Table_4_Functional Neurological Disorders as Seen by a Cohort of General Practitioners in Northern Italy: Evidence From an Online Survey.DOCX

General practitioners (GPs) provide primary care and advise their patients on which diagnostic and therapeutic pathways they judge most appropriate. For patients with functional neurological disorders (FND), receiving a proper explanation of diagnosis by their GP from the very beginning may drastically improve prognosis. Novel approaches to the diagnosis and treatment of FND have important implications for effective management. The aim of this study was to investigate Italian GP opinion and knowledge about FND in light of new approaches to the illness. To do this, we evaluated the responses to a 13-item web-based survey completed by 133 GPs practicing in northern Italy. Psychological terms to describe FND were more frequently used than functional neurological disorder and mental illness was considered an important predictor of diagnosis. Referral to a neurologist rather than to a psychiatrist was largely preferred, while physiotherapy consultation was seldom recognized as a valuable approach to treating FND. Overall, the survey findings suggest that knowledge about novel approaches to FND is somewhat lacking. Currently, GPs appear to be transitioning from a classical psychological view of the disorder toward a more modern conceptualization, in which neurobiological, psychological, and social factors all play an important role. Professional education during this transition would be an advantageous way to optimize physician management of FND and to enhance diagnosis, explanation, and management across primary and secondary care pathways.

全科医师（General practitioners, GPs）提供初级医疗服务，并为患者推荐其认定为最优的诊断与治疗路径。对于功能性神经障碍（functional neurological disorders, FND）患者而言，由全科医师从接诊初期就给出规范的诊断解释，或可大幅改善其预后。针对FND的新型诊断与治疗方案，对高效开展疾病管理具有重要价值。本研究旨在基于该疾病的新型诊疗理念，调研意大利全科医师对FND的认知与看法。为此，本研究对意大利北部133名执业全科医师填写的13项网络问卷调查结果进行了评估分析。调研结果显示，相较于“功能性神经障碍”，受试者更频繁地使用心理学相关术语描述FND，且认为精神疾病是该疾病诊断的重要预测因素；多数医师更倾向于将患者转诊至神经内科医师而非精神科医师，却极少将物理治疗会诊视为治疗FND的有效手段。整体而言，本次调查结果表明，全科医师对FND新型诊疗方案的认知仍存在一定缺口。当前，全科医师对该疾病的认知正从传统心理学视角，向涵盖神经生物学、心理学与社会因素共同发挥关键作用的现代化概念转变。在此转型阶段开展专业教育，或是优化全科医师FND管理水平、提升初级与二级医疗路径中疾病诊断、病情告知与管理质量的可行途径。