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Larcombe P. Prehospital management of functional neurological disorder. Emerg Med Australas 2024. [PMID: 39189402 DOI: 10.1111/1742-6723.14491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024]
Affiliation(s)
- Penelope Larcombe
- Adolescent Young Adult Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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2
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Cheval M, Garcin B. The high cost of functional neurological disorders: A call for action! Rev Neurol (Paris) 2023; 179:935-936. [PMID: 37704536 DOI: 10.1016/j.neurol.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 09/15/2023]
Affiliation(s)
- M Cheval
- Department of Neurology, Hôpital Avicenne, Assistance publique-Hôpitaux de Paris, Paris, Île-de-France, France; Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
| | - B Garcin
- Department of Neurology, Hôpital Avicenne, Assistance publique-Hôpitaux de Paris, Paris, Île-de-France, France; UPMC UMRS 1127, Inserm U 1127, CNRS UMR 7225, Institut du cerveau et de la moelle épinère (ICM), 75013 Paris, France
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3
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Finkelstein SA, O'Neal MA, Gaston Baslet, Dworetzky BA, Godena E, Maggio J, Millstein D, Milligan T, Perez DL. Developing a Curriculum for Functional Neurological Disorder in Neurology Training: Questions and Answers. Neurol Clin 2023; 41:711-728. [PMID: 37775200 DOI: 10.1016/j.ncl.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional neurologic disorder (FND) is a common condition for which neurology residents often receive little to no formal teaching. Using a question-and-answer format, this article puts forward a case for why an FND curriculum is needed and aims to provide guidance on possible curricular content including medical knowledge, clinical skills, communication, and team-based collaboration. The authors also discuss methods for teaching and evaluating this knowledge and associated clinical skills, linking this to current Accreditation Council for Graduate Medical Education neurology milestones. Finally, the authors consider how to better engage and energize neurology trainees around this underserved yet challenging patient population.
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Affiliation(s)
- Sara A Finkelstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - M Angela O'Neal
- Division of General Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Gaston Baslet
- Division of Neuropsychiatry, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
| | - Barbara A Dworetzky
- Division of Epilepsy, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
| | - Ellen Godena
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Julie Maggio
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Physical Therapy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Daniel Millstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Tracey Milligan
- Department of Neurology, Westchester Medical Center Health Network, New York Medical College, Valhalla, NY, USA
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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4
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O'Mahony B, Nielsen G, Baxendale S, Edwards MJ, Yogarajah M. Economic Cost of Functional Neurologic Disorders: A Systematic Review. Neurology 2023; 101:e202-e214. [PMID: 37339887 PMCID: PMC10351557 DOI: 10.1212/wnl.0000000000207388] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 03/22/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Functional neurologic disorder (FND) represents genuine involuntary neurologic symptoms and signs including seizures, weakness, and sensory disturbance, which have characteristic clinical features, and represent a problem of voluntary control and perception despite normal basic structure of the nervous system. The historical view of FND as a diagnosis of exclusion can lead to unnecessary health care resource utilization and high direct and indirect economic costs. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to assess these economic costs and to assess for any cost-effective treatments. METHODS We searched electronic databases (PubMed, PsycInfo, MEDLINE, EMBASE, and the National Health Service Economic Evaluations Database of the University of York) for original, primary research publications between inception of the databases and April 8, 2022. A hand search of conference abstracts was also conducted. Key search terms included "functional neurologic disorder," "conversion disorder," and "functional seizures." Reviews, case reports, case series, and qualitative studies were excluded. We performed a descriptive and qualitative thematic analysis of the resulting studies. RESULTS The search resulted in a total of 3,244 studies. Sixteen studies were included after screening and exclusion of duplicates. These included the following: cost-of-illness (COI) studies that were conducted alongside cohort studies without intervention and those that included a comparator group, for example, another neurologic disorder (n = 4); COI studies that were conducted alongside cohort studies without intervention and those that did not include a comparator group (n = 4); economic evaluations of interventions that were either pre-post cohort studies (n = 6) or randomized controlled trials (n = 2). Of these, 5 studies assessed active interventions, and 3 studies assessed costs before and after a definitive diagnosis of FND. Studies showed an excess annual cost associated with FND (range $4,964-$86,722 2021 US dollars), which consisted of both direct and large indirect costs. Studies showed promise that interventions, including provision of a definitive diagnosis, could reduce this cost (range 9%-90.7%). No cost-effective treatments were identified. Study comparison was limited by study design and location heterogeneity. DISCUSSION FND is associated with a significant use of health care resources, resulting in economic costs to both the patient and the taxpayer and intangible losses. Interventions, including accurate diagnosis, seem to offer an avenue toward reducing these costs.
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Affiliation(s)
- Brian O'Mahony
- From the Institute of Psychiatry, Psychology & Neuroscience (B.O.M.), King's College London; Molecular and Clinical Sciences Research Institute (G.N., M.J.E.), St. George's University of London; Department of Clinical and Experimental Epilepsy (S.B., M.Y.), University College London, Institute of Neurology; Department of Neurology (S.B., M.Y.), National Hospital for Neurology and Neurosurgery; Epilepsy Society (S.B., M.Y.), Chalfont Centre for Epilepsy; and Neurology Department (M.J.E.), Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals, London, United Kingdom
| | - Glenn Nielsen
- From the Institute of Psychiatry, Psychology & Neuroscience (B.O.M.), King's College London; Molecular and Clinical Sciences Research Institute (G.N., M.J.E.), St. George's University of London; Department of Clinical and Experimental Epilepsy (S.B., M.Y.), University College London, Institute of Neurology; Department of Neurology (S.B., M.Y.), National Hospital for Neurology and Neurosurgery; Epilepsy Society (S.B., M.Y.), Chalfont Centre for Epilepsy; and Neurology Department (M.J.E.), Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals, London, United Kingdom
| | - Sallie Baxendale
- From the Institute of Psychiatry, Psychology & Neuroscience (B.O.M.), King's College London; Molecular and Clinical Sciences Research Institute (G.N., M.J.E.), St. George's University of London; Department of Clinical and Experimental Epilepsy (S.B., M.Y.), University College London, Institute of Neurology; Department of Neurology (S.B., M.Y.), National Hospital for Neurology and Neurosurgery; Epilepsy Society (S.B., M.Y.), Chalfont Centre for Epilepsy; and Neurology Department (M.J.E.), Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals, London, United Kingdom
| | - Mark J Edwards
- From the Institute of Psychiatry, Psychology & Neuroscience (B.O.M.), King's College London; Molecular and Clinical Sciences Research Institute (G.N., M.J.E.), St. George's University of London; Department of Clinical and Experimental Epilepsy (S.B., M.Y.), University College London, Institute of Neurology; Department of Neurology (S.B., M.Y.), National Hospital for Neurology and Neurosurgery; Epilepsy Society (S.B., M.Y.), Chalfont Centre for Epilepsy; and Neurology Department (M.J.E.), Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals, London, United Kingdom
| | - Mahinda Yogarajah
- From the Institute of Psychiatry, Psychology & Neuroscience (B.O.M.), King's College London; Molecular and Clinical Sciences Research Institute (G.N., M.J.E.), St. George's University of London; Department of Clinical and Experimental Epilepsy (S.B., M.Y.), University College London, Institute of Neurology; Department of Neurology (S.B., M.Y.), National Hospital for Neurology and Neurosurgery; Epilepsy Society (S.B., M.Y.), Chalfont Centre for Epilepsy; and Neurology Department (M.J.E.), Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals, London, United Kingdom.
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5
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Yu JRT, Shuaib U, Mate KKV, Kaur H, Sonneborn C, Hogue O, Morrison J, Yu XX. Identifying misconceptions and knowledge gaps in functional neurological disorders among emergency care providers. J Clin Neurosci 2023; 114:81-88. [PMID: 37329664 DOI: 10.1016/j.jocn.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Functional Neurologic Disorders (FND) are a common but heterogeneous group of disabling conditions. The Emergency Department (ED) is an important venue for care and referral as it is often the first point of contact when patients with FND are faced with a crisis or exacerbation of symptoms. METHODS ED providers (n = 273) practicing in the Cleveland Clinic Foundation Northeast Ohio network were invited to participate through secure web application electronic surveys. Data were collected on practice profiles, knowledge, attitudes, management of FND, and awareness of available resources for FND. RESULTS Sixty providers completed the survey (22% response rate; n = 50 ED physicians, 10 advanced care providers) with 95.0% (n = 57) reporting a lack of understanding about FND. The terms Psychogenic Nonepileptic Seizures and stress induced/stress related disease were used by 60.0% (n = 36) and 58.3% (n = 35) respectively. Ninety percent (n = 53) rated their experience with managing FND patients as at least more difficult. Eighty- five percent (n = 51) agreed with "rule out others" and 60% (n = 36) agreed with "caused by psych stress". Eighty six percent (n = 50) believe that there is a difference between FND from malingering. Only one respondent was familiar with any FND resources and 79% (n = 47) reported the need for FND specific educational materials. CONCLUSION This survey revealed major gaps in knowledge, inaccurate perceptions, and management that differs from the current standard of care among ED providers caring for patients with FND. Educational opportunities are needed to guide diagnosis and evidence-based treatment to optimize management of patients with FND.
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Affiliation(s)
- Jeryl Ritzi T Yu
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Umar Shuaib
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Kedar K V Mate
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Department of Musculoskeletal Oncology, Mayo Clinic, Arizona, United States
| | - Harpreet Kaur
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States
| | - Claire Sonneborn
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, United States
| | - Olivia Hogue
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, OH, United States
| | - James Morrison
- Emergency Services Institute & Respiratory Institute, Cleveland Clinic, OH, United States
| | - Xin Xin Yu
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, OH, United States.
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6
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To the emergency room and back again: Circular healthcare pathways for acute functional neurological disorders. J Neurol Sci 2022; 437:120251. [DOI: 10.1016/j.jns.2022.120251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/20/2022]
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7
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Finkelstein SA, Cortel‐LeBlanc MA, Cortel‐LeBlanc A, Stone J. Functional neurological disorder in the emergency department. Acad Emerg Med 2021; 28:685-696. [PMID: 33866653 DOI: 10.1111/acem.14263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/27/2022]
Abstract
We provide a narrative review of functional neurological disorder (FND, or conversion disorder) for the emergency department (ED). Diagnosis of FND has shifted from a "rule-out" disorder to one now based on the recognition of positive clinical signs, allowing the ED physician to make a suspected or likely diagnosis of FND. PubMed, Google Scholar, academic books, and a hand search through review article references were used to conduct a literature review. We review clinical features and diagnostic pitfalls for the most common functional neurologic presentations to the ED, including functional limb weakness, functional (nonepileptic) seizures, and functional movement disorders. We provide practical advice for discussing FND as a possible diagnosis and suggestions for initial steps in workup and management plans.
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Affiliation(s)
| | - Miguel A. Cortel‐LeBlanc
- Faculty of Medicine University of Ottawa Ottawa Ontario Canada
- The Ottawa Hospital Ottawa Ontario Canada
- Queensway Carleton Hospital Ottawa Ontario Canada
| | - Achelle Cortel‐LeBlanc
- Faculty of Medicine University of Ottawa Ottawa Ontario Canada
- Queensway Carleton Hospital Ottawa Ontario Canada
| | - Jon Stone
- Centre for Clinical Brain Sciences University of Edinburgh Edinburgh UK
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8
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Beharry J, Palmer D, Wu T, Wilson D, Le Heron C, Mason D, Reimers J, Fink J, Mulder R, Duncan R. Functional neurological disorders presenting as emergencies to secondary care. Eur J Neurol 2021; 28:1441-1445. [PMID: 33426732 DOI: 10.1111/ene.14728] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/25/2020] [Accepted: 12/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Functional neurological disorders (FND) represent a significant proportion of presentations to outpatient adult neurology services. There is little information relating to patients presenting to acute inpatient care. METHODS We identified patients presenting as acute admissions with FND to Christchurch Hospital, Christchurch, New Zealand, from 2016 to 2018. We analyzed relevant demographic and clinical data from electronic records and measured incidence of presentation to secondary care and healthcare utilization. RESULTS One hundred sixty-two patients presented on 173 occasions with FND, representing 9% of all admissions to the neurology service during the 3-year study period. The mean age was 40 (SD 17) years, 111 (69%) patients were female and the median length of stay was 3 (IQR 2-4) days. A total of 92 computed tomography brain scans, 77 magnetic resonance imaging brain scans and 42 electroencephalograms were carried out. On 22 (13%) occasions, patients were referred for outpatient psychological therapy. In the 3 years prior to each patient's last presentation in the study period, these 162 patients had a total of 671 presentations to the emergency department. Healthcare demand did not decrease after the index admission. The rate of acute inpatient admission for FND was 10 per 100,000 per year for the total Christchurch Hospital catchment, 6/100,000/year in rural areas, and 11/100,000/year in urban areas. CONCLUSION FND represented almost 1 in 10 acute neurology admissions with significant inpatient healthcare resource utilization.
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Affiliation(s)
- James Beharry
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - David Palmer
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Teddy Wu
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Duncan Wilson
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Campbell Le Heron
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Deborah Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Jon Reimers
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - John Fink
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychiatry, Christchurch Hospital, Christchurch, New Zealand
| | - Roderick Duncan
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
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9
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Van der Feltz-Cornelis CM, Allen SF, Van Eck van der Sluijs JF. Childhood sexual abuse predicts treatment outcome in conversion disorder/functional neurological disorder. An observational longitudinal study. Brain Behav 2020; 10:e01558. [PMID: 32031757 PMCID: PMC7066336 DOI: 10.1002/brb3.1558] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/19/2019] [Accepted: 01/14/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Explore trauma, stress, and other predictive factors for treatment outcome in conversion disorder/functional neurological disorder (CD/FND). METHODS Prospective observational design. Clinical cohort study among consecutive outpatients with DSM-IV CD/FND in a specialized mental health institution for somatic symptom disorders and related disorders (SSRD), presented between 1 February 2010 and 31 December 2017. Patient files were assessed for early childhood trauma, childhood sexual abuse, current stress, and other predictive factors. Patient-related routine outcome monitoring (PROM) data were evaluated for treatment outcome at physical (Patient Health Questionnaire [PHQ15], Physical Symptoms Questionnaire [PSQ]) level as primary outcome, and depression (Patient Health Questionnaire [PHQ9]), anxiety (General Anxiety Disorder [GAD7]), general functioning (Short Form 36 Health Survey [SF36]), and pain (Brief Pain Inventory [BPI]) as secondary outcome. RESULTS A total of 64 outpatients were included in the study. 70.3% of the sample reported childhood trauma and 64.1% a recent life event. Mean scores of patients proceeding to treatment improved. Sexual abuse in childhood (F(1, 28) = 30.068, β = 0.608 p < .001) was significantly associated with worse physical (PHQ15, PSQ) treatment outcome. 42.2% reported comorbid depression, and this was significantly associated with worse concomitant depressive (PHQ9) (F[1, 39] = 11.526, β = 0.478, p = .002) and anxiety (GAD7) (F[1,34] = 7.950, β = 0.435, p = .008) outcome. CONCLUSION Childhood sexual abuse is significantly associated with poor treatment outcome in CD/FND. Randomized clinical trials evaluating treatment models addressing childhood sexual abuse in CD are needed.
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Affiliation(s)
- Christina M Van der Feltz-Cornelis
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands.,Tranzo Department, Tilburg University, Tilburg, The Netherlands.,Department of Health Sciences, HYMS, University of York, York, UK
| | - Sarah F Allen
- Department of Health Sciences, HYMS, University of York, York, UK
| | - Jonna F Van Eck van der Sluijs
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands.,Tranzo Department, Tilburg University, Tilburg, The Netherlands
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10
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Klinke ME, Hjartardóttir TE, Hauksdóttir A, Jónsdóttir H, Hjaltason H, Andrésdóttir GT. Moving from stigmatization toward competent interdisciplinary care of patients with functional neurological disorders: focus group interviews. Disabil Rehabil 2019; 43:1237-1246. [PMID: 31526059 DOI: 10.1080/09638288.2019.1661037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To explore facilitating and inhibiting factors in the inpatient care of patients with functional neurological disorders as experienced by interdisciplinary teams of healthcare professionals. METHOD Qualitative focus group interviews were conducted with 18 healthcare professionals of various professions. Data were analyzed using qualitative content analysis with inductive coding of data. RESULTS Two main categories were formulated: (a) Giving the diagnosis to patients - a moment of fragility and opportunities, and (b) Organization of care - ensuring the continuity and protecting patients' self-image. One overarching theme tied the two categories together: Establishing coherence in the inpatient trajectory - moving from stigmatization toward competent care. Coherence and steadiness in care was a prerequisite for transparency in goalsetting and for designating the responsibilities of individual healthcare professionals. Stigma and having clinical experience and knowledge of functional neurological disorders, as two counter-factors, influenced the extent to which this was achieved. Examples of facilitating factors for enhancing competent care were documentation of symptoms, effective ways of passing on clinical information, education, professional dialog, and organizational support. DISCUSSION To nurture competent care, guidelines, structured educational initiatives and other supportive actions should be promoted. We provide ideas for the next logical steps for clinical practice and research.IMPLICATIONS FOR REHABILITATIONClose collaboration between interdisciplinary healthcare professionals plays an important role for reaching optimal results in the rehabilitation of inpatients with functional neurological disorder.There is currently limited knowledge regarding the facilitating and inhibiting features encountered by interdisciplinary healthcare professionals in the provision of care for patients with a functional neurological disorder.The findings show that a working environment that endorses a skillful culture of practice and which facilitates actions to reduce problems that hamper effective teamwork needs to be promoted.Solutions that help to solve many obstacles encountered by the team of healthcare professionals in the care provision of patients with functional neurological disorders include open dialog regarding symptoms, diagnosis and treatment, effective ways of documenting and reporting symptoms, and availability of guidelines and supporting educational material.
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Affiliation(s)
- Marianne E Klinke
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,The National University Hospital of Iceland, Reykjavik, Iceland
| | - Haukur Hjaltason
- The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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11
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Reddi VSK, Salian HH, Muliyala KP, Chandra PS. Profile and outcome of dissociative disorders presenting as psychiatric emergencies to a tertiary hospital setting in India. Asian J Psychiatr 2019; 44:187-188. [PMID: 31398684 DOI: 10.1016/j.ajp.2019.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/12/2019] [Accepted: 07/29/2019] [Indexed: 11/16/2022]
Affiliation(s)
- V Senthil Kumar Reddi
- Additional Professor of Psychiatry, Co-Ordinator of Emergency Psychiatry and Acute Care Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore -560029.
| | - Harshit Hemant Salian
- Post-doctoral Fellow in Emergency Psychiatry and Acute Care Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore -560029.
| | - Krishna Prasad Muliyala
- Associate Professor of Psychiatry, Co-Ordinator of Emergency Psychiatry and Acute Care Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore -560029.
| | - Prabha S Chandra
- Professor of Psychiatry, Chief of Emergency Psychiatry and Acute Care Services, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore -560029.
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12
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Perez DL, Matin N, Barsky A, Costumero-Ramos V, Makaretz SJ, Young SS, Sepulcre J, LaFrance WC, Keshavan MS, Dickerson BC. Cingulo-insular structural alterations associated with psychogenic symptoms, childhood abuse and PTSD in functional neurological disorders. J Neurol Neurosurg Psychiatry 2017; 88:491-497. [PMID: 28416565 PMCID: PMC5497745 DOI: 10.1136/jnnp-2016-314998] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/24/2017] [Accepted: 02/01/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Adverse early-life events are predisposing factors for functional neurological disorder (FND) and post-traumatic stress disorder (PTSD). Cingulo-insular regions are implicated in the biology of both conditions and are sites of stress-mediated neuroplasticity. We hypothesised that functional neurological symptoms and the magnitude of childhood abuse would be associated with overlapping anterior cingulate cortex (ACC) and insular volumetric reductions, and that FND and PTSD symptoms would map onto distinct cingulo-insular areas. METHODS This within-group voxel-based morphometry study probes volumetric associations with self-report measures of functional neurological symptoms, adverse life events and PTSD symptoms in 23 mixed-gender FND patients. Separate secondary analyses were also performed in the subset of 18 women with FND to account for gender-specific effects. RESULTS Across the entire cohort, there were no statistically significant volumetric associations with self-report measures of functional neurological symptom severity or childhood abuse. In women with FND, however, parallel inverse associations were observed between left anterior insular volume and functional neurological symptoms as measured by the Patient Health Questionnaire-15 and the Screening for Somatoform Symptoms Conversion Disorder subscale. Similar inverse relationships were also appreciated between childhood abuse burden and left anterior insular volume. Across all subjects, PTSD symptom severity was inversely associated with dorsal ACC volume, and the magnitude of lifetime adverse events was inversely associated with left hippocampal volume. CONCLUSIONS This study reveals distinct cingulo-insular alterations for FND and PTSD symptoms and may advance our understanding of FND. Potential biological convergence between stress-related neuroplasticity, functional neurological symptoms and reduced insular volume was identified.
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Affiliation(s)
- David L. Perez
- Massachusetts General Hospital, Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Department of Psychiatry, Neuropsychiatry Unit, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Nassim Matin
- Massachusetts General Hospital, Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Harvard Medical School, Boston, MA, USA
| | - Arthur Barsky
- Brigham and Women’s Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Sara J Makaretz
- Massachusetts General Hospital, Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Department of Neurology, Frontotemporal Disorders Unit, Harvard Medical School, Boston, MA, USA
| | - Sigrid S. Young
- Massachusetts General Hospital, Department of Neurology, Functional Neurology Research Group, Cognitive Behavioral Neurology Unit, Harvard Medical School, Boston, MA, USA
| | - Jorge Sepulcre
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - W. Curt LaFrance
- Neuropsychiatry and Behavioral Neurology Division, Rhode Island Hospital, Departments of Psychiatry and Neurology, Brown University, Alpert Medical School, Providence, Rhode Island, USA
| | | | - Bradford C Dickerson
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
- Massachusetts General Hospital, Department of Neurology, Frontotemporal Disorders Unit, Harvard Medical School, Boston, MA, USA
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