Persistent Diagnostic Disagreement Among Individuals With Functional Movement Disorders

Area of Science:

• Neurology
• Psychiatry
• Clinical Psychology

Background:

• Diagnostic agreement is crucial for effective treatment outcomes in neurological disorders.
• Persistent diagnostic disagreement (PDD) in functional movement disorder (FMD) has not been well-studied.
• Understanding PDD is essential for improving patient care and therapeutic success in FMD.

Purpose of the Study:

• To propose a definition for persistent diagnostic disagreement (PDD) in functional movement disorder (FMD).
• To identify demographic and clinical factors associated with PDD in FMD patients.
• To evaluate the accuracy of patient self-reports and referring clinician impressions in identifying PDD.

Main Methods:

• Retrospective review of clinical data from 158 FMD patients.
• Assessment of patient self-reported diagnostic agreement and specialist-determined PDD status.
• Utilized logistic regression and LASSO modeling to identify factors associated with PDD.
• Evaluated concordance between referring clinician impressions and patient self-reports.

Main Results:

• 41% of FMD patients (47 out of 116) were classified as having PDD.
• PDD was associated with low agency, cluster B traits, lower readiness to change, and inability to notice symptom variability.
• Low agency was the only factor retained in the LASSO analysis.
• Concordance between referring physician impressions and patient self-reported disagreement was low (weighted κ=0.21).

Conclusions:

• Persistent diagnostic disagreement is prevalent in functional movement disorder.
• Neither patient self-reports nor initial clinical impressions accurately identify PDD.
• PDD may be associated with modifiable psychological processes, suggesting potential therapeutic targets.