Functional neurological disorder: Characteristics and outcome in a limited-resources country (Sudan), 2020, Osman et al

[Andy]

Background
There is a scarcity of reports from limited-resources countries on functional neurological disorder (FND). We therefore carried out this descriptive study from Sudan to highlight the clinical characteristics of patients and the cultural, diagnostic, and management outcome.
Method
Of 1000 new referrals and patients seen at a central neuropsychiatric clinic in Khartoum, Sudan, 40 fulfilled the criteria for FND. Subjects were diagnosed by excluding organic illness and confirming psychological distress through neuropsychological assessment and clinical interview. Mood was measured using the Beck Depression Inventory (BDI) and Hospital Anxiety and Depression (HAD) scales.
Results
Young unemployed women constituted 60% of our sample. Most subjects presented with psychogenic nonepileptic seizures (82.5%), speech abnormalities (47.5%), and limb paralysis or weakness was (35%). Associated mood disorder was found in 97.5% of all subjects. However, 95% of our sample showed a remarkable clinical response to combination therapy (antidepressants and psychotherapy).
Significance
Patients with FND showed strong evidence of comorbid affective disorders in the form of depression and anxiety disorder. Most patients (95%) responded well to combination therapy with antidepressants and psychotherapy. Sociodemographic correlates of FND in Sudan prove to be consistent with features found in Western cultures, with only minor idiosyncratic characteristics due to local culture.

Paywall, https://www.epilepsybehavior.com/article/S1525-5050(20)30330-9/pdf
Not available via Sci hub at time of posting.

 

[rvallee]

Weird how it was confidently argued for decades, and largely still is, that a primary driver for "FND"/MUS is secondary benefits, which no more exist in Sudan than they do in Sweden, and that as such this was largely a first-world affliction. Makes total sense to find this "affliction of modern life" in a largely agrarian society with no safety nets.

Nothing that can't be shrugged away using the very scientific and rational method of "don't care".

 

[Arnie Pye]

If people in Sudan present to doctors with mental health problems it really isn't very surprising.

Top 10 Facts About Living Conditions in Sudan

Top 10 Facts About Girls’ Education in Sudan

Searching this website for "Sudan" brings up loads of info, including the above links I gave :

https://borgenproject.org/

The research as it stands has a slant that in some cultures could actually make living even more precarious than it already is. Labelling people as mentally ill in some cultures could end up with them being stoned to death, beaten, raped, shot etc.

Diagnosing FND, whether you believe in it or not, should be bottom of the list of anyone's priorities. The people need food, healthcare (for physical ailments), sanitation, and education before they need treatment for FND. If you fix those issues then cases of FND might actually drop.

The research described in post #1 just makes me feel embarrassed that someone could be so tone-deaf.

 

[Hutan]

Sudan has been plagued by one of the longest and deadliest civil wars in the world. For the past 27 years, President Omar al-Bashir has clung to power in a brutal fashion, including the 2003 genocide in Darfur that drew international condemnation. Fighting between the Sudanese government and southern rebels finally cooled in 2011 when an almost unanimous referendum granted what is now South Sudan independence. However, the violence within Sudan continues today. The constant war weighs heavy on the civilian population as more than 2 million people remain displaced in Darfur, with a PTSD prevalence of 55 percent in some areas.

The most interesting thing about that abstract to me is that, despite the dire conditions in Sudan for decades, only 40 people out of a 1000 people referred to a neuropsychiatric clinic there fulfilled the criteria for a Functional Neurological Disorder. If FNDs are caused by people not coping with the stresses of their life and childhood trauma and PTSD, surely a much greater percentage of the people referred to the clinic would have FNDs?

 

[Woolie]

 

[rvallee]

The most interesting thing about that abstract to me is that, despite the dire conditions in Sudan for decades, only 40 people out of a 1000 people referred to a neuropsychiatric clinic there fulfilled the criteria for a Functional Neurological Disorder. If FNDs are caused by people not coping with the stresses of their life and childhood trauma and PTSD, surely a much greater percentage of the people referred to the clinic would have FNDs?

Yeah I'm going to go ahead and boldly suggest that people who have lived their entire lives in a civil war-torn country have it slightly more difficult than privileged Victorian era city folks in England who had the means to consult a psychiatrist. One would expect slightly more of this malady of the soul in truly harsh conditions.

Bold, I know. I mean it's not as bad as not achieving everything in a privileged life but surely it must be somewhat hard.