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Here is a clear side-by-side table comparing Functional Neurological Disorder (FND) with Psychosis and Autoimmune Encephalitis (AE).
FND vs Psychosis vs Autoimmune Encephalitis — Comparison Table
| Feature | Functional Neurological Disorder (FND) | Psychosis | Autoimmune Encephalitis (AE) |
|---|---|---|---|
| Primary Nature | Disorder of brain function, not structural damage | Severe disturbance in thought, perception, and reality testing | Inflammatory/immune attack on the brain |
| Typical Symptoms | Weakness, tremor, gait issues, sensory loss, non-epileptic seizures, speech issues | Delusions, hallucinations, disorganized thought/behavior | Memory loss, confusion, seizures, abnormal movements, autonomic instability |
| Onset | Often sudden after stress/trigger; stable neurological exam with “positive signs” | Gradual or acute depending on cause (schizophrenia, mood disorders, substances) | Subacute (days–weeks) progressive decline |
| Consciousness / Awareness | Usually preserved; spells may resemble seizures but EEG normal | Preserved but impaired insight | Often fluctuating consciousness, agitation, catatonia |
| Orientation | Intact | Usually intact | Frequently impaired (disorientation common) |
| Movement Abnormalities | Inconsistent weakness, tremor distractible or entrainable | Usually none (unless catatonia or medication side effects) | Dystonia, chorea, abnormal postures, orofacial dyskinesias common (e.g., anti-NMDAR AE) |
| Memory | Usually normal; selective attention problems | Sometimes impaired (depending on disorder) | Prominent short-term memory loss |
| Seizures | Dissociative/non-epileptic seizures possible (normal EEG) | Rare (unless comorbid epilepsy, drug withdrawal) | Common, often with abnormal EEG |
| Psychiatric Symptoms | Anxiety, functional seizures, dissociation | Core symptoms include delusions, hallucinations, thought disorder | Often early psychiatric symptoms: anxiety, agitation, psychosis |
| Autonomic Symptoms | Mild (e.g., dizziness) | Not typical | Prominent: tachycardia, fever, blood pressure swings |
| MRI Brain | Normal | Normal | Often abnormal (inflammatory changes; sometimes normal early) |
| EEG | Normal even during episodes | Usually normal | Often abnormal — diffuse slowing or seizure activity |
| CSF (Lumbar Puncture) | Normal | Normal | Abnormal: pleocytosis, oligoclonal bands, elevated protein |
| Autoantibodies | None | None | Present in many cases (e.g., anti-NMDAR, LGI1, GABA-B, CASPR2) |
| Response to Distraction / Suggestibility | Symptoms improve with distraction or be internally inconsistent | Not applicable | No improvement with distraction |
| Treatment | Education, specialized PT/OT, CBT, multidisciplinary rehabilitation | Antipsychotics, mood stabilizers, psychotherapy | Immunotherapy: steroids, IVIG, plasmapheresis, rituximab; ICU care if severe |
| Prognosis | Variable but good with proper therapy | Variable | High recovery rate with early treatment; life-threatening if untreated |
If you want, I can also make:
✅ A clinical diagnostic flowchart
✅ A more detailed table focused only on psychosis in AE vs primary psychiatric psychosis
✅ A symptom-by-symptom differential breakdown (memory, movement, seizures, behavior, etc.)
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