Characteristics of patients with motor functional neurological disorder in a large UK mental health service (2019) O'Connell, Wessely et al

S

ScottTriGuy

Senior Member (Voting Rights)
Ugh.

Have you seen this new piece @dave30th ?

"Conclusions

mFND patients have distinct demographic characteristics compared with psychiatric controls. Experiences of abuse appear to be equally prevalent across psychiatric patient groups. This study establishes the socio-demographic and life experience profile of this understudied patient group and may be used to guide future therapeutic interventions designed specifically for mFND."

https://www.cambridge.org/core/jour...ntrol-study/9314AC746E831FAB8E4B3F7AC76B420D#
 
O'Connell, N., Nicholson, T., Wessely, S., & David, A. (n.d.). Characteristics of patients with motor functional neurological disorder in a large UK mental health service: A case–control study. Psychological Medicine, 1-10. doi:10.1017/S0033291719000266

(Paywalled)

Abstract
Background
Functional neurological disorder (FND), previously known as conversion disorder, is common and often results in substantial distress and disability. Previous research lacks large sample sizes and clinical surveys are most commonly derived from neurological settings, limiting our understanding of the disorder and its associations in other contexts. We sought to address this by analysing a large anonymised electronic psychiatric health record dataset.

Methods
Data were obtained from 322 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who had an ICD-10 diagnosis of motor FND (mFND) (limb weakness or disorders of movement or gait) between 1 January 2006 and 31 December 2016. Data were collected on a range of socio-demographic and clinical factors and compared to 644 psychiatric control patients from the same register.

Results
Weakness was the most commonly occurring functional symptom. mFND patients were more likely to be female, British, married, employed pre-morbidly, to have a carer and a physical health condition, but less likely to have had an inpatient psychiatric admission or to receive benefits. No differences in self-reported sexual or physical abuse rates were observed between groups, although mFND patients were more likely to experience life events linked to inter-personal difficulties.

Conclusions
mFND patients have distinct demographic characteristics compared with psychiatric controls. Experiences of abuse appear to be equally prevalent across psychiatric patient groups. This study establishes the socio-demographic and life experience profile of this understudied patient group and may be used to guide future therapeutic interventions designed specifically for mFND.
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@Jonathan Edwards
 
It would appear that one of the common characteristics across the board for this retrospective cohort is that they are British. Who knew?!?

A possible therapeutic intervention, by extension, may be to immigrate.

That or divorce, seeing as marriage also seems to be a qualifier.
 
Does the psychiatric community acknowledge channelopathies? I am not trying to be flippant. This is a genuine question. With new insight into these organic medical conditions emerging more frequently, and keeping in mind only 10 years ago so little was known that they might as well not have seemed to exist except in the delusional...How can any component of any medical community any longer not defer to the possibility of a channelopathy instead of it's no more than patient fantasy?

Keep in mind that testing for the different types of periodic paralysis is still nascent, even primitive. But the symptom cluster is so similar to what psychs characterize as mFND, that it seems to me that out of sheer human decency clinicians and researchers would err on behalf of the patient, would believe the patient - if only because this is a brand new neurological frontier that matches patients' reports.
 
Cinders66 said:
It seems wessely was worried an FND group was lacking PS factors so ran in to rescue the situation. I couldn’t see they found anything significant though?
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It seems the investigators found a need to "stimulate" demand for their own future studies and treatments...
By establishing the sociodemographic and life experience profile of this understudied patient group, we hope to stimulate novel psychosocial interventions.
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I think the weakness of the study is that it is supposed to tease out demographics but is based on the referrals to a psychiatric clinic. So there is no chance that it will tell us anything useful about demographics of the illness, as opposed to demographics of attendees. Using psychiatric patients as controls also seems inappropriate. Maybe psychiatric patients are less likely to be employed because they have a psychiatric illness.

With regard to the diagnostic category of motor functional neurological disorder I don't have a big problem with this. There is no doubt that there are people who have apparent weakness which can be shown by physical examination not to be due to defects in peripheral neurological or involuntary central pathways. These problems must have something to do with brain function without any structural changes (imaging ins normal). This sort of problem has to have a name and functional disorder is certainly better than conversion disorder.

Maybe the problem is this. In the old days people with problems like this went to neurologists, who did not refer to psychiatrists because they did not think psychiatrists could help. With the invention of 'liaison psychiatry' with a pro-active marketing strategy for getting more patients neurologists have found it convenient to refer on to psychiatry. Rather than taking an objective biological approach to the problem the psychiatrists have resurrected old Freudian theories. Nobody has noticed that they have no idea what they are doing and are probably not bright enough ever to know.
 
Jonathan Edwards said:
These problems must have something to do with brain function without any structural changes (imaging ins normal).
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Although channelopathies have been shoehorned into a neurological category, to ascribe them to a brain function to me seems like a stretch. These are frequently inherited conditions that involve intracellular ion issues with potassium or sodium or calcium in different areas of patients' muscles. These are not uniform amongst the PP community in terms of location or even manifestation. And indeed, you can have acquired PP.

Where does brain function factor in?

Of course, this is only a subset of what some call FNDs
 
The somewhat lower childhood abuse rates reported in ourstudy may be an underestimation due to the observational, retro-spective method and lack of structured interviewing, as studiesutilising interview techniques report higher CSA rates in FND(Ludwiget al.,2018).
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Interview techiques may result in higher prevalence of childhood abuse because interviewers can inject their bias.

A retrospective design is also susceptible to recall bias, which would increase rates.

The authors appear to be thinking that patients need help remembering or something like that.
 
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Jonathan Edwards said:
Channelopathies are not part of the motor functional neurological disorder category, although they may well get misdiagnosed as that if the clinical assessment is not thorough.
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You've made my point. Perhaps mFND are in truth vanishingly rare, at least in the way some of the BPS contingent seems to have co-opted it for, and truth be told what is today ascribed to that umbrella may eventually be attributed to other organic conditions such as channelopathies. I have to add there are very very few neurologists or any other clinician that currently checks for PP as part of a differential diagnosis. One of the reasons is the tests are new and few, and the condition still considered rare (although that is beginning to change).

More to the issue at hand, if these BPS and other psychs can overlook channelopathies, what else are they missing at the expense of stigmatizing a patient community? Why aren't they defaulting to unknown organic causes vs childhood trauma or the like? It seems to me a disservice to patients.
 
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Just presuming the methodology is sound. That's safe, right?

Jonathan Edwards said:
but is based on the referrals to a psychiatric clinic.
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Yep. :thumbup:

This was a case–control study of mFND patients in contact with secondary mental health services
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So they were already referred to psych. Though that doesn't necessarily mean they have a psychiatric disorder, it does increase their chances.

Without going into it in too great a depth, it does seem like a lot of what they mention as associated with mFND is associated with slightly higher wealth/privilege (married women have a higher household income on average; pre-morbidly employed and married means there's a likelihood for a two-income family; access to benefits is much more likely with a small stockpile of funds -- discussed extensively in another thread). It might be that wealth, privilege, or education enabled these women to escape a nastier or more stigmatizing diagnosis than mFND.

I know Wessley et al. aren't sociologists, but it does show how they're still pretty much operating in a bubble of their own making. I didn't read the whole thing, but searching for 'income' or 'money' or 'funds' brought up nothing. They didn't measure it, I guess. It would be a quick answer to every commonality but 'female'.
 
My understanding is diseases such as MS may take quite some time to get to a proper diagnosis. I can imagine some with MS may be incorrectly diagnosed with FND and be subjected to "novel psychosocial interventions".

There have been numerous instances of conditions thought to be psychological that science finally proved are organically caused. I agree with @duncan, out of sheer human decency, patients should be given the benefit of the doubt.
 
Jonathan Edwards said:
I think the weakness of the study is that it is supposed to tease out demographics but is based on the referrals to a psychiatric clinic. So there is no chance that it will tell us anything useful about demographics of the illness, as opposed to demographics of attendees. Using psychiatric patients as controls also seems inappropriate. Maybe psychiatric patients are less likely to be employed because they have a psychiatric illness.

With regard to the diagnostic category of motor functional neurological disorder I don't have a big problem with this. There is no doubt that there are people who have apparent weakness which can be shown by physical examination not to be due to defects in peripheral neurological or involuntary central pathways. These problems must have something to do with brain function without any structural changes (imaging ins normal). This sort of problem has to have a name and functional disorder is certainly better than conversion disorder.

Maybe the problem is this. In the old days people with problems like this went to neurologists, who did not refer to psychiatrists because they did not think psychiatrists could help. With the invention of 'liaison psychiatry' with a pro-active marketing strategy for getting more patients neurologists have found it convenient to refer on to psychiatry. Rather than taking an objective biological approach to the problem the psychiatrists have resurrected old Freudian theories. Nobody has noticed that they have no idea what they are doing and are probably not bright enough ever to know.
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Yes I’ve no issue with FND as a category for that type of issue. I do think the fnd people are reductionist of CFS when they decide we belong in that group too and I worry when CFS is put under FND and right back into a BPS framework again .I think that Simon Wessely couldn’t bear such disorders to be treated purely from a poorly understood biological perspective when he’s long believed PS factors provide much of the missing link in the medically unexplained
 
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