Mind over Matter?... Referral of Patients with Symptoms of Non-Organic Origin to a Tertiary Inpatient Paediatric Neurology Service

Background: The paediatric neurology department in OLCHC receives an average of twelve new referrals for inpatient neurology consultation per week. We found that many of these patients were subsequently diagnosed with a non-organic illness or a psychosomatic cause for their symptoms.

Objective: To assess the proportion of neurology referrals which had an underlying non-organic cause. To carefully qualify and quantify the type and number of investigations performed prior to diagnosis of these patients, and services involved in subsequent management.

Methods: Retrospective audit of inpatient neurology referrals over a six-week period was performed. Ethical approval was obtained. Patients with presentation of non-organic origin were identified and the course of their hospital stay assessed. Outcomes were measured in terms of investigations performed, services involved, and time to diagnosis.

Results: Of n=73 new patients reviewed over a six week period, we identified n=15 patients for inclusion in our final cohort. 87% of patients had a co-morbid organic illness. A trigger for symptom onset was identified in 60% of patients. Reasons for neurology referral included pseudoseizure, collapse, abnormal eye movements and gait abnormalities. MRI brain was performed in 40% of patients and EEG in 60%. The clinical psychology service was involved in 53% of our cohort, and medical social work services in 13%. Parents were in support of the diagnosis made in 73% of cases, by time of discharge.

Conclusion: Though non-organic illness may present in a wide variety of ways, we found that it represented a significant proportion of our team workload. We recommend 1. Education sessions for healthcare professionals to encourage early identification of non-organic illness 2. A hospital wide protocol for management of non-organic illness once diagnosed, including early cessation of unnecessary investigation 3. Early input from psychology services and allied health professionals.