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Expectations ranged from definite and strong for more FMSs at the health clinics to low expectation for FMSs' involvement in research; to mal-expectation on FMSs' involvement in community and public health programmes.
Of the many expectations reported, the priority areas for FMSs to improve on are their clinical competency, and personal and professional attributes.
In addition to the above expectations on FMSs to focus on clinical duty, there were some longings for FMSs to be involved in managing staff issues and in running the clinics.
Our neurobiological explanation for FMSS rests on hierarchical Bayesian models of the brain underwritten by a theory of nervous system function called the 'free-energy principle' (Friston et al., 2006, 2010; Feldman and Friston, 2010).
The framework for FMSS proposed here posits a single mechanism for the generation of a wide variety of symptoms: if this is correct, certain features can be expected to generalize from one symptom type to another.
Given the common causal mechanism for FMSS outlined above, we would expect attention to have an exacerbating effect on the severity of all FMSS, including sensory loss; given the difficulty of using self-reports of sensation in patients with anaesthesia, proxies such as sensory evoked potentials (Levy and Mushin 1973; Kenntner-Mabiela et al., 2008) could be used instead.
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There is certainly evidence for FMSS-related activations in the amygdala, orbitofrontal cortices and posterior cingulate cortices.
Five Minute Speech sample (FMSS): The FMSS provides a measurement of parents' Expressed Emotion (EE) toward their child [ 46].
Below, we explain how a hierarchical Bayesian formulation of brain function can account for the generation of FMSS by attentional and belief-driven processes, and how such processes operating within the normal functional anatomy of perception and voluntary movement might generate symptoms that are interpreted by patients as involuntary and unwilled.
We wish to highlight here the notion of physical precipitating factors in the generation of FMSS, something highlighted by others, for example Reynolds (1869).
We suggest that this phenomenon could lie behind the emergence of 'blocking' phenomena reported commonly by patients with FMSS, for example a sudden transient inability to move, speak or swallow, often occurring during examination or other time of heightened attention to symptoms, also consistent with some previous experimental findings in FMSS (Roelofs et al., 2003, 2006).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com