The clinical management of functional neurological disorder in UK health services: a mixed-methods study of diagnostic assessments and treatments, experiences, and perspectives

Background: Functional neurological disorder (FND) is a debilitating and disabling health condition. It is associated with a broad set of symptoms, and onset is typically spontaneous. The exact aetiology of FND is unknown, however there are several sociodemographic, neurobiological and psychological factors thought to be linked to its onset. There has been little published evidence on how FND is clinically managed in the UK, or the experiences of patients, caregivers and healthcare workers on the associated diagnostic and treatment processes. This mixed-methods thesis aimed to establish the current UK clinical management of FND, and examine the experiences of healthcare workers, patients and caregivers on the diagnostic and treatment processes for FND. Methods: A scoping review was conducted to identify current FND diagnostic assessments and treatments, alongside a comparison of current FND clinical guidelines. This was followed by an online survey to map the clinical management of FND in UK health services, and finally an interview study to explore the experiences of patients, caregivers and healthcare workers on the clinical management of FND. Results: While there are a range of FND diagnostic tools and treatments, many do not have an evidence base reporting their effectiveness. The findings from this thesis highlight the high variability of service provision across the UK. Healthcare worker awareness of FND is limited, and instances of stigma and negative attitudes towards FND are still occurring in health services. Patient needs during the clinical management of FND were dismissed by healthcare workers. Conclusion: This thesis has provided further support on the prioritisation of FND in UK services, and has revealed a great disparity across UK health services when supporting FND patients. The development of UK clinical guidelines, an effective education package and implementation of multidisciplinary teams are recommended, in order to improve the clinical management of FND.