All in the mind? The neural correlates of unexplained physical symptoms

Emotion and dissociative seizures: A phenomenological analysis of patients' perspectives

Quantitative research has indicated that patients with dissociative seizures (DS) show altered responses to emotional stimuli, in addition to considerable emotional distress and dysregulation. The present study sought to further explore emotional processes in this population, to extend previous findings, and to provide a phenomenological insight into patients' perspectives on these issues. Semistructured interviews were carried out with 15 patients with DS, and the principles of interpretative phenomenological analysis (IPA) were adopted in data analysis. Key themes elicited included: i) general emotional functioning; ii) adverse (stressful/traumatic) life experiences; iii) the role of emotions in DS; iv) relating to others; and v) resilience, protective factors, and coping mechanisms. The clinical and theoretical implications of the findings are discussed.

Caloric vestibular stimulation as a treatment for conversion disorder: a case report and medical hypothesis

Conversion disorder is a medical condition in which a person has paralysis, blindness, or other neurological symptoms that cannot be clearly explained physiologically. To date, there is neither specific nor conclusive treatment. In this paper, we draw together a number of disparate pieces of knowledge to propose a novel intervention to provide transient alleviation for this condition. As caloric vestibular stimulation has been demonstrated to modulate a variety of cognitive functions associated with brain activations, especially in the temporal-parietal cortex, anterior cingulate cortex, and insular cortex, there is evidence to assume an effect in specific mental disorders. Therefore, we go on to hypothesize that lateralized cold vestibular caloric stimulation will be effective in treating conversion disorder and we present provisional evidence from one patient that supports this conclusion. If our hypothesis is correct, this will be the first time in psychiatry and neurology that a clinically well-known mental disorder, long considered difficult to understand and to treat, is relieved by a simple or common, non-invasive medical procedure.

Psychotherapy training for psychiatrists: UK and global perspectives

Psychotherapy training for psychiatrists has often been honoured more in the breach than the observance. While most training schemes pay lip service to psychotherapy, few provide the comprehensive training to which national and international bodies aspire. Recent educational changes, especially the move from course completion to competency evaluation, and the implementation of 'requirements' as opposed to 'recommendations', provide an opportunity for psychotherapy to become more central to psychiatric training. Based on international systematic enquiry and specific experience in the UK, this article makes a number of theoretical and practical suggestions: (a) mentalization as a relevant indicator of psychological mindedness for trainees and ways in which it might be measured (b) the importance of identifying the small number of trainees at risk for dangerous practice and remedial measures (c) the importance of local and national leadership if change is to be initiated and followed through over a number of years (d) ways in which the paradox of underdevelopment of psychotherapy training can be overcome via the reinforcement of existing expertise and values as well as the use of visiting 'experts' and modern IT aids.