CFS and FND in context of "Functional cognitive disorder" in "Non-Dementia Pathways Guidance" from London Dementia Clinical Networks, Jan 2020

[Dx Revision Watch]

NHS Clinical Networks

Non-Dementia Pathways Guidance from the London Dementia Clinical Networks

January 2020 (Version 2)

PDF: https://www.england.nhs.uk/london/w.../8/2019/07/Final-non-dementia-pathways-V2.pdf


Selected extracts:

The aim of this document is to provide commissioners and clinicians in memory services and primary care with guidance on the appropriate pathways for patients who present with memory complains [sic] due to a range of non-dementia causes

Introduction

The 2019 London memory service audit looked at 988 case notes across 20 services. In addition to finding considerable variation between services; the audit found that overall 40% of patients were not given a diagnosis of dementia and 85% of patients under the age of 65 were not given a diagnosis of dementia


Slide #3:

Slide #7

Functional cognitive disorder (FCD)

[Ed: For ICD-11, Dissociative neurological symptom disorder, with cognitive symptoms is coded at 6B60.9 as a child category under parent class: 6B60 Dissociative neurological symptom disorder.]


Slide #25 (My blue highlighting)

Primary care

[Ed: NICE NG127 = Suspected neurological conditions: recognition and referral NICE guideline [NG127] Published date: May 2019 Last updated: July 2019 https://www.nice.org.uk/guidance/ng127]


Slide #26 (My blue highlighting)

MAS triage

Slide #28

Diagnostic and post diagnostic pathway

Slide #29 (My blue highlighting)

FCD Flags

Slide #30

Case study

PDF URL (and attached below): https://www.england.nhs.uk/london/w.../8/2019/07/Final-non-dementia-pathways-V2.pdf

 

[InitialConditions]

what a mess.

 

[rvallee]

Potemkin medicine.

Honestly, I think it's worth giving a look at the increasing use of this ideology and staff dissatisfaction in health care services. None of this is of any value and has no usefulness, but it is standard practice, leading to frustrated patients who complain about the uselessness and frustrated staff who essentially have the task of trying to get people to swallow BS as a cost-saving measure.

It essentially turns large segments of medicine into a meaningless rote where everyone is frustrated with outcomes, functionally the same as having to knowingly performed a meaningless task that is simply dismantled every day so it can be done again the next.

I think there will be many similarities with some of the most boring and meaningless jobs out there, basically losing all sense of purpose by being fully aware that it's BS but having to do it instead of the actual purpose of helping people.

In addition to being toxic work environments where hazing and bullying are the norm, this could explain a lot of the breakdown in job satisfaction. I frankly have little doubt that most understand this is tripe but do it anyway because it's what demanded of them.

 

[spinoza577]

FCD

Perfectionistic expectations of memory ability

hope they find a way to treat it

 

[spinoza577]

It essentially turns large segments of medicine into a meaningless rote ...

I think rote may actually the core of learning any medicine, and then the doctors simply are applying it. I even can understand that doctors don´t want to step away from what they have learned and what they can do without getting criticized from the whole machinery. Sadly so far there is not much sense in the minds.

So I think this:

In addition to being toxic work environments where hazing and bullying are the norm, this could explain a lot of the breakdown in job satisfaction. I frankly have little doubt that most understand this is tripe but do it anyway because it's what demanded of them.

might be half true. But it does not help the patients whose disease is not understood nevertheless. It actually may be that the imagination (including the imagination of success and meaning) exceeds the really productive fantasy. Ironically, they are working on the diagnosis of themselves.

 

[rvallee]

FCD

hope they find a way to treat it

That's one of the most annoying contradictions to this belief system, that we are both too young to be this sick but also it is normal to have crippling reduction in cognitive and physical ability the second you hit 20 and any recall of a normal functioning memory is just rosily remembering our youth when our memories are at peak performance, or something like that, even though this is not how any of this works.

Not that I expect any consistency to this nonsense but the fact that nobody in medicine seems concerned about the complete lack of self-consistency is disappointingly absurd. I don't think there is any situation or system that is improved by allowing doublethink yet it is normal to the practice of psychosomatic medicine. Ugh.

 

[spinoza577]

That's one of the most annoying contradictions to this belief system, that we are both too young to be this sick but also it is normal to have crippling reduction in cognitive and physical ability the second you hit 20 and any recall of a normal functioning memory is just rosily remembering our youth when our memories are at peak performance,

Very well noticed.

Not that I expect any consistency to this nonsense but the fact that nobody in medicine seems concerned about the complete lack of self-consistency is disappointingly absurd. I don't think there is any situation or system that is improved by allowing doublethink yet it is normal to the practice of psychosomatic medicine. Ugh.

It may work like so: As long as there is a problem as along there will be an explanation. For practical reasons they turn their attention to the minding as the body is utterly complex - ironically this may happen subconsciously. Indeed and but, that there is for sure a medical unexplained disease will hardly be shown already these days. So, it shows a kind of hybris, and the approach is partly evolving from a negative "insight".

It cannot be denied, though, that the nice success the medicine can claim, evolves from such practical reasons, for the most medicals the mechanism of action is unknown.

The honest alternative would be to notice that only 200 years ago the most people have died quite early, and that we today are not as much developed as ... we like to think. In proper minding it wouldn´t be hard to say: "There is the possibility that we absolutely don´t know what it could be."
When I phoned to my insurance and had a talk, the friendly woman answered to me: "I understand, but this is not what doctors do."

 

[livinglighter]

When it comes to non organic causes is ME/CFS always referred to as CFS?

I’ve noticed ME/CFS is only referred to as ME within the NHS England neurological conditions website.

I wonder if they separate the names depending on whether they consider the cause organic vs non organic.

 

[Andy]

When it comes to non organic causes is ME/CFS always referred to as CFS?

I’ve noticed ME/CFS is only referred to as ME within the NHS England neurological conditions website.

I wonder if they separate the names depending on whether they consider the cause organic vs non organic.

Always? No, generally, it's a mess. In the UK it is most likely that anybody using CFS/ME will view things from the BPS point of view. CFS, by itself, tends to be more widely used in the US by both 'sides'. With the NHS being a collection of parts, any part that deals with ME will have an individual approach to naming, although with NICE adopting ME/CFS for the new guideline I would imagine that ME/CFS will be widely adopted over time, but I certainly wouldn't rely on a particular name as an indicator of their beliefs.