Managing functional neurological disorder: treatment recommendations for health professionals in Australia

TL;DR

This paper provides updated treatment guidelines for Functional Neurological Disorder in Australia, emphasizing multidisciplinary care and improved patient communication.

Contribution

The paper introduces a shift from a psychiatric-focused approach to a multidisciplinary and culturally sensitive biopsychosocial framework for managing FND.

Findings

FND should be diagnosed using positive signs rather than by excluding other conditions.

Multidisciplinary teams are recommended to manage the complex symptoms of FND effectively.

General Practitioners play a key role in long-term care and facilitating access to specialist services.

Abstract

Functional Neurological Disorder (FND) can present significant management challenges due to its sometimes-complex presentation and the historical stigma attached to this diagnosis. Recent advances have improved understanding and management of FND, emphasising the benefit of a multidisciplinary approach to management. The prognosis of FND varies but evidence-based treatments offer the potential of remission to many people for whom FND might otherwise cause long-term disability, and meaningful symptomatic and functional improvement for many more. Despite this, limited and inequitable access to treatment means that many people with FND in Australia continue to experience treatable disability due to the condition.Diagnosis: FND should be diagnosed based on positive signs rather than exclusion. This includes identifying inconsistencies and incongruencies in symptoms that differentiate them from other neurological conditions.Communication: The diagnosis of FND should be communicated to patients promptly and clearly upon diagnosis of the condition. Information provided should include the name of the condition, the basis on which the diagnosis has been made, key principles that can aid self-management, and shared planning of next steps in treatment or accessing treatment.Multidisciplinary Management: Across healthcare service models, treatment should involve a multidisciplinary team to address the multifaceted, and sometimes complex symptoms of FND.Role of General Practitioners (GPs): GPs are integral in the long-term management of FND, providing continuity of care, patient support and education, and facilitating access to specialist services. An informed GP can provide the patient with confidence and agency to be pro-active in their symptoms.

Diagnosis: FND should be diagnosed based on positive signs rather than exclusion. This includes identifying inconsistencies and incongruencies in symptoms that differentiate them from other neurological conditions.

Communication: The diagnosis of FND should be communicated to patients promptly and clearly upon diagnosis of the condition. Information provided should include the name of the condition, the basis on which the diagnosis has been made, key principles that can aid self-management, and shared planning of next steps in treatment or accessing treatment.

Multidisciplinary Management: Across healthcare service models, treatment should involve a multidisciplinary team to address the multifaceted, and sometimes complex symptoms of FND.

Role of General Practitioners (GPs): GPs are integral in the long-term management of FND, providing continuity of care, patient support and education, and facilitating access to specialist services. An informed GP can provide the patient with confidence and agency to be pro-active in their symptoms.

Main RecommendationsDiagnosis: FND should be diagnosed based on positive signs rather than exclusion. This includes identifying inconsistencies and incongruencies in symptoms that differentiate them from other neurological conditions.Communication: The diagnosis of FND should be communicated to patients promptly and clearly upon diagnosis of the condition. Information provided should include the name of the condition, the basis on which the diagnosis has been made, key principles that can aid self-management, and shared planning of next steps in treatment or accessing treatment.Multidisciplinary Management: Across healthcare service models, treatment should involve a multidisciplinary team to address the multifaceted, and sometimes complex symptoms of FND.Role of General Practitioners (GPs): GPs are integral in the long-term management of FND, providing continuity of care, patient support and education, and facilitating access to specialist services. An informed GP can provide the patient with confidence and agency to be pro-active in their symptoms.

Diagnosis: FND should be diagnosed based on positive signs rather than exclusion. This includes identifying inconsistencies and incongruencies in symptoms that differentiate them from other neurological conditions.

Communication: The diagnosis of FND should be communicated to patients promptly and clearly upon diagnosis of the condition. Information provided should include the name of the condition, the basis on which the diagnosis has been made, key principles that can aid self-management, and shared planning of next steps in treatment or accessing treatment.

Multidisciplinary Management: Across healthcare service models, treatment should involve a multidisciplinary team to address the multifaceted, and sometimes complex symptoms of FND.

Role of General Practitioners (GPs): GPs are integral in the long-term management of FND, providing continuity of care, patient support and education, and facilitating access to specialist services. An informed GP can provide the patient with confidence and agency to be pro-active in their symptoms.

Changes in Management as a result of the recommendations

The recommendations advocate for a shift from a pure psychiatric framework to a multidisciplinary and person-centred approach. Employing the biopsychosocial framework can enhance patient outcomes, including addressing protective and risk factors for Aboriginal and Torres Strait Islander people.