Functional Neurological Disorders in the medical education: An urgent need to fill the gaps

Liège, Astrid De; Carle, Guilhem; Hingray, Coraline; Lehn, Alexander; Autier, L.; Degos, Bertrand; Garcin, Béatrice

doi:10.1016/j.neurol.2022.03.018

Cited by 17 publications

(5 citation statements)

References 27 publications

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“…Additionally, this finding may reflect the limited training that many HCPs receive on FND. A recent survey reported that nearly 90% of doctors feel their training leaves them unprepared to manage FND (de Liège et al, 2022), which is incongruent with the high frequency of FND presentations in clinical practice (Stone et al, 2013). Both explanations suggest a role for greater training on FND and the potential for implicit bias among HCPs, regardless of career stage.…”

Section: Discussionmentioning

confidence: 99%

“…Negative attitudes to FND perhaps reflect the limited formal training that many HCPs receive on FND management (de Liège et al, 2022; Stone et al, 2020). Yet, such attitudes are important given evidence from other health conditions that HCPs' attitudes influence clinical decision making, such as writing letters of support for patients (Drake et al, 2018) or decisions to prescribe medications or psychological therapy (Schäfer et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Clinicians' implicit and explicit attitudes about the legitimacy of functional neurological disorders correlate with referral decisions

Begley

Farrell

Lyttle

et al. 2023

British J Health Psychol

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Objectives: Uncertainty regarding the legitimacy of functional neurological disorder (FND) remains among some health care professionals. Despite treatment guidelines and consensus recommendations, variability in clinical practice referral decisions persists. Evidence from other conditions suggests such clinical decision making is impacted by practitioners' implicit and explicit attitudes. We aimed to identify whether health care professionals hold implicit and/or explicit attitudes about the legitimacy of FND and whether these attitudes are associated with referral decision making. Design/Methods: We included 66 health care professionals who work with people with neurological conditions: n = 37 medical doctors, mainly neurologists (n = 18) and psychiatrists (n = 10), and n = 29 doctoral level practitioner psychologists. Participants completed an Implicit Association Test (IAT), Implicit Relational Assessment Procedure (IRAP), a referral decision-making vignette task and self-report measures of explicit attitudes on FND-legitimacy, therapeutic optimism and clinician confidence. Multiple Sclerosis (MS) was used as a comparator condition. Results: Participants self-reported strong explicit FND-legitimate and MS-legitimate attitudes but demonstrated an implicit FND-illegitimate/MS-legitimate bias. Deeper examination provided by the IRAP data indicated pro-FND-legitimate attitudes, but no bias for or against FND-illegitimate-contrasting the pro-MS-legitimate, anti-MS-illegitimate attitudes for the comparator condition. Attitudes about FND-illegitimacy were negatively associated

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinicians' implicit and explicit attitudes about the legitimacy of functional neurological disorders correlate with referral decisions

Begley

Farrell

Lyttle

et al. 2023

British J Health Psychol

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show abstract

“…Educational interventions could enhance collaboration between different health professionals, thus improving a multidisciplinary approach to FND. For instance, the interaction between specialties could be optimized by training psychiatrists to perform a clinical assessment of physical symptoms for FND, while neurologists should be trained to better recognizing psychiatric comorbidities (2,49,50). Also, promoting the adoption of shared terminology and explanation of symptoms is needed to enhance consistency across health professionals in the communication of diagnosis to patients.…”

Section: Discussionmentioning

confidence: 99%

Psychiatrists’ attitudes towards functional neurological disorders: results from a national survey

et al. 2023

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IntroductionFunctional neurological disorder (FND) presents motor, sensory, and cognitive symptoms characterized by clinical signs incongruent with known neurological disease. Together with other health professionals, like neurologists, psychiatrists can play an essential role in diagnosing and managing these disorders. Hence, understanding their opinion and clinical experience with FND is of utmost importance to catch potential educational needs and improve healthcare services for patients. This study aims at assessing the knowledge, opinion, and clinical approach of Italian psychiatrists to FND.MethodsMembers of the Italian Society of Psychiatry completed a 14-item web-based survey investigating their approach to FND. Results. Overall, 174 questionnaires were completed. Our main findings suggest that Italian psychiatrists have a psychogenetic conceptualization of FND. “Conversion disorders”, in fact, is the term most frequently used by Italian psychiatrists to refer to FND, thus implying a psychological etiology of these disorders. Congruently with this view, psychotherapy associated with pharmacological therapy is considered the most appropriate treatment by psychiatrists, while physiotherapy is an under-recognized treatment option for FND.DiscussionThe present study highlights that a psychogenetic view of FND dominates among Italian psychiatrists. This could be due to out-of-date knowledge about the pathophysiology of this group of disorders. Promoting education about novel approaches to FND would be of crucial importance to improving care for patients suffering from this condition.

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“…The fact that this common condition is generally not taught during medical and nursing education may be a consequence of this stigma. [68][69][70] Appropriate education, empathic listening, and connection to resources could improve outcomes for patients by giving patients and their parents the tools needed to support them in both their TGNC identity and FND care. We provided psychoeducation regarding FND for all 4 of our patients' families.…”

Section: Discussionmentioning

confidence: 99%

A Case Series of Transgender and Gender-Nonconforming Patients in a Pediatric Functional Neurologic Disorder Clinic

Wilkinson-Smith,

Lerario,

Klindt

et al. 2023

J Child Neurol

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Youth who identify as transgender and gender nonconforming (TGNC) are at increased risk of anxiety, depression, bullying, and loss of social and family support. These factors may increase the risk of developing functional neurologic disorder (FND). If the risk of FND is increased in TGNC youth, then identifying which youth are at increased risk, and the particular times when risk is increased, may allow for earlier diagnosis and treatment of FND. Better awareness of functional symptoms among clinicians who care for TGNC youth may prevent disruption of gender-affirming care if FND symptoms emerge. Patients diagnosed with FND who are TGNC may require different forms of intervention than other youth with FND. We present 4 cases from our multidisciplinary pediatric FND program of TGNC youth who developed FND. In all individuals for whom follow-up information was available, access to gender-affirming health care was associated with marked improvement or resolution of FND symptoms.

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Functional Neurological Disorders in the medical education: An urgent need to fill the gaps

Cited by 17 publications

References 27 publications

Clinicians' implicit and explicit attitudes about the legitimacy of functional neurological disorders correlate with referral decisions

Clinicians' implicit and explicit attitudes about the legitimacy of functional neurological disorders correlate with referral decisions

Psychiatrists’ attitudes towards functional neurological disorders: results from a national survey

A Case Series of Transgender and Gender-Nonconforming Patients in a Pediatric Functional Neurologic Disorder Clinic

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