FNDs, disorders to be managed by neurologists, or are neurologists wandering in a dangerous field with inadequate resources 2023 Onofrj et al

Full title: Functional Neurologic Disorders, disorders to be managed by neurologists, or are neurologists wandering in a dangerous field with inadequate resources?

In recent years, some neurologists reconsidered their approach to Medically Unexplained Symptoms and proposed Functional Neurologic Disorders (FND) as a new entity, claiming that neurology could offer alternative treatment options to the psychotherapies provided in psychiatry settings. FNDs, for this purpose, should include only the disorders listed as Conversion from the Somatic Symptom and Related Disorders (SSRD) group.

The present review analyzes the rationale of this position and challenges the arguments provided for its support. The review also discusses the systematization of these disorders as provided by public health systems. It outlines risks stemming from economic support and public funding uncertainty, given their negligible epidemiological dimensions resulting from the parcellation of SSRD. The review underlines the unresolved issue of Factitious Disorders, which are in the same SSRD category of the international classification but are, nonetheless, overlooked by the theoretical proponents of the FND entity. Comorbidity with other psychiatric disorders is also analyzed. We propose a model that supports the continuum between different SSRD conditions, including Factitious Disorders. The model is based on the emergence of feigned death reflex and deception from frontal lobe dysfunction.

Finally, the paper summarizes the wealth of historical psychiatric and psychodynamic approaches and critical reviews. The study also puts in context the categorization and interpretation efforts provided by the most eminent researchers of the past century.

Open access, https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1120981/full

 

"The arguments in favor of a neurologic reclassification of FND

The prevalence of patients with FND or Medically Unexplained Symptoms (MUS, including fibromyalgia, chronic fatigue syndrome, and reflex sympathetic algodystrophy/causalgia) in neurology clinics is estimated to be around 16–30% (2). Several authors have described such a high prevalence as representing a crisis, or a silent epidemic (8), invoking calls for newer approaches to reaching out to help patients with FND. As an extreme example of the attitude, an authoritative editorial wrote that “the patients do not want to hear that they have a psychiatric disorder and they go from doctor to doctor, psychiatrists do not seem interested anyway, and the prognosis is terrible” (19), and the concept was plainly reported in a very recent paper"