Unveiling the enigma: physicians' perceptions of functional neurological disorders in Egypt—a cross-sectional study

Background: In medical practice, it is common to see patients who present with physical symptoms for which no disease pathology can be found. The presence of neurological symptoms that are shown to be incompatible with neurological pathophysiology is classically known as “conversion disorder” or “Functional Neurological Symptom Disorder” (FND). While FND is common in Egypt as in the rest of the world, few scientific studies systematically evaluate the degree of knowledge, attitude, and care provided by health care professionals to FND patients. We aimed to assess Egyptian physicians’ perspectives on FND. Results: A cross-sectional study has been conducted on 152 physicians dealing with FND practicing in Egypt from specialties of psychiatry, neurology, and other specialties. We found that for 45% of the participants, disordered functioning of the nervous system plus psychogenesis was the accepted etiology behind FND. Most participants were significantly not satisfied with their education about FND (p-value 0.01). Psychiatrists and neurologists significantly preferred to use the term “conversion disorder” while other specialties mainly used “psychic” and “Somatization/Somatoform Disorder” (p-value 0.001). Forty-four percent of the participants think they have a good knowledge of functional neurological disorders (FND), while the majority (86.8%) were worried about missing an organic disorder. Psychiatrists were the most confident in diagnosing FND and the most comfortable discussing it with patients (p-values 0.055 and 0.007, respectively). Conclusion: Here we highlight the common theme of worry about FND patients prevailing among healthcare professionals who are mostly perplexed about the mechanisms behind FND, and how to communicate these symptoms to other professionals and patients themselves. Future directions need to be devoted to minimizing the gap between the research finding and the currently applied care. Better education and teaching about FND may improve patient care.