The challenge of functional neurological disorder – views of patients, doctors and medical students

2021 ◽  
Vol 16 (2) ◽  
pp. 123-138
Author(s):  
Gareth Hutchinson ◽  
Stefanie Caroline Linden
Keyword(s):  
Medical Students ◽  
Therapeutic Relationship ◽  
Neurological Disorder ◽  
Treatment Options ◽  
Patient Survey ◽  
Structured Interviews ◽  
Content Type ◽  
Doctor Patient Communication ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Purpose This study aims to explore views and attitudes of doctors, patients and medical students in regard to Functional Neurological Disorders (FND), a common presentation in neurological and psychiatric practice. Design/methodology/approach We conducted semi-structured interviews with 11 clinicians and obtained online questionnaires from 21 patients and 75 medical students. We applied thematic analysis. Findings The clinician and patient surveys highlighted the importance of the therapeutic relationship and need for transparent communication. However, patients criticised excessive reliance on online resources in doctor–patient communication. They also emphasised the relevance of triggering life events, which was not a prominent theme for clinicians. Medical students had only scant knowledge of the concept of functional neurological disorder. Practical implications A good therapeutic relationship is considered central for outcome of FND by both clinicians and patients. The survey of medical students has identified considerable gaps in undergraduate medical education in FND. The patient survey can inform recommendations for the explanation of aetiological models and treatment options in clinical practice. Originality/value This is the first study exploring the attitudes of clinicians, medical students and patients to FND. The study highlights potential areas of disagreement between these groups.

Medical student and psychiatrist perceptions towards a psychiatric career

2017 ◽  
Vol 22 (4) ◽  
pp. 315-323
Author(s):  
Thomas Flamini ◽  
Natasha R. Matthews ◽  
George S. Castle ◽  
Elliot M. Jones-Williams
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Medical School ◽  
Family Life ◽  
Design Methodology ◽  
Online Survey ◽  
Structured Interview ◽  
Structured Interviews ◽  
Content Type ◽  
Practical Implications

Purpose The purpose of this paper is to investigate perceptions towards a career in psychiatry among medical students and psychiatrists and identify how recruitment into the specialty may be improved. Design/methodology/approach This study locally compares medical student and psychiatric doctor responses to a structured online survey and structured interviews with key managerial figures in the Humber NHS Foundation Trust. Findings Comparison across two main areas (pre-decision exposure to psychiatry and reasons for considering a psychiatric career) found that both students and doctors were influenced to make a choice about a career in psychiatry during medical school. Medical students found compatibility with family life to be more important when considering psychiatry, whereas doctors cited content-based reasons as significant pull factors. Stigma and fear of being harmed deterred some students from choosing a career in psychiatry. Structured interview responses reiterated the importance of pre-medical school and undergraduate mentorship in bolstering future recruitment to psychiatry. Practical implications Medical students perceive certain career issues differently to their postgraduate counterparts. Widening the content-based appeal of psychiatry and optimising the medical school experience of the specialty via varied and high-quality placements may be a key step towards tackling the national shortfall in qualified psychiatrists. Originality/value This is the first published study comparing medical student and psychiatric doctor perceptions of a career in psychiatry.

scholarly journals Functional neurological disorders in patients with brain tumours

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv12-iv12
Author(s):  
Charmaine Toh ◽  
Dorothy Joe ◽  
Katia Cikurel ◽  
Julia Johnson ◽  
Francesco Vergani ◽  
...  
Keyword(s):  
Brain Tumour ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Brain Tumours ◽  
Neurological Symptoms ◽  
Adult Brain ◽  
Case Review ◽  
Functional Neurological Symptoms ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Abstract Aims Signs and symptoms that develop in people with brain tumours are often attributed to their tumour. The prevalence and management of functional neurological symptoms in brain tumour patients have received little attention. This is surprising because functional neurological symptoms complicate management greatly and misdiagnosis can lead to inappropriate treatment and iatrogenic side-effects. Therefore, we investigated the presentation, diagnosis and management of functional neurological disorders (FND) in patients who had a brain or meningeal tumour. Method A retrospective case review was performed from 2017 - 2021 to identify adult brain tumour patients who developed a functional neurological disorder that caused significant disability necessitating expedited investigations. All patients attended a regional neuro-oncology centre. We recorded type of brain tumour and diagnostic investigations. The onset of functional symptoms was divided into three time windows: before tumour diagnosis, after diagnosis and before treatment or after tumour treatment. A neuropsychological review looked for evidence of previous adverse life events. Therapeutic interventions for functional neurological disorder and their outcomes were documented. The case review was combined with a systematic review of the literature to identify the published presentations of functional neurological disorder in the adult brain tumour population. MEDLINE, EMBASE and PsycINFO databases were searched for studies published between January 1980 and February 2021. Results Six patients (5 female, 1 male) were identified from the case review with a median age of 41 (range 29 - 56) years old. Four patients had non-epileptic attack disorder, which was diagnosed with videotelemetry of habitual attacks. One patient had a functional hemiparesis with normal central motor conduction time. One patient had a functional speech disorder with normal EEG. Half of these patients had functional neurological symptoms prior to surgery/oncological treatment. Five patients (83%) were referred for further neuropsychiatric or psychological evaluation. A history of significant psychological trauma prior to the brain tumour diagnosis was elicited in four (66%) patients. Conclusion Patients with either a brain or meningeal tumour may develop functional neurological symptoms. Our findings suggest the possibility that diagnosis of a brain tumour may precipitate a debilitating functional neurological disorder. The neurobiological basis for functional neurological disorders is being actively investigated. There are suggestions in the literature that some brain diseases increase the risk of developing a functional neurological disorder. Further work is needed to determine whether this is true for patients with brain tumours. Increased awareness of functional neurological disorders will improve management. Withdrawal of unnecessary treatment, such as anticonvulsant drugs, reduces the risk of iatrogenic side effects. Initiation of multi-disciplinary care pathways, e.g. physiotherapy, speech and language therapy and psychological treatments, promotes recovery. Collectively, these interventions improve our patients’ quality of life.

scholarly journals Don’t Shoot the Messenger: Experiences of Delivering Prognostic Information in the Context of Advanced Cancer

2018 ◽  
Vol 35 (12) ◽  
pp. 1526-1531 ◽  
Author(s):  
Melissa P. Masterson ◽  
Allison J. Applebaum ◽  
Kara Buda ◽  
Sally Reisch ◽  
Barry Rosenfeld
Keyword(s):  
Palliative Care ◽  
Best Practice ◽  
Individualized Medicine ◽  
Treatment Options ◽  
Structured Interviews ◽  
Prognostic Information ◽  
Doctor Patient Communication ◽  
Information Preferences ◽  
Current State ◽  
Types Of Information

The study of prognostic understanding is imperative as the trend toward individualized medicine continues. However, without guidelines for discussing prognosis, palliative care clinicians face challenges presenting prognostic information in a way that optimizes patient understanding, psychological adjustment, and decision-making. The present study draws on the experiences of experts in the field of palliative care in order to examine the communication of prognostic information. Fifteen oncology, psycho-oncology, and palliative care professionals with expertise in doctor–patient communication participated in semi-structured interviews that focused on identifying the breadth of factors underlying prognostic understanding, as well as methods to identify and quantify this understanding. Three independent raters utilized a thematic content analysis framework to identify core themes that reflected unique aspects of prognostic understanding. Interviews yielded 2 types of information. Participants described the multifaceted nature of prognostic understanding and identified 5 distinct elements of prognostic understanding: understanding of current state of disease, life expectancy, curability, decline trajectory, and available treatment options. Participants also offered “best practice” techniques, including methods for determining a patient’s preferences for and understanding of prognostic information, assessing patient fears and concerns, and communicating medical uncertainties. Results emphasize the need for clinicians to join with patients to ensure that prognostic information is well understood. These results highlight the salience of health information preferences and strategies to provide comprehensive prognostic information, compassionately and with respect for each individual patient.

scholarly journals The Arc de Siècle: functional neurological disorder during the ‘forgotten’ years of the 20th century

Brain ◽  
2020 ◽  
Vol 143 (4) ◽  
pp. 1278-1284
Author(s):  
Max Fend ◽  
Louise Williams ◽  
Alan J Carson ◽  
Jon Stone
Keyword(s):  
20Th Century ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Oral Histories ◽  
Pragmatic Approach ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Using archived records, plus oral histories from retired neurologists, Fend et al. examine attitudes to functional neurological disorders in the mid-20th century. While frequently scathing in their correspondence, most neurologists of the time adopted a pragmatic approach with many referring patients to psychiatrists.

scholarly journals User-driven efforts in creating knowledge graph information system

2020 ◽  
Vol 36 (2) ◽  
pp. 97-111
Author(s):  
Stanislava Gardasevic
Keyword(s):  
Information System ◽  
Information Seeking ◽  
Information Needs ◽  
Resource Discovery ◽  
The Body ◽  
Knowledge Graph ◽  
Structured Interviews ◽  
Community Members ◽  
Study Objective ◽  
Content Type

Purpose This paper presents the results of a qualitative study that involved students of an interdisciplinary PhD program. The study objective was to gather requirements to create a knowledge graph information system. The purpose of this study was to determine information-seeking practices and information needs of this community, to inform the functionalities of a proposed system, intended to help students with relevant resource discovery and decision-making. Design/methodology/approach The study design included semi-structured interviews with eight members of the community, followed by a website usability study with the same student participants. Findings Two main information-seeking styles are recognized and reported through user personas of international and domestic (USA) students. The findings show that the useful information resides within the community and not so much on the program website. Students rely on peer communication, although they report lack of opportunities to connect. Students’ information needs and information seeking are dependent on their progress through the program, as well as their motivation and the projected timeline. Practical implications Considering the current information needs and practices, a knowledge graph hosting both information on social networks and the knowledge produced by the activities of the community members would be useful. By recording data on their activities (for example, collaboration with professors and coursework), students would reveal further useful system functionalities and facilitate transfer of tacit knowledge. Originality/value Aside from the practical value of this research that is directly influencing the design of a system, it contributes to the body of knowledge on interdisciplinary PhD programs.

scholarly journals Views about sensory modulation from people with schizophrenia and treating staff: A multisite qualitative study

2021 ◽  
pp. 030802262098847
Author(s):  
Tawanda Machingura ◽  
Chris Lloyd ◽  
Karen Murphy ◽  
Sarah Goulder ◽  
David Shum ◽  
...  
Keyword(s):  
Content Analysis ◽  
Treatment Option ◽  
Perceived Risk ◽  
Quantitative Methods ◽  
Qualitative Content Analysis ◽  
Treatment Options ◽  
Occupational Therapists ◽  
Sensory Modulation ◽  
Structured Interviews ◽  
Effective Training

Introduction Current non-pharmacological treatment options for people with schizophrenia are limited. There is, however, emerging evidence that sensory modulation can be beneficial for this population. This study aimed to gain insight into sensory modulation from the user’s and the treating staff’s perspectives. Method A qualitative content analysis design was used. Transcripts from occupational therapists ( n=11) and patients with schizophrenia ( n=13) derived from in-depth semi-structured interviews were analysed for themes using content analysis. Results Five themes emerged from this study: Service user education on the sensory approach is the key; A variety of tools should be tried; Sensory modulation provides a valued treatment option; There are challenges of managing perceived risk at an organisational level; and There is a shortage of accessible and effective training. Conclusion People with schizophrenia and treating staff had congruent perceptions regarding the use of sensory modulation as a treatment option. The findings suggest that sensory modulation can be a valued addition to treatment options for people with schizophrenia. We suggest further research on sensory modulation intervention effectiveness using quantitative methods so these results can be further explored.

scholarly journals Unpacking the package

2015 ◽  
Vol 12 (4) ◽  
pp. 346-376 ◽  
Author(s):  
Mark Evans ◽  
Basil Phillip Tucker
Keyword(s):  
Organisational Change ◽  
Clean Energy ◽  
Management Control ◽  
Theory And Practice ◽  
Structured Interviews ◽  
Informal Control ◽  
Content Type ◽  
Energy Company ◽  
Management Controls ◽  
Control Package

Purpose – The purpose of this paper is to explore the ways in which both formal and informal control, operating as a package, are implicated in responding to organisational change arising from the introduction of the Australian Federal Government’s Clean Energy Act (2011). Design/methodology/approach – This investigation is based on a review of archival data, and semi-structured interviews conducted with 15 staff at different hierarchical levels within an Australian renewable energy company. Findings – Although formal management control systems and informal control both played important roles in the organisation’s reorientation to organisational change, it was the latter form of control that predominated over the former. The influence of the prevailing organisational culture, however, was pivotal in orchestrating both formal and informal control efforts within this organisation. Originality/value – This study contributes to management control theory and practice in two ways: first, it provides much needed empirical evidence about the ways in which management controls act as a package; second, it offers insights into the relative importance of the components of a management control package in the context of a particular organisational change. In addition, it responds to Laughlin’s (1991) call for empirical “flesh” to be added to the skeletal framework he advocates to make this conceptualisation of organisational change, “more meaningful”.

Experience and expression of social isolation by inner-city high-rise residents

2014 ◽  
Vol 17 (3) ◽  
pp. 151-166 ◽  
Author(s):  
Love M. Chile ◽  
Xavier M. Black ◽  
Carol Neill
Keyword(s):  
Older Adults ◽  
Inner City ◽  
Social Isolation ◽  
Age Groups ◽  
Evidence Base ◽  
Structured Interviews ◽  
Content Type ◽  
High Rise ◽  
Starting Point ◽  
Health And Social Care

Purpose – The purpose of this paper is to examine the significance of social isolation and the factors that create social isolation for residents of inner-city high-rise apartment communities. We critically examine how the physical environment and perceptions of safety in apartment buildings and the inner-city implicate the quality of interactions between residents and with their neighbourhood community. Design/methodology/approach – The authors used mixed-methods consisting of survey questionnaires supplemented by semi-structured interviews and focus group discussions using stratified random sampling to access predetermined key strata of inner-city high-rise resident population. Using coefficient of correlation we examine the significance of the association between social isolation, age and ethnicity amongst Auckland's inner-city high-rise residents. Findings – The authors found the experience and expression of social isolation consistent across all age groups, with highest correlation between functional social isolation and “being student”, and older adults (60+ years), length of tenure in current apartment and length of time residents have lived in the inner-city. Research limitations/implications – As a case study, we did not seek in this research to compare the experience and expressions of social isolation in different inner-city contexts, nor of inner-city high-rise residents in New Zealand and other countries, although these will be useful areas to explore in future studies. Practical implications – This study is a useful starting point to build evidence base for professionals working in health and social care services to develop interventions that will help reduce functional social isolation amongst young adults and older adults in inner-city high-rise apartments. This is particularly important as the inner-city population of older adults grow due to international migration, and sub-national shifts from suburbs to the inner-cities in response to governmental policies of urban consolidation. Originality/value – By identifying two forms of social isolation, namely functional and structural social isolation, we have extended previous analysis of social isolation and found that “living alone” or structural social isolation did not necessarily lead to functional social isolation. It also touched on the links between functional social isolation and self-efficacy of older adults, particularly those from immigrant backgrounds.

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