Functional neurological disorder: Engaging patients in treatment

Abstract

Patients with a functional neurological disorder can be difficult to engage in treatment. The reasons for this are complex and may be related to physician, patient and health care system issues. Providers contribute to difficulties in treatment engagement by giving confusing explanations for the patient symptoms, stigmatizing patients, and not allowing patients time to voice their questions and concerns. Patient factors include a lack of engagement after an explanation of the diagnosis, resistance to treatment, family/work dynamics and prior negative experiences with the health care system. The scarcity of providers skilled in the treatment of functional neurological disorder is yet another hurdle. This article will define these barriers and discuss good clinical practices to help improve outcomes by tackling those challenges and discuss why for many patients an integrated care team approach is needed.

Functional Overlay Model of Persistent Post-Concussion Syndrome

“…Additionally, it was shown that some aspects of the holistic approach in treating FNDs could be applied in PPCS with promising results [91][92][93], and this could be a reason to suspect that they are based on similar grounds in terms of symptoms persistence mechanisms, or that the holistic approach is generally of use in multiple component neurological disorders. However, some studies reported that the provider-patient relationship could be affected by an FND diagnosis [62,94,95]; thus, further research could better describe the degree of overlap between FND and PPCS in order to find the source of similarity between them or to test the possibility that the mechanistical aspects could better suggest overlaps with other chronic neurological disorders.…”

Functional Neurological Disorders

“…Similarly, lack of engagement after a proper explanation of the diagnosis, resistance to treatment, and family and work dynamics along with prior negative experiences with the health care system are several patient-related factors that affect outcomes. 198 Several issues that further contribute to poor treatment adherence include communication gaps, and patient, provider, and system barriers, which must be carefully addressed. 199,200 Notwithstanding, it is essential to remember that a diagnosis of FND does not rule out the possibility of another comorbid neurological disorder; in fact, a co-existent neurological disorder is itself a risk factor for FND and it is important to note the possibility of other concurrent or future medical comorbidities like comorbid epilepsy or PD.…”

“…Coordinating explanations among multiple clinicians, especially with those who the patient already trusts, can prove to be quite helpful, as poor adherence negatively impacts the outcomes. Similarly, lack of engagement after a proper explanation of the diagnosis, resistance to treatment, and family and work dynamics along with prior negative experiences with the health care system are several patient-related factors that affect outcomes 198. Several issues that further contribute to poor treatment adherence include communication gaps, and patient, provider, and system barriers, which must be carefully addressed 199,200.…”

Content or context? A study protocol for a three-arm parallel randomised controlled trial of Re-PROGRAM, a brief internet-based intervention for patients with functional seizures

“…In Australia, individuals with FS struggle to access specialised treatment 22. Barriers to treatment include a lack of knowledge of functional disorders among health professionals, referral patterns, circular healthcare pathways, with patients often falling between the cracks of different medical specialties in public versus private healthcare and between physical and mental healthcare 15 23 24. Limited access to specialised treatment services for FS catalysed our research team to develop R e -PROGRAM, an internet-based therapy for FS.…”