![]() ![]() Fixating on whether symptoms are neurologic or psychologic can lead to feelings of irreversibility, as if it were “something in the brain I cannot change” or “it is down to me and my personality.”Ħ. Highlight the potential for improvement with treatment. Avoid speculating on possible causes during the initial visit and redirect to questions about “how” this happened rather than “why” it happened or what caused it to happen.ĥ. Share positive examination findings (eg, Hoover sign or tremor entrainment) to help build confidence in the diagnosis.Ĥ. Demonstrate the rationale for the diagnosis. Focus on the diagnosis the patient does have and avoid overemphasis of the conditions that are not present.ģ. Phrases such as, “this is familiar,” or “I believe you” help patients feel they are being heard and encourage a collaborative footing for moving forward.Ģ. It is unnecessary to emphasize conditions the patient does not have, because this deviates from the diagnosis of any other neurologic condition and can add to confusion. Next, clearly stating the diagnosis helps direct patients to information, resources, and appropriate treatment. Simply stating “I believe you” or “this is familiar” will be helpful for patients who have likely felt dismissed in previous health care encounters. 9,10 First, the clinician should be explicit in their belief of their patient’s symptoms. With these barriers in mind, communication frameworks for diagnosis of FND have been developed (Box). 9 Individuals may also find it difficult to accept an FMD diagnosis owing to a lack of public awareness, absence of supporting radiologic or laboratory findings, or strong beliefs regarding alternate diagnoses. 8 Perceiving a clinician’s lack of interest, negative attitude, or use of inconsistent terminology impedes patient’s ability to receive an FMD diagnosis and thereby hinders effective treatment. Conveying the DiagnosisĬommunicating a clear, unambiguous diagnosis of FMD to the patient is a key therapeutic step. Current best practices can still be implemented effectively while we await and advocate for improved infrastructure. 6,7 Many barriers to truly interdisciplinary care for FMD exist, including continued misconceptions and stigma around functional disorders and lack of reimbursement and incentives for integrated care. ![]() Persons with FMD are often significantly disabled by their condition and best served by an interdisciplinary approach, with collaboration among neurology, rehabilitation, psychiatry, psychology, and social work professionals. ![]() Less emphasis on psychologic triggers and more focus on positively made diagnoses through neurologic examination improve the therapeutic alliance between patient and clinicians, foster research, potentially decrease healthcare expenditures, and improve patient safety. 1-5 Recent progress has been made in understanding the physiologic underpinnings of functional disorders, with encouraging paths forward for care of the sizeable and vulnerable population of people with these conditions. 1-3 Accounting for 3% to 20% of clinical visits for movement disorders, FMD is characterized by sudden symptom onset, distractibility, and inconsistent or incongruent movements. Functional movement disorder (FMD) may be the most common functional neurologic symptom disorder (FND), representing a significant therapeutic challenge for healthcare providers.
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