Triggers and Clinical Presentations of Functional Neurological Disorders: Lessons from World War 1, 2020, Linden

[Andy]

Introduction: The psychological contribution to functional neurological and somatic symptom disorders is a major topic in current medical debate.

Objective: For an understanding of the processes leading to functional somatic symptoms, it is paramount to explore their relationship with stress and life events and to elucidate the contribution of cultural factors. Methods: A total of 937 case records of civilian and military patients with functional somatic disorders treated in London during World War 1 were analysed. Group differences in symptom profiles and contemporaneous diagnoses were tested with χ2 tests.

Results: Paralyses and speech disturbances were significantly more common in soldiers (43.3 and 17.2% of cases) than in civilian male (28.1 and 6.5%) and female patients (32.4 and 7.5%), whereas female patients had the highest rates of pain (48.6%) and somatic symptoms (67%). Triggers were identified in around two-thirds of cases and included accidents, physical illness, and work stress, in addition to the combat experience of the soldier patients. The nature of the trigger influenced symptom expression, with acute (combat and noncombat) events being particularly prone to trigger loss of motor function. Symptom profiles showed a great deal of multi-morbidity and overlap, although some symptom clusters were more (motor and speech disturbance) or less common (pain and loss of energy) in soldiers than civilians. Triggering life events in civilians were similar to those reported by patients with somatic symptom disorders today, with an important role of physical factors. Patterns of multi-morbidity and symptom clusters also resembled those of modern cohorts.

Conclusions: Analysis of historical records, illness trajectories, and treatments can enhance the understanding of the presentation, mechanisms, and course of functional neurological and related disorders and their consistency over time.

Open access, https://www.karger.com/Article/FullText/507698

 

[rvallee]

The psychological contribution to functional neurological and somatic symptom disorders is a major topic in current medical debate

A full century after the first lines of debate, the very same lines are still being debated. Exactly as is, without change or progress. It's hard to dispute that when the same people are literally bringing up the exact same debate from a full century ago as being relevant to the debate happening today. Largely on account of being on exactly the same issues, stuck in an endless circle of pointlessness. Which is odd because science is not supposed to be debating things, it's supposed to apply a rigorous process and deal only with objectively verifiable things. Debate can occur but it is peripheral to the work that actually counts.

There is no comparable failure in any other field of science. The outcome is completely disastrous. Plus my own medical file, not an historical archive, is full of mistakes, opinions and things I did not even say or weren't even actually discussed and missing many things. So I would not exactly vouch for the accuracy of historical accounts from a century ago.

Maybe, just maybe, medicine is not the place for philosophical debate among people with no stake in the matter and who constantly display disregard for the basics of science and even more disregard for the lives they lay waste to. Because the consequences are in real lives. Since the debate started, tens of millions of lives were wasted on this philosophical circle jerk. Lives who did not consent to being wasted. Which makes it all grotesquely criminal to continue with this absurd death-and-suffering cult.

 

[Mithriel]

Paralyses and speech disturbances

are very likely to be percussive injuries. The wonder is that anyone survived the bombardments of the first world war without brain damage when their only protection was a tin helmet.

 

[dave30th]

so paralysis and speech disturbances were greater among soldiers? and these were usually from acute events? Hm. just a wild guess, but maybe physical injuries from the acute event during war caused these problems?

 

[alktipping]

there has been more recent research into the effects of explosions in causing low level inflammation of the brain ie shellshock another politically motivated choice of diagnosis cant have soldiers being medically exempted from duty if their still capable of being cannon fodder . the research I wanted to mention was done on police swat teams who where often using small level explosions to gain entry . unfortunately cant remember any more at this time other than repeated exposure to shockwaves causes some damage gee who knew .

 

[Lidia]

So amazing they found the MRI and PET scans of those patients 100 years ago!