Autism Spectrum Disorder May Be Highly Prevalent in People with Functional Neurological Disorders 2022 González-Herrero, Edwards et al

[CRG]

Isn't one of major flaws in the fnd arguement that lumping many conditions under one roof with just one treatment option pyshc and physio.
Plus there is non exsistance of pathophysiological only a presumption that that the body is coverting thoughts and emotions into physical synptoms

I don't think treatment is a sound line of criticism of 'lumping', it's quite possible to have an overarching nosological definition while having different treatment regimes for sub categories of illness.

Lack of pathophysiological evidence for FND doesn't help in excluding ME/CFS from an FND 'lump' because there currently is no certain ME/CFS pathophysiology. Clearly the FND adherents have some definitional issues, having allowed/accepted common ground with the wholly psychologically orientated Body Distress Disorder enthusiasts like Per Fink but I don't think that's enough to wholly undermine the nosological argument.

 

[Trish]

Lack of pathophysiological evidence for FND doesn't help in excluding ME/CFS from an FND 'lump' because there currently is no certain ME/CFS pathophysiology.

Given that ME/CFS is defined by a specific set of core symptoms, there is no good reason to lump it with other conditions with a different set of symptoms.

I think it is up to the lumpers to explain why they lump ME/CFS with FND, IBS, MUS, PPS, conversion disorder, etc.

If their only reason is that there isn't biomedical evidence of difference, then that logic would also lump us with super healthy people, which is clearly nonsensical - and also clearly their unstated intention.

 

[rvallee]

No point in pretending that every one of those acronyms, or the OG conversion disorder, isn't based on the same god of the gaps as always. It's a mindless algorithm that assigns everything not understood, which is most things, in the same trash bin until it can be placed correctly, massively delaying it.

There is no more to it and it's said plainly most of the time: "all tests are normal". The issue is that "all tests" here does not mean all tests, it's an invalid proposition, and the concept was invented over a century ago, when not a single test in use today was even imagined yet because they did not know. Medical science isn't even half-way done yet, back then it was infantile to the point of being mostly harmful.

It's not a valid concept. The patients are mislead and deserve better, there is no need to explain how conversion disorder is wrong anymore than the same need exists about the Humours, phrenology or astrology. Peptic ulcers would still be in their grabby hands if it wasn't for the kind of conclusive proof that is extremely rare to be able to do with limited resources.

All this talk about "splitting" and "lumping" is wasted, the details of this are irrelevant, the evidence they claim is simply false and the simple fact that they are OK with having zero evidence for their claims make all their claims about us hypocritical and dumb, they do worse in every regard. All of this is still around because of a long-standing tradition, there is nothing more to it than a historical mistake that was never corrected.

 

[livinglighter]

There's a fairly complete FND manifesto by Mark Edwards here: https://fndhope.org/fnd-guide/diagnosis/

In my experience the commonest scenario at the onset of FND is the combination of a “typical” physical event (illness, injury) and a period prior to this of hard work a degree of fatigue caused by this and “normal” chronic life stressors that affect many people. The physical triggering event is usually something that would be expected to get better, for example a flu that would be expected to go after a few days rest, but instead symptoms continue and functional symptoms emerge. Sometimes this process can be very quick and dramatic or sometimes much slower.

Thanks for the link. The above common onset mechanism described for FND is strikingly similar to the onset mechanism of post-concussion syndrome minus detail, which has a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction (ICD-10) and is better understood within trauma neurology. Post-concussion syndrome is another condition that is now said to be FND.

JOURNAL ARTICLE
Reframing postconcussional syndrome as an interface disorder of neurology, psychiatry and psychology
Camilla N Clark, Mark J Edwards, Bee Eng Ong, Luke Goodliffe, Hena Ahmad, Michael D Dilley, Shai Betteridge, Colette Griffin, Peter O Jenkins
Brain, Volume 145, Issue 6, June 2022, Pages 1906–1915, https://doi.org/10.1093/brain/awac149

https://academic.oup.com/brain/article/145/6/1906/6574496

So is post concussion syndrome caused by brain damage then?

In a nutshell, no.

It is TRIGGERED by a blow to the head, during which there may have been some minimal damage to the brain. But don’t forget that adults lose brain cells every day.

If it was a minor brain injury, by the time 8-12 weeks have gone by its very unlikely that any of the symptoms that are left are still caused by brain damage. Instead they arise because of abnormal nervous system and brain functioning. In other words they are functional neurological symptoms.

The symptoms of dizziness, poor concentration, fatigue are identical to those seen in patients with functional disorders who have not had blow to the head. So the advice about them on this website is therefore relevant to you if this is your situation.

https://www.neurosymptoms.org/en/symptoms/common-associated-symptoms/post-concussion-syndrome/

Functional neurological symptoms are neurological symptoms that are genuine, but not due to a disease of the nervous system.

They are called functional symptoms because they affect the “function” of the body rather than being caused by damage to the “structure”.

This problem has been around for a long time, for most of history it was called “hysteria”, though it is common in men as well as women. More recently, psychiatrists called it “conversion disorder” because patients were thought to be “converting” stress into physical symptoms.

However not all patients experience significant psychological problems. A lot of patients just have an accident or a period of illness and then get functional symptoms afterwards.

https://www.nbt.nhs.uk/our-services/a-z-services/neuropsychiatry/functional-neurological-symptoms

 

[CRG]

Oh.
Persistent Physical Symptoms Research and Treatment Unit

CBT for persistent physical symptom Professor Trudie Chalder discussion here: https://www.s4me.info/threads/cbtreach-cbt-for-persistent-physical-symptoms-chalder.31439/

reference for above: Lumping” and “splitting” medically unexplained symptoms: is there a role for a transdiagnostic approach?

"Medically unexplained syndromes (MUS) are defined as persistent bodily symptoms with functional disability but no explanatory pathology. They are highly prevalent in both primary and secondary care. In a meta-analysis of medically unexplained symptoms (not syndromes) in primary care, the percentage of patients complaining of at least one medically unexplained symptom ranged from 40.2 (95% CI 0.9–79.4%; I2 = 98%) to 49% (95% CI 18–79.8%, I2 = 98%) (Haller et al., 2015).

MUS are associated with high levels of distress and do not respond easily to reassurance and simple explanation (Barsky & Borus, 1999). They are seen in all medical specialties. Fibromyalgia (FM) is frequently seen in rheumatology, irritable bowel syndrome (IBS) in gastroenterology, non-cardiac chest pain in cardiology, chronic fatigue syndrome (CFS) in infectious diseases, non-cardiac chest pain and functional palpitations in cardiology, hyperventilation syndrome in respiratory medicine, tension headache in neurology and multiple chemical sensitivity in allergy.

These syndromes have mostly been studied in isolation. However, research has observed extensive symptom overlap with more than half of patients with one MUS condition fulfilling diagnostic criteria for at least one other MUS condition (Nimnuan et al., 2001). For this reason, Wessely et al. (1999) suggested advantages to redefining MUS as one syndrome. Fink & Schroder (2010) advocated a new over-arching term, “bodily distress syndrome”, to encompass all the different MUS. They submit that there is now substantial evidence that MUS conditions are not clearly distinct disease entities but rather a common phenomenon with different subtypes.

They describe similarities in diagnostic criteria, aetiology, pathophysiological, neurobiology, psychological mechanisms, patient characteristics and treatment response. Some years earlier Yunus (2007) had suggested the generic term “central sensitivity syndrome” which suggests that the common mechanism underlying various MUS is central sensitisation which is the hyper-excitement of neurons in the central nervous system."

Note the references in the above intro para include 3 - Wessely 1999, Yunus 2007, and Fink 2010 that appear in the intro para of the González-Herrero et al paper we are discussing in this thread !

 

[livinglighter]

Lack of pathophysiological evidence for FND doesn't help in excluding ME/CFS from an FND 'lump' because there currently is no certain ME/CFS pathophysiology.

Trying not to derail the whole thread, but I keep lamenting about this. If the name of the condition is myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome (ME/CFS). https://www.nice.org.uk/guidance/ng206

Doesn't Myalgic encephalopathy indicate the condition is an acquired brain injury without a single cause? Encephalopathy is understood to have various causes.

 

[JemPD]

Sure but the inclusion of ME in the name is basically a sop for patients who hate the term CFS. There is no conclusive proof of encephalomyelitis & encephalopathy is argued over. Hence the BPS crew's insistence on calling it CFS/ME rather than the now NICE recognised ME/CFS.

So an appeal to the name meaning that means there is some kind of (currently) unequivocal demonstrable pathology wont work, especially with the FND fans

 

[Mithriel]

ME is not a sop to patients. The disease was originally given the name because of widespread muscle pain and neurological signs in patients which, alongside the belief it was caused by enteroviral infection attacking the brain led to encephalomyelitis. Originally it was called benign ME because it became chronic rather than fatal. It was not meant to imply it was a mild disease.

It may not be accurate, but it was an attempt to give a name which accurately reflected the nature of the patient's symptoms. It was more accurate than chronic fatigue syndrome because they never checked to see if patients actually had chronic fatigue. In fact, the typical ME patient was ill, then recovered for a few weeks and then became ill again, what we now know as PEM episodes. It was a good faith, medical name based on patient experience with no other agenda.

One reason it looked as if LC is similar to ME is that in 2020 there were so many people saying they kept thinking they were well, returning to work, then collapsing a few days later. Exactly what Ramsay described and I experienced when I was first ill.

 

[Sid]

From the Limitations section:

Almost 70% of people with FND in our sample scored in the range suggesting autism spectrum. Although we have anecdotally recognized several individuals in our clinics with probable ASD, this extremely high prevalence was surprising to us and makes it important to consider potential sources of bias in our data.

Very biased and bad study published in an obscure open access Chinese journal. People with ASD are often rejected, ostracised and bullied by neurotypical people so it's not surprising that they spend a lot of time on the internet. It's also unsurprising that people with analytical, systematising, obsessional traits are more likely to end up researching their condition on the internet and hanging out on websites like "FND".

 

[ToneAl]

This post reminds me of this post earlier

Abstract

Autistic-like features and functional somatic symptoms (FSS) frequently co-occur. It remains unknown how autistic-like features and FSS affect each other and develop throughout adolescence. This study examined reciprocal relations between autistic-like features and FSS in adolescence. Participants were 2772 adolescents (52.5% male) from the Tracking Adolescents’ Individual Lives Survey population and clinical cohort. Data from four waves were included, covering the ages between 11 and 19 years.

Autistic-like features were measured using the Children’s Social Behavior Questionnaire. FSS were assessed using the Youth Self Report and Adult Self Report, respectively. Using the random intercept cross-lagged panel model, a stable positive, moderately strong between-persons association was found between autistic-like features and FSS. No within-persons reciprocal effects from wave to wave were observed. Secondary analyses revealed a consistent relation with FSS for three different domains of autistic-like features (social and communication behaviors, repetitive behaviors, and self-regulatory behaviors), and highly similar interrelations in a subsample of adolescents with a clinical autism spectrum disorder diagnosis.

In conclusion, the co-occurrence between autistic-like features and FSS is stable throughout adolescence. Clinicians working with adolescents with autistic-like features should be alert to the presence FSS, and vice versa.

Open access, https://journals.sagepub.com/doi/10.1177/13623613221143874

Ao why are they making things up without evidence and only biased questionaires.