Review The Impact of Depression, Anxiety and Personality Disorders on the Outcome of Patients with Functional Limb Weakness... 2023 Calma, Perez, Stone et al

Andy

Andy

Retired committee member
Full title: The Impact of Depression, Anxiety and Personality Disorders on the Outcome of Patients with Functional Limb Weakness – Individual Patient Data Meta-Analysis

Objective
Psychiatric comorbidities such as depression, anxiety, and personality disorders are common in patients with functional limb weakness/paresis (FND-par). The impact of these conditions on the prognosis of FND-par has not been systematically reviewed. The aim of this study was to identify a potential prognostic effect of comorbid depression, anxiety, and/or personality disorder on prognosis in patients with FND-par.

Methods
A systematic review was performed to identify studies that reported measures of baseline depression, anxiety, and/or personality disorder, and physical disability. An individual patient data meta-analysis was subsequently performed.

Results
Eight studies comprising 348 individuals were included (7 prospective cohorts; 1 case-control study). There was heterogeneity in sample size, follow-up duration, and treatment modality. Depression and anxiety were present in 51.4% and 53.0% of FND-par patients, respectively. In individuals whose FND-par improved, there was no significant difference between those with versus without depression (52.6% vs 47.4%, p = 0.69) or those with versus without anxiety (50.3% vs 49.7%, p = 0.38). Meta-analysis showed no clear impact of baseline depression or anxiety per se [pooled OR for depression 0.85 (95%CI 0.50–1.45; p = 0.40) and anxiety 0.84 (95%CI 0.51–1.38; p = 0.91)]; and of depression or anxiety severity [pooled OR for depression 1.23 (95%CI 0.63–2.39; p = 0.91) and anxiety 1.40 (95%CI 0.70–2.78; p = 0.58)] on FND-par outcome. Insufficient data were available to assess the impact of personality disorders.

Conclusion
We found no evidence that depression or anxiety influenced outcome in FND-par. Large-scale, prospective studies in FND-par, and other FND subtypes, are needed to fully contextualize the impact of concurrent mental health concerns on outcomes.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0022399923003707
 
What's going on? Another review finding that commonly held beliefs that prop up the "functional disease" construct don't hold up. And this one has Jon Stone as an author.

So, it seems that neither depression nor anxiety (and neither presence nor severity of these problems) have any impact on the chance of recovery.
 
Hutan said:
So, it seems that neither depression nor anxiety (and neither presence nor severity of these problems) have any impact on the chance of recovery.
Click to expand...

And David Perez, the US version of Jon Stone/Alan Carson. And since this review produced bupkus, they need "large-scale, prospective studies" to try to find the evidence that this study did not produce. And interestingly, in this paper at least they did not trot out the false claim that a seminal 2010 study showed FND to be the second-most common presentation--the claim I have been trying to correct for months.
 
FND is an in-your-face-Science! moment; you'd think there'd be more Scientists stepping forward in outrage to call out the fact that it exists. After all, it's an affront to to what Science strives for. It is unScience.

My brain is struggling to find the words. I'm sure it's an "im" or "in" word.

It is Science impudence. Science impedence. Science incompetence. Science inchoate. Science incoherence. Science incontinence.

Too many in that category. Let's return an "un" string:

Science undone.

There.
 
So the state this quackery is in: having asserted for decades that all those things are the causative and perpetuating mechanisms of conversion disorder, they can't even support the notion of an association, and their conclusion is that more research is needed.

Because they made up all those explanations and showed many diagrams with boxes and arrows showing explicit causative processes, going back decades. Those are also the explanations they give out whenever they use "education" as a therapeutic tool, and in trials where they "test" the "education" as a treatment. Education based on speculation about causative mechanisms that can't even be supported as mere associations.

Somehow, though, it will change nothing. They will keep asserting those things, I think everyone here is fully aware of that. And those new-but-also-identical assertions will keep being published and repeated verbatim to patients, to peers and written down as actual evidence. Somehow.

Now of course there is a point to make that both the quantity and quality of this evidence is very poor. But it also undermines the very credibility of having made those assertions, especially since the research followed the assertions, which are well over a century old. And that much of that very poor evidence was made by them. I guess they'll really mean it next time? I don't know. This is all impossible to understand.

But the assertions are a belief system, so they will keep on being believed. I guess this is why they have no problem publishing research undermining their whole thing: evidence literally doesn't matter here. They'll probably cite this paper with a few chosen cherry-picked parts to support some partial assertion or another and no one will care. It will get them more funding to do more of the same old. Somehow. Because the quantity and quality of their past work is very low. Somehow in this ideology, it works out to handing out yet more resources to waste doing the same old failed things to the same people who have made assertions not only without evidence, but even against evidence.

What an odd thing to exist. This truly is the exact equivalent of a $1B/year astrology department at NASA. It completely baffles the mind, but you can't argue against beliefs. They are deeply held, and of course projected onto us, turning a flaw into a strength. Somehow. Just baffling.
 
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From @MSEsperanza:

There has been a follow-up and an update on @dave30th's blog post.

From the 'follow-up' on 2023-10-19/ David Tuller:
https://virology.ws/2023/10/19/trial-by-error-a-follow-up-on-anxiety-and-depression/

UPDATE:

Physical therapist Zachary Grin, whose criticism prompted this follow-up post, has posted a response, so I have highlighted it right below this introduction. He continues to believe I misrepresented the study.

I continue to disagree. Prognostic factors, as he notes, are baseline characteristics. (In this case, “baseline” means mid-illness, so these are not presented here as pre-existing conditions.) Despite the statement that the study focuses on the “prognostic” value of these factors, the investigators throughout—and not just in the title and abstract—refer to the “impact,” the “effects” and the “influence” of anxiety and depression on “outcomes.” To me this usage is indisputably causal and can only be read as referring to whether anxiety and depression directly make things worse—that is, whether they perpetuate the illness.
Click to expand...
 
I wonder if anyone does research to the effect of giving a patient this label and when symptoms get worst and the doctor dismissal of symptoms and further investigations, the depression and anxiety the label caused
 
ToneAl said:
I wonder if anyone does research to the effect of giving a patient this label and when symptoms get worst and the doctor dismissal of symptoms and further investigations, the depression and anxiety the label caused
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Unfortunately, I don't think anyone can actually do such research.

We will create quantum computers able to fully simulate physical matter and have commercial nuclear fusion before humans develop the ability to self-reflect to this degree. And probably general artificial intelligence.

Turns out that the social sciences are actually the hard ones. General intelligence is so much harder than being a specialist. The future belongs to generalists (although I may be strongly biased here, I still think it will hold up).
 
ToneAl said:
I wonder if anyone does research to the effect of giving a patient this label and when symptoms get worst and the doctor dismissal of symptoms and further investigations, the depression and anxiety the label caused
Click to expand...
Yeah, interesting how the psychosocial crowd only seem to worry about iatrogenic danger with biomedical explanations, never with the psychosocial ones.

There is definitely a big psychosocial component to our problems, but it is with how we are viewed and treated by the advocates of psychosocial factors. In other words, it is a secondary and contingent phenomenon, not a primary one.
 
Sean said:
Yeah, interesting how the psychosocial crowd only seem to worry about iatrogenic danger with biomedical explanations, never with the psychosocial ones.

There is definitely a big psychosocial component to our problems, but it is with how we are viewed and treated by the advocates of psychosocial factors. In other words, it is a secondary and contingent phenomenon, not a primary one.
Click to expand...
When a biological cause is found the doctors pushing this never discuss the harm they do or they try to explain it using functional overlay. Or the harm they do when advocating psychology or rehabilitation treatments.
 
rvallee said:
So the state this quackery is in: having asserted for decades that all those things are the causative and perpetuating mechanisms of conversion disorder, they can't even support the notion of an association, and their conclusion is that more research is needed.

Because they made up all those explanations and showed many diagrams with boxes and arrows showing explicit causative processes, going back decades. Those are also the explanations they give out whenever they use "education" as a therapeutic tool, and in trials where they "test" the "education" as a treatment. Education based on speculation about causative mechanisms that can't even be supported as mere associations.

Somehow, though, it will change nothing. They will keep asserting those things, I think everyone here is fully aware of that. And those new-but-also-identical assertions will keep being published and repeated verbatim to patients, to peers and written down as actual evidence. Somehow.

Now of course there is a point to make that both the quantity and quality of this evidence is very poor. But it also undermines the very credibility of having made those assertions, especially since the research followed the assertions, which are well over a century old. And that much of that very poor evidence was made by them. I guess they'll really mean it next time? I don't know. This is all impossible to understand.

But the assertions are a belief system, so they will keep on being believed. I guess this is why they have no problem publishing research undermining their whole thing: evidence literally doesn't matter here. They'll probably cite this paper with a few chosen cherry-picked parts to support some partial assertion or another and no one will care. It will get them more funding to do more of the same old. Somehow. Because the quantity and quality of their past work is very low. Somehow in this ideology, it works out to handing out yet more resources to waste doing the same old failed things to the same people who have made assertions not only without evidence, but even against evidence.

What an odd thing to exist. This truly is the exact equivalent of a $1B/year astrology department at NASA. It completely baffles the mind, but you can't argue against beliefs. They are deeply held, and of course projected onto us, turning a flaw into a strength. Somehow. Just baffling.
Click to expand...
Religion / cult ?
Has all the attributes
 
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