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Milano BA, Moutoussis M, Convertino L. The neurobiology of functional neurological disorders characterised by impaired awareness. Front Psychiatry 2023; 14:1122865. [PMID: 37009094 PMCID: PMC10060839 DOI: 10.3389/fpsyt.2023.1122865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
We review the neurobiology of Functional Neurological Disorders (FND), i.e., neurological disorders not explained by currently identifiable histopathological processes, in order to focus on those characterised by impaired awareness (functionally impaired awareness disorders, FIAD), and especially, on the paradigmatic case of Resignation Syndrome (RS). We thus provide an improved more integrated theory of FIAD, able to guide both research priorities and the diagnostic formulation of FIAD. We systematically address the diverse spectrum of clinical presentations of FND with impaired awareness, and offer a new framework for understanding FIAD. We find that unraveling the historical development of neurobiological theory of FIAD is of paramount importance for its current understanding. Then, we integrate contemporary clinical material in order to contextualise the neurobiology of FIAD within social, cultural, and psychological perspectives. We thus review neuro-computational insights in FND in general, to arrive at a more coherent account of FIAD. FIAD may be based on maladaptive predictive coding, shaped by stress, attention, uncertainty, and, ultimately, neurally encoded beliefs and their updates. We also critically appraise arguments in support of and against such Bayesian models. Finally, we discuss implications of our theoretical account and provide pointers towards an improved clinical diagnostic formulation of FIAD. We suggest directions for future research towards a more unified theory on which future interventions and management strategies could be based, as effective treatments and clinical trial evidence remain limited.
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Affiliation(s)
- Beatrice Annunziata Milano
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
- Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Michael Moutoussis
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
- National Hospital of Neurology and Neurosurgery (UCLH), London, United Kingdom
| | - Laura Convertino
- Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom
- National Hospital of Neurology and Neurosurgery (UCLH), London, United Kingdom
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
- *Correspondence: Laura Convertino,
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Siegel ML, Gullestad Binder EM, Dahl HSJ, Czajkowski NO, Critchfield KL, Høglend PA, Ulberg R. Therapeutic Atmosphere in Psychotherapy Sessions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114105. [PMID: 32526849 PMCID: PMC7312465 DOI: 10.3390/ijerph17114105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 11/22/2022]
Abstract
There is uncertainty concerning what the active ingredients in psychotherapy are. The First Experimental Study of Transference interpretations (FEST) was a randomized controlled trial of the effects of transference work (TW) in psychodynamic psychotherapy. Women with low quality of object relations (QOR) showed a large positive effect of transference work, while men with high QOR showed a slight negative effect. The present study aimed to expand the knowledge from the FEST by investigating the therapeutic atmosphere with Structural Analysis of Social Behavior (SASB). Two-way ANOVAs were conducted to investigate differences between SASB cluster scores between subgroups. The therapeutic atmosphere was characterized by Protect–Trust, Affirm–Disclose and Control–Submit. Multilevel modeling was used to assess the relationship between a therapist variable and outcomes for men and women. Contrary to expectations, no significant differences in therapeutic atmosphere between subgroups (with or without TW in women with low QOR and men with high QOR) were observed using the process measure SASB.
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Affiliation(s)
- Marte L. Siegel
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway; (H.S.J.D.); (N.O.C.)
- Correspondence: (M.L.S.); (E.M.G.B.)
| | - Eva M. Gullestad Binder
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway; (H.S.J.D.); (N.O.C.)
- Correspondence: (M.L.S.); (E.M.G.B.)
| | - Hanne Sofie J. Dahl
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway; (H.S.J.D.); (N.O.C.)
- Vestfold Hospital Trust, Halfdan Wilhelmsens alle 17, 3103 Tønsberg, Norway
| | - Nikolai O. Czajkowski
- Department of Psychology, University of Oslo, Forskningsveien 3A, 0373 Oslo, Norway; (H.S.J.D.); (N.O.C.)
| | - Kenneth L. Critchfield
- Department of Graduate Psychology, James Madison University, Harrisonburg, VA 22807, USA;
| | - Per A. Høglend
- Division of Mental Health and Addiction, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (P.A.H.); (R.U.)
| | - Randi Ulberg
- Division of Mental Health and Addiction, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway; (P.A.H.); (R.U.)
- Department of Psychiatry, Diakonhjemmet Hospital, Forskningsveien 7, 0370 Oslo, Norway
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International classification of diseases/disorders diagnosis and International Classification of Functioning, Disability and Health activity/participation limitation among psychiatric patients: a cross-sectional and exploratory study. Int J Rehabil Res 2019; 43:48-54. [PMID: 31688222 DOI: 10.1097/mrr.0000000000000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To explore the relationships between international classification of diseases/disorders (ICD)-10 diagnoses and International Classification of Functioning, Disability and Health (ICF) disability dimensions - activity and participation restriction among mental health service users. Three hundred sixty patients from different health services diagnosed with diverse mental disorders (ICD-10) participated in the study. Functioning restrictions were evaluated by use of the Mini-ICF-APP. Selected sociodemographic and clinical variables were also analysed. The Mini-ICF-APP scores correlated positively with the clinical impression of disease severity and negatively with general functioning. As independent factors determining the Mini-ICF-APP score, regression analysis suggests diagnosis and severity of disorder but also contextual factors such as general functioning and active occupation. Percentage and percentile distributions of activity and participation restrictions in diagnostic sections and categories revealed noticeable variability regardless of diagnosis-related differences. The diagnosis determines them neither in an ambiguous nor an absolute manner. There is a need to further explore the covariability between clinical diagnosis and ICF activity and participation restriction, particularly in regard the rationalization of social welfare benefits.
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Linden M, Muschalla B, Noack N, Heintze C, Doepfmer S. Treatment Changes in General Practice Patients With Chronic Mental Disorders Following a Psychiatric-Psychosomatic Consultation. Health Serv Res Manag Epidemiol 2018; 5:2333392818758523. [PMID: 29568790 PMCID: PMC5858609 DOI: 10.1177/2333392818758523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine whether a psychiatric–psychosomatic consultation can identify unmet treatment needs and improve treatment of patients with mental disorders in general practice. Methods: In 40 primary care practices, 307 consecutive primary patients who met criteria for chronic mental disorders were assessed by a psychiatric–psychosomatic consultant. After random assignment, general practitioners (GPs) were informed for half of the patients about the results of the assessment and received recommendations on how to improve treatment. Changes in treatment and patient status were reevaluated after 6 months. Results: Patients were mostly having depression, adjustment, or anxiety disorders, with 28.8% on sick leave. Contact with their respective GPs was longer than a year in 77.2% of cases. Patients had already received pharmacotherapy (60.9%), psychotherapeutic counseling by GPs themselves (27.7%), psychotherapy by specialists (73.9%), psychiatric outpatient care (57%), inpatient psychiatric treatment (12.1%), inpatient psychosomatic rehabilitation (ie, specialized behavioral medicine facilities for patients with work problems; 41.4%), and a broad spectrum of other diagnostic and therapeutic measures. Newly recommended interventions included leisure activities (42%), a new specialist psychotherapy (37.5%), or inpatient psychosomatic treatment (15.3%). Most recommendations were agreed upon by the GP. Nevertheless, there was only a limited increase in therapeutic actions 6 months later, and no statistically significant improvement in the status of patients. Conclusion: General practitioners undertake a broad spectrum of therapeutic interventions in patients with chronic mental disorders. According to our results, additional psychiatric–psychosomatic consultations can intensify treatment but does not significantly change the general course of chronic mental disorders.
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Affiliation(s)
- Michael Linden
- Psychosomatic Rehabilitation Research Group, Charité University Medicine, Berlin, Germany
| | - Beate Muschalla
- Psychosomatic Rehabilitation Research Group, Charité University Medicine, Berlin, Germany
| | - Nils Noack
- Psychosomatic Rehabilitation Research Group, Charité University Medicine, Berlin, Germany
| | - Christoph Heintze
- Institute of General Medicine and Family Medicine, Charité University Medicine, Berlin, Germany
| | - Susanne Doepfmer
- Institute of General Medicine and Family Medicine, Charité University Medicine, Berlin, Germany
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Farrants K, Kjeldgård L, Marklund S, Head J, Alexanderson K. Sick leave before and after the age of 65 years among those in paid work in Sweden in 2000 or 2005: a register-based cohort study. J Int Med Res 2017; 46:564-577. [PMID: 29103347 PMCID: PMC5971523 DOI: 10.1177/0300060517734744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective With pressure for older people to remain in work, research is needed on how people aged over 65 years fare in the labour market. However, few studies have focused on sick leave among older workers, especially those over the standard retirement age. This study investigated changes in sick-leave patterns among people aged over 65 years still in work. Methods All individuals in Sweden who turned 65 years old in 2000 or 2005 were followed from 1995 to 2010. The mean number of sick-leave days per year was measured for those who remained in paid work past the age of 65 years. Results Those over 65 years still working had fewer sick-leave days before the age of 65 years than those who retired. They also had fewer sick-leave days after 65 years than before. There were fewer socioeconomic differences after 65 years than before, but these differences were greater for workers over 65 years in the 2005 cohort. Conclusions Although there were more people over 65 years in paid work in 2005, sick-leave days and socioeconomic differences in sick leave were lower in this age group. Sick-leave days and socioeconomic differences in sick leave were greater in the 2005 cohort.
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Affiliation(s)
- Kristin Farrants
- 1 Division of Insurance Medicine, 97092 Department of Clinical Neuroscience, Karolinska Institutet , SE-171 77 Stockholm, Sweden
| | - Linnea Kjeldgård
- 1 Division of Insurance Medicine, 97092 Department of Clinical Neuroscience, Karolinska Institutet , SE-171 77 Stockholm, Sweden
| | - Staffan Marklund
- 1 Division of Insurance Medicine, 97092 Department of Clinical Neuroscience, Karolinska Institutet , SE-171 77 Stockholm, Sweden
| | - Jenny Head
- 1 Division of Insurance Medicine, 97092 Department of Clinical Neuroscience, Karolinska Institutet , SE-171 77 Stockholm, Sweden.,2 Department of Epidemiology and Public Health, 9687 University College of London , London, United Kingdom
| | - Kristina Alexanderson
- 1 Division of Insurance Medicine, 97092 Department of Clinical Neuroscience, Karolinska Institutet , SE-171 77 Stockholm, Sweden
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Linden M, Bernert S, Funke A, Dreinhöfer KE, Jöbges M, von Kardorff E, Riedel-Heller SG, Spyra K, Völler H, Warschburger P, Wippert PM. [Medical rehabilitation from a lifespan perspective]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:445-452. [PMID: 28204902 DOI: 10.1007/s00103-017-2520-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lifespan research investigates the development of individuals over the course of life. As medical rehabilitation deals with primary and secondary prophylaxis, treatment, and compensation of chronic illnesses, a lifespan perspective is needed for the classification and diagnosis of chronic disorders, the assessment of course modifying factors, the identification of vulnerable life periods and critical incidents, the implementation of preventive measures, the development of methods for the evaluation of prior treatments, the selection and prioritization of interventions, including specialized inpatient rehabilitation, the coordination of therapies and therapists, and for evaluations in social and forensic medicine. Due to the variety of individual risk constellations, illness courses and treatment situations across the lifespan, personalized medicine is especially important in the context of medical rehabilitation, which takes into consideration hindering and fostering factors alike.
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Affiliation(s)
- Michael Linden
- Rehabilitationswissenschaftlicher Verbund Berlin, Brandenburg und Sachsen (BBS), Luisenstr. 13, 10117, Berlin, Deutschland.
- Forschungsgruppe Psychosomatische Rehabilitation, CBF, Hs II, E01, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
| | - Sebastian Bernert
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ariane Funke
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Karsten E Dreinhöfer
- Abt. für Orthopädie und Unfallchirurgie, Medical Park Berlin Humboldtmühle, Berlin, Deutschland
| | - Michael Jöbges
- Brandenburgklinik Berlin-Brandenburg, Berlin, Deutschland
| | - Ernst von Kardorff
- Institut für Rehabilitationswissenschaften, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | | | - Karla Spyra
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Heinz Völler
- Professur für Rehabilitationswissenschaften, Universität Potsdam, Potsdam, Deutschland
| | - Petra Warschburger
- Professur für Beratungspsychologie, Universität Potsdam, Potsdam, Deutschland
| | - Pia-Maria Wippert
- Professur für Sport- und Gesundheitspsychologie, Universität Potsdam, Potsdam, Deutschland
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Fähigkeitsbeeinträchtigungen und Teilhabeeinschränkungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1147-53. [DOI: 10.1007/s00103-016-2404-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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