up
Patient preferences	Assessing patients treatment preferences, practical, social and systematic support preferences with regards to the FND diagnosis asked through open questions by the study team	immediately after the intervention and at the first follow up
Communication quality	Assess the patient's rating of the communication quality with the clinician, assessed with the standardized EORTC-QLQ-COMU26-questionnaire (translated and validated german version) Range: 0-100, high score indicates good communication.	immediately post-intervention.
Substance Addiction	WHO - ASSIST V3.0 (Alcohol, Smoking & Substance Involvement Screening Test), scores are evaluated for each substance separetely with higher values indicating higher risk for addiction. Range from 0 to 27+ for high risk level.	at baseline

Collaborators and Investigators

• Sponsor: Medical University of Graz

Study record dates

Study Major Dates

• Study Start (Actual): March 31, 2026
• Primary Completion (Estimated): July 31, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: May 5, 2026
• First Submitted That Met QC Criteria: May 11, 2026
• First Posted (Actual): May 14, 2026

Study Record Updates

• Last Update Posted (Actual): May 14, 2026
• Last Update Submitted That Met QC Criteria: May 11, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Somatoform Disorders; Conversion Disorder
• Other Study ID Numbers: 1392/2025

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No