Functional neurological disorders among hospitalized patients in a resource-limited setting: current situation in Colombia and paths to improvement.

backgroundFunctional neurological disorders (FND) are increasingly recognized in various clinical settings. However, early diagnosis and appropriate treatment remain challenging among hospitalized patients.

objectiveTo describe the clinical characteristics, diagnostic process, treatment, and outcomes of hospitalized patients with FND and to propose a pathway for improvement.

methodsWe conducted a retrospective chart review of hospitalized adult patients diagnosed with FND between 2020 and 2023 at a tertiary hospital in Colombia. Follow-up was conducted via phone interviews.

resultsSixty-seven patients were included, 84% female, with a median age of 34 (24-47) years. The most common FND subtypes were weakness (57%) and seizures (49%), with 37% presenting mixed FND. Concomitant symptoms and comorbid medical, neurological, and psychiatric conditions were frequent. Misdiagnosis was common, mostly as stroke or epilepsy/status epilepticus. Only 12% were correctly identified at admission, highlighting a lack of early recognition. The diagnostic process reflected an exclusion-based approach and underuse of appropriate diagnostic criteria for FND. Most patients underwent imaging and additional testing, 16% required extensive workups, and 13% were exposed to potentially harmful interventions. Treatment for FND primarily included outpatient psychotherapy (61%), psychiatric follow-up (66%), and antidepressants (37%). Standard outpatient physiotherapy was only indicated in 21%, and neurology follow-up was not considered in one-third of cases. Among patients contacted by phone (n = 51), 37% reported partial or insufficient understanding of the diagnosis.

conclusionsLimited awareness of FND diagnosis and management is a major factor in misdiagnosis and iatrogenic harm. We proposed an inpatient pathway to improve care for these patients.