Longitudinal outcome of Functional Neurological Disorder in Children and Adolescents in a Tertiary Care centre from Northern India 2022 Rohatgi et al

[Andy]

Abstract

FND is common in Indian children and adolescents. Outcome related factors are not well known. With objective to study short-term outcome of FND, prospective, longitudinal, nine months follow-up study of 6–16 years was planned. Socioeconomic, clinical variables, I.Q. and personality traits at baseline and new psychiatric/physical illness, psychosocial factors and comorbidities during follow-up were assessed. Out of 68 children, scholastic (64.7%) and family problems (23.5%) were common psychosocial factors. After nine months,73% achieved remission. Reasons for non-remission were persistence of psychosocial factors and psychiatric comorbidities. A need arises for increasing awareness among general practitioners for early identification and management.

Paywall, https://www.sciencedirect.com/science/article/abs/pii/S1876201822003306

 

[alex3619]

FND is common in Indian children and adolescents.

Objective diagnostic test? Or FND based on dubious diagnostic criteria? I think we know the answer to this.

Reasons for non-remission

Don't they mean either associations or attributions? Claimed reasons need to be distinguished from proven reasons.

for early identification and management.

Really?

 

[rvallee]

Not to diss on sociology, but even by the standards of sociological research, this is garbage-tier.

Really have to come up with terms that even the very best evidence in EBM is significantly below the bare minimum used in other professions, and this here is as much below the best EBM out there as systematic reviews are below the normal standards used in professional settings, where if evidence is not predictive, it's useless.

Biology and physiology are hard sciences. This is poop-tier soft pseudoscience.

 

[CRG]

I think this a case where understanding the specific society and culture in question is necessary to have a full grasp of what the paper is describing.

Some unpicking can be done but I don't think to any point of clear resolution. The authors equate FND with "Hysteria" by referencing a (small) 1993 paper: Characteristics of a Child Inpatient Population with Hysteria in India and go on to acknowledge this has historically been diagnosed at five to fifteen times higher in India than the rest of the world average. The hysteria paper has this to say:

"Children with hysterical symptoms form a notable proportion of cases in child guidance and psychiatry clinics in India. It could be that, in this culture, having a “medical” illness is one of the more acceptable means of seeking psychiatric help. The use of a structured and intensive inpatient treatment package appeared to bring about rapid symptom remission."

Mental health is challenging in all settings, but dealing child and adolescent mental health is particularly difficult and getting to grips with that across cultural boundaries is no simple task. That Indian doctors are making exceptionally high rates of FND/hysteria diagnoses in children might represent profound levels of 'misdiagnosis', or it might represent a diagnosis that has a fundamentally different function within Indian society than within Europe and the Anglophone countries, or it may be that in Indian culture the voice of a child is only effectively heard when physical but not psychological illness or distress is presented. This latter might be considered an epistemic injustice, which might be between child and and parents, child and doctor, parents and doctor or between family and societal norms.

If the quoted prevalence figure is correct then there are potentially tens of millions of Indian children diagnosed with FND/hysteria although the imbalance in health between rural/urban and rich/poor means this exceptionally high number is probably unlikely, however the potentiality of such large numbers alone fundamentally affects what the diagnosis may mean in India compared to Europe and the Anglophone countries.

 

[rvallee]

Children with hysterical symptoms form a notable proportion of cases in child guidance and psychiatry clinics in India. It could be that, in this culture, having a “medical” illness is one of the more acceptable means of seeking psychiatric help

I will always remain baffled at how psychiatry, a branch of medicine, does not think it deals with medical issues. Or something like that. It's very unclear and frankly keeping this mysterious appears somewhat similar to how the Catholic church kept mass in Latin for so long, so that people wouldn't know what it says.

They say it straddles issues in psychology, biology and sociology, but there is zero formal knowledge from any of those, it's strictly speculative and rhetorical. Not even biology, the technology doesn't exist yet and only technological progress makes a real difference here. So it's a little knowledge from many areas that amount to nothing.

As you note, this is obviously cultural, and oddly enough that's often mentioned. Except it's not the patients' culture, it's mostly the psychiatrists. Just like the Victorian psychiatrists who invented the fundamentals of psychosomatic ideology were certain that this was a thing that only exists in cities, because this is where they lived and worked and people from rural areas really had no reason to go see a city psychiatrist for medical problems, and would not be referred to by whatever passed for a rural doctor around where they lived.

This is really a problem of perspectives. Multiple perspectives are needed to understand a complex issue. From the start psychiatrists have brought a singular perspective that has not shifted since, and has never incorporated, or bothered listening, to the perspective of patients. In fact the basis of the BPS ideology stems directly from rejecting that perspective, and preferring a fantasy one where illness is not even real, only disease is.

 

[Sean]

Mental health is challenging in all settings, but dealing child and adolescent mental health is particularly difficult and getting to grips with that across cultural boundaries is no simple task. That Indian doctors are making exceptionally high rates of FND/hysteria diagnoses in children might represent profound levels of 'misdiagnosis', or it might represent a diagnosis that has a fundamentally different function within Indian society than within Europe and the Anglophone countries, or it may be that in Indian culture the voice of a child is only effectively heard when physical but not psychological illness or distress is presented.

And this lack of clarity is what happens when you don't use adequate controls.