Neurology, functional disorders, and Autonomic Disorders Fellowships

PhakeDoc

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I know that functional disorders have been in the domain of GI docs and some psychiatrists, but have any of you currently practicing neurologists/residents seen a movement of this area into the world of neurology, even vaguely? Is neurogastroenterology only viable through GI or also via the neuro route initially? I would think that IBS caused by enteric nervous system dysfunction would be a logical, multi-discipline area of focus for NEUROlogists. Or do functional disorders still suffer from the same stigma as fibromyalgia ("Refer those folks to the psychiatrists or anyone else but me")?

Also, most of the descriptions of autonomic disorders fellowships seem to be rather vague. Would functional disorders come under their heading?
 

neurologist

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I know that functional disorders have been in the domain of GI docs and some psychiatrists, but have any of you currently practicing neurologists/residents seen a movement of this area into the world of neurology, even vaguely?
?????????
Half the stuff I see in general neurology is probably "functional."

If you can prove there is no underlying severe pathology and the patient is receptive to it, you can send them for cognitive behavioral therapy (CBT); that's generally done by a psychologist. Otherwise there's really not much that neurologists have to offer.

Is neurogastroenterology only viable through GI or also via the neuro route initially? I would think that IBS caused by enteric nervous system dysfunction would be a logical, multi-discipline area of focus for NEUROlogists.
Neurogastroenterology?!?!?! Wow, that's pretty subspecialized. Won't make much of a living off that in day to day practice . . .

I can probably pretty safely say I speak for most neurologists when I say that I want nothing to do with the a$$ end . . . . :eek: I am more than happy to defer this to GI and/or psychology (CBT can work nicely for IBS).


Or do functional disorders still suffer from the same stigma as fibromyalgia ("Refer those folks to the psychiatrists or anyone else but me")?
In a word, Yes.

In more words, despite the obvious (but often ignored) fact that "functional" disorders are behavioral and the brain is the organ of behavior, and therefore functional disorders are of the nervous system, neurologists are really not particularly adept at or interested in treating them. Mostly these patients need a course of CBT (sorry to keep harping on this, but it's really the best thing for them . . . ) and ongoing followup and reinforcement. This is too time consuming for most neurologists and generally best done by a psychologist.

Also, most of the descriptions of autonomic disorders fellowships seem to be rather vague. Would functional disorders come under their heading?
No. The population you see in autonomics is generally peripheral neuropathy and movement disorders. Yes, you get your flaky "spells" as well and end up doing tilt tables to rule out dysautonomic syncope . . . once you've ruled it out, you generally say goodbye to the patient.