Functional Neurologic Disorders, disorders to be managed by neurologists, or are neurologists wandering in a dangerous field with inadequate resources?

Marco Onofrj, Paola Ajdinaj, Anna Digiovanni, Naveed Malek, Giovanni Martinotti, Filippo Maria Ferro, Mirella Russo, Astrid Thomas, Stefano Luca Sensi

Research output: Contribution to journalReview articlepeer-review

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Abstract

In recent years, some neurologists reconsidered their approach to Medically Unexplained Symptoms and proposed Functional Neurologic Disorders (FND) as a new entity, claiming that neurology could offer alternative treatment options to the psychotherapies provided in psychiatry settings. FNDs, for this purpose, should include only the disorders listed as Conversion from the Somatic Symptom and Related Disorders (SSRD) group. The present review analyzes the rationale of this position and challenges the arguments provided for its support. The review also discusses the systematization of these disorders as provided by public health systems. It outlines risks stemming from economic support and public funding uncertainty, given their negligible epidemiological dimensions resulting from the parcellation of SSRD. The review underlines the unresolved issue of Factitious Disorders, which are in the same SSRD category of the international classification but are, nonetheless, overlooked by the theoretical proponents of the FND entity. Comorbidity with other psychiatric disorders is also analyzed. We propose a model that supports the continuum between different SSRD conditions, including Factitious Disorders. The model is based on the emergence of feigned death reflex and deception from frontal lobe dysfunction. Finally, the paper summarizes the wealth of historical psychiatric and psychodynamic approaches and critical reviews. The study also puts in context the categorization and interpretation efforts provided by the most eminent researchers of the past century.
Original languageEnglish
Article number1120981
Pages (from-to)1-16
Number of pages16
JournalFrontiers in Psychiatry
Volume14
Early online date17 Mar 2023
DOIs
Publication statusPublished - 17 Mar 2023

Keywords

  • Psychiatry
  • somatic symptom and related disorders
  • factitious disorder
  • utilization behavior
  • deception
  • hysteria

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