Zachary Grin, PT, DPT

New review article on health anxiety for neurologists with Huw Green in Practical Neurology

❌Health anxiety is NOT FND.
✅Can occur in any neurological condition,
✅Reassurance usually makes it worse
✅Specific treatment.
pn.bmj.com/content/earl...

Free link - tinyurl.com/5n7shutv

A square canvas. Only the top corner is filled with Harings distinctive figures, rendered in Lavender, the rest is blank.

Keith Haring died of AIDS aged 31 on 16 Feb 1990.
One of his last works, Unfinished Painting, was deliberately incomplete, reflecting the devastating, unquantifiable loss to the arts due to AIDS.
#LGBTplusHistoryMonth

“Current evidence did not show an association between patients with MCADs #MCAS and those with #POTS and/or #EDS.”

www.jacionline.org/article/S009...

If you’re a clinician looking for resources to share with patients with FND, neurosymptoms.org should be your go-to!

Lots of great info on FND diagnosis, subtypes, treatment, and formulation - presented in wonderfully clear language.

By expert neurologist @jonstoneneuro.bsky.social

I’m glad you found this helpful!

You can learn more about FCD here: neurosymptoms.org/en/symptoms/...

Yes starting a new med can be tricky. Anti-anxiety meds can sometimes be very helpful but you are right, it’s a new thing for your body to adjust to & that can sometimes cause problems w/ FND.

The mind/body revolution: how the division between ‘mental’ and ‘physical’ illness fails us all New research shows western medicine’s traditional split between brain and body is, in fact, far from clear cut – and could provide a breakthrough for many complex conditions

The mind/body revolution: how the division between ‘mental’ and ‘physical’ illness fails us all www.theguardian.com/society/2025...

What @mcuban.bsky.social said!!!!!

As a medical professional, the things I could tell you about how foul it is dealing with #insurance would blow your damn mind.

I’m concerned you get many patients with FND who are being misdiagnosed & mismanaged.
It doesn’t have to be that way though!

FND is real, reliability diagnosed with validated clinical signs on exam, and treatable.

Please learn 🙏🏼

www.bmj.com/content/376/...

www.nature.com/articles/s41...

The FND misinformation in this video is very concerning. They discuss a number of FND symptoms but wrongly believe FND means feigning. They admit they don’t know the cause of the symptoms but they are open to learning more to figure it out.

Dr. Ruhoy, please consider learning about FND ⬇️

#FNDaware

Any data to back up what you’re saying? I do and it says you’re wrong 🤷🏻‍♂️

“There are a small number of very specific circumstances where life expectancy is reduced as a result of having ME/CFS - suicide and malnutrition being 2 important examples”

meassociation.org.uk/wp-content/u...

The Diagnosis of Functional Movement Disorder - Practical Neurology Functional movement disorder is diagnosed using positive signs, allowing a clinician to “rule-in” the diagnosis.

Hi. That is not true at all. It is not a diagnosis of exclusion. It is diagnosed in the exact same way as migraines, Parkinson’s Disease, and other conditions. All diseases do not need to be ruled out.

Here’s a table of positive clinical signs to help rule-in: practicalneurology.com/articles/202...

No. This is not true. Most deaths in people with ME/CFS are sadly due to suicide and starvation. The people with Long Covid who die of heart attacks and strokes are typically not the patients who present similar to ME/CFS. The patients in the above study seem to have the ME/CFS subtype.

That is 100% not true. Organs don’t shut down in ME/CFS or the long COVID subtype that presents similar to ME/CFS after mild infection. This would happen if someone is unable to eat but that is due to lack of nutrition, not disease. The symptoms are not consistent with basic anatomy & physiology.

I disagree. There’s nothing unsafe about them. The only time they could be considered problematic is when the person believes they are unsafe and cannot update that belief. The threat value of energy expenditure and symptoms + excessive self-monitoring will continue to perpetuate the cycle.

…these mechanisms may be accompanied by more frequent cognitive problems and greater perceived effort in task performance, which creates a vicious cycle that results in over-attention on these cognitive symptoms.”

…excessive self-monitoring, attentional bias, negative beliefs about the disease or ageing, health anxiety, perseverative cognition (rumination, obsession, worry), and abnormal emotional processing…

“…global metacognition errors (i.e., errors in the way in which an individual assesses their own cognitive performance) and perfectionism in memory assessment, which ultimately results in low tolerance to memory lapses that may be considered normal in everyday life…

We need to consider the neuropsychological & behavioral consequences of an infection too.

The study’s results seem consistent with functional cognitive disorder.

Good overview: www.elsevier.es/es-revista-n...

#LongCovid

The problem is the perception of energy expenditure required by an activity, not the actual energy expenditure. Engaging in meaningful activities can help reduce the threat of energy expenditure. Treatment aims to reduce excessive attention & threat value of symptoms, not ignore them.

There’s plenty of evidence showing no disease or meaningful tissue damage to explain the condition. People w/ mitochondrial diseases have clear evidence of disease and do not present similarly to people with ME/CFS or Long Covid. This doesn’t make the symptoms, limitations, suffering any less real.

I reject the narrative that there is a clinically meaningful reduction in energy production that is incapable of adapting to controlled increases in physiological demands.

The best evidence shows dysfunction of stress systems and any energy production issues are downstream effects.

I disagree. Sure you can say there’s an assumption of how it works based on the rationale for providing the intervention, but the study was not meant to confirm how it works. It could be the actual CBT elements, therapeutic alliance, something else. Regardless, it was still better than usual care.

As clinicians we look at the body of evidence, not one study. The best available evidence says active rehabilitation. That may or may not change in the future.

Also, medication and surgeries are very different. They tend to come with higher costs and much higher risks including death.

I understand, but the study is still comparing two choices a clinician would recommend to a patient. Based on this study, a clinician should refer to CBT-based rehabilitation. Even if the benefit is mostly due to contextual factors, it did better than usual care with very low risk.

It was a pragmatic study. They weren’t looking at how it worked. They wanted to know if CBT intervention was more effective than usual care. The study results say yes. Rehabilitative treatment always consists of contextual factors & can be considered part of the intervention (therapeutic alliance).

Videos of people suffering from severe neurological symptoms get shared on social media periodically. These videos are often presented as the person faking, but some may have functional neurological disorder. It's important to recognize that FND =/= fake.

What is FND? A brief primer for HCWs:

Want to save yourself heartache, discomfort and prevent medical errors when admitted to the hospital? Have your doctor arm you with a signed letter you can hand out to all the healthcare professionals who will be in your orbit. www.parkinson.org/library/book...

I've put together a starter pack for the FND science community.

Please repost to share the link and do let me know of folks I've missed so I can add them to the group.

Thanks everyone 🙏

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This is not true - it’s still covered.

www.tricare.mil/autism

www.military.com/daily-news/2...

www.militarytimes.com/pay-benefits...

A very nice statement from the American Academy of Allergy, Asthma & Immunology (AAAAI) debunking the myth of "toxic mold illness" that is spread by functional and integrative medicine quacks:

www.aaaai.org/tools-for-th...