What should we say to patients with unexplained neurological symptoms? How explanation affects offence

Abstract

Please cite this article as: Ding Juen Mei, Kanaan Richard Antony Alexander, What should we say to patients with unexplained neurological symptoms? How explanation affects offence, Journal of Psychosomatic Research (2016Research ( ), doi:10.1016Research ( /j.jpsychores.2016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Tables: 3 Figures: 3 References: 27 A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT ABSTRACTObjectives: Unexplained neurological symptoms (UNS) are common presentations in neurology but there is no consensus as to what they should be called. This is important, as patient acceptance is a predictor of outcome and there is evidence that patients are unhappy with the terms used. Patient understanding of these terms may be limited, however, and, once explained, the terms may seem more or less offensive. We sought to elicit patients" views of 7 frequently used terms for UNS, and whether these changed once definitions were provided.Methods: 185 participants were recruited from a medical outpatients" waiting area. They were given questionnaires outlining a hypothetical situation of leg weakness, with 7 possible labels.Participants were asked whether they endorsed 4 connotations for each label and the "number needed to offend" (NNO) calculated, before and after definitions were given.

Functional seizures: An evaluation of the attitudes of general practitioners local to a tertiary neuroscience service in London

“…25 Nearly one-third of GPs agreed with, or were unsure about, the statement that patients only ever have functional seizures when stressed. This should be relatively straightforward to implement using simple measures such as basic information sheets, 31,32 and clear, consistent language when communicating and explaining the diagnosis to GPs. In reality <50% of patients report feeling stressed before functional seizures, and in many cases patients do not identify obvious triggers.…”

“…30 We therefore propose that educational attempts should be made to ensure that local GPs seeing these patients have a basic understanding of functional seizures, especially around the issue of feigning. This should be relatively straightforward to implement using simple measures such as basic information sheets, 31,32 and clear, consistent language when communicating and explaining the diagnosis to GPs. 33 The International League Against Epilepsy (ILAE) has recently published a consensus document outlining expert recommendations for the diagnosis and management of patients with functional seizures.…”

Who thinks functional neurological symptoms are feigned, and what can we do about it?

“…They were asked whether they had a ‘fair idea’ of what each term meant, and then given brief definitions for each of the seven terms (e.g., ‘stroke’ - a blood clot has damaged the part of your brain that moves your leg), and again asked to select the connotations that they felt were appropriate. Details of the survey, its methods and results have been published elsewhere,4 but we here present some information on those who felt that these terms would imply a patient was ‘faking (their) symptoms’.…”

Functional non-epileptic attacks: essential information for psychiatrists

“…FNEA have been described in multiple cultures without a specific diagnostic label for 4000 years, the term hysteria was then used for the next 2500 years, 1 followed by conversion, dissociation and now FNEA, which is theoretically neutral from a psychological standpoint and considered to be acceptable to patients. 2…”