OBJECTIVE: Diagnostic agreement influences treatment outcomes, but studies on persistent diagnostic disagreement (PDD) in functional movement disorder (FMD) are lacking. The authors propose a definition for PDD and ident...OBJECTIVE: Diagnostic agreement influences treatment outcomes, but studies on persistent diagnostic disagreement (PDD) in functional movement disorder (FMD) are lacking. The authors propose a definition for PDD and identified associated factors in a clinical cohort of patients with FMD. METHODS: The authors retrospectively reviewed clinical data of 158 FMD patients seen in an integrated movement disorders program from July 2019 to December 2021. Patients self-reported diagnostic agreement before an initial assessment (as disagree, unsure, or agree). PDD status was determined by a specialist assessment on the basis of observable behaviors. Exploratory logistic regression and a least absolute shrinkage and selection operator (LASSO) model were used to examine associations of demographic and clinical features with PDD. Alignment between referring clinician impressions and patient self-reports was also evaluated. RESULTS: Of 158 patients, 116 had complete data for both baseline self-reports and specialist PDD determination. Forty-seven patients (41%) were classified as having PDD. PDD was observed for 52% (N=15 of 29) of those who self-reported disagreement, 71% (N=17 of 24) who self-reported ambivalence, and 24% (N=15 of 63) who self-reported agreement. Variables associated with PDD included low agency, cluster B traits, lower readiness to change, inability to notice symptom variability, and lower self-reported agreement; only low agency was retained in the LASSO analysis. Among 78 patients with complete data including referring physician impressions, concordance with patient self-reported disagreement was low (weighted κ=0.21, p<0.001). CONCLUSIONS: PDD was common in FMD, was not accurately identified by referral impressions or patients' self-reports, and may be linked to modifiable psychological processes.
OBJECTIVE: Apathy, defined as diminished self-initiated purposeful behavior, is common in Parkinson's disease (PD) and affects health-related quality of life (HRQoL). Although apathy is now recognized as a multidimension...OBJECTIVE: Apathy, defined as diminished self-initiated purposeful behavior, is common in Parkinson's disease (PD) and affects health-related quality of life (HRQoL). Although apathy is now recognized as a multidimensional syndrome, the contributions of total apathy and its dimensions to HRQoL, when mood and cognition are accounted for, remain unclear. The authors examined these relationships for individuals with PD. METHODS: Twenty-eight adults with PD without dementia completed the Dimensional Apathy Scale (DAS), General Anxiety Disorder-7 (GAD-7), Beck Depression Inventory-II (BDI-II), Parkinson's Disease Questionnaire-39, and a neuropsychological battery. Motor severity was assessed via the Movement Disorders Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III). A cognitive composite score reflected mean within-individual performance across cognitive tests. Hierarchical regression analyses were conducted to identify predictors of HRQoL. RESULTS: GAD-7, BDI-II, MDS-UPDRS III, and cognitive composite scores explained 61% of the variance in HRQoL (R=0.605, p<0.001). Adding the DAS total score to the analysis accounted for an additional 9% of the variance (ΔR=0.088, p=0.026), with greater apathy being associated with lower HRQoL (β=0.369, p=0.026). Secondary analyses revealed that this effect was driven exclusively by the DAS executive subdomain. CONCLUSIONS: Total apathy and executive apathy have distinct negative effects on HRQoL in PD when mood and cognition are controlled for in analyses. These findings highlight the importance of assessing apathy subdomains in the setting of PD.
Delirium occurs in a significant proportion of hospitalized and older patients, contributing to increased morbidity and mortality rates, lengthier hospitalizations, increased readmissions, higher health care costs, great...Delirium occurs in a significant proportion of hospitalized and older patients, contributing to increased morbidity and mortality rates, lengthier hospitalizations, increased readmissions, higher health care costs, greater odds of persistent functional decline, and psychological distress for patients, their families, and clinicians. Given that the global population continues to age, the incidence of delirium is expected to rise. The recently updated American Psychiatric Association Practice Guideline for the Prevention and Treatment of Delirium includes 15 statements to help clinicians prevent delirium, improve its detection, and optimize treatment for delirium in adult patient populations. In this analysis and commentary, the authors review each of the guideline statements, providing context and discussion of their clinical implications.
Pressman PS, Schaffer J, Finch K
… +3 more, Dino F, Filley CM, Arciniegas DB
J Neuropsychiatry Clin Neurosci
· 2026 Feb · PMID 41649237
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OBJECTIVE: Hoarding disorder is defined as persistent difficulty discarding or parting with possessions, regardless of their actual value. Hoarding is associated with biopsychosocial distress and reduced quality of life,...OBJECTIVE: Hoarding disorder is defined as persistent difficulty discarding or parting with possessions, regardless of their actual value. Hoarding is associated with biopsychosocial distress and reduced quality of life, and although it is often associated with obsessive-compulsive spectrum disorders, hoarding is also encountered in cases of neurodegeneration. Assessments of hoarding behavior traditionally involve a comprehensive evaluation that may be challenging in clinical settings. The authors developed a simplified hoarding screen for patients with neurobehavioral disorders. METHODS: The Single-Item Hoarding Screen (SIHS) is a single-item questionnaire. In total, 135 patients from the University of Colorado Behavioral Neurology Clinic were surveyed; caregivers filled out the SIHS. Patients' diagnoses included a range of neurobehavioral disorders, including Alzheimer's disease, behavioral variant frontotemporal dementia, Lewy body dementia, primary progressive aphasia, major neurocognitive disorder not otherwise specified, and minor neurocognitive disorder not otherwise specified. RESULTS: The mean age of the patients was 70.9 years, and 39% were female. Among the patients surveyed, 10% and 13% of caregivers (23% total) answered yes and maybe, respectively, to the question on the SIHS. Yes responses on this screen were significantly associated with higher scores on the established Hoarding Rating Scale, compared with maybe responses. Statistical analyses revealed significant correlations between hoarding behaviors and neuropsychiatric symptom severity as well as caregiver well-being. CONCLUSIONS: These results suggest the potential benefits of a tool containing only a single item to screen for hoarding behavior in neurobehavioral disorders. Future research may focus on refining and validating the SIHS.
OBJECTIVE: Besides cognitive deficits, dementias are characterized by behavioral symptoms, hampering efforts to distinguish between different types of dementia, such as Alzheimer's disease (AD) and behavioral variant fro...OBJECTIVE: Besides cognitive deficits, dementias are characterized by behavioral symptoms, hampering efforts to distinguish between different types of dementia, such as Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD). Moreover, instruments adapted to the local sociocultural context are lacking in non-English-speaking countries. The authors developed a scoring instrument (the Behavioral Evaluation Scale of Frontotemporal Dementia [BES-FTD]) for use in the Latin American context to assess behavioral changes among patients with bvFTD and to test its accuracy to differentiate bvFTD from AD. METHODS: The BES-FTD and the Cambridge Behavioral Inventory-Revised (CBI-R) were administered to three groups of participants: patients with probable bvFTD, patients with probable AD, and cognitively healthy individuals (control). The authors investigated diagnostic accuracies with receiver operating characteristic (ROC) curve analysis. RESULTS: The sample comprised 86 participants matched on sex, age, and education: bvFTD group, N=26; AD group, N=16; and healthy control group, N=44. The AD and bvFTD groups were also matched on the severity of disease. The individuals in the bvFTD group had significantly higher scores on the BES-FTD and on the CBI-R compared with the control and AD groups, indicating more severe behavioral disorders. ROC curve analysis indicated an area under the curve of 0.86 for the BES-FTD and 0.58 for the CBI-R. The BES-FTD had higher specificity (93.7%) than the CBI-R (81.2%). CONCLUSIONS: The BES-FTD provided higher diagnostic accuracy than the CBI-R for distinguishing between bvFTD and AD, demonstrating the clinical usefulness of the BES-FTD. Future studies are needed to confirm these results.
OBJECTIVE: Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia after Alzheimer's disease but remains underdiagnosed because of its heterogeneous symptomatology. Network analysis may captu...OBJECTIVE: Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia after Alzheimer's disease but remains underdiagnosed because of its heterogeneous symptomatology. Network analysis may capture interrelationships among symptoms, potentially improving diagnostic precision. The authors applied network analysis to a cohort of patients with DLB to map symptom connections, identify central features, and explore clustering patterns. METHODS: Clinical records of 107 patients with a confirmed DLB diagnosis from Brugmann University Hospital, Brussels, were retrospectively analyzed. Sixteen core and supportive symptoms were coded as binary variables. Pairwise Markov random fields with least absolute shrinkage and selection operator regularization were used to construct a symptom network. Centrality indices, predictability, and community detection were computed to assess the structural importance and clustering of symptoms. Stability was evaluated via nonparametric bootstrap procedures, and redundancy was addressed with unique variable analysis, prompting reestimation of a reduced network. RESULTS: The network was characterized by positive correlations among symptoms, with visual hallucinations and urinary incontinence showing the highest centrality. Cognitive fluctuation and tactile hallucinations were disconnected despite high predictability from low variance. Three clusters emerged: cognitive-perceptual, motor-perceptual, and autonomic-somatic. Removal of agitation, prompted by redundancy between agitation and delirious thoughts, reduced centrality for delirious thoughts and depression. Stability analyses indicated moderate robustness for the full network and slightly improved stability in the revised model. CONCLUSIONS: Central symptoms such as visual hallucinations and urinary incontinence may serve as high-yield diagnostic targets in DLB, and clustering patterns could represent meaningful clinical dimensions. Network analysis may help refine diagnoses and guide targeted interventions in DLB.
OBJECTIVE: Catatonia is a neuropsychiatric syndrome that can occur in association with psychiatric conditions, general medical disorders, or use of psychoactive substances. Roughly 20% of catatonia cases are due to gener...OBJECTIVE: Catatonia is a neuropsychiatric syndrome that can occur in association with psychiatric conditions, general medical disorders, or use of psychoactive substances. Roughly 20% of catatonia cases are due to general medical conditions, two-thirds of which are neurological conditions. The authors aimed to review the diagnostic and treatment challenges posed by catatonia due to neurological conditions, including neurodevelopmental disorders. METHODS: The authors considered the diagnostic and treatment challenges of catatonia in three areas: neurodevelopmental disorders, with a focus on autism spectrum disorder; acquired neurological disorders of epilepsy, anti--methyl-d-aspartate receptor encephalitis, and neuropsychiatric disorders due to traumatic brain injury; and the neurocognitive conditions delirium and dementia. One consideration was how clinicians might differentiate features of catatonia from common neurological findings in these conditions. RESULTS: Many of catatonia's features overlap with those in neurological conditions and vice versa. This overlap often leads to underdiagnosis of catatonia, misdiagnosis, or diagnostic uncertainty, which may introduce clinical conundrums and make accurate identification of catatonia clinically important, with potential diagnostic and therapeutic implications. CONCLUSIONS: Accurate diagnosis of catatonia is necessary to ensure timely workup and clinical management. The challenges reviewed here emphasize the importance of a collaborative and multidisciplinary approach to managing catatonia in neurological and psychiatric settings. Additional research is needed to understand the complex relationship between catatonia and neurological conditions.
Syrjanen JA, Krell-Roesch J, Kremers WK
… +5 more, Fields JA, Knopman DS, Petersen RC, Vassilaki M, Geda YE
J Neuropsychiatry Clin Neurosci
· 2026 · PMID 41572474
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OBJECTIVE: The authors used data from the Rochester Epidemiology Project (REP) and the population-based Mayo Clinic Study of Aging (MCSA) to examine how depression relates to cognitive outcomes. METHODS: Depression data...OBJECTIVE: The authors used data from the Rochester Epidemiology Project (REP) and the population-based Mayo Clinic Study of Aging (MCSA) to examine how depression relates to cognitive outcomes. METHODS: Depression data were acquired from electronic medical records (EMRs) via the REP for a sample of MCSA participants who were cognitively unimpaired at baseline. Participants were classified as having depression if a depression diagnosis was noted in the EMR or if a medication for depression was indicated. The authors calculated hazard ratios (HRs) with Cox proportional hazards models to elucidate the relationship between depression and incident mild cognitive impairment (MCI) and dementia. Linear mixed-effects models were used to study depression with the outcomes of global and domain-specific cognitive z scores. All models were adjusted for pertinent covariates. RESULTS: The study included 1,805 community-dwelling adults (51% men) with a mean±SD age of 74.5 ± 7.3 years. Depression was associated with a significantly increased risk for progression to MCI (HR=1.37, 95% CI=1.13 to 1.65) and dementia (HR=1.33, 95% CI=1.04 to 1.70). In sensitivity analyses, only participants taking antidepressants were at increased risk for progressing to these outcomes, relative to those without depression. Depression was also associated with lower baseline cognitive z scores in all domains except memory. Associations with longitudinal cognitive trajectories were noted only when the timing of depression (no depression, before MCSA baseline only, at MCSA baseline only, or at both times) was considered. CONCLUSIONS: Depression was associated with baseline and longitudinal measures of cognition among community-dwelling older adults. Only individuals receiving antidepressants had a significantly increased risk for incident MCI and dementia.
Functional neurological disorder (FND) is an often-disabling condition with a complex path to diagnosis, further challenged by limited availability of evidence-based treatment resources. Providers hoping to offer treatme...Functional neurological disorder (FND) is an often-disabling condition with a complex path to diagnosis, further challenged by limited availability of evidence-based treatment resources. Providers hoping to offer treatment resources face the challenge of identifying effective and sustainable implementation of interventions. The existing literature provides limited guidance on the logistics of creating specialized programs for FND outside of tertiary care centers or high-resource medical settings. Members of a multidisciplinary treatment team may find it challenging to identify program development resources that provide a unified perspective on each member's role and how they function together. The authors' FND program at the Stanford University School of Medicine has recently fielded a high number of requests by clinicians, health care staff, and administrators across the United States for collaboration to start new programs. Frequently asked questions include the criteria for patient selection, what personnel to include, how to ensure prompt staff responses to FND symptoms, when to hospitalize patients, how to obtain funding for services, and more. The intended audience for this review includes seasoned and new clinicians, allied health professionals, and nonclinicians, including administrators. The authors discuss diagnosis and evidence-based treatment strategies and provide guidance on practical issues, including work, disability, and driving. The authors' program experience is highlighted as an example, and alternative working models are discussed. The aim of this article is to improve providers' knowledge and confidence and remove frequently encountered barriers to program development. The authors seek to provide a resource that may help connect those in need of care to FND services.
The semiology of clinical phenomena is central to neurological reasoning. When clinical manifestations occur in combination (e.g., weakness plus sensory loss), they are traditionally analyzed by considering anatomical lo...The semiology of clinical phenomena is central to neurological reasoning. When clinical manifestations occur in combination (e.g., weakness plus sensory loss), they are traditionally analyzed by considering anatomical localization (e.g., right-sided weakness and aphasia implicate the left cerebral cortex) and disease pattern recognition (e.g., tremor, bradykinesia, and rigidity indicate parkinsonism). The authors introduce a third, complementary approach-phenoconsonance-that relates neurological phenomena to each other not by their anatomical localization or disease pattern recognition but by their shared phenomenology. The authors identify the main components of the description of neurological phenomena in relation to where, what, and how neurological function is affected: examples for "where" include left-arm deficits in left brachial plexopathy or left hemispace neglect in right parietal lesions; examples for "what" include motor strength, visuospatial reasoning, or abstract planning; and examples for "how" include slowness, incoordination, or difficulty with initiation, because either the same function can be disrupted in qualitatively different ways-movement can be slowed or uncoordinated-or the same qualitative abnormality can apply to different functions-slowing may characterize movement, and it may also characterize thinking. The where, what, and how of neurological phenomenology correspond in the authors' synthesis to spatial phenoconsonance, domain phenoconsonance, and qualitative phenoconsonance, respectively. The historical context and conceptual underpinning of the notion of phenoconsonance are reviewed, as is its usefulness for the study of brain-behavior relationships in the evaluation and treatment of individuals with neurological and neuropsychiatric disorders.
OBJECTIVE: In this exploratory study, the authors used subjective participant data to investigate sleep disturbance in functional neurological disorder (FND) and its impact on FND symptoms. METHODS: An online questionnai...OBJECTIVE: In this exploratory study, the authors used subjective participant data to investigate sleep disturbance in functional neurological disorder (FND) and its impact on FND symptoms. METHODS: An online questionnaire was designed in collaboration with FND charities and administered to 373 adult participants with a self-reported FND diagnosis. RESULTS: Most participants (86%) were women, and most (73%) perceived their sleep quality over the past 3 months as poor. Almost all (93%) reported nonpositive dream content, with 78% experiencing nightmares at least once per week. Self-rated bad sleep quality increased by 41 percentage points since the onset of FND, and the frequency of nightmares also significantly increased. Obesity was highly prevalent (44% with a body mass index >30 kg/m²), but formally diagnosed sleep-related breathing disorders were rare (8%). Many participants (46%) noticed symptom improvement after a good night's sleep. Most (88%) reported worsening of functional symptoms when falling asleep, during sleep, or when waking up. About one-quarter noted symptom changes after specific dreams or nightmares, with almost all (97%) reporting negative changes, which were more common among participants reporting poor sleep quality. Moderate rates of sleep paralysis and functional seizure were observed. Among those who experienced functional seizures, 74% reported that they arose during sleep. CONCLUSIONS: These findings support the common perception of poor sleep quality, nightmares, and negative dreams among individuals with FND and suggest that self-reported sleep and dream content may also influence FND symptoms. However, the authors recognize a high risk for selection and recall bias.
OBJECTIVE: Traumatic brain injury (TBI) often involves injury to limbic structures that may be linked to posttraumatic psychological health difficulties. The authors investigated whether the relationship of amygdala and...OBJECTIVE: Traumatic brain injury (TBI) often involves injury to limbic structures that may be linked to posttraumatic psychological health difficulties. The authors investigated whether the relationship of amygdala and hippocampal volumes with anxiety differed among children with TBI versus children without a history of TBI over time since injury. METHODS: Structural MRI scans were acquired for children ages 8-15 years at 7 weeks (time point 1) and 14 months (time point 2) after a TBI (N=51) as well as for age-matched healthy control (HC) children (N=36). The Screen for Child Anxiety Related Emotional Disorders (SCARED) was administered at both time points. Generalized linear models were used to evaluate the relationship of limbic volumes, experimental group, time of scan, and their interactions with SCARED scores. Pubertal status at time point 1, sex, and total gray matter volume were included as covariates. RESULTS: The group × volume × time interaction was statistically significant for both structures bilaterally. Relative to the HC group, children with TBI showed altered directionality of the relationship of amygdala and hippocampal volumes with SCARED scores that changed between the two time points. During the subacute stage of recovery, higher self-reported anxiety was associated with larger amygdala and hippocampal volumes. During the chronic stage, higher anxiety was associated with lower volumes. SCARED scores were higher among girls than among boys when limbic volumes were controlled for. CONCLUSIONS: TBI significantly affected the typical relationship between amygdala and hippocampal volumes and anxiety scores, suggesting that limbic volumes may serve as markers of later developing psychological health.
Tanev KS, Lasko N, Shenton ME
… +3 more, Orr SP, Pitman RK, Gilbertson MW
J Neuropsychiatry Clin Neurosci
· 2025 Nov · PMID 41194616
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OBJECTIVE: A significant percentage of individuals diagnosed as having posttraumatic stress disorder (PTSD) show remission within the first year after traumatic exposure, with more gradual improvement over the next sever...OBJECTIVE: A significant percentage of individuals diagnosed as having posttraumatic stress disorder (PTSD) show remission within the first year after traumatic exposure, with more gradual improvement over the next several years. However, a subgroup of individuals with PTSD have an unremitting course of illness that may persist for years or decades despite treatment efforts. The authors tested the hypothesis that reduced hippocampal volume is associated with chronic, unremitting PTSD rather than with PTSD that has remitted over time. METHODS: The study included 44 Vietnam War veterans whose traumatic exposure had occurred more than three decades before study participation. The authors studied the association between hippocampal volume and three PTSD diagnostic categories: veterans with unremitting PTSD (N=26), veterans with sustained remission from earlier PTSD (N=8), and veterans who never developed PTSD (N=10). RESULTS: Compared with trauma-exposed veterans who never developed PTSD, those with unremitting PTSD, but not those who had recovered, showed reduced hippocampal volume. The results were anatomically lateralized to the right hippocampus, consistent with previous neuroimaging studies of male combat veterans. CONCLUSIONS: These results support an emerging literature suggesting that reduced hippocampal volume observed among individuals with PTSD may be related to failure to recover from rather than to the development of PTSD after trauma exposure. These findings may define a subpopulation of combat veterans who are at increased risk for long-term failure to recover from PTSD because of their smaller right hippocampi.
OBJECTIVE: Although high-frequency brain stimulation has demonstrated efficacy in various translational models of posttraumatic stress disorder (PTSD), there is a scarcity of studies investigating deep brain stimulation...OBJECTIVE: Although high-frequency brain stimulation has demonstrated efficacy in various translational models of posttraumatic stress disorder (PTSD), there is a scarcity of studies investigating deep brain stimulation (DBS) in human PTSD populations. The authors sought to investigate the current state of DBS in the setting of treatment-resistant PTSD. METHODS: A systematic search was performed in PubMed, Scopus, and Web of Science Core Collection databases by using keywords related to DBS and PTSD. A secondary search for gray literature was conducted in ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. RESULTS: Five articles reporting the effect of DBS on six patients with PTSD were retrieved. Electrodes were implanted bilaterally either in the basolateral amygdala (BLa; N=2) or in contact with the subgenual cingulum and uncinate fasciculus (SGC-UF; N=4). No significant perioperative complications related to BLa or SGC-UF lead implantation were reported in all five studies. BLa patients reported mild neuropsychiatric effects during stimulation. All but one patient had a significant decrease in Clinician-Administered PTSD Scale score, with most reporting a subjective reduction in PTSD symptoms. CONCLUSIONS: Although additional research is needed to assess the safety and efficacy of BLa and SGC-UF DBS, these preliminary findings are encouraging. However, the application of DBS in psychiatric treatment remains controversial and largely experimental. Continued studies with larger samples are essential to establish the efficacy and safety profile of DBS specifically with PTSD patients.
OBJECTIVE: The authors sought to determine the relationships among cognitive impairment, psychiatric outcome, and functional status 3 months after a hemorrhagic stroke. METHODS: Patients with nontraumatic intracerebral h...OBJECTIVE: The authors sought to determine the relationships among cognitive impairment, psychiatric outcome, and functional status 3 months after a hemorrhagic stroke. METHODS: Patients with nontraumatic intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were assessed by telephone 3 months after discharge by using the Quality of Life in Neurological Disorders (Neuro-QoL) cognitive function, anxiety, depression, and sleep disturbance short forms, as well as the modified Rankin Scale (mRS). The relationships between poor cognition (Neuro-QoL T score≤50), functional status, and psychiatric outcome among patients with ICH or SAH and patients with ICH only were evaluated. RESULTS: Of 101 patients (N=62 with ICH and N=39 with SAH), 51% had poor cognition 3 months posthemorrhage, with 61% having mRS scores of 3-5, 43% having anxiety, 28% having depression, and 31% having sleep disturbance. Univariate analysis of the full cohort indicated that poor cognition was significantly associated with anxiety, depression, sleep disturbance, and mRS scores of 3-5 (p<0.05). Multivariate analysis revealed that poor cognition was significantly associated with anxiety (OR=4.38, 95% CI=1.30-14.74, p=0.017) and mRS scores of 3-5 (OR=6.15, 95% CI=1.96-19.32, p=0.002). Univariate analysis of the 62 patients with ICH indicated that poor cognition was significantly associated with anxiety, sleep disturbance, and mRS scores of 3-5 (p<0.05). Multivariate analysis revealed that poor cognition was significantly associated with anxiety (OR=10.98, 95% CI=2.32-51.99, p=0.003). CONCLUSIONS: Poor cognition was associated with anxiety 3 months after hemorrhagic stroke. Additional research is needed to understand whether treatment for anxiety would improve cognition in this population.
OBJECTIVE: Given limited access and long wait times for individualized behavioral health care focused on functional neurological disorder (FND), FND-specific group psychotherapy formats may offer patients early access to...OBJECTIVE: Given limited access and long wait times for individualized behavioral health care focused on functional neurological disorder (FND), FND-specific group psychotherapy formats may offer patients early access to tools that could help alleviate symptoms. In this pilot study, the authors investigated the utility of using a well-known, evidence-based, and FND-focused self-help cognitive-behavioral therapy (CBT) workbook in a therapist-led skills group format for patients with primary functional movement disorder (FMD). METHODS: Six patients with primary FMD received a 10-week therapist-led CBT psychotherapy skills group based on the workbook . Basic metrics of feasibility, tolerability, utility, and exploratory Patient-Reported Outcomes Measurement Information System (PROMIS) measures were compared pre- and postintervention. Pregroup guidelines and postgroup summary (summary of skills, supplemental tools, and FND next steps checklist) were included. RESULTS: Feasibility and tolerability metrics were sound, and three of the six patients had significant improvement in at least two of the 11 PROMIS measures. The PROMIS measures with the greatest improvement included fatigue, anxiety, depression, self-efficacy in managing symptoms, social interactions, emotions, and medications and treatments. Further, the Patient Global Impression of Change (PGIC) may alternatively be used to capture group outcomes, because two of the participants whose PROMIS scores did not change (despite reported benefits) provided PGIC ratings of 1 and 2 (very much improved and much improved, respectively). CONCLUSIONS: These findings suggest that this therapist-led FND skills group intervention format has feasibility, tolerability, and early utility. However, further research is necessary to establish its efficacy.