Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33227
Title: Principles for delivering improved care of people with functional seizures: Closing the treatment gap.
Austin Authors: Winton-Brown, Toby;Wilson, Sarah J;Felmingham, Kim;Rayner, Genevieve ;O'Brien, Terence J;O'Brien, Patrick;Mohan, Adith;Velakoulis, Dennis;Kanaan, Richard A A 
Affiliation: Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.;Alfred Mental and Addiction Health, Alfred Health, Melbourne, VIC, Australia.
Clinical Neuropsychology
Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.
Department of Clinical Neurosciences, St Vincent's Hospital, Fitzroy, VIC, Australia.
Centre for Healthy Brain Ageing, University of New South Wales, Randwick, NSW, Australia.;Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia.
Neuropsychiatry, The Royal Melbourne Hospital, Melbourne, VIC, Australia.;Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.
Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.;Austin Health, Heidelberg, VIC, Australia.
General Medicine
Issue Date: Dec-2023
Date: 2023
Publication information: The Australian and New Zealand Journal of Psychiatry 2023-12; 57(12)
Abstract: Patients diagnosed with functional (psychogenic nonepileptic) seizures have similar or greater levels of disability, morbidity and mortality than people with epilepsy, but there are far fewer treatment services. In contrast to epilepsy, the current understanding of pathophysiological mechanisms and the development of evidence-based treatments for functional seizures is rudimentary. This leads to high direct healthcare costs and high indirect costs to the patient, family and wider society. There are many patient, clinician and system-level barriers to improving outcomes for functional seizures. At a patient level, these include the heterogeneity of symptoms, diagnostic uncertainty, family factors and difficulty in perceiving psychological aspects of illness and potential benefits of treatment. Clinician-level barriers include sub-specialism, poor knowledge, skills and attitudes and stigma. System-level barriers include the siloed nature of healthcare, the high prevalence of functional seizures and funding models relying on individual medical practitioners. Through the examination of international examples and expert recommendations, several themes emerge that may address some of these barriers. These include (1) stepped care with low-level, brief generalised interventions, proceeding to higher level, extended and individualised treatments; (2) active triage of complexity, acuity and treatment readiness; (3) integrated interdisciplinary teams that individualise formulation, triage, and treatment planning and (4) shared care with primary, emergency and community providers and secondary consultation. Consideration of the application of these principles to the Australian and New Zealand context is proposed as a significant opportunity to meet an urgent need.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33227
DOI: 10.1177/00048674231180509
ORCID: 0000-0001-8940-7816
0000-0003-0992-1917
Journal: The Australian and New Zealand Journal of Psychiatry
Start page: 48674231180509
PubMed URL: 37394954
ISSN: 1440-1614
Type: Journal Article
Subjects: FND
Functional Neurological Disorder
Functional seizures
PNES
health services
psychogenic non-epileptic seizures
Appears in Collections:Journal articles

Show full item record

Page view(s)

42
checked on Nov 8, 2024

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.