32 Pathway to care of patients with functional neurological disorders in Iran
Authors: Arbabi Mohammad , Masjedi Neda , Eybpoosh Sana , Shafaghi Lida , Yasami Mohammadtaghi 
Published: December 2022

Aim

Despite the significant evidence of the importance and high prevalence of functional neurological disorders (conversion disorders), these patients‘ referral pathway has not yet been fully explained and elaborated among different physicians. We aimed to determine the pathway to care for patients with functional neurological disorders (conversion disorders) in Roozbeh Psychiatric Hospital. The fact that misdiagnosis of conversion disease is common among neurologists and psychiatrists, and it will be harmful to both patients and mental health systems, this study would be helpful.

Methods

In this cross-sectional study, 101 patients attending the psychiatric clinic of Roozbeh Hospital in Tehran during 2019–20 due to symptoms of conversion disorder were studied. The probable diagnosis was based on the diagnosis of a non-psychiatric physician. We identified the psychiatric disease in these patients based on clinical symptoms; then the diagnosis was confirmed with another psychiatrist using the FNSS scale and taking history. Comorbid conditions were diagnosed by using clinical diagnosis. Then, a basic information questionnaire and an interview form were completed to determine the path of seeking treatment in a patient with a conversion disorder. All analyses ere performed in SPSS v26 software. To examine the qualitative variables, the relationships Chi-square test and Fisher exact Test were used. The quantitative variable distribution of ‘the time of onset to diagnosis’ was examined by the Shapiro-Wilk test. Due to abnormal distribution, the Mann-Whitney test and Kruskal-Wallis test were used to evaluate differences in the duration of illness between different groups. P-value was statically significant in p<0.05.

Results

101 patients (66.3% female, 55% married) with a mean age of 36.0 ± 12.98 years participated in this study. Most of them were family members of 4 and 5 and unemployed (40.8%). Most people were referred to a neurologist (38.6%) and a general practitioner (37.6%) at the first visit. The mean number of visits to the first therapist was 3.46 ± 2.94 times. Treatment was useless in 61.8% of patients. The most common symptoms were convulsive movements (15.8%), the most common comorbid disorders were major depressive disorder (44.4%). A significant amount of the patients (78%) were affected by different stressors, and among them, family quarrels were the most(17.1%). The disease duration had a statistically significant relationship with supplementary insurance, type of symptom presentation and associated mental disorder. There was a statistically significant relationship between generalized anxiety disorder with family quarrels and the death of a relative and between major depressive disorder and the death of a relative.

Conclusions

It seems that reaching patients with functional neurological disorders to a mental health professional is too late when they have spent a lot of time and money on unnecessary investigations and treatment. Irrelevant therapies and their adverse effects on the recovery and treatment of patients should be recognized, and it is essential to identify Solutions to improve them. Also, considering psychosocial factors is very important because 78 per cent of patients had a specific stressor before presenting the symptoms.