Mcloughlin Caoimhe, Lee Wei Hao, Carson Alan, Stone Jon
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh Bioquarter, Edinburgh E16 4SB, Scotland, UK.
Brain. 2025 Jan 7;148(1):27-38. doi: 10.1093/brain/awae283.
Functional neurological disorder (FND) is continuing to gain increasing recognition globally as a valid and potentially treatable disorder. Iatrogenic harm towards patients with FND is significant, however, and has been around for centuries. Despite advances in our understanding around the aetiology, pathophysiology and treatment of FND, many aspects of such harm continue to persist. Avoidance of iatrogenic harm has been highlighted by clinicians as one of the most important therapeutic considerations in FND; however, the sources and range of potential harms, or indeed ways to mitigate them, have not previously been summarized. Using a combination of clinical and research experience and scoping review methodology, this review aims to describe the main sources of iatrogenic harm towards patients with FND, including harm from misdiagnosis, delayed diagnosis and treatment, direct harm from professional interactions, other stigma-related harms, harm related to diagnostic overshadowing and over-diagnosis of FND. We also describe some potential ways to address and prevent such harms, such as ways to reduce misdiagnosis with a focus on rule in signs, optimizing teaching and communication, ensuring parity of FND with other medical conditions and continued integration of patient and professional organizations.
功能性神经障碍（FND）作为一种有效的且可能可治疗的疾病，在全球范围内正持续获得越来越多的认可。然而，对FND患者的医源性伤害十分严重，且已存在数百年。尽管我们对FND的病因、病理生理学及治疗的理解有所进步，但此类伤害的许多方面依然存在。临床医生已强调避免医源性伤害是FND最重要的治疗考量之一；然而，潜在伤害的来源和范围，以及减轻这些伤害的实际方法，此前尚未得到总结。本综述结合临床和研究经验以及范围综述方法，旨在描述对FND患者医源性伤害的主要来源，包括误诊、诊断和治疗延误造成的伤害、专业互动带来的直接伤害、其他与污名相关的伤害、与诊断遮蔽及FND过度诊断相关的伤害。我们还描述了一些应对和预防此类伤害的潜在方法，例如通过重点关注确诊体征来减少误诊的方法、优化教学与沟通、确保FND与其他疾病同等对待，以及患者组织和专业组织的持续融合。
