#7128 Using critical theory to improve clinical care for functional neurological disorders

<h3></h3> This review evaluated how applied Critical Theory (CT) can be used to enhance understanding, diagnosis, and clinical management of Functional Neurological Disorders (FND), by strengthening patient voices and addressing clinician and researcher blind spots. Through the analysis of doctor-patient relationships and power differentials, using concepts such as (bio)power, knowledge, and discourse analysis, CT provides insights into the complex interaction between medical power and patient agency and participation in clinical and research practice. <h3>Background</h3> FNDs encompass diverse motor, sensory, cognitive, neuropsychiatric and other symptoms, without neuropathological changes, thus standing at the intersection of neurology and psychiatry. The divergence between these two disciplines, and the challenges in defining boundaries between mind, body and society in FND, impair clinical management and patients‘ quality of life. By critiquing the prevailing power structures and norms, CT gives voice to marginalized groups, highlighting gaps and inequities in our understanding of FND. <h3>Methods</h3> The literature was searched via Scopus, Web of Science, and PsycINFO. We included empirical studies in English that included FND or synonymous terminology as a primary measure, identifying 30 appropriate studies. We appraised these in the light of CT, also considering the limitations of CT. <h3>Results</h3> Both patients and healthcare professionals (HCPs) reported serious knowledge gaps among HCPs about FND, with negative repercussions for patients. Outdated knowledge and beliefs continue to lead to patient stigmatization and marginalization, fostering reluctance among HCPs to engage effectively. These biases and knowledge deficits translate into feelings of neglect, blame, and humiliation among patients. Although patients try hard to understand their condition, they often express dissatisfaction with the explanations they receive. These often involve metaphors of misalignment or miscommunication within the brain and body, with which patients don’t relate. <h3>Discussion</h3> The findings emphasize the need for improving knowledge among HCPs regarding FND, as well as the importance of effective communication and patient participation in the diagnostic process. However, in our view it is not just a matter of education, but also of genuine gaps in our scientific and philosophical understanding of FND, pointing to a need for better concepts and better empirical science. By scrutinizing societal power dynamics, i.e., how the exercise of authority contributes to and perpetuate disparities, CT can uncover biases and challenge established norms, which can ultimately enhance the understanding of FND in clinical practice and can improve both research and clinical outcomes.