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Explaining functional disorders in the neurology clinic: a photo story
  1. Alan Carson1,
  2. Alexander Lehn2,3,
  3. Lea Ludwig1,
  4. Jon Stone1
  1. 1Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
  2. 2Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia
  3. 3School of Medicine, University of Queensland, Brisbane, Australia
  1. Correspondence to Dr Jon Stone, Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU, UK; Jon.Stone{at}

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There is an increasing understanding and interest in functional disorders among neurologists. These are common problems that make up a large proportion of a neurologist's workload.1 Nonetheless many doctors are still apprehensive about this area as they find explanation and treatment challenging.2 ,3 However, a successful explanation is generally regarded as an essential platform for further treatment.4 There is evidence that a successful consultation can resolve symptoms in some patients5 ,6 and is associated with improved patient's outcome.7 ,8

Here we explore some issues in explaining the diagnosis of a functional disorder using the unconventional medium of the photo story (figures 1–4). We chose this format to make the article accessible and thought provoking, not because it is a light-hearted topic; far from it.

Figure 1

Photo story part 1.

Figure 2

Photo story part 2.

Figure 3

Photo story part 3.

Figure 4

Photo story part 4.

There is no ‘one size fits all’ method for every patient, but there are some approaches to the consultation that, we have found, help our practice. Our approach is based as much as possible on how neurologists might explain other conditions in the neurology clinic, such as Parkinson's disease: giving a clear diagnosis, explaining transparently how that diagnosis has been made and something about ‘how’ the problem occurs even if the ‘why’ can often be speculative and can be left for later consultations. In an accompanying article, Jon Stone explores the question of whether it is possible to turn a neurological assessment into treatment for the patient with a functional disorder.9

Even neurologists who are keen to help patients with functional disorders sometimes find themselves in avoidable situations that can have a negative impact on outcomes. This cartoon highlights some of these common pitfalls: making or …

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  • Contributors JS and AC conceived of the article and wrote the first draft. AL and LL revised the text. All authors (and no patients) appear in the photo story.

  • Competing interests JS started and maintains a free self-help website for patients, that is mentioned in this article.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Mark Edwards, London, UK.

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