The clinical management of functional neurological disorder: A scoping review of the literature 2022 Sweetman, van der Feltz-Cornelis et al

[Andy]

Highlights

• Diagnosing FND is a challenging process for clinicians and patients.
• There is limited information on the experiences of FND patients accessing services.
• Research is prioritising tests which confirm a diagnosis rather than ‘ruling-out’.
• Negative attitudes and stigma from clinicians to FND patients have been reported.
• Further research is needed to establish how FND patients can be better supported.

Abstract

Objective
To date, there have been no reviews bringing together evidence on the clinical management of functional neurological disorder (FND) and patients', caregivers', and healthcare workers' experiences. This review provides an overview of the literature focused on the clinical management of FND.

Methods
Four databases were searched, and a consultation exercise was conducted to retrieve relevant records dated from September 2010 to September 2020. Articles documenting diagnostic methods, treatments or interventions, or the experiences and perspectives of patients and healthcare workers in the clinical management of FND were included.

Results
In total, 2756 records were retrieved, with 162 included in this review. The diagnostic methods reported predominantly included positive clinical signs, v-EEG and EEG. Psychological treatments and medication were the most reported treatments. Mixed findings of the effectiveness of CBT were found. Haloperidol, physiotherapy and scripted diagnosis were found to be effective in reducing FND symptoms. Several facilitators and barriers for patients accessing treatment for FND were reported.

Conclusion
The literature describing the clinical management for FND has increased considerably in recent times. A wide variety of diagnostic tools and treatments and interventions were found, with more focus being placed on tests that confirm a diagnosis than ‘rule-out’ tests. The main treatment type found in this review was medication. This review revealed that there is a lack of high-quality evidence and reflects the need for official clinical guidelines for FND, providing healthcare workers and patients the support needed to navigate the process to diagnose and manage FND.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399922004068

 

[Sean]

The main treatment type found in this review was medication.

Which doesn't exactly support psychogenic causation.

This review revealed that there is a lack of high-quality evidence...

Yet...

...and reflects the need for official clinical guidelines for FND, providing healthcare workers and patients the support needed to navigate the process to diagnose and manage FND.

Dare I suggest a much more rigorous and honest assessment of the whole FND concept would be more productive.

 

[CRG]

"The main treatment type found in this review was medication."
Which doesn't exactly support psychogenic causation.

I'm afraid the medication approach suggests a strong research commitment to psychogenic causation.

"3.2.2. Medication

Medication (such as antidepressants, anti-epileptics, and benzodiazepines) was investigated in 15 studies. One RCT [32] compared the effect of midazolam versus haloperidol and found that haloperidol was significantly more effective in managing FND symptoms than midazolam. Another RCT investigating haloperidol and quetiapine found that both reduced FND symptoms, but fewer side effects were reported in the quetiapine group [33]. Kale and colleagues [34] found that adrenergic modulation therapy was beneficial in reducing PNES. However, in studies comparing medication to psychological treatment, the latter was found to be more effective in reducing FND symptoms [35,36]."

From the treatment list in Table 2.

haloperidol
midazolam
quetiapine
Sertraline
Antidepressant drugs unspecified
Propanolol
Prazosin
Clonidine
Antipsychotic drugs unspecified
Anti-epileptic drugs unspecified
Beta-blockers
Benzodiazepines

 

[Arnie Pye]

Wow. So doctors think these people with functional disorders are mentally ill i.e. not really physically ill, but they have to make the patient's condition worse by prescribing lots of addictive drugs with severe withdrawal effects? Yup, compassionate medicine in action [/sarcasm off]

 

[rvallee]

Research is prioritising tests which confirm a diagnosis rather than ‘ruling-out’.

Falsification is a cornerstone of science. When you avoid falsification, that's a giant tell.

Negative attitudes and stigma from clinicians to FND patients have been reported.
Further research is needed to establish how FND patients can be better supported.

I'll give you that one for free: go away, then the real work can finally begin. Psychosomatic ideology is nothing but a self-serving anchor, dead weight dragging us all down.

File under: when that doesn't clue you in

scripted diagnosis were found to be effective in reducing FND symptoms

that this is all performative. Potemkin medicine. The inability to learn anything or adapt to contradictory evidence is shocking. This is exactly what scientists aren't supposed to do, the entire point of experts is to have exactly this ability to self-reflect and grow knowledge, not obsess over trivial nonsense.

 

[ToneAl]

Falsification is a cornerstone of science. When you avoid falsification, that's a giant tell.

I'll give you that one for free: go away, then the real work can finally begin. Psychosomatic ideology is nothing but a self-serving anchor, dead weight dragging us all down.

File under: when that doesn't clue you in

that this is all performative. Potemkin medicine. The inability to learn anything or adapt to contradictory evidence is shocking. This is exactly what scientists aren't supposed to do, the entire point of experts is to have exactly this ability to self-reflect and grow knowledge, not obsess over trivial nonsense.

Or maybe they are making it up along the way because they have no knowledge only beliefs. So they continue in cirlces and no one is brave enough to question their beliefs or ideals. We see it numerous time in academic papers where peer reviews are just rubber stamps