JNNP: Suggestive of functional neurological disorders: a meta-analysis

Functional neuropathy (FND) is characterized by impaired motor, cognitive, or sensory function and can be clinically distinguished from: FND includes a range of different symptom subtypes, including non-epileptic seizures (NES) and functional motor disorders, which are often conceptualized as a separation disorder.
FND is also associated with somassy disorders, in which a wider range of functional symptoms can occur.
FND, formerly known as hysteria, is also known as conversion disorder, functional neurological disorder, and separation neurodegenerative disorder, with a prevalence rate of 4-12 per 100,000.
associated with considerable diagnostic delays and frequent misdiagnosis, which increases the already significant psychological, social and economic impact.
has long assumed that FND is characterized by an increased refringing response to direct verbal advice (innuendo).
implies that the theory is to reveal FND vulnerability through abnormal metaconscious intent, the ability to trigger automatic behavioral habits or psychological symptoms, or the tendency to develop precise (symptoms) a priori that overrides the motor and perceptic systems.
use of cues to stimulate FND symptoms is widely used to aid diagnosis, and functional symptoms are used in suggestive-based treatments such as hypnosis and placebos.
conditions with closely related symptoms, such as separation disorders, are also characterized by elevated hypnotic suggestiveness.
, despite these different evidences, suggests that the empirical correlation with FND appears to be highly variable.
the authors conducted a randomized meta-analysis of all suggestive control studies of FND subsypes, including somatosal disorder/Briquet syndrome.
November 2019, a complete database of PubMed, PsycINFO, Science.com and Academic Search was searched, using terminology related to innuendo and FND, and then consolidated into a separate database.
study was conducted again in April 2020, but no new findings were 2000.
list of all eligible studies (and related review papers) is manually searched to determine other studies.
the author when the data is not available or when methodological ambiguities are clarified.
two scorers independently screened and assessed the eligibility of all studies using a two-stage process.
, all titles and summaries are filtered and articles that do not meet eligibility criteria are rejected.
, all remaining papers were reviewed to determine the final list of articles.
result types (standardized cues and symptom cues) are measured using continuity and classification measurement methods, respectively.
Excluding two studies where the data overlapped, the extract table was used to independently extract and encode the data from the qualified study to obtain the original study that assessed the suggestiveness of FND patients and control groups using standardized behavioral scales or suggestive symptom induction schemes.
meta-analysis follows the meta-analysis of the study observed in The Cochrane, the preferred reporting item for systematic review, meta-analysis and epidemiology (MOOSE) guidelines.
data extraction and research quality codes are conducted by two independent reviewers.
standardized suggestive scores and responses to symptom-inducing schemes were used to calculate standardized average differences (SMDs) between groups.
of the 26,643 search results, 19 articles provided 11 standardized suggestive data sets (FND:n=316; contrast: n=360) and 11 symptom suggestive data sets (FND:n=1285; contrast:n=1409) were included in the random effect meta-analysis.
meta-analysis showed that FND patients showed greater suggestiveness and greater response to suggestive symptom induction (SMD, 1.39 (95% CI 0.92-1.86) on standardized behavioral scales (SMD, 0.48 (95%C, 0.15-0.81)).
the moderate analysis provides mixed evidence as to the extent to which the size of the impact is related to the methodological differences between different studies.
found no evidence of bias.
most studies meet some criteria, many are not reliable.
Only 5 (23 per cent) of the 22 studies reported that the subjects did not know the group, 18 (82 per cent) described inclusion/exclusion criteria, 16 (73 per cent) described diagnostic procedures and criteria in detail, 10 (45 per cent) described participant characteristics and 3 (14 per cent) showed demographic comparability between patients and control groups.
in standardized studies, 7 out of 11 (64 per cent) described scales and procedures in detail, while only 1 (9 per cent) included measures to correct subsysm.
in the symptom study, 8/11 (73%) clearly described the excitation method.
meta-analysis confirms the long-standing view that FND is characterized by an implied increase.
suggestive increase directly affects potential risk factors, suggesting the use of complementary diagnostics, based on the effectiveness of suggestive treatment of functional symptoms and the heterogeneity of the population.
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