Identifying misconceptions and knowledge gaps in functional neurological disorders among emergency care providers

• Published in: Journal of clinical neuroscience 2023-08, Vol.114, p.81-88
• Main Authors: Yu, Jeryl Ritzi T., Shuaib, Umar, Mate, Kedar K.V., Kaur, Harpreet, Sonneborn, Claire, Hogue, Olivia, Morrison, James, Yu, Xin Xin
• Format: Article
• Language: English
• Subjects: Conversion Disorder; Emergency department; Emergency Service, Hospital; Functional neurological disorders; Humans; Knowledge gaps; Misconceptions; Nervous System Diseases - diagnosis; Nervous System Diseases - therapy; Providers; Psychophysiologic Disorders
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2023.06.008

•Despite a change in criteria, majority of ED providers in this study still believe that FND is a “rule out” diagnosis and that a psychological stressor is necessary in making the diagnosis.•Contrary to previous reports where providers did not make a distinction between malingering and FND, most providers did make a distinction.•Majority of ED providers were unfamiliar with FND resources and rated their experience with managing FND as more difficult.•Findings from this study shed light on knowledge gaps and educational opportunities for mechanisms to guide FND diagnosis and evidence-based treatment. 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. 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. 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. 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.