Objective: To dissect the diagnostic challenges in distinguishing Functional Neurological Disorder (FND) coexisting with psychosis, highlighting the imperative for comprehensive and nuanced neuro-psychiatric assessment.

Background: FND, particularly when manifesting with seizure-mimicking symptoms entwined with psychotic phenomena, poses diagnostic conundrums. This complexity underscores the exigency for extensive, multi-dimensional diagnostic approaches in these clinical cases.

Method: This analysis delves into the case of a 41-year-old female presenting with seizure-like episodes. The diagnostic peregrination encompassed continuous EEG monitoring, exhaustive metabolic profiling, and MRI scans, culminating in inconclusive or normative results, pointing towards a diagnosis of psychogenic non-epileptic seizures (PNES). This diagnostic trajectory underscores the intricacies and limitations of conventional neurological investigations.

Results: The absence of epileptiform activity in EEG, alongside unremarkable metabolic and MRI results, steered the diagnosis towards PNES. Concurrent hallucinatory experiences raised the specter of a co-morbid psychotic disorder, yet existing diagnostic modalities fell short in unveiling a definitive neurological underpinning. This gap necessitated the contemplation of advanced neuroimaging avenues, such as PET scans and fMRI. These advanced techniques promise insights into the nuanced neurophysiological undercurrents in FND and psychosis. In tandem, comprehensive neuropsychological and psychiatric evaluations, potentially employing sophisticated tools like SCID-5 or PANSS, can be indispensable for an in-depth exploration of the patient’s cognitive and psychiatric dimensions, facilitating a differential diagnosis that disentangles the neurological from the psychiatric components of her clinical presentation.

Conclusion: This case serves as a microcosm of the diagnostic intricacies inherent in FND with overlapping psychiatric symptoms, laying bare the shortcomings of traditional neurological evaluations. It accentuates the utility of avant-garde neuroimaging modalities, including PET and fMRI. Moreover, it underscores the indispensability of an integrative neuro-psychiatric methodology in the diagnostic and therapeutic realms of FND, advocating a paradigm shift towards a more holistic and patient-centric approach.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnostic-challenges-in-functional-neurological-disorder-convergent-psychogenic-non-epileptic-seizures-and-psychosis/