The role of evidence-based guidelines in the diagnosis and treatment of functional neurological disorder, 2021, Tolchin, Baslet, Carson, Perez, Stone

Highlights

• Evidence-based guidelines use systematic reviews to support clinical recommendations.
• Adherence to evidence-based guidelines improves healthcare costs and patient outcomes.
• Recent randomized trials make guidelines for functional neurological disorders possible.

Abstract

Evidence-based clinical practice guidelines, based on systematic reviews of existing evidence, play an important role in improving and standardizing the quality of patient care in many medical and psychiatric disorders, and could play an important role in the diagnosis and treatment of functional seizures and other functional neurological disorder (FND) subtypes.

There are several reasons to think that evidence-based guidelines might be especially beneficial for the management of FND. In particular, the interdisciplinary and multidisciplinary teamwork necessary for the care of people with FND, the current lack of formal clinical training in FND, and the rapidly expanding body of evidence relating to FND all make guidelines based on systematic literature reviews especially valuable.

In this perspective piece, we review clinical practice guidelines, their advantages and limitations, the reasons why evidence-based guidelines might be especially beneficial in the diagnosis and treatment of FND, and the steps that must be taken to create such guidelines for FND. We propose that professional organizations such as the American Academy of Neurology and the American Psychiatric Association undertake guideline development, ideally to create a co-authored or jointly endorsed set of guidelines that can set standards for interdisciplinary care for neurologists and mental health clinicians alike.

Open access, https://www.sciencedirect.com/science/article/pii/S258998642100068X

 

Thank-you for posting this concerning article. It's like watching a bug exploit vulnerabilities in a system.

Eyeroll moment in the introduction:

"FND is associated with... increased dependence on public disability programs. There is a growing body of evidence suggesting that FND may be associated with significantly elevated healthcare costs... FND can be effectively treated with psychotherapy and physiotherapy..."

An unstoppable formula?

 

So they skipped the pretense for once and instead of studying themselves indirectly, now they are studying themselves directly. Holy narcissism Batman. What is this absolute nonsense? They are literally studying themselves to praise their own work and give it meaning removed from its context. It's so superficial and devoid of any substance that they have to directly prop it up by doing self-serving puff pieces on themselves.

This is such bird-brain thinking, it's hard to believe it got published. Basically like trying to argue "water is good, therefore our massive flooding strategy should be beneficial". The problem with their junk is that it's entirely devoid of evidence, so arguing for evidence-based medicine makes it even more absurd, their ideology isn't and it's not even close.

 

A researcher focuses their work openly and squarely on the “cost” of disabled people staying alive.

They find “costs” are rising. They express interest in reducing these.

We know. We understand the implications.

Again a researcher offers less and less concealment for a particular ideological perspective. Somehow they will find fault with the suffering subject.

Again a researcher has chosen to frame suffering as a sign of a failure on behalf of the suffer.

Again a researcher has chosen to absolve society of a responsibility to provide care for its members. Healthcare or social care or shelter water and food, they bulk at the “expense”.

A group of researchers have once more decided that to proceed with this aim they will first need to remove their subjects from the biological realm.

A right to biological care is established. So to remove this right from some requires repeated reinforcement.

A reframing of your subject as other than their presentation would suggest. Other than a patient with a straight forward need for medical care.


These researchers do not work on behalf of patients. They do not work on behalf of public health. They do not work to alleviate suffering. They do not work to treat pain.

These researchers work only for those who do not need their help. Those who will offer reward. Those with the power and influence to direct.

The researchers work to save the ruling class and corporate bodies from an obligation to pay the costs of public health.

These researchers work to convince the public to view disabled people as not worthy of the support to live.

These researchers work to undermine solidarity of the public for their fellow human beings.

These researchers work to convince the public that healthcare is too expensive for any State to support.

These researchers work to frighten the public into sacrificing their own into the fire of massive funding cuts to public services.

These researchers work is conceived and carried out and put into use, to facilitate the removal of the resources for life.

These researchers work is “associated” with eugenics.

These researchers work is “associated” with killings.

These researchers work is “associated” with the ecological collapse of our planet.

Disabled lives are devalued, in service of “cost saving”. All lives are allocated a monetary value. As it is for some, so it will be for all.

Hoarding of resources a by an unimaginably wealthy few escalates. Less is available to meet to “costs” to care for the population.

I would like to imagine that few of these researchers understand and embrace the full implications of their chosen course.

Still….

If these researchers are unable to contemplate the context and history that surrounds their work, this will not be for lack of ability or knowledge. They have passed through the higher education system. They have access to relevant information. Some of this is even presented to them during formal training.

Much of historical importance is concealed from certain audiences. One part of recent history that is not entirely reconstructed for European and colonial countries audiences is WW II. So many were slaughtered. Some of the first chosen for death were disabled people. This is both known and forgotten.

Let us assume that these researchers have failed to account for the scale of the suffering that is already in existence and would be further aided by their work.

None the less we cannot put this down to a lack of opportunity or capacity to do so. Rather it must be that they would find the contemplation of consequences rather unpleasant.

:::::::::::::::::::::::::::::::::::

Temporarily removing this study from all context, at a superficial level this study remains both unethical and void of scientific value.

I find an “association” in this research with language which is discriminatory inflammatory.

I find an “association” in this research with un-evidenced “associations” made repeatedly though out. I find that these are dis-favourable to the study subjects.

I find the conclusions to be “associated” with circular reasoning.

Someone who most certainly knows better, was incentivised to pass this study at the stage of ethical approval. A very frequent occurrence.


Perhaps the self interest of rapidly sickening peoples will provide some opposition, now?

 

1. Like, we knew that. Whether they should or not is unclear.
2. How do we know that? Maybe healthcare costs and patient outcomes improved because the healthcare professionals knew what was good value. Who knows whether or not this had anything to do with 'adherence to guidelines'.
3. Hardly, the trials look weak and at least some of them seem to give largely negative results.

This has the feel of that sketch where a female scientist played by John Cleese describes 'a theory that is all my own' about dinosaurs. (Anne Elk's theory about brontosauruses)

 

At least she had some evidence:

Presenter: You have a new theory about the brontosaurus.

Miss Elk: Can I just say Chris for one moment that I have a new theory about
the brontosaurus.

Presenter: Exactly. (he gestures but she does not say anything) What is it?

Miss Elk: Where? (looks around)

Presenter: No, no your new theory.

Miss Elk: Oh, what is my theory?

Presenter: Yes.

Miss Elk: Oh what is my theory that it is. Well Chris you may well ask me what is my theory.

Presenter: I am asking.

Miss Elk: Good for you. My word yes. Well Chris, what is it that it is - this theory of mine. Well, this is what it is - my theory that I have, that is to
say, which is mine, is mine.

Presenter: (beginning to show signs of exasperation) Yes, I know it's yours, what is it?

Miss Elk: Where? Oh, what is my theory? This is it. (clears throat at some
length) My theory that belongs to me is as follows. (clears throat at great
length) This is how it goes. The next thing I'm going to say is my theory.
Ready?

Presenter: Yes.

Miss Elk: My theory by A. Elk. Brackets Miss, brackets. This theory goes as
follows and begins now. All brontosauruses are thin at one end, much, much
thicker in the middle and then thin again at the far end. That is my theory,
it is mine, and belongs to me and I own it, and what it is too.

Presenter: That's it, is it?

Miss Elk: Spot on, Chris.

Presenter: Well, er, this theory of yours appears to have hit the nail on the head.

Miss Elk: And it's mine.

Presenter: Yes, thank you very much for coming along to the studio. Thank you.

Miss Elk: My pleasure, Chris...

Presenter: Next week Britain's newest wasp farm...

Miss Elk: It's been a lot of fun.

Presenter: Yes, thank you very much.

Miss Elk: Saying what my theory is.

Presenter: Yes, thank you.

Miss Elk: And whose it is.

 

Thanks I enjoy that!

I’ve not heard it before but it does sound rather familiar

 

@Ash 100 likes for post #5.

 

Thank you @Arnie Pye.

The post was inconsiderately long I appreciate you for reading.

I over read on BPS today.
In looking back I just realised I’ve posted in the wrong thread, so my words may or may not apply to this particular batch of bad research. I hope they don’t actually.

 

leads to this:

===
Chapter 14 - The role of the anterior and midcingulate cortex in the neurobiology of functional neurologic disorder
Author links open overlay panelJuan PabloOspina1RozitaJalilianhasanpour1David L.Perez2
https://doi.org/10.1016/B978-0-444-64196-0.00014-5
Get rights and content
Abstract

Functional neurologic disorder (FND)/conversion disorder is a prevalent and disabling condition at the intersection of neurology and psychiatry. Clinicians often report feeling ill-equipped treating patients with FND,
===
--- https://www.sciencedirect.com/science/article/abs/pii/B9780444641960000145

===

this stuff can sometimes feel[edit: /be] like 1930s all over again. watch out for burden/danger to society messages.

i want the cingulate cortex studied scientifically for executive dysnfcution and so on.

but not by pseudoscientists seeking defective human -> defective brain -> hysteria.

your disease is real, but not "real". the double quote school of ontology.

 

At any point in time, is there a guideline that advises people with neurological symptoms should have brain scans?

It seems there has never been for many erroneously and preemptively diagnosed as having some form of mental health problem.

Dish these people off to the dustbin, and save governments money. However, these people continue to suffer and live on life's fringes.