Psychiatric and functional disorders

Neurological diseases, such as traumatic brain injuries or multiple sclerosis, are often accompanied by comorbid conditions. Since illnesses, accidents, and other personal misfortunes cause profound changes in the lives of those affected and their surroundings, they often result in additional psychological and physical complaints. These complaints are typically depressive symptoms and anxiety. Self-esteem is often impacted, leading to social isolation. About half of all patients with neurological diseases experience comorbid mental disorders.

These should be distinguished from functional neurological disorders. Functional neurological disorders involve neurological symptoms that a known physical neurological disease cannot explain. In these cases, so-called functional changes are assumed to occur despite the brain’s and nerves’ unchanged structure. Psychological factors may sometimes play a role, but not always. A functional neurological disorder can affect different body regions and cause various symptoms. Some patients experience paralysis, and others suffer from involuntary movements or dizziness. Functional neurological disorders are also common; about half of the cases are characterised by a chronic course.

Comorbid Mental Disorders

Patients with multiple sclerosis (MS) often suffer from anxiety and depression. Additionally, fatigue (“exhaustion syndrome”) impaired their quality of life. Between 75% to 95% of patients are affected by this, particularly young women who have to manage their lives, which includes aspects of family planning, career, and the frequent fear of new relapses. MS rehabilitation centres certified by the German Multiple Sclerosis Society are in Kliniken Schmieder Konstanz and Kliniken Schmieder Gailingen.

Patients with cerebrovascular diseases often experience comorbid affective disorders such as depression or anxiety and problems coping with their illness. This is usually reactive but can also be caused directly by the stroke (i.e., brain damage).

Traumatic brain injuries can affect various age groups. For this condition, it is crucial to differentiate the neuropsychological deficits that frequently occur carefully. These can include impulse control disorders, affective disorders, and, although less commonly recognised, post-traumatic stress disorder (PTSD).

In neuro-oncology, at least 30% of all patients with malignant diseases suffer from manifest mental disorders; for neurological tumours, this figure is up to 60%. Tumours, even benign ones, are very distressing for patients as they affect the “organ of thought and emotion,” the brain. Despite advances in various therapies (surgery, radiotherapy, or chemotherapy), there remains significant stress for patients and their families due to the uncertain prognosis and the risk of progression.

All comorbidities can be treated in the specialized “Psychotherapeutic Neurology” department at Kliniken Schmieder Gailingen.

Functional Neurological

Functional neurological disorders, also known as conversion disorders or dissociative neurological disorders, are widespread. About 10% are affected by these conditions. Around half of the affected individuals experience a chronic course with frequent social-medical problems. Patients are generally very unsettled due to the lack of a “specific neurological diagnosis,” which often leads to a somatic understanding of their illness.

Therapeutic options are scarce. For many years, the specialized department of Psychotherapeutic Neurology in Gailingen has been treating this group of patients, integrating psychotherapeutic-psychosomatic and neurological modules.

Treatment

The prerequisite for treatment is a respectful, open therapeutic attitude. Therapy is conducted holistically, following an integrative biopsychosocial approach. Patients receive all functional therapy modules typical of a neurological rehabilitation clinic (physiotherapy, occupational therapy, speech therapy, sports therapy, etc.), as well as relaxation groups, mindfulness, individual and group psychotherapy, creative therapies (body-oriented methods, art therapy, music therapy), and psychoeducational groups (pain management, functional disorders).

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