What Is the Role of a Specialist Assessment Clinic for FND? Lessons From Three National Referral Centers, 2019, Aybek et al

[Andy]

Objective:
A growing interest in functional neurological disorders (FND) has led to the development of specialized clinics. This study aimed to better understand the structure and role of such clinics.

Methods:
Data were retrospectively collected from clinical records at three national referral centers, two specifically for motor FND and one for FND in general. Data were for 492 consecutive patients referred over a 9- to 15-month period: 100 from the United Kingdom clinic, 302 from the Swiss clinic, and 90 from the Canadian clinic. Data included symptom subtype and duration, comorbid pain and fatigue, disability, and treatment recommendations.

Results:
The mean age of the 492 patients was 44 years, and most (73%) were female. Most had a prolonged motor FND (mean symptom duration of 6 years); 35% were not working because of ill health, 26% received disability benefits, and up to 38% required a care giver for personal care. In the Swiss cohort, 39% were given a diagnosis of another somatic symptom disorder rather than an FND diagnosis. Pain was common in the United Kingdom (79%) and Canada (56%), as was fatigue (48% and 47%, respectively). Most patients (61%) were offered physiotherapy; referral to neuropsychiatry or psychology differed across centers (32%−100%).

Conclusions:
FND specialty clinics have an important role in ensuring correct diagnosis and appropriate treatment. Most patients with motor FND require specialized neurophysiotherapy. Patients readily accepted an integrated neuropsychiatric approach. Close collaboration between FND clinics and acute neurology facilities might improve early detection of FND and could improve outcomes.

Paywall, https://neuro.psychiatryonline.org/doi/full/10.1176/appi.neuropsych.19040083
Sci hub, https://sci-hub.se/10.1176/appi.neuropsych.19040083

 

[rvallee]

This is a weird paper. Basically just listing a few cherry-picked services and concluding, without much supporting facts, that more would be useful. It's at least accurate in saying that there is an unmet need but not on the basis of a problem that needs to be solved and rather as a solution that needs to be explained the right way. It seems basically built on the same model as chronic fatigue clinics with a CBT/GET paradigm.

It lists "lessons" but those pretty much just sound like a pitch by people who believe in psychomagic that there should be more employment in psychomagic because, uh, reasons. The lessons don't seem to have any connection to the data presented, it's purely aspirational. Reads more like PR with sciencey language than anything.

Lesson 1: FND is a syndrome with multiple comorbidities, and specialized neurological evaluation is useful for specific patients

Lesson 2: A high percentage of patients require physical rehabilitation, and specialized services are needed.

Lesson 3: Neuropsychiatric evaluation and treatment specific to FND are needed

Lesson 4: Earlier detection and treatment of FND are needed

This could just as well have been written by any pseudoscience practitioners pretending to make a case for why their pseudoscience should be more widely available because it already is available.

Prospective and outcome data are needed to better refine the goals and understand the added value of FND clinics in international health care systems. However, our retrospective data and clinical experience suggest that specialized FND clinics integrated in neurology departments are needed and will help improve the clinical care of FND patients.

TL;DR: give us job security for this thing we can't prove is of any use but we like it.

 

[alktipping]

wouldn't a range of comorbidities actually prove the so called diagnosis of fnd to be wrong . or are they having their cake and eating it again .when will they ever learn that medical ignorance and gross incompetence does not mean someone has a made up psych disease.