The importance of screening for functional neurological disorders in patients with persistent post-concussion symptoms 2023 Debert, Silverberg et al

BACKGROUND:Functional neurological disorder (FND) may commonly co-occur with persistent symptoms following a psychological trauma or physical injury such as concussion.

OBJECTIVE:To explore the occurrence of FND in a population with persistent post-concussion symptoms (PPCS) and the associations between FND and depression as well as anxiety in participants with PPCS.

METHODS:Sixty-three individuals with PPCS presenting to a specialized brain injury clinic completed the following questionnaires: screening for somatoform disorder conversion disorder subscale (SOM-CD), Rivermead post-concussion symptom questionnaire (RPQ), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder questionnaire- 7 (GAD-7). Both multiple linear regression and logistic regression were conducted to evaluate the relationship between questionnaires and adjust for covariates.

RESULTS:We found that total RPQ score ( βˆ = 0.27; 95% CI = [0.16, 0.38]), GAD-7 score ( βˆ = 0.71; 95% CI = [0.50, 0.92]) and PHQ-9 score ( βˆ = 0.54; 95% CI = [0.32, 0.76]) were positively associated with SOM-CD score individually, after consideration of other covariates. Participants meeting the criteria for severe FND symptoms were 4.87 times more likely to have high PPCS symptom burden (95% CI = [1.57, 22.84]), 8.95 times more likely to have severe anxiety (95% CI = [3.31, 35.03]) and 4.11 times more likely to have severe depression symptom burden (95% CI = [1.77, 11.53]).

CONCLUSION:The findings of this study indicate an association between FND and post-concussion symptoms as well as an association between FND and symptoms of depression and anxiety in patients with PPCS. Patients with PPCS should be screened for FND to provide a more targeted treatment approach that includes somatic-focused interventions.

Paywall, https://content.iospress.com/articles/neurorehabilitation/nre237002

 

But... they literally can't tell the difference. How do they even think they're differentiating from the symptoms of the concussion here? They simply ask about symptoms. And it's pretty obvious and common sense that people who had concussions will score some points on questionnaires of depression and anxiety, they literally ask about similar symptoms. They're not supposed to be conflated with symptoms of illness or injury.

All they have are associations and they all make sense as consequences of concussions. If anything, they're actually showing how silly the construct is, since everyone with any illness will rate at least some way on their rating scale, since they built it by asking about the same common symptoms. Good grief this is a hubristic clown show.

 

Erm given the first correlation that they saw was that there was a strong correlation between those who had severe post-concussion symtpoms and their claimed 'FND score' then aren't all of the inferences they have made in their conclusion actually about the real construct of post-concussion syndrome, and have nothing to do with validating a scale that doesn't seem to differentiate itself. As per usual this is behind a paywall with little detail and so I have no idea what questions are in the 'somatoform-conversion scale' but there are only 30 (vs some which are 90 apparently, which sounds like fun for someone with brain or cognitive issues to have to deal with).

I can't help but feel with a lot of these things, like when they put those with ME/CFS through ridiculous amoutns of questionnaires after you suspect they've been bombarded by a therapist being inappropriate for their cognitive pace and made them ill, after a journey and who knows if there was a wait or uncomfortable chair, that a lot of these methodologies are more showing individuals taking advatnage/being opportunistic with the most vulnerable individuals specifically targeting their vulnerability because they know they are the most manipulable on their various techniques and manipulations.

Because they are desperate to get home, because they struggle to find words, because of the lack of support to protect them and because........ and I don't know why not, inappropriately there is not a big old safeguarding flag saying if someone hs a condition that gives them cognitive fatigue then hammering with leading questions or bombarding with 'combative techniques' isn't 'helping them' but... I can think of a lot of other terms - then claiming they've 'discovered something'

I find it tasteless and struggle to believe this isn't a topic and issue that is being talked about all over the place for the last decade - just because someone says 'help' instead of 'not checking harm whilst I get the results I want without designing around the limitation of the patients' seems to provide some look the other way free pass. Which seems to be being used towards suggesting putting the poor people into treatment for a condition they haven't differentiated from the one they are/should be being treated for, but could well undermine/contradict it?

 

It was interesting because yesterday (or maybe say before) I watched the daily politics show for a bit and, in relation to another topics (I think the getting sick people to get jobs working from home) Chris Bryant MP noted he worked closely with people with brain injuries and a big issue there was a tendency to want to ‘people please’ - EDIT: he put it a lot better than I have but he meant when in a conversation where someone is 'encouraging' etc.

I was so pleased to see this finally being mentioned as an issue because it’s certainly the case for pwme or at least many of them when faced with manipulative/'assertive' communication techniques and particularly when they are being exhausted by such techniques being entirely unkind and inappropriate to the very disability that -if they really knew psychology and cared about psychological health - would be what they’d be focusing on and understanding and adapting to as kind and not callous people manage innately.

I have to say it but I do see the conditions and demographics chosen by these psychosomatic people and the techniques and methods they use (opposite of what they should be doing from a safeguarding and accessibility perspective) and it’s been so long and do many and so specific to the most vulnerable I. This way conditions I can’t help but think this whole phenomenon is about staff with certain personality and ideology and manipulative issues having sought out the most vulnerable and a subject allowing them to do the opposite of what they should re health or medicine but actively taking advantage by designing methods that exploit being allowed to metaphorically ‘foot on neck’ with these disabilities by exhausting with ambiguously written questions bonbarded at them by domineering people and the impact being people giving answer that you want.

 

I have no idea whether the two questionnaires are related (as this one is 9 questions, the one in this link is 15), however having read the followigg paper which includes Sharpe, Stone, Carson saying that the PHQ 15 doesn't identify people with unexplained symptoms better than chance I thought I'd do a quick google in case there were papers for which this reference might be relevant:

Somatic symptom count scores do not identify patients with symptoms unexplained by disease: a prospective cohort study of neurology outpatients - PubMed (nih.gov)

Conclusions: Self-rated symptom count scores should not be used to identify patients with symptoms unexplained by disease."

To discuss this paper, go to this thread:
Somatic symptom count scores do not identify patients with symptoms unexplained by disease: a ... study of neurology outpatients, 2015, Carson, Sharpe