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A historical review of functional neurological disorder and comparison to contemporary models, 2021, Raynor and Baslet

Discussion in 'Other psychosomatic news and research' started by Andy, Nov 11, 2021.

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  1. Andy

    Andy Committee Member

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    Abstract

    Over the centuries, various etiologies have been proposed to explain functional neurological disorders (FND), including functional seizures. These have included models relying on supernatural influences upon the body, emphasis on consequences of malfunctioning reproductive organs, the bodily expression of painful emotions involving traumatic memories, or cognitive distortions through attention and predictive biases. Many theorists, especially since the 19th century, have had overlapping themes that continue to be relevant in modern clinical use. Treatments developed in accordance with different conceptual mechanisms. Given the heterogeneity of the disorder and the variable response to individual treatments obtained through history, physicians must consider symptom expression of an FND as an overestimation. An appreciation of multiple theories allows flexible development of unique treatment plans for individual patients.

    Open access, https://www.sciencedirect.com/science/article/pii/S2589986421000630
     
  2. Andy

    Andy Committee Member

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    "An appreciation of multiple theories allows flexible development of unique treatment plans for individual patients."

    Because of course that sort of view would be fine for, say, cancer or heart attacks..
     
  3. chrisb

    chrisb Senior Member (Voting Rights)

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    Wherever did they get the notion that "Language is precise", and how come that that sentence seems so imprecise?
     
  4. alktipping

    alktipping Senior Member (Voting Rights)

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    so science direct is another rag that will publish any old tripe with zero attention or editorial discretion .
     
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  5. Mithriel

    Mithriel Senior Member (Voting Rights)

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    I think it was PDW who said that the more symptoms the more likely it is for a disease to be psychological.

    However, have multiple theories means a robust diagnosis, in fact is even better because it allows for unique treatments. Note, they carefully do not mention cures. If these unique treatments returned people to normal health and functioning it would be a different story.

    The only evidenced result of snake oil is to provide snake oil purveyors with a decent living.
     
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  6. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    Presumably he believes hypothyroidism is psychological then - the lists of symptoms (created by patients) on the web are often incredibly long.

    List from a thyroid charity : https://thyroiduk.org/if-you-are-undiagnosed/hypothyroid-signs-and-symptoms/
    List from the NHS : https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/symptoms/

    And what about vitamin B12 deficiency?

    List from a patient-created and managed website : https://www.b12deficiency.info/signs-and-symptoms/
    List from the NHS : https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/symptoms/

    Comment from the creator of the B12 deficiency site above :

    The lack of knowledge around B12 deficiency is staggering


    The biggest thing I struggled with before I gained my diagnosis was the huge lack of knowledge about the condition amongst health professionals. I first learned abut B12 deficiency when researching for a loved one who had been misdiagnosed with bipolar when it was severe vitamin B12 deficiency at the root of their many symptoms. Nobody involved in her care understood vitamin B12 deficiency, doctors suggested she eat broccoli! Like so many others I’ve now spoken to, it just felt like I was hitting dead ends at every step. Neither me or my loved one was being heard. That was the hardest thing to understand.


    I personally know people who’ve been sectioned due to B12 deficiency. I know people who’ve been misdiagnosed with Parkinson’s, Alzheimer’s autism and fibromyalgia. And most sadly of all, I’ve known people who have tried to take their own lives due to lack of adequate treatment.


    I wouldn't be at all surprised if many patients with a thyroid problem or a B12 deficiency are diagnosed with FND, prescribed anti-depressants, offered CBT... And none of them will get well with such a diagnosis because CBT won't create thyroid hormones or vitamin B12 out of thin air.

    And this link is shocking...

    https://www.b12deficiency.info/imagine-being-sectioned-for-a-vitamin-b12-deficiency/
     
  7. Mithriel

    Mithriel Senior Member (Voting Rights)

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    Yes Arnie, most diseases have a long lists of symptoms. The get away with saying what they do because most diseases have a few major symptoms that are well recognised or a diagnostic test that confirms what it is.

    It is only when the major symptoms are denied - like PEM in ME or there is no test that a lot of symptoms are needed for diagnosis.

    The main reason they can claim it is psychological, though, is that with diseases they consign to MUS patients need to list every symptom to try to get a proper biomedical diagnosis. It is a circular argument.

    No one with diabetes needs to list the strange skin rashes and itches or the sudden bouts of hunger or the tingling in the feet or the blurred vision and on and on.
     
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  8. Sean

    Sean Moderator Staff Member

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  9. Midnattsol

    Midnattsol Moderator Staff Member

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    And with B12 it is so easy to say that a bloodtest is "fine", while the lower reference range is really really low... Germany recently updated their B12 requirements from diet, it is now twice the amount of the Norwegian recommended daily intake(RDI). A few years ago I read some Danish researchers that wanted the RDI to be even higher than that. A common used lower reference range is ~150 pmol/L, but subclinical deficiency can occur when it is <249, and then there is functional deficiency where blood levels are adequate but the body is not able to use the B12. A problem here is that homocysteine is still used to check for (functional) B12 deficiency. This is unfortunate as homocysteine will rise due to either B12 or B9 deficiency and an adequate B9 intake can hide a B12 deficiency if homocysteine is used. Methylmalonic acid must be used instead. But not everyone is aware of the threshold for subclinical deficiency, or how to test for functional deficiency :(

    Another often missed deficiency that can cause many problems, also with the thyroid, is iodine. For a proper assessment one needs 24h of urine output, which for obvious reasons are seldom collected. A short dietary interview can be used to discover deficient intake (and since iodine is only found in a few foods this is very short. In Norway it would require to ask about the intake of two-three types of food), but GPs lack this knowledge.
     
    Last edited: Nov 13, 2021
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  10. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    It's something I've always wanted to test but it's expensive so I've never had it done.

    I remember iodine seemed to be something people often had at home when I was a child. They would paint it on to cuts to kill off bacteria. Nowadays I don't see it for sale anywhere (offline), nobody ever mentions using it for the things it was used for when I was a child, and people seem to be afraid of it.

    Given that the main sources of iodine that I'm aware of are sea fish, seafood and sea weed, none of which I eat very often, I'm probably quite deficient. At most I'll eat tuna occasionally, and prawns perhaps once or twice a year, and seaweed never, maybe I should test iodine.
     
  11. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    I don't think that is true in the UK. The NHS uses serum B12 and people are usually dismissed if the result is anywhere within range, even bottom of range. And if the result is just below range then doctors often appear to think "That's close enough". The same attitude of "That's close enough" often happens with iron and/or ferritin in the UK too. I think homocysteine is only tested if Pernicious Anaemia is suspected, and that rarely happens.

    Also, reference ranges for folate are of the form " > 3.9 ", so if your result is 4.0 you're considered fine. And low levels are treated with folic acid rather than folate, which with certain very common genetic issues can't be converted into folate, so functional deficiencies are common.
     
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  12. Midnattsol

    Midnattsol Moderator Staff Member

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    Yes, the homocysteine/methylmalonic acid issue is really only an issue if functional/subclinical is acknowledged in the first place :(
     
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  13. Mithriel

    Mithriel Senior Member (Voting Rights)

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    If anyone is interested, MS research found that B12 uptake is as good from sublingual sources as from injections and you can buy it easily. Many people with MS feel it helps with fatigue but only some neurologists prescribe injections.

    I get methylcobalamin from Amazon and take it a few times a week.
     
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