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Outcome measurement in functional neurological disorder: a systematic review and recommendations, 2020, Pick et al

Discussion in 'Other psychosomatic news and research' started by Andy, Mar 2, 2020.

  1. Andy

    Andy Committee Member

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    Chalder and Stone are among the authors of this.
    Open access, https://jnnp.bmj.com/content/early/2020/02/28/jnnp-2019-322180
     
    Andy, Mar 2, 2020
    #1
    Invisible Woman, Cheshire, Hutan and 3 others like this.
  2. Esther12

    Esther12 Senior Member (Voting Rights)

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    Their recommended outcomes (table 4) are all self-report questionnaires, aside from healthcare resource use. So the aim is to get FND patients to fill in questionnaires a bit more positively and bother doctors less?

     
    Last edited: Mar 2, 2020
    Esther12, Mar 2, 2020
    #2
    Invisible Woman, ladycatlover, feeb and 7 others like this.
  3. Mithriel

    Mithriel Senior Member (Voting Rights)

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    Patients go to a neurology clinic because they are experiencing neurological symptoms. The doctor finds that objective signs do not fit disease categories so they are given a diagnosis of FND

    The only outcome measure for any treatments offered is that the original presenting symptoms (all the symptoms!) are gone or minimised. How is that difficult?

    Nowadays they say that FND is not a disease of exclusion but can be shown by signs and brain imaging so it is easy to set objective outcomes.
     
    Mithriel, Mar 2, 2020
    #3
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  4. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    FND has features that make decisions regarding outcome measurement particularly complex.4 5 These include heterogeneity and variability of symptoms and the marked influence of attention, beliefs and expectations.6–8 Discrepancy between objective measures and patients’ subjective experiences of symptoms can also be a prominent feature.9 These aspects of FND potentially make objective ‘snapshot’ measures (eg, clinician-rated scales and objective performance tests) less reliable and valid. They also suggest that patient-rated outcomes may be particularly meaningful in this population.

    This seems plain stupid. If the problem is that outcome measures are affected by beliefs and expectations then patient-rated outcomes are going to be less reliable.
     
    Jonathan Edwards, Mar 2, 2020
    #4
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  5. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    I had to laugh when I read this. It sounds like they are observing that attention, beliefs and expectations influence how people report their symptoms and they interpret that as sign the illness is mysteriously arising from the mind.
     
    Hoopoe, Mar 2, 2020
    #5
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  6. Hutan

    Hutan Moderator Staff Member

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    Yes.
    And the first part of that sentence is equally laughable.
    If you are going to create a category of illnesses that lumps people together with 'tremor, dystonia, limb weakness, numbness and seizures' along with various
    then don't be surprised if people laugh at you when you bleat about the complex situation you have to cope with because of the heterogeneity and variability of symptoms.
     
    Hutan, Mar 2, 2020
    #6
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  7. Sean

    Sean Moderator Staff Member

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    These aspects of FND potentially make objective ‘snapshot’ measures (eg, clinician-rated scales...

    FFS, what is objective about clinicians rating self-report symptoms?
     
    Sean, Mar 3, 2020
    #7
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  8. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Yesterday upon the stair
    I met an illness that wasn't there
    (According to SF36) it wasn't there again today
    But Dr Stone will make it go away!
     
    Jonathan Edwards, Mar 3, 2020
    #8
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  9. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    The patient enters the room and rates their SF36 score as 60.

    The patient is then subtly given the message that the illness is a product of their mind and that there isn't anything wrong with their body and that they shouldn't view their symptoms the way they do now.

    Before leaving, the patient rates themselves at 70. The therapist is thrilled at their own ability to treat psychosomatic disease and is pleased to once again have seen confirmation that it can be treated by manipulating the patient's cognition.
     
    Last edited: Mar 3, 2020
    Hoopoe, Mar 3, 2020
    #9
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  10. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

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    The improvement does not correlate with objective performance tests indicating these are less reliable and valid and should, therefore, be avoided.

    The treatment effect disappears at follow-up. The illness is mysterious. Booster sessions are advised. The patient needs more psychosomatic therapy.
     
    ME/CFS Skeptic, Mar 3, 2020
    #10
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  11. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    One of the therapists, while discussing the topic with colleagues, wrings her hands and says that they could achieve even better results if the patients weren't so resistent to the therapy.
     
    Hoopoe, Mar 3, 2020
    #11
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  12. Hutan

    Hutan Moderator Staff Member

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    It is determined that it is the parents (in the case of young people with MUS) and the partners (in the case of people with MUS with partners) who are facilitating this resistance. It is proposed that therapy be extended to these facilitators.
     
    Hutan, Mar 3, 2020
    #12
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  13. Invisible Woman

    Invisible Woman Senior Member (Voting Rights)

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    The b*****ds just don't want to get better!!!
     
    Invisible Woman, Mar 3, 2020
    #13
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  14. Daisybell

    Daisybell Senior Member (Voting Rights)

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    The striking consistency of the results of trials looking into this issue further encourages the researchers that they are definitely right. They work towards proposing that most, if not all, illness fits neatly into their model of perpetuation.
     
    Daisybell, Mar 3, 2020
    #14
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