FREQUENCY AND FACTORS ASSOCIATED WITH SUSPECTED FUNCTIONAL NEUROLOGICAL DISORDER AMONG PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT OF A TERTIARY CARE HOSPITAL IN PESHAWAR

Abstract

Background: Functional Neurological Disorder (FND) produces genuine but neurologically unexplained symptoms that are diagnostically difficult to separate from deliberate symptom fabrication in the high-pressure setting of the emergency department (ED). No published data describe the frequency of suspected FND-consistent presentations in a Pakistani ED prior to this study. Objective: To determine the frequency of suspected FND-consistent presentations, and their associated sociodemographic and clinical factors, among patients attending the ED of a tertiary care hospital in Peshawar. Methods: In this four-month cross-sectional study, 140 patients above five years of age were enrolled by convenience sampling at the ED of Lady Reading Hospital (LRH), Peshawar. A structured questionnaire recorded sociodemographic and clinical presentation data alongside seven pre-specified behavioural indicators; patients with three or more positive indicators, together with the attending physician's overall clinical impression, were classified as having a suspected FND-consistent presentation. Data were analysed descriptively using SPSS v22.0. Results: A suspected FND-consistent presentation was identified in 89.3% of patients (n=125/140; 95% CI 84.2–94.4%). The sample was predominantly female (80.0%), under 40 years old (73.6%), unemployed (69.3%), and without formal education (52.1%). Shelter-seeking was the commonest primary reason for ED attendance (45.0%). The most prevalent behavioural indicators were inconsistency between symptoms and physical findings (95.0%), inconsistent history on repeated questioning (90.0%), and symptom worsening when discharge was discussed (85.7%). Most patients were discharged (67.1%). Conclusion: Suspected FND-consistent presentations were highly prevalent in this ED population and were closely linked to unmet social need. Structured, checklist-based assessment and locally adapted clinical pathways may improve the consistency and compassion of care for this population.

Keywords:

Functional Neurological Disorder; Conversion Disorder; Emergency Service, Hospital; Prevalence; Secondary Gain; Somatoform Disorders; Pakistan; Cross-Sectional Studies.