Functional Neurological Disorders - discussion thread

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Inconsistent?

https://rarediseases.org/rare-diseases/fnd/

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Affected Populations
The exact prevalence of FND is unknown. However, research suggests FND is the second most common reason for a neurological outpatient visit after headache/migraine; accounting for one sixth of diagnoses. This means FND is as common as multiple sclerosis or Parkinson’s disease.
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Are MS and PD considered "rare diseases"?
 
Mithriel said:
more a case that Stone is a persuasive talker than anything scientific. They may well come to regret it.
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Another Wessely. Very persuasive talker. Very unpersuasive scientist.
Mithriel said:
Yet they are willing to be associated with FND just as Stone is dragging every disease you can think of it its web.
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Are there no alarm bells going off in neurology? Is nobody within the specialty starting to wonder that the FND claim is just too good and too broad to be true? At this rate Stone et al will have claimed all remaining unexplained symptoms across medicine within a couple of years.
 
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It seems Neurologists have solved everything there is to know about medical neurology that they can be so certain that any symptom pattern or sign that doesn't fit into a readily diagnosable disorder can be dismissed as FND and the patient shunted off to the psychologist or psychiatrist for their treatment and care (and then back to the GP with an instruction for no further referrals to be made)! I am so shocked that in this age (where the technological possibilities in medicine are just beginning to take off) that neurology as a medical discipline appears to be regressing back to the Victorian days.
 
Sean said:
Another Wessely. Very persuasive talker. Very unpersuasive scientist.

Are there no alarm bells going off neurology? Is nobody within the specialty starting to wonder that the FND claim is just too good and too broad to be true? At this rate Stone et al will have claimed all remaining unexplained symptoms across medicine within a couple of years.
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Prof Raad Shakir, a former President of the World Federation of Neurology, lobbied the WHO long and hard with Stone et al to have a functional neurological disorders category block moved from under the ICD-11 Mental, behavioural and neurodevelopmental disorders chapter and relocated under the Neurology chapter. (Not because he considered these categories to be neurological but because neurologists often see these patients.)

Shakir had been Chair of the ICD-11 Topic Advisory Group for Neurology but he and Stone failed in their proposal and obtained only secondary parenting under Neurology and also had to settle for a Concept Title term that Shakir and Stone did not approve of, with their term of choice, FND, under Synonyms.

Shakir's TAG was the same ICD-11 external working group, who, if they had had their way (according to the WHO's Dr Tarun Dua), would have deleted CFS and ME from the Neurology chapter and relocated these two terms in the Symptoms, signs chapter, under Symptoms, signs or clinical findings of the musculoskeletal system.
 
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Sean said:
Are there no alarm bells going off neurology? Is nobody within the specialty starting to wonder that the FND claim is just too good and too broad to be true? At this rate Stone et al will have claimed all remaining unexplained symptoms across medicine within a couple of years.
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Or are they just pleased that their lives are made easier in the same way that GPs are happy to consign difficult patients to the 'MUS' IAPT pathway?
 
Ariel said:
Is "FND" actually accepted by most mainstream medical practitioners as a legitimate illness or phenomenon? Or do they just think "ah, not my problem" and have a structure to be able to move on to the next patient/item/etc and don't really think about whether it's legitimate? Have they even heard of it? Seems to have spread as an idea fairly recently to me.
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I'd say it has 99% acceptance, it's considered as true as "the blood belongs in the body" as far as most are concerned. Not everyone fully buys into it but I have more than enough fingers to count the number who have voiced even mute criticism over the concept. The only dissent is over particulars, how it should work, but as an idea it's fully accepted. This is the golden age of psychosomatics, never been more influential and promoted, and predictably enough it's exactly as awful as it sounds.
 
Peter Trewhitt said:
Increasingly I have read the claim that FND is not a diagnosis of exclusion, but rather a positive diagnosis based on clearly identifiable signs, though I have seen no unambiguous or uniquely identifying symptoms in what usually follows. This is particularly worrying, in that if clinicians believe they can make a definite diagnosis from just an initial consultation and case history, then the likely outcome is that formal testing does not happen so serious and potentially life threatening alternative diagnoses will be missed.
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This has been the recent development, arguing that it's not longer a diagnosis of exclusion. Everything else is the same but it's the natural course of a con, you can only proclaim more confidence in it over time. And of course they rely exclusively on chronic illness features to prove their point, the very features they dismiss as psychogenic in us. As evidence grows over whatever post-infectious chronic illness is, you can bet your ass they will use it as proof positive of FND while dismissing it as mere correlation for us. Belief systems make even smart people act like complete fools.
 
rvallee said:
I'd say it has 99% acceptance, it's considered as true as "the blood belongs in the body" as far as most are concerned. Not everyone fully buys into it but I have more than enough fingers to count the number who have voiced even mute criticism over the concept. The only dissent is over particulars, how it should work, but as an idea it's fully accepted. This is the golden age of psychosomatics, never been more influential and promoted, and predictably enough it's exactly as awful as it sounds.
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And the Dissociative disorders and conversion disorder have a long classificatory history.

See:

https://www.indjsp.org/article.asp?...=34;issue=5;spage=44;epage=48;aulast=Malhotra

Dissociative disorders: Reinvention or reconceptualization of the concept?

section: Dissociative Disorders in Modern Classificatory Systems
 
Here's some of my research about the term "functional".

  • - Functional is a lie, means psychosomatic.

  • https://jnnp.bmj.com/content/83/3/248 -
    One advantage of ‘functional’ may thus be as a simplifying euphemism, allowing neurologists to use the same term to mean one thing to colleagues and another to patients. It may be precisely this ambiguity which has allowed the construct to survive despite the uncertainty and conflicts underpinning its meaning at any point in time.
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I think each time a new term for unexplained physical diseases is invented the BPS Brigade (which includes much of the medical profession) hijack the term and psychologize it. I hope they are not successful with Long Covid.
 
What's silly about this is FND can get diagnosed due to a lack of ruling out other conditions, and in this day and age GP's are discouraged from carrying out vast amounts of blood tests.

My current neurologist labelled me FND, even though I keep saying my symptoms are real. :nerd:

I requested another neurologist, who then decided to run tons of blood tests. It turns out my blood is sticky, and I'm positive for Borrelia or EBV. Now I require referral to an infectious disease specialist as Lyme is known to cause neurological impairment if left untreated. If I go down the route of comorbid post-infectious Lyme or whatever, what happens to FND?
 
Woolie said:
This is absolutely terrifying, isn't it? Now anyone can be accused of having "functional overlay", and sent off for reeducation.

SO helpful, to have a 30-something fit, educated, healthy clinician explain to you how you need to think more positively about your incapacitating - and very possibly ultimately fatal - neurological illness.

I'm finding this cropping up in my own area, which is neuropsychology. I get a lot of questions from clinical neuropsychologists about head injury and concussion, and whether these patients' problems might be partly or wholly due to anxiety, depression or "central sensitisation".
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That’s really worrying. My eldest daughter has permanent post concussion syndrome as the result of a head injury from falling off her bike a few years ago, and the PCS has disabled her to the point of not been able to work and severely affecting her life in all areas. She lives independently of me and her father, but requires a lot of support to do so. She has cognitive symptoms that would be extremely familiar to everyone here - memory problems, language problems, concentration problems, sensory overload to the point of severe distress and nausea if not managed properly (her home is permanently darkened and she wears sunglasses most of the time) and she becomes very tired and exhausted very fast during conversations or when put under cognitive load, particularly when stressed or already tired. It’s actually extraordinary how similar her symptoms are to mine.

Thankfully she was diagnosed by a neurologist who understood that this is a physical injury and that her symptoms are not “psychological”. There is no treatment for her condition, and having had it now for six years, she’s stuck with it for the rest of her life (PCS usually resolves within six months, but apparently if you have it for more than two years the damage is permanent). It is terrifying to think that people with traumatic brain injuries (because that is what PCS and concussion are, and they are not always “minor” or transient conditions despite what we are led to believe) could be told that they’re just suffering with depression - yes, depression can definitely be a symptom of concussion and PCS, and it can be both a pre-existing condition or a result of the changes the injury has wrought in someone’s life, but, like us, it’s not the cause of the condition.

This insistent and insidious psychologisation of medicine, from MUS to FND, is like a hydra - cut one “head” off and the next one appears in a different medical specialisation. When are these people going to realise that the emperor really isn’t wearing a white coat and stethoscope, and his attire is nothing but a mirage of poorly realised theories accessorised with more than a hint of ego?
 
Blueskytoo said:
This insistent and insidious psychologisation of medicine, from MUS to FND, is like a hydra - cut one “head” off and the next one appears in a different medical specialisation.
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I see the hands of insurance companies and government in this. Governments just want to save money in any fashion they can, and insurance companies don't want to pay out on their policies for long term healthcare - and they can achieve this by saying that all disease is effectively rooted in a mental health problem.
 
Arnie Pye said:
I see the hands of insurance companies and government in this. Governments just want to save money in any fashion they can, and insurance companies don't want to pay out on their policies for long term healthcare - and they can achieve this by saying that all disease is effectively rooted in a mental health problem.
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I have never understood why authorities and consumers allow insurers to exclude mental health disorders from health insurance cover. Is it because they believe mental health issues are easier to fake or that they are somehow self inflicted?

In general severely life disrupting mental health issues must be as distressing and as unwanted as physical conditions, and as much, if not more, vulnerable than biomedical conditions deteriorate from lack of appropriate support.

If both mental illness and physical illness were covered by health insurance, then the problem of insurers responding to financial pressure encourage medical biomedical conditions being miscategorised or misdiagnosed as mental illnesses would disappear.
 
Yes, to the above post. It's quite telling IMO that the BPS cabal has gone on at length about PwME stigmatising mental health by violently shouting that "their illness is physical dammit" because we do not want to be viewed as having mental ill health.

And the cabal further goes on at length about how mind and body are one. Therefore our (to them) mental health problems are "real" as they have a physical component.

And yet . . . never do you hear the BPS ever stand up for mental health by suggesting it should have parity with physical disease. In fact, quite the opposite. They have been trying pared down mental health help to group sessions online and if they could do that with a robot (AI) they would. How does that reflect their attitude toward mental health?

This "offering of help" is actually worse than doing nothing and no doubt contributes more to many a persons mental suffering after they realise that under that compassionate, caring visage is an sausage machine factory employee. And they may well have been misdiagnosed to boot.

And yes, no insurance coverage to take the time necessary to deal with their (mind-body it's all connected) condition.
 
Peter Trewhitt said:
I have never understood why authorities and consumers allow insurers to exclude mental health disorders from health insurance cover. Is it because they believe mental health issues are easier to fake or that they are somehow self inflicted?
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Every explanation I have seen was exactly this, that they are too easy to fake.

The other side of this is of course an admission that no one can tell either way, so that labelling something as mental illness is completely unreliable. Basically if a physician can't tell that something isn't mental illness, they sure as hell can't tell when it is, certainly not by the mere assertion of "you have anxiety/depression" with zero tests or even self-consistency. Somehow this is brushed aside because the house always wins.

One does have to question the morality involved here, that the people arguing this should understand that being unable to tell one way means the same the other way around. But that's easy to ignore given that it's a long-standing tradition. It's millions of lives but, you know, out of sight, out of mind.
 
rvallee said:
Every explanation I have seen was exactly this, that they are too easy to fake.
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One wonders how many people would be able to fake a serious mental illness that is such that it seriously disrupts their daily life and makes it impossible to work.

Also why would most people want to fake such an illness. I suspect the cost of such as severe depression or schizophrenia is far greater than any possible benefits from an insurance claim, so that a successful faker would be costing themselves more than they could possibly gain.

If the issue was differentiating transient and permanent conditions, then just conduct reviews.
 
rvallee said:
The other side of this is of course an admission that no one can tell either way, so that labelling something as mental illness is completely unreliable. Basically if a physician can't tell that something isn't mental illness, they sure as hell can't tell when it is, certainly not by the mere assertion of "you have anxiety/depression" with zero tests or even self-consistency. Somehow this is brushed aside because the house always wins.
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THIS!
 
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