Understanding the Care Pathway in Iranian Patients with Functional Neurological Symptom Disorders

Background: The vague pathology of conversion disorders (Functional Neurological Disorders (FNDs)) creates diagnostic and therapeutic challenges and uncertainties, requiring individuals to navigate various medical specialties and treatments. This study aims to explore pathways individuals with FNDs take in seeking care, uncovering factors influencing their healthcare journey. Methods: Conducted at Roozbeh and Imam Khomeini Educational Hospitals in Tehran from 2019 to 2022, this cross-sectional study included 101 FND-diagnosed patients. They were interviewed using a validated questionnaire by a trained psychiatrist to explore their care-seeking journey, diagnosis delay, and related factors retrospectively. Results: Participants, averaging 36.9 years in age (SD: 12.98), were predominantly female (66.3%) and married (55.0%). Initially, most participants sought consultation from neurologists (40.2%), then general practitioners (36.3%), with subsequent referrals mainly to neurologists in the 2^nd (71.2%) and 3^rd (72.7%) visits. Alongside with the low rates of visiting a general physician in first exposure that is a pronounced deviation from the hierarchy of care (primary, secondary, and tertiary), referral to psychiatrists was minimal in the whole reported visits (2.9%, 3.4%, and 9.1%, respectively). On average, participants had 1-5 specialist visits before visiting with a psychiatrist, with average disorder duration of 37.1 months. Movement disorders were found in 31.7%, and major depressive disorders in 42.6% of this population. A majority of patients (n=79, 78%) experienced at least one stressor before FND onset, with family conflict being the most significant one (17.1%). Conclusion: Our study highlights the significant challenges in the care pathway for Iranian adults with FNDs. Individuals sought consultations with a varying number of medical specialists before ultimately being referred to a psychiatrist. This is especially notable given the high prevalence of psychiatric comorbidities and associated stressors, which emphasize the crucial role of psychiatrists in addressing these complexities. However, both patients and healthcare providers seem to perceive the symptoms with a tendency toward more organic origins, indicating a potential gap in understanding and communication. Enhancing awareness and collaboration among healthcare providers, advocating for early intervention and routine psychiatric evaluation for individuals with FNDs, and addressing perceptions of symptoms through targeted education is recommended. Further research is needed to explore the pathway to care for patients experiencing each type of FND symptoms.