Preventing the risk of iatrogenic harm when assessing and diagnosing [FND]s and other functional somatic symptoms 2024 Stanghellini et al

Abstract

The present commentary raises some concerns about the risk of iatrogenic harm arising out of the diagnosis of functional neurologic and somatic disorders. These concerns are supported by evidence from the history of hysteria and findings from contemporary brain imaging. We discuss their implications for practice.

Open access, https://www.cambridge.org/core/jour...tic-symptoms/9E610E0A022686FD8FA6B70FD37B85B4

 

This seems to be some Italian psychiatrists complaining that Jon Stone is pinching their hysterical patients. It repeats all the nonsense about clinics being full of functional patients @dave30th !

The pomposity of the claim to deep knowledge of the inner workings of peoples' minds is even worse than mine.

 

worse than your what?? Yes, they think Stone et al have gone way too far in "de-psychologizing" hysteria into brain networks alone and this is causing patients damage, since some of them just want a medical term to fulfull their huge desire to have a "sick role" and get attention.

 

Wow

Misses the harms of misdiagnosis completely.

Repeats all the 'usual' - patronising view of patients; clinics overflowing etc.

Fails to define what an FND is. What conditions comes under the umbrella - other than those J Stone et al think. Just like MUS. A random list of conditions that we don't understand that much.

Misses one big risk of iatrogenic harm: the psychiatrisation / psychologisation of conditions from other medical disciplines leading to overreach into believing these disorders are understood - when the explanations of Stone et al re FND are of no more or less value than any other understanding - as we don't know what causes these conditions.

The overreach into the usual suspects become factualised in the clinical encounter (trauma, adverse life events etc) which can cause stigma, shock, upset and confusion amongst patients - who get told their symptoms are "real" while referring them for psychotherapy. This duplicity is obvious and also subtle. When pts figure it out they can experience this as an assault against their sense of self. It can be highly destructive to a person's sense of identify and can result in breakdown of their sense of self and integrity. This loss of sense of self increases people's risk, isolates them from loved ones, community and so forth. It can shut them up too - embarrassment, shame, etc. Keeps them away from medical professionals which can run the risk of misdiagnosis not being investigated or non-diagnosis of new problems over time. I'm sure it makes pts much less reluctant to return to the neurology clinic. Why go back if you felt abused and gaslighted?

It's as if what the pt presents with in clinic is some form of performance for the benefit of the smart doctor to make inferences about but not be required to present any objective evidence for what they know - myths, stereotypes - like a cult or religion. Harks back to psychoanalysis and very much doing things to the patient. Doctor know best. Rather than working with people to help them best we can, and being honest and humble about the limitations when we cannot do very much.... Simply saying, "We don't know..."

The failure of the CODES trial for non-epileptic attacks tells us that using objective measures, non-epileptic seizures are not reduced by non-specific psychotherapy. CODES used 100% psychotherapy method - pts had anxiety that wasn't anxiety. Proponents of FND are not even that bothered about using appropriate evidence based trauma focused psychotherapy to test out their tentative hypotheses.

If trauma was such a powerful driving force - you would think that any clinical trial of psychotherapy for any FND would be at least a trauma focused therapy (using objective outcome measures...) and in the mean time that the historical use of psychotherapy in some quarters for these pts should be stopped - as they are no more or no less effective than anti-epileptics - which gets stopped asap when seizures and defined as non-epileptic.

In the mean time, these tentative hypotheses are being presented as fact to patients. I cannot imagine that is ok in other parts of medicine.

One last thought re FND from : Stone et al (2024) [ Stone J, Hoeritzauer I, McWhirter L, Carson A. Functional neurological
disorder: defying dualism. World Psychiatry. 2024;23:53–4. doi:10.1002/wps.21151. ]

"FND is a diagnosis of inclusion, with a diagnostic stability similar to other conditions in neurology and psychiatry2. People with FND have clinical features that are characteristic of the disorder. Hoover’s sign describes impairment of voluntary hip extension in the presence of normal automatic hip extension during contralateral hip flexion. A functional tremor stops or entrains to the rhythm of the examiner in the tremor entrainment test in a way that does not occur in other tremor disorders. People having a functional seizure typically experience a brief prodrome with autonomic arousal and dissociation, followed by an event in which
their eyes are closed, and there are either vigorous tremor-like movements, or they fall down and lie still for more than a minute in ways that only occur in this condition."

Has there been systematic independent study of whether Hoover's sign, for example, is present in pw Fibromyalgia? I do not recall seeing this. It gets repeated over and over as fact - where from? Where is their evidence? I'm assuming that if Hoover's sign is not present in pw fibromyalgia by their logic this could then exclude pw Fibro from FND label? And other conditions too?

 

Pompous nonsense from the school of thought that doesn't want to bother pretending that beyond a label change, psychosomatic illness is the old Freudian hysterical conversion disorder, and that attempts from the biopsychosocial school of thought to pretend to legitimize them as being medical entities worthy of any attention beyond the patronizing traditions of old are misguided. Because they know better.

So basically ultra-orthodox fanatics tsk-tsking at orthodox fanatics trying to make the traditional beliefs superficially more palatable, even though they share the same beliefs, just have different opinions about tactics. Personally I don't even think that ideologues like Stone and the rest believe in their network BS. It's just like the old 'chemical imbalance' that had to be invented because too many people labeled with depression had great lives and no psychosocial reason to be. It's all blatant BS.

Really, though, framing this under iatrogenic harm is some mighty impressive self-aware wolves.

Einstein said that two things are infinite: the universe, and human stupidity. But it's missing the big one: humans are so freaking weiiiiird.

 

editus sum ergo sum

Sorry, didn't realise you were gods.

This paper has surpassed pompous and is in the realm of masturbatory.

 

These guys heard about psychology's falsification crisis and said 'hold my aperitivo'.