#7139 Illness perceptions, experiences of stigma and engagement in functional neurological disorder (FND) – exploring the role of multidisciplinary group education sessions

<h3>Background</h3> A critical first step in managing functional neurological disorder (FND) is a positive diagnosis and clear explanation using an understandable illness model. Multidisciplinary group education sessions are one way to achieve this, and there is some evidence they improve understanding, confidence in diagnosis and outcomes with further treatment. In many conditions illness perceptions and stigma affect distress, functioning, quality of life and treatment engagement. A multidisciplinary (MDT), cognitive behavioural therapy (CBT) informed FND group education session has been run by the neuropsychiatry service at St. George’s Hospital, London since 2016. FND group education sessions could be a cost-effective addition to FND pathways but their impact on outcomes and illness perceptions has not been studied. We sought to examine illness perceptions in education session attendees and relationships with comorbidities, quality of life and experiences of stigma. A secondary aim was to consider how education might influence illness perceptions and engagement. Exploring relationships between these factors could generate deeper understanding of the impacts of educational interventions on outcomes. <h3>Methods</h3> Questionnaires assessing illness perceptions, quality of life, mood, anxiety, comorbidities, treatment engagement, and stigma (both experienced and anticipated) were completed before, immediately and one month after a multidisciplinary online group education session for FND at St George’s Neuropsychiatry service (a regional neurosciences centre). Free text data on causal attributions and needs were also collected. <h3>Results</h3> 61 patients with FND completed baseline assessments, 33 (54%) completed 1 month follow up. Patients reported multiple comorbidities, poor quality of life, functioning and high levels of stigma. Illness perception scores indicated FND as threatening, mysterious and unpredictable, with low personal or treatment control over symptoms. Illness coherence/understanding (20.9% mean change, 2.72 mean difference, p&lt;0.01 CI: 1.22 – 4.23) and engagement (16.9% mean change, 2.25 mean difference p&lt;0.01 95% CI: 0.46–4.36) scores increased after the session. There were no significant changes in stigma, distress, sense of control or anticipated discrimination. Free text analysis revealed stress and trauma as the most common causal attributions, followed by physical illnesses. Self-reported needs highlighted the importance of personalised formulations, practical advice on living with disability, help with explaining the condition to others (e.g. employers), and accessing peer support and treatment. <h3>Conclusion</h3> Multidisciplinary group FND education sessions potentially improve patient understanding and engagement. Clinicians should consider the possible benefits of personalised formulations and linking to practical and peer support. Further work assessing illness perceptions is needed, such as adapting measures for FND.