Abstract
A multidisciplinary expert review of key issues and future directions from the conference “Controversial labels and clinical uncertainties: psychogenic disorders, conversion disorder, and functional symptoms.”On October 9 and 10, 2015, a conference entitled “Controversial labels and clinical uncertainties: psychogenic disorders, conversion disorder, and functional symptoms” was held at the Center for Ethics, Emory University, Atlanta, GA, USA. This conference brought together a select group of 30 distinguished thought leaders and practitioners, including ethicists, researchers, clinicians, humanities scholars, and advocates to discuss the unique challenges and controversies related to the diagnosis, treatment, and stigma for patients with what is currently recognized as functional (“psychogenic”) neurological disorders. Our group of experts explored the conflicts and ethical tensions within health care that must be addressed in order to advance care for these disorders. What follows is a reflection on the conversations between conference attendees outlining key challenges and value conflicts in the diagnosis and treatment of patients with functional disorders. With this report, we aim to provide a roadmap for reducing stigma and improving care for functional neurological disorders (FND). A path forward would involve (1) setting a multifactorial research agenda that equally prioritized access to effective psychotherapy as well as identification of novel biomarkers; (2) empowering patients with FND to be heard and to drive changes in care; and (3) reducing isolation for clinicians by providing formal training and setting up multidisciplinary care teams and support networks.
Highlights
Functional neurological disorders (FND) are conceptualized as a manifestation of neurological symptoms that arise from a psychiatric origin
Functional non-epileptic seizures (PNES), like Functional movement disorders (FMDs), are presumed to be caused by psychological distress and have been reported to affect up to 30% of patients who are referred to epilepsy centers [15, 16]
Training modules for medical students and residents—similar to those created by the Accreditation Council for Graduate Medical Education (ACGME) [52]—could be adapted for discussing the complex nature of FND diagnosis and treatment as well as how to respond to challenging questions (“so you are saying this is all in my head,” “you don’t believe me?”)
Summary
Functional neurological disorders (FND) are conceptualized as a manifestation of neurological symptoms that arise from a psychiatric origin. Jake suddenly developed a constellation of symptoms including stumbling gait, jerking movements, and impaired speech. Alarmed and concerned, his family rushed him to the emergency department (ED). The neurologist indicated to him that his symptoms were likely psychological and that this was good news because it was not serious He was instructed to see a psychiatrist. Jake continued to see many providers looking for an answer They appeared to dread seeing him and wondered if he was malingering or feigning illness. Jake and his family were left feeling frustrated and helpless.
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