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Pick S, Millman LM, Ward E, Short E, Stanton B, Reinders AS, Winston JS, Nicholson TR, Edwards MJ, Goldstein LH, David AS, Chalder T, Hotopf M, Mehta MA. Unravelling the influence of affective stimulation on functional neurological symptoms: a pilot experiment examining potential mechanisms. J Neurol Neurosurg Psychiatry 2024; 95:461-470. [PMID: 37963722 DOI: 10.1136/jnnp-2023-332364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Differences in affective processing have previously been shown in functional neurological disorder (FND); however, the mechanistic relevance is uncertain. We tested the hypotheses that highly arousing affective stimulation would result in elevated subjective functional neurological symptoms (FNS), and this would be associated with elevated autonomic reactivity. The possible influence of cognitive detachment was also explored. METHOD Individuals diagnosed with FND (motor symptoms/seizures; n=14) and healthy controls (n=14) viewed Positive, Negative and Neutral images in blocks, while passively observing the stimuli ('Watch') or detaching themselves ('Distance'). The FND group rated their primary FNS, and all participants rated subjective physical (arousal, pain, fatigue) and psychological states (positive/negative affect, dissociation), immediately after each block. Skin conductance (SC) and heart rate (HR) were monitored continuously. RESULTS FNS ratings were higher after Negative compared with Positive and Neutral blocks in the FND group (p=0.002, ηp 2=0.386); however, this effect was diminished in the Distance condition relative to the Watch condition (p=0.018, ηp 2=0.267). SC and/or HR correlated with FNS ratings in the Negative-Watch and Neutral-Distance conditions (r values=0.527-0.672, p values=0.006-0.035). The groups did not differ in subjective affect or perceived arousal (p values=0.541-0.919, ηp 2=<0.001-0.015). CONCLUSIONS Emotionally significant events may exert an influence on FNS which is related to autonomic activation rather than altered subjective affect or perceived arousal. This influence may be modulated by cognitive detachment. Further work is needed to determine the relevance and neural bases of these processes in specific FND phenotypes.
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Affiliation(s)
- Susannah Pick
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ls Merritt Millman
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Emily Ward
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Eleanor Short
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Biba Stanton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Aat Simone Reinders
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Joel S Winston
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy R Nicholson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mark J Edwards
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Laura H Goldstein
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Trudie Chalder
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Matthew Hotopf
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mitul A Mehta
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Millman LSM, Short E, Ward E, Stanton B, Bradley-Westguard A, Goldstein LH, Winston JS, Mehta MA, Nicholson TR, Reinders AATS, David AS, Edwards MJ, Chalder T, Hotopf M, Pick S. Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures: A Pilot Investigation. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230103. [PMID: 38481167 DOI: 10.1176/appi.neuropsych.20230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE This study examined etiological factors and symptom triggers of functional motor symptoms (FMS) or functional seizures (FS) and assessed potential relationships with relevant clinical features (i.e., functional symptoms, quality of life, and general functioning). METHODS Seventeen participants with FMS or FS and 17 healthy control participants underwent an in-depth clinical interview and completed questionnaires assessing adverse life events, psychological and physical symptoms, alexithymia, autistic traits, illness perceptions, health-related quality of life (HRQoL), and work and social functioning. RESULTS Participants with FMS or FS perceived various causes of the disorder, including physical symptoms (65%), emotional problems (53%), adverse life events (47%), and work-related factors (29%). Triggers of FMS and FS included physical activity or exertion (59%), stress and emotions (59%), sensory experiences (47%), and fatigue (41%). Compared with healthy control participants, participants with FMS or FS reported more adverse events during adolescence and higher levels of alexithymia, somatoform dissociation, psychological dissociation (disengagement, depersonalization, and derealization), anxiety, depression, and physical symptoms. Participants with FMS or FS had worse HRQoL than healthy control participants and impaired work and social functioning. There were inverse associations between HRQoL scores and somatoform dissociation, anxiety, and adverse life events. CONCLUSIONS Participants with FMS or FS reported diverse biopsychosocial etiological factors and symptom triggers. Ongoing psychological symptoms and lifetime adverse experiences were associated with worse HRQoL. Future studies will examine these factors in larger samples of individuals with FMS or FS to better understand their shared and distinct etiological underpinnings.
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Affiliation(s)
- L S Merritt Millman
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Eleanor Short
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Emily Ward
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Biba Stanton
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Abigail Bradley-Westguard
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Joel S Winston
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Mitul A Mehta
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Antje A T S Reinders
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Anthony S David
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Mark J Edwards
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Trudie Chalder
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Susannah Pick
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
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Dima A, Abdelsamie A, Clark-Castillo R, Webb-Wilson H, Shergill SS, Stanton B, Gaughran F, Whiskey E, Nettis MA. Overcoming Obstacles to Clozapine Treatment: A Case of Clozapine Rechallenge in ECT-Resistant Schizophrenia With Catatonic Features. J Clin Psychopharmacol 2024; 44:182-185. [PMID: 38315142 DOI: 10.1097/jcp.0000000000001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
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Carlton Jones L, Hoffmann J, Mohideen S, Stanton B, Bleil C, Britton T, Goadsby PJ, Zebian B. Management of cervical CSF-venous fistula causing acute cognitive impairment and coma. Acta Neurochir (Wien) 2024; 166:37. [PMID: 38277029 DOI: 10.1007/s00701-024-05935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/03/2023] [Indexed: 01/27/2024]
Abstract
CSF-venous fistulas (CVFs) are increasingly recognised as a cause of spontaneous intracranial hypotension. They may present atypically including with brain sagging pseudo-dementia. Cervical CVFs are rare and their management can be difficult due to associated eloquent nerve roots. We report the case of a 49-year-old woman who presented with cognitive decline progressing to coma. Brain imaging showed features of spontaneous intracranial hypotension and a right C7 CVF was identified at digital subtraction and CT myelography. Initial treatment with CT-guided injection of fibrin sealant produced temporary improvement in symptoms before surgical treatment resulted in total clinical remission and radiological resolution.
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Affiliation(s)
- Lalani Carlton Jones
- Department of Neuroradiology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
- Department of Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, St Thomas' Hospital, Westminster Bridge Rd, London, SE1 7EH, UK.
| | - Jan Hoffmann
- Department of Neurology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Saamir Mohideen
- Department of Neurology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Cristina Bleil
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Tom Britton
- Department of Neurology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Peter J Goadsby
- Department of Neurology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
- Wolfson Centre for Age-Related Diseases, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Bassel Zebian
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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Stanton B, Chalder T, Carvalho C. Cognitive behavioural therapy for neurologists. Pract Neurol 2024; 24:22-27. [PMID: 37932039 DOI: 10.1136/pn-2023-003857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 11/08/2023]
Abstract
In neurological practice, we take pride in accurate diagnosis and using neuroscience to develop novel disease-modifying therapies, but we sometimes neglect symptom management and the treatment of distress. Most patients with neurological disorders report that their mental health needs are not being met. Of the many forms of psychological therapy, cognitive behavioural therapy (CBT) is the most likely to be available to our patients. This article sets out to answer the following questions: (1) What is CBT? (2) What will patients experience if they have CBT? (3) Is CBT effective for people with neurological disorders? (4) Who is most suitable for CBT? (5) How and where can a neurologist refer their patients for CBT? (6) Can we as neurologists use aspects of the CBT model in our own consultations?
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Affiliation(s)
- Biba Stanton
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London, London, UK
| | - Carolina Carvalho
- Department of Psychological Medicine, King's College London, London, UK
- School of Psychology, University of Surrey, Guildford, UK
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Varmpompiti K, Westwood AJ, Ben-Joseph A, Sibtain N, Ibrahim MAA, Stanton B, Zuckerman M, Hadden R, Ritter LM. Progressive multifocal leukoencephalopathy secondary to idiopathic CD4 lymphocytopenia treated with pembrolizumab. J Neuroimmunol 2023; 385:578248. [PMID: 37995595 DOI: 10.1016/j.jneuroim.2023.578248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease due to a lytic infection of oligodendrocytes caused by John Cunningham polyoma virus (JCV) infection. Idiopathic CD4+ T-cell lymphocytopenia (ICL) is a very rare cause of PML. METHODS We present an individual with PML secondary to ICL treated with 3 doses of pembrolizumab, a Programmed-Death-1 Immune Checkpoint Inhibitor following with complete resolution of symptoms and conduct a review of the literature. CONCLUSION This report illustrates the objective clinical and radiological improvement in a patient with PML due to ICL and suggests further study of immune checkpoint inhibitors as potential treatment for patients with PML.
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Affiliation(s)
| | - Andrew J Westwood
- Maidstone and Tunbridge Wells NHS Tust, Hermitage Lane Maidstone, Kent, United Kingdom
| | - Aaron Ben-Joseph
- Maidstone and Tunbridge Wells NHS Tust, Hermitage Lane Maidstone, Kent, United Kingdom
| | - Naomi Sibtain
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Biba Stanton
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Zuckerman
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Robert Hadden
- King's College Hospital NHS Foundation Trust, London, United Kingdom; Maidstone and Tunbridge Wells NHS Tust, Hermitage Lane Maidstone, Kent, United Kingdom
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Pick S, Millman LSM, Sun Y, Short E, Stanton B, Winston JS, Mehta MA, Nicholson TR, Reinders AATS, David AS, Edwards MJ, Goldstein LH, Hotopf M, Chalder T. Objective and subjective neurocognitive functioning in functional motor symptoms and functional seizures: preliminary findings. J Clin Exp Neuropsychol 2023; 45:970-987. [PMID: 37724767 DOI: 10.1080/13803395.2023.2245110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/30/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION This study aimed to provide a preliminary assessment of objective and subjective neurocognitive functioning in individuals with functional motor symptoms (FMS) and/or functional seizures (FS). We tested the hypotheses that the FMS/FS group would display poorer objective attentional and executive functioning, altered social cognition, and reduced metacognitive accuracy. METHOD Individuals with FMS/FS (n = 16) and healthy controls (HCs, n = 17) completed an abbreviated CANTAB battery, and measures of intellectual functioning, subjective cognitive complaints, performance validity, and comorbid symptoms. Subjective performance ratings were obtained to assess local metacognitive accuracy. RESULTS The groups were comparable in age (p = 0.45), sex (p = 0.62), IQ (p = 0.57), and performance validity (p-values = 0.10-0.91). We observed no impairment on any CANTAB test in this FMS/FS sample compared to HCs, although the FMS/FS group displayed shorter reaction times on the Emotional Bias task (anger) (p = 0.01, np2 = 0.20). The groups did not differ in subjective performance ratings (p-values 0.15). Whilst CANTAB attentional set-shifting performance (total trials/errors) correlated with subjective performance ratings in HCs (p-values<0.005, rs = -0.85), these correlations were non-significant in the FMS/FS sample (p-values = 0.10-0.13, rs-values = -0.46-0.50). The FMS/FS group reported more daily cognitive complaints than HCs (p = 0.006, g = 0.92), which were associated with subjective performance ratings on CANTAB sustained attention (p = 0.001, rs = -0.74) and working memory tests (p < 0.001, rs = -0.75), and with depression (p = 0.003, rs = 0.70), and somatoform (p = 0.003, rs = 0.70) and psychological dissociation (p-values<0.005, rs-values = 0.67-0.85). CONCLUSIONS These results suggest a discordance between objective and subjective neurocognitive functioning in this FMS/FS sample, reflecting intact test performance alongside poorer subjective cognitive functioning. Further investigation of neurocognitive functioning in FND subgroups is necessary.
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Affiliation(s)
- Susannah Pick
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - L S Merritt Millman
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Yiqing Sun
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Eleanor Short
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Biba Stanton
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Joel S Winston
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Mitul A Mehta
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Antje A T S Reinders
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | | | - Mark J Edwards
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
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White P, Abbey S, Angus B, Ball HA, Buchwald DS, Burness C, Carson AJ, Chalder T, Clauw DJ, Coebergh J, David AS, Dworetzky BA, Edwards MJ, Espay AJ, Etherington J, Fink P, Flottorp S, Garcin B, Garner P, Glasziou P, Hamilton W, Henningsen P, Hoeritzauer I, Husain M, Huys ACML, Knoop H, Kroenke K, Lehn A, Levenson JL, Little P, Lloyd A, Madan I, van der Meer JWM, Miller A, Murphy M, Nazareth I, Perez DL, Phillips W, Reuber M, Rief W, Santhouse A, Serranova T, Sharpe M, Stanton B, Stewart DE, Stone J, Tinazzi M, Wade DT, Wessely SC, Wyller V, Zeman A. Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis. J Neurol Neurosurg Psychiatry 2023; 94:1056-1063. [PMID: 37434321 DOI: 10.1136/jnnp-2022-330463] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/03/2023] [Indexed: 07/13/2023]
Abstract
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive-behavioural therapy should only be used to manage symptoms and reduce distress, not to aid recovery. This U-turn in recommendations from the previous 2007 guideline is controversial.We suggest that the controversy stems from anomalies in both processing and interpretation of the evidence by the NICE committee. The committee: (1) created a new definition of CFS/ME, which 'downgraded' the certainty of trial evidence; (2) omitted data from standard trial end points used to assess efficacy; (3) discounted trial data when assessing treatment harm in favour of lower quality surveys and qualitative studies; (4) minimised the importance of fatigue as an outcome; (5) did not use accepted practices to synthesise trial evidence adequately using GRADE (Grading of Recommendations, Assessment, Development and Evaluations trial evidence); (6) interpreted GET as mandating fixed increments of change when trials defined it as collaborative, negotiated and symptom dependent; (7) deviated from NICE recommendations of rehabilitation for related conditions, such as chronic primary pain and (8) recommended an energy management approach in the absence of supportive research evidence.We conclude that the dissonance between this and the previous guideline was the result of deviating from usual scientific standards of the NICE process. The consequences of this are that patients may be denied helpful treatments and therefore risk persistent ill health and disability.
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Affiliation(s)
- Peter White
- Wolfson Institute for Population Health, Queen Mary University Barts and The London School of Medicine and Dentistry, London, UK
| | - Susan Abbey
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brian Angus
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | | | - Alan J Carson
- Centre for Clinical Brain Sciences, Royal Infirmary, Edinburgh, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Daniel J Clauw
- Departments of Anesthesiology, Medicine and Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jan Coebergh
- Ashford St Peter's NHS Foundation Trust, Chertsey, St George's University Hospitals, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Barbara A Dworetzky
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark J Edwards
- Neuroscience Research Centre, St George's University, London, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Per Fink
- Research Clinic for Functional Disorders, Aarhus University, Aarhus, Denmark
| | - Signe Flottorp
- Centre for Epidemic Interventions Research, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Béatrice Garcin
- Hopital Avicenne, Universite Sorbonne Paris Nord - Campus de Bobigny, Bobigny, France
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Willie Hamilton
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Peter Henningsen
- Psychosomatic Medicine, University Hospital, Technical University Munich, Munich, Germany
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mujtaba Husain
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Hans Knoop
- Department of Medical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexander Lehn
- Brisbane Clinical Neuroscience Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew Lloyd
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ira Madan
- Faculty of Occupational Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical College, Nijmegen, Netherlands
| | - Alastair Miller
- Department of Medicine, Cumberland Infirmary Carlisle, Carlisle, UK
| | - Maurice Murphy
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Irwin Nazareth
- Primary Care & Population Science, University College London, London, UK
| | - David L Perez
- Neurology and Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Markus Reuber
- Department of Neuroscience, The Medical School, University of Sheffield, Sheffield, UK
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy Clinic, University of Marburg, Marburg, Germany
| | - Alastair Santhouse
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Tereza Serranova
- Dept. of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford, Oxford, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital, London, UK
| | - Donna E Stewart
- Centre for Mental Health, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Jon Stone
- Centre for Clinical Brain Sciences, Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Derick T Wade
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Simon C Wessely
- Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Vegard Wyller
- Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Adam Zeman
- Cognitve Neurology Research Group, University of Exeter Medical School, Exeter, UK
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McLoughlin C, Hoeritzauer I, Cabreira V, Aybek S, Adams C, Alty J, Ball HA, Baker J, Bullock K, Burness C, Dworetzky BA, Finkelstein S, Garcin B, Gelauff J, Goldstein LH, Jordbru A, Huys ACM, Laffan A, Lidstone SC, Linden SC, Ludwig L, Maggio J, Morgante F, Mallam E, Nicholson C, O'Neal M, O'Sullivan S, Pareés I, Petrochilos P, Pick S, Phillips W, Roelofs K, Newby R, Stanton B, Gray C, Joyce EM, Tijssen MA, Chalder T, McCormick M, Gardiner P, Bègue I, Tuttle MC, Williams I, McRae S, Voon V, McWhirter L. Functional neurological disorder is a feminist issue. J Neurol Neurosurg Psychiatry 2023; 94:855-862. [PMID: 36977553 PMCID: PMC10511956 DOI: 10.1136/jnnp-2022-330192] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/26/2023] [Indexed: 03/30/2023]
Abstract
Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.
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Affiliation(s)
- Caoimhe McLoughlin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Verónica Cabreira
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Neurology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Selma Aybek
- Department of Clinical Neuroscience, Hopitaux Universitaires de Geneve, Geneva, Switzerland
- Department of Clinical Neuroscience, Inselspital Universitatsspital Bern Universitatsklinik fur Neurologie, Bern, Switzerland
| | - Caitlin Adams
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jane Alty
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Neurology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
- Neurology, North Bristol NHS Trust, Westbury on Trym, UK
| | - Janet Baker
- Randwick Specialist Centre, Private Practice, Randwick, New South Wales, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, California, USA
| | | | - Barbara A Dworetzky
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Finkelstein
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jeannette Gelauff
- Department of Neurology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anika Jordbru
- Faculty of Humanities, Sport and Educational Science, University of South-Eastern Norway, Kongsberg, Norway
| | - Anne-Catherine Ml Huys
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Aoife Laffan
- Neurology, St. James's Hospital, Dublin, Ireland
| | - Sarah C Lidstone
- University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Stefanie Caroline Linden
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Lea Ludwig
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Julie Maggio
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Physical Therapy and Functional Neurological Disorder Unit and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Experimental and Clinical Medicine, University of Messina, Messina, Italy
| | - Elizabeth Mallam
- The Rosa Burden Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Clare Nicholson
- Therapy Services, National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary O'Neal
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Isabel Pareés
- Movement Disorders Program, Neurology Deparment Hospital Ruber Internacional, Madrid, Spain
- Movement Disorders Unit, Neurology Department, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Susannah Pick
- Section of Cognitive Neuropsychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Karin Roelofs
- Donders Institute for Brain Cognition and Behaviour: Donders Centre for Cognitive Neuroimaging, Radboud University Nijmegen, Nijmegen, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Rachel Newby
- Neurology, Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Cordelia Gray
- Neurology Psychotherapy Service, Sheffield Teaching Hospital, Academic Neurology Unit, The University of Sheffield, Sheffield, UK
| | - Eileen M Joyce
- Neuropsychiatry, UCL Queen Square Institute of Neurology, London, UK
| | - Marina Aj Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Maxanne McCormick
- Physician assistant/patient with FND, FNDRecovery.com, -, Monument CO, USA
| | - Paula Gardiner
- Psychological Therapy in Primary Care, University of Dundee, Dundee, UK
- enhance-cbt.com therapist, NeuroSpecialist Physiotherapist, Stirling, UK
| | - Indrit Bègue
- Department of Psychiatry, Geneva University Hospitals, Geneve, Switzerland
| | - Margaret C Tuttle
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Functional Neurological Disorder Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Isobel Williams
- Neuropsychology, Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Sarah McRae
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Valerie Voon
- Psychiatry, University of Cambridge, Cambridge, UK
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Lichtblau N, Aliaga-Arias J, Kalaitzoglou D, Bodi I, Ashkan K, Bhangoo R, Vergani F, Joe D, Stanton B, Galloway J, Carlton-Jones L, Lavrador JP. IgG4-related hypertrophic pachymeningitis with chronic subdural haematoma. Pract Neurol 2023; 23:441-445. [PMID: 37460210 DOI: 10.1136/pn-2023-003750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 10/04/2023]
Abstract
Hypertrophic pachymeningitis is a rare disorder of the dura mater of the spine or brain. It can be caused by inflammatory, infective or neoplastic conditions or can be idiopathic. We report a man with hypertrophic pachymeningitis and bilateral chronic subdural haematoma caused by IgG4-related disease. We highlight the diagnostic challenges and discuss possible underlying mechanisms of subdural haematoma formation in inflammatory conditions. Isolated IgG4-related hypertrophic pachymeningitis with chronic subdural haematoma is very rare; previously reported cases have suggested a possible predilection for men in their sixth decade, presenting with headache as the dominant symptom. Given the rarity and complexity of the condition, it should be managed in a multidisciplinary team setting.
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Affiliation(s)
- Nicole Lichtblau
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jahard Aliaga-Arias
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Universita degli Studi di Brescia, Brescia, Italy
| | | | - Istvan Bodi
- Clinical Neuropathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ranj Bhangoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Dorothy Joe
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
- Neuropsychiatry Service, South London and Maudsley NHS Trust, London, UK
| | - James Galloway
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Lalani Carlton-Jones
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jose Pedro Lavrador
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
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Millman LSM, Short E, Stanton B, Winston JS, Nicholson TR, Mehta MA, Reinders AATS, Edwards MJ, Goldstein LH, David AS, Hotopf M, Chalder T, Pick S. Interoception in functional motor symptoms and functional seizures: Preliminary evidence of intact accuracy alongside reduced insight and altered sensibility. Behav Res Ther 2023; 168:104379. [PMID: 37516011 PMCID: PMC10788481 DOI: 10.1016/j.brat.2023.104379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
Altered interoception may be a pathophysiological mechanism in functional neurological disorder (FND). However, findings have been inconsistent across interoceptive dimensions in FND including functional motor symptoms (FMS) and seizures (FS). Here, individuals with FMS/FS (n = 17) and healthy controls (HC, n = 17) completed measures of interoceptive accuracy and insight (adapted heartbeat tracking task [HTT] with confidence ratings), a time estimation control task (TET) and the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2) to assess interoceptive sensibility. The groups did not differ in interoceptive accuracy (p = 1.00, g = 0.00) or confidence (p = .99, g = 0.004), although the FMS/FS group displayed lower scores on the "Not-Distracting" (p < .001, g = 1.42) and "Trusting" (p = .005, g = 1.17) MAIA-2 subscales, relative to HCs. The groups did not differ in TET performance (p = .82, g = 0.08). There was a positive relationship between HTT accuracy and confidence (insight) in HCs (r = .61, p = .016) but not in FMS/FS (r = 0.11, p = .69). HTT confidence was positively correlated with MAIA-2 "Self-Regulation" (r = 0.77, p = .002) and negatively correlated with FND symptom severity (r = -0.84, p < .001) and impact (r = -0.86, p < .001) in FMS/FS. Impaired interoceptive accuracy may not be a core feature in FMS/FS, but reduced insight and altered sensibility may be relevant. Reduced certainty in self-evaluations of bodily experiences may contribute to the pathogenesis of FND symptoms.
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Affiliation(s)
- L S Merritt Millman
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Eleanor Short
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Biba Stanton
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Joel S Winston
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Mitul A Mehta
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Antje A T S Reinders
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Mark J Edwards
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | | | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Susannah Pick
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.
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12
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Stanton B, Segal T, Bradley-Westguard A, Edwards M. How to set up a functional neurological disorder education group. Pract Neurol 2023:pn-2023-003713. [PMID: 37100593 DOI: 10.1136/pn-2023-003713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 04/28/2023]
Abstract
Functional neurological disorder (FND) can be a difficult diagnosis for patients to understand and for clinicians to explain. The postdiagnostic support that patients with other chronic neurological illnesses normally receive is often not available to patients with FND. Here, we share our experience of how to set up an FND education group, including the content, practical aspects of delivering groups and how to avoid potential pitfalls. A group education session can improve understanding of the diagnosis among patients and caregivers, reduce stigma and provide self-management advice. Such groups should be multidisciplinary and include input from service users.
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Affiliation(s)
- Biba Stanton
- Neuropsychiatry, South London and Maudsley NHS Trust, London, UK
- Neurology, King's College Hospital, London, UK
| | - Tim Segal
- Neuropsychiatry, South London and Maudsley NHS Trust, London, UK
| | | | - Mark Edwards
- Neuropsychiatry, South London and Maudsley NHS Trust, London, UK
- Institute of Psychiatry Psychology & Neuroscience, King's College London, London, UK
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13
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Hosseini P, Whincup R, Devan K, Ghanem DA, Fanshawe JB, Saini A, Cross B, Vijay A, Mastellari T, Vivekananda U, White S, Brunnhuber F, Zandi MS, David AS, Carter B, Oliver D, Lewis G, Fry C, Mehta PR, Stanton B, Rogers JP. The role of the electroencephalogram (EEG) in determining the aetiology of catatonia: a systematic review and meta-analysis of diagnostic test accuracy. EClinicalMedicine 2023; 56:101808. [PMID: 36636294 PMCID: PMC9829703 DOI: 10.1016/j.eclinm.2022.101808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Catatonia is a psychomotor syndrome that has a wide range of aetiologies. Determining whether catatonia is due to a medical or psychiatric cause is important for directing treatment but is clinically challenging. We aimed to ascertain the performance of the electroencephalogram (EEG) in determining whether catatonia has a medical or psychiatric cause, conventionally defined. METHODS In this systematic review and meta-analysis of diagnostic test accuracy (PROSPERO CRD42021239027), Medline, EMBASE, PsycInfo, and AMED were searched from inception to May 11, 2022 for articles published in peer-reviewed journals that reported EEG findings in catatonia of a medical or psychiatric origin and were reported in English, French, or Italian. Eligible study types were clinical trials, cohort studies, case-control studies, cross-sectional studies, case series, and case reports. The reference standard was the final clinical diagnosis. Data extraction was conducted using individual patient-level data, where available, by two authors. We prespecified two types of studies to overcome the limitations anticipated in the data: larger studies (n ≥ 5), which were suitable for formal meta-analytic methods but generally lacked detailed information about participants, and smaller studies (n < 5), which were unsuitable for formal meta-analytic methods but had detailed individual patient level data, enabling additional sensitivity analyses. Risk of bias and applicability were assessed with the QUADAS-2 tool for larger studies, and with a published tool designed for case reports and series for smaller studies. The primary outcomes were sensitivity and specificity, which were derived using a bivariate mixed-effects regression model. FINDINGS 355 studies were included, spanning 707 patients. Of the 12 larger studies (5 cohort studies and 7 case series), 308 patients were included with a mean age of 48.2 (SD = 8.9) years. 85 (52.8%) were reported as male and 99 had catatonia due to a general medical condition. In the larger studies, we found that an abnormal EEG predicted a medical cause of catatonia with a sensitivity of 0.82 (95% CI 0.67-0.91) and a specificity of 0.66 (95% CI 0.45-0.82) with an I 2 of 74% (95% CI 42-100%). The area under the summary ROC curve offered excellent discrimination (AUC = 0.83). The positive likelihood ratio was 2.4 (95% CI 1.4-4.1) and the negative likelihood ratio was 0.28 (95% CI 0.15-0.51). Only 5 studies had low concerns in terms of risk of bias and applicability, but a sensitivity analysis limited to these studies was similar to the main analysis. Among the 343 smaller studies, 399 patients were included, resulting in a sensitivity of 0.76 (95% CI 0.71-0.81), specificity of 0.67 (0.57-0.76) and AUC = 0.71 (95% CI 0.67-0.76). In multiple sensitivity analyses, the results were robust to the exclusion of reports of studies and individuals considered at high risk of bias. Features of limbic encephalitis, epileptiform discharges, focal abnormality, or status epilepticus were highly specific to medical catatonia, but features of encephalopathy had only moderate specificity and occurred in 23% of the cases of psychiatric catatonia in smaller studies. INTERPRETATION In cases of diagnostic uncertainty, the EEG should be used alongside other investigations to ascertain whether the underlying cause of catatonia is medical. The main limitation of this review is the differing thresholds for considering an EEG abnormal between studies. FUNDING Wellcome Trust, NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust.
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Affiliation(s)
- Paris Hosseini
- Department of Neuropsychiatry, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Karrish Devan
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Aman Saini
- Medical School, University College London, London, UK
| | | | - Apoorva Vijay
- GKT School of Medical Education, King's College London, London, UK
| | - Tomas Mastellari
- Division of Psychiatry, University College London, London, UK
- Inserm U1172, CHU de Lille, Lille Neuroscience & Cognition (LilNCog), Université de Lille, Lille, France
| | - Umesh Vivekananda
- Department of Clinical and Experimental Epilepsy, Institute of Neurology UCL, London, UK
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Steven White
- Department of Clinical Neurophysiology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Franz Brunnhuber
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Michael S. Zandi
- National Hospital for Neurology and Neurosurgery, London, UK
- Queen Square Institute of Neurology, University College London, London, UK
| | - Anthony S. David
- Institute of Mental Health, University College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Dominic Oliver
- Department of Psychosis Studies, King's College London, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Charles Fry
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Puja R. Mehta
- Queen Square Institute of Neurology, University College London, London, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
- Neuropsychiatry Service, South London and Maudsley NHS Trust, St. Thomas' Hospital, London, UK
| | - Jonathan P. Rogers
- South London and Maudsley NHS Foundation Trust, London, UK
- Division of Psychiatry, University College London, London, UK
- Corresponding author. UCL Division of Psychiatry, 6th Floor, Maple House, 149 Tottenham Court Rd, Bloomsbury, London W1T 7NF, UK.
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14
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Alexandratou A, Ashjaei S, Coutinho E, Stanton B. 001 An unusual cause of lymphocytic meningitis. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A 36-year-old Spanish man, with a background of ketamine use, presented with a 10-day history of severe headache, photophobia, nausea, unsteadiness and slurring of speech. His CT head was normal. CSF white cell count was 151 (lymphocytes), protein 0.7, glucose 2.3 (serum 3.6). He was treated with IV acyclovir for two weeks with no clinical improvement.On examination he remained distressed by headache and photophobic with severe dysarthria, bidirec- tional nystagmus and ataxia.Blood tests were normal or negative including HIV, serology for syphilis, mycoplasma, lyme and brucella, ANA, ENA, dsDNA, ANCA, ACE, LGI1 and NMDA antibodies, anti-Hu, Ri and Yo. IGRA was positive. MRI brain scan was normal. Serial lumbar punctures showed a variable CSF white cell count, with a negative extended virology panel, TB PCR, bacterial cultures, cytology and immunophenotyping.There was no improvement with pulsed steroids or antimicrobial cover for listeria. After 5 plasma exchanges there was some improvement in his CSF white cell count and headache, but he remained very ataxic.An extended paraneoplastic panel revealed positive anti-Tr antibodies. This is a well recognised cause of paraneoplastic cerebellar degeneration, normally associated with Hodgkin’s lymphoma. There have been no previous reported cases of anti-Tr antibodies associated with meningitic symptoms.
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15
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Ashjaei S, Varmpompiti K, Alexandratou A, Wu K, Stanton B, Theochari E, Weeks R. 017 Neurology virtual clinic: quality improvement project. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn2.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundNeurology patients with complex diagnoses in a busy tertiary centre can undergo multiple investigations to reach a diagnosis and are usually discharged with pending results, as tests can take a considerable amount of time to be processed (and released).AimWe set up a Virtual Clinic to follow-up patients’ results post discharge to avoid loss to follow up and improve safety of patient care.MethodsWe identified a significant proportion of neurology inpatients who were not followed-up efficiently (30.8% over 3-month-period) and addressed this issue by initiating a Virtual Clinic. The clinic was run weekly by neurology junior doctors, with protected clinic hours. The outcome of the clinic was communicated to the referring neurology consultant. We compared the follow up rates in the three months pre-clinic (October to December 2019) to the three months after setting up the clinic (January to March 2020).ResultsUsing the PDSA methodology, we successfully managed to increase the follow-up for outstanding investigations to 68.8% from 30.8% (pre-clinic setup), via the implementation of the Neurology Virtual Clinic. We re-audited for another three-month period using the same methodology. For the period September to November 2020, this percentage increased further to 73.68%.ConclusionThis new service was effective at improving test result monitoring and decreased the number of investigations that were not followed up promptly. Most importantly improved the safety of our patients’ care.
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Mohideen M, Benger M, Mahmood A, Hoffman J, Goadsby P, Stanton B, Carlton-Jones L. 201 Management of an unusual presentation of spontaneous intracranial hypotension (SIH). J Neurol Neurosurg Psychiatry 2022. [DOI: 10.1136/jnnp-2022-abn.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 49-year-old woman presented with 9 months of progressive cognitive decline and somnolence. In the last few weeks she developed right hand tremor, unsteadiness and urinary incontinence, which improved after lying flat. There was no headache. Examination findings included vertical gaze restriction, hypomimia, right-sided rest tremor, rigidity and bradykinesia, globally brisk reflexes and an unsteady gait. She scored 50/100 on the Addenbrooke’s Cognitive Examination.Brain MRI showed features consistent with intracranial hypotension with marked ‘brain sag’ but standard imaging did not identify the site of the leak. Two blind blood patches were followed by only transient symptomatic improvement. Initial Digital Subtraction Myelogram (DSM) was non-diagnostic, but repeat DSM identified a leak at C6–7 with an irregular diverticulum/CSF-venous fistula.A CT-guided fibrin patch injected at C6/7 resulted in transient improvement. Finally, a neurosurgical procedure was performed to coagulate the venous plexus adjacent to the C7 nerve root. This effected a dramatic and sustained improvement in her cognitive and motor symptoms.SIH is a treatable cause of cognitive decline and parkinsonism. DSM is a novel approach to localising CSF leaks. This is the first reported cognitive presentation of SIH where identification of a CSF leak with DSM led to successful surgical treatment.saamir.mohideen@nhs.net
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17
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Butler M, Scott F, Stanton B, Rogers J. Psychiatrists should investigate their patients less. BJPsych Bull 2021; 46:1-4. [PMID: 34859761 PMCID: PMC9347514 DOI: 10.1192/bjb.2021.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/01/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Psychiatrists often order investigations such as blood tests, neuroimaging and electroencephalograms for their patients. Rationales include ruling out 'organic' causes of psychiatric presentations, providing baseline parameters before starting psychotropic medications, and screening for general cardiometabolic health. Hospital protocols often recommend an extensive panel of blood tests on admission to a psychiatric ward. In this Against the Stream article, we argue that many of these investigations are at best useless and at worst harmful: the yield of positive findings that change clinical management is extremely low; special investigations are a poor substitute for a targeted history and examination; and incidental findings may cause anxiety and further unwarranted investigation. Cognitive and cultural reasons why over-investigation continues are discussed. We conclude by encouraging a more targeted approach guided by a thorough bedside clinical assessment.
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Affiliation(s)
- Matthew Butler
- King's College London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Fraser Scott
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Biba Stanton
- South London and Maudsley NHS Foundation Trust, London, UK
- King's College Hospital, London, UK
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Koeppen K, Hampton T, Kolling F, Gerber S, Stanton B. 471: Short RNAs in extracellular vesicles secreted by human airway epithelial cells increase antibiotic sensitivity of Pseudomonas aeruginosa. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01895-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
A 53-year-old woman developed subacute onset of upper limb weakness, sensory loss and cerebellar dysfunction. She was known to have human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy. MR scan of the brain showed extensive T2 hyperintensity within the deep and subcortical white matter, with punctate contrast enhancement. Cerebrospinal fluid (CSF) was lymphocytic with very high levels of HTLV-1 provirus in both CSF and peripheral blood lymphocytes. We diagnosed HTLV-1 encephalomyelitis and started high-dose methylprednisolone followed by a slow corticosteroid taper. She recovered well and regained functional independence in the upper limbs. Neurological manifestations of HTLV-1 infection extend beyond classical 'tropical spastic paraparesis' and are under-recognised. We review the literature on HTLV-1 encephalitis and discuss its diagnosis and management.
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Affiliation(s)
| | - Timothy Hampton
- Neuroradiology Department, King's College Hospital, London, UK
| | - Carolina Rosadas
- Department of Infectious Disease, Imperial College London, London, UK
| | - Graham P Taylor
- Department of Infectious Disease, Imperial College London, London, UK
| | - Biba Stanton
- Neurology Department, King's College Hospital, London, UK
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20
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Hoeritzauer I, Stanton B, Carson A, Stone J. 'Scan-negative' cauda equina syndrome: what to do when there is no neurosurgical cause. Pract Neurol 2021; 22:6-13. [PMID: 34389643 DOI: 10.1136/practneurol-2020-002830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/03/2022]
Abstract
Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As neurologists become more involved with 'front door' neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with 'scan-negative' cauda equina syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain-bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.
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Affiliation(s)
- Ingrid Hoeritzauer
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital, Neuropsychiatry Service, South London & Maudsley NHS Trust, London, UK
| | - Alan Carson
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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21
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Pick S, Hodsoll J, Stanton B, Eskander A, Stavropoulos I, Samra K, Bottini J, Ahmad H, David AS, Purves A, Nicholson TR. Trial Of Neurostimulation In Conversion Symptoms (TONICS): a feasibility randomised controlled trial of transcranial magnetic stimulation for functional limb weakness. BMJ Open 2020; 10:e037198. [PMID: 33028550 PMCID: PMC7539585 DOI: 10.1136/bmjopen-2020-037198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Transcranial magnetic stimulation (TMS) has been used therapeutically for functional (conversion) motor symptoms but there is limited evidence for its efficacy and the optimal protocol. We examined the feasibility of a novel randomised controlled trial (RCT) protocol of TMS to treat functional limb weakness. DESIGN A double-blind (patient, outcome assessor) two parallel-arm, controlled RCT. SETTING Specialist neurology and neuropsychiatry services at a large National Health Service Foundation Trust in London, UK. PARTICIPANTS Patients with a diagnosis of functional limb weakness (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition). Exclusion criteria included comorbid neurological or major psychiatric disorder, contraindications to TMS or previous TMS treatment. INTERVENTIONS Patients were randomised to receive either active (single-pulse TMS to primary motor cortex (M1) above resting motor threshold) or inactive treatment (single-pulse TMS to M1 below resting motor threshold). Both groups received two TMS sessions, 4 weeks apart. OUTCOME MEASURES We assessed recruitment, randomisation and retention rates. The primary outcome was patient-rated symptom change (Clinical Global Impression-Improvement scale, CGI-I). Secondary outcomes included clinician-rated symptom change, psychosocial functioning and disability. Outcomes were assessed at baseline, both TMS visits and at 3-month follow-up. RESULTS Twenty-two patients were recruited and 21 (96%) were successfully randomised (active=10; inactive=11). Nineteen (91%) patients were included at follow-up (active=9; inactive=10). Completion rates for most outcomes were good (80%-100%). Most patients were satisfied/very satisfied with the trial in both groups, although ratings were higher in the inactive arm (active=60%, inactive=92%). Adverse events were not more common for the active treatment. Treatment effect sizes for patient-rated CGI-I scores were small-moderate (Cliff's delta=-0.1-0.3, CIs-0.79 to 0.28), reflecting a more positive outcome for the active treatment (67% and 44% of active arm-rated symptoms as 'much improved' at session 2 and follow-up, respectively, vs 20% inactive group). Effect sizes for secondary outcomes were variable. CONCLUSIONS Our protocol is feasible. The findings suggest that supramotor threshold TMS of M1 is safe, acceptable and potentially beneficial as a treatment for functional limb weakness. A larger RCT is warranted. TRIAL REGISTRATION NUMBER ISRCTN51225587.
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Affiliation(s)
- Susannah Pick
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - John Hodsoll
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Biba Stanton
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Amy Eskander
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ioannis Stavropoulos
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kiran Samra
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Julia Bottini
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Hena Ahmad
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Alistair Purves
- Department of Clinical Neurophysiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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Abstract
A 22-year-old African woman developed acute behavioural change, against a background of sickle cell disease with strokes requiring a ventriculoperitoneal shunt. She alternated between mutism with prolonged staring and posturing, and a state of agitation with elation and echolalia. Cerebrospinal fluid (CSF) protein was elevated and electroencephalogram showed mild slowing with bitemporal slow and sharp waves. We suspected catatonia secondary to possible autoimmune encephalitis but her condition persisted despite intravenous methylprednisolone. After identifying a positive serum anti-gamma-aminobutyric acid-A (GABAA) antibody, treatment with intravenous immunoglobulin, oral corticosteroids and rituximab led to gradual improvement. Patients with catatonia may show reduced GABAA receptor density and there are two other reports of catatonia with anti-GABAA antibodies. This patient's treatment response supports the antibody's causative role.
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Affiliation(s)
- Kiran Samra
- Neurology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Jonathan Rogers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Neuropsychiatry Department, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Biba Stanton
- Neurology Department, King's College Hospital NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Neuropsychiatry Department, South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
Aims and MethodIn order to investigate cognitive aspects of the experience of delusions, including onset and recovery, autobiographical accounts of schizophrenia were reviewed.ResultsThe sample was self-selected and biased towards women and highly-educated patients. The delusions described were usually gradual in onset and often occurred in the context of an odd or fearful mood, which was accompanied by distorted reasoning. Recovery was also gradual with an intermediate stage of reality-testing or fluctuation between belief and disbelief. Many patients retained residual aspects of delusional thinking after recovery. Most attributed their recovery to a combination of medication, psychotherapy, social support and personal coping strategies; some felt that their illness had enhanced their self-awareness or spirituality.Clinical ImplicationsFurther exploration of spontaneous coping strategies in recovery from delusions through personal accounts of illness would be valuable.
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Yu S, Deveaux L, Lunn S, Liu H, Brathwaite N, Li X, Cottrell L, Marshall S, Stanton B. At greatest risk: pre- and early adolescent Bahamian youth experiencing anal intercourse. Int J STD AIDS 2016; 18:396-401. [PMID: 17609029 DOI: 10.1258/095646207781024784] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although anal intercourse carries great risk for HIV transmission, little research has focused on it among the general population, particularly pre- and early adolescents. This study describes the prevalence of anal and vaginal intercourse among Bahamian pre- and early adolescents and associations with other risk behaviours, family interactions and intrapersonal correlates. Data were from 1274 sixth-grade students aged 9–14 years who completed self-administered questionnaires at baseline of a larger school-based behavioural intervention study. Youth who reported having had anal intercourse engaged in significantly higher rates of several risk behaviours and were significantly more likely to engage in risk behaviours over the next six months, compared with youth with a history of vaginal intercourse only, who in turn were more likely than virgin adolescents. Youth indulging in anal intercourse also perceived significantly lower levels of parental monitoring. Multivariate analyses revealed that anal intercourse, vaginal intercourse, reduced parental monitoring, depression and perceived friend high-risk involvement were associated with both past involvement and future intention to engage in other risk behaviours. Anal intercourse poses a direct threat to the health of these children and is a flag for a constellation of other risks.
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Affiliation(s)
- S Yu
- The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA
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25
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Léguillette R, Steinmann M, Bond SL, Stanton B. Tracheobronchoscopic Assessment of Exercise-Induced Pulmonary Hemorrhage and Airway Inflammation in Barrel Racing Horses. J Vet Intern Med 2016; 30:1327-32. [PMID: 27278854 PMCID: PMC5089608 DOI: 10.1111/jvim.13959] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/22/2016] [Accepted: 04/13/2016] [Indexed: 11/27/2022] Open
Abstract
Background Poor performance is often suspected to be associated with EIPH in barrel racing horses; however, there are no published reports of EIPH for this discipline. The prevalence of EIPH in barrel racing horses is also unknown. Objectives This study was performed to determine the prevalence of EIPH and signs of airway inflammation in barrel racing horses under normal racing conditions in Alberta. Animals About 170 barrel racing horses. Methods Observational cross‐sectional study. Tracheobronchoscopic examinations were performed at least 30 minutes postrace. Video recordings were scored off‐site independently by two observers for EIPH and tracheal mucus accumulation (TMA). Horses with an EIPH score ≥2 were not assessed for TMA. Interobserver agreement was calculated by weighted κ statistics. Run times, environmental variables, and clinical information were also recorded for analysis. Results 77/170 (45.3%) of horses examined showed evidence of EIPH (grade ≥ 1). Interobserver agreement was 0.94. 140/141 (99.3%) of horses assessed for TMA showed evidence of tracheal mucus accumulation (grade ≥ 1) with 104/141 (73.8%) having a TMA score ≥ 2. Interobserver agreement was 0.73. A weak positive association was found between EIPH scores and average run speed, the presence of cough at rest reported by the riders, increased recovery time, exercise intolerance, and outdoor pattern. Conclusions and clinical importance The high prevalence of EIPH observed in the sampled population indicates that barrel racing induces substantial stress on the lungs. The presence of EIPH did not impact negatively on performance. Factors such as environmental dust and frequent traveling might have contributed to the high prevalence of TMA observed.
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Affiliation(s)
- R Léguillette
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Services, University of Calgary, Calgary, AB, T2N 4N1, Canada.,Moore Equine Veterinary Centre, 260048A Writing Creek Cres, Rocky View County, AB, T4A 0M9, Canada
| | - M Steinmann
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Services, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - S L Bond
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Services, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - B Stanton
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Services, University of Calgary, Calgary, AB, T2N 4N1, Canada.,Moore Equine Veterinary Centre, 260048A Writing Creek Cres, Rocky View County, AB, T4A 0M9, Canada
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26
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Geraldes A, Hefer CA, Capron A, Kolosova N, Martinez-Nuñez F, Soolanayakanahally RY, Stanton B, Guy RD, Mansfield SD, Douglas CJ, Cronk QCB. Recent Y chromosome divergence despite ancient origin of dioecy in poplars (Populus). Mol Ecol 2015; 24:3243-56. [PMID: 25728270 DOI: 10.1111/mec.13126] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/15/2015] [Accepted: 02/19/2015] [Indexed: 12/16/2022]
Abstract
All species of the genus Populus (poplar, aspen) are dioecious, suggesting an ancient origin of this trait. Despite some empirical counter examples, theory suggests that nonrecombining sex-linked regions should quickly spread, eventually becoming heteromorphic chromosomes. In contrast, we show using whole-genome scans that the sex-associated region in Populus trichocarpa is small and much younger than the age of the genus. This indicates that sex determination is highly labile in poplar, consistent with recent evidence of 'turnover' of sex-determination regions in animals. We performed whole-genome resequencing of 52 P. trichocarpa (black cottonwood) and 34 Populus balsamifera (balsam poplar) individuals of known sex. Genomewide association studies in these unstructured populations identified 650 SNPs significantly associated with sex. We estimate the size of the sex-linked region to be ~100 kbp. All SNPs significantly associated with sex were in strong linkage disequilibrium despite the fact that they were mapped to six different chromosomes (plus 3 unmapped scaffolds) in version 2.2 of the reference genome. We show that this is likely due to genome misassembly. The segregation pattern of sex-associated SNPs revealed this to be an XY sex-determining system. Estimated divergence times of X and Y haplotype sequences (6-7 Ma) are much more recent than the divergence of P. trichocarpa (poplar) and Populus tremuloides (aspen). Consistent with this, in P. tremuloides, we found no XY haplotype divergence within the P. trichocarpa sex-determining region. These two species therefore have a different genomic architecture of sex, suggestive of at least one turnover event in the recent past.
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Affiliation(s)
- A Geraldes
- Department of Botany, University of British Columbia, 6270 University Boulevard, Vancouver, BC, V6T 1Z4, Canada
| | - C A Hefer
- Department of Botany, University of British Columbia, 6270 University Boulevard, Vancouver, BC, V6T 1Z4, Canada
| | - A Capron
- Department of Botany, University of British Columbia, 6270 University Boulevard, Vancouver, BC, V6T 1Z4, Canada
| | - N Kolosova
- Department of Botany, University of British Columbia, 6270 University Boulevard, Vancouver, BC, V6T 1Z4, Canada
| | - F Martinez-Nuñez
- Department of Botany, University of British Columbia, 6270 University Boulevard, Vancouver, BC, V6T 1Z4, Canada
| | - R Y Soolanayakanahally
- Agroforestry Development Centre, Agriculture and Agri-Food Canada, Indian Head, SK, S0G 2K0, Canada
| | - B Stanton
- Greenwood Resources, Portland, OR, 97201, USA
| | - R D Guy
- Department of Forest and Conservation Sciences, University of British Columbia, 6270 University Boulevard, Vancouver, BC, V6T 1Z4, Canada
| | - S D Mansfield
- Department of Wood Science, University of British Columbia, 6270 University Boulevard, Vancouver, BC, V6T 1Z4, Canada
| | - C J Douglas
- Department of Botany, University of British Columbia, 6270 University Boulevard, Vancouver, BC, V6T 1Z4, Canada
| | - Q C B Cronk
- Department of Botany, University of British Columbia, 6270 University Boulevard, Vancouver, BC, V6T 1Z4, Canada
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Rohrer JD, Devine H, Foulkes A, Johnston A, Mallam B, Marshall C, Stanton B, Thomas R, Blackburn D. DEVELOPING A NEUROLOGY MENTORING PROGRAMME FOR TRAINEES. J Neurol Neurosurg Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309236.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zhou Y, Li X, Yang H, Hong Y, Fang X, Wang B, Stanton B. Effect of condom-use measures in predicting sexually transmitted diseases: variation by individual and contextual factors of sexual risk. Int J STD AIDS 2012; 23:e27-34. [DOI: 10.1258/ijsa.2009.009071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Inconsistent findings in the global literature regarding the effectiveness of condom use against sexually transmitted diseases (STDs) may result from variations in the measurement of condom use. In this study, we assess the sensitivity and specificity of six condom-use measures in predicting STD infection, and assess the difference in sensitivity and specificity by type of sexual partner (clients versus stable partners), type of STD, ethnicity (Han versus non-Han), years of formal schooling (≤6 versus >6 years) and level of risk of STD exposure (high versus low). Cross-sectional data were obtained from 454 female sex workers (FSWs) in Guangxi, China. Measurements of condom use were created along types of use (any use, consistent use, correct use, or the combination of consistent and correct use) and periods of recall (life time, last month or recent three sexual episodes). Measures of consistent use had higher sensitivity and lower specificity than measures of any use in predicting STDs among FSWs, regardless of the recall period and type of sexual partner. Incorporating correct use improved the measures of consistent use. Measures of consistent use and the combination of consistent and correct use demonstrated high sensitivity in predicting particular STDs. They showed higher sensitivity in predicting STDs among FSWs who reported higher risk for STD exposure than among FSWs who reported lower risk of exposure to STDs. In conclusion, the findings suggest the superiority of consistent use and correct use of condoms in predicting STD infection. The findings also underscore the importance of considering the context of sexual risk such as type of sexual partner and risk of exposure to STD infection when we measure condom use. Future studies of condom effectiveness should collect and quantify these contextual and individual factors among the target population.
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Affiliation(s)
- Y Zhou
- Guangxi Provincial CDC AIDS/STD Division, Nanning, Guangxi, China
| | - X Li
- Wayne State University, Carman and Ann Adams Department of Pediatrics Prevention Research Center, Detroit, MI
| | - H Yang
- Population Services International, Washington, DC
| | - Y Hong
- Texas A&M Health Science Center Department of Social and Behavioral Health, College Station, TX, USA
| | - X Fang
- Beijing Normal University Institute of Developmental Psychology, Beijing, China
| | - B Wang
- University of Southern Mississippi, Department of Community Health Sciences, Hattiesburg, MS, USA
| | - B Stanton
- Wayne State University, Carman and Ann Adams Department of Pediatrics Prevention Research Center, Detroit, MI
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Chen X, Stanton B, Gomez P, Lunn S, Deveaux L, Brathwaite N, Li X, Marshall S, Cottrell L, Harris C. Effects on condom use of an HIV prevention programme 36 months postintervention: a cluster randomized controlled trial among Bahamian youth. Int J STD AIDS 2011; 21:622-30. [PMID: 21097734 DOI: 10.1258/ijsa.2010.010039] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Data are lacking on long-term effects of HIV behavioural intervention programmes. In this study, we report intervention effects 36 months postintervention on condom use and relevant outcome variables from the theory-based programme 'Focus on Youth in the Caribbean' (FOYC). Participants (1360 sixth-grade youth) were randomized by school into: (1) FOYC, plus one of two brief parent interventions or (2) the control condition 'Wondrous Wetlands', plus a brief parent intervention. Mixed effect analysis demonstrated significant programme effects, including enhanced HIV/AIDS knowledge (effect size D = 0.44, 95% confidence interval [CI]: 0.43, 0.46), increased self-efficacy of (D = 0.42, 95% CI: 0.30, 0.54), skills for (D = 0.62, 95% CI: 0.56, 0.64) and intention to use a condom (D = 0.20, 95% CI: 0.03, 0.37). Youth who received FOYC plus the parental monitoring intervention had higher condom use rates (odds ratio = 1.49, 95% CI: 0.97, 2.28). Feedback effects from key variables were also detected, supporting the sustained effect.
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Affiliation(s)
- X Chen
- The Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, MI, USA.
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Gong J, Saxena V, Mathur A, Li X, Stanton B, Kaljee L, Kamat D. HIV risk and prevention behaviours, intentions, perceptions and knowledge among youth in Goa, India. Int J STD AIDS 2010; 21:392-9. [PMID: 20071444 DOI: 10.1258/ijsa.2009.008479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In order to examine the association between HIV/AIDS knowledge and perceptions, and risk intentions and behaviours among adolescents in Goa, India, cross-sectional data from 942 youth were collected and assessed. The prevalence rates in the past six months for fighting, smoking, drinking and drug use were 16.5%, 3.8%, 17.8% and 1.1%, respectively; 5.2% acknowledged ever having engaged in sex. Prior risk involvement was significantly correlated with future risk intention (odds ratio [OR]: 9.7-19.7), and those involved in one risk behaviour were more likely to engage in other risk behaviours (OR: 1.3-23.5). The findings suggest the importance of targeted interventions for youth engaging or intending to engage in risk behaviours and universal interventions regarding basic facts and skills for all youth in Goa.
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Affiliation(s)
- J Gong
- The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Gong J, Li X, Fang X, Zhao G, Lv Y, Zhao J, Lin X, Zhang L, Chen X, Stanton B. Sibling separation and psychological problems of double AIDS orphans in rural China - a comparison analysis. Child Care Health Dev 2009; 35:534-41. [PMID: 19323668 DOI: 10.1111/j.1365-2214.2009.00969.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We investigated the psychological impact of sibling separation among children who lost both of their parents to AIDS and were placed in group care or kinship care settings in rural China. METHODS Comparative analysis of cross-sectional survey data among 155 children among whom 96 experienced sibling separation. Trauma symptoms (Anxiety, Depression, Anger, Post-traumatic stress, Dissociation, Sexual concerns) were compared between the AIDS orphans who experienced sibling separation and those who did not using analysis of variance and multivariate analysis of covariance. RESULTS Among the participants (47.7% girls) with an average age of 12.4 years, univariate and multivariate analyses showed that separation from siblings was associated with significantly higher scores in anxiety, depression, anger and dissociation before or after controlling for gender, age, care arrangement, number of household replacement, trusting relationship with the current caregivers and perceived quality of current living condition. Sibling separation among orphans was not associated with level of post-traumatic stress and sexual concerns. CONCLUSION AIDS orphans separated from their siblings suffered from increased psychological distress compared with those who remained with their siblings. The data in the current study suggest that care arrangement for AIDS orphan should include accommodating the siblings together or providing them with opportunities for frequent contact and/or communication with each other. Appropriate psychological counselling should be given to those orphans experiencing sibling separation.
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Affiliation(s)
- J Gong
- The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI 48201, USA
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Stanton B, Deveaux L, Lunn S, Yu S, Brathwaite N, Li X, Cottrell L, Harris C, Clemens R, Marshall S. Condom-use skills checklist: a proxy for assessing condom-use knowledge and skills when direct observation is not possible. J Health Popul Nutr 2009; 27:406-13. [PMID: 19507756 PMCID: PMC2761789 DOI: 10.3329/jhpn.v27i3.3383] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Because of the continued importance of correct condom-use in controlling the HIV epidemic and the limited availability of tools for assessing correct condom-use, methods for assessing condom-application skills, especially when direct observation is not feasible, are needed. Accordingly, in the context of a high-risk population (The Bahamas) for HIV, a 17-item scale--the Condom-use Skills Checklist (CUSC)--was developed for use among young adolescents and adults. The rationale and approach to developing the scale and some measures of internal consistency, construct validity, and criterion-related validity have been described. It is concluded that the scale offers a reasonable alternative to direct observation among older subjects and that further development may make it more useful among pre-adolescents.
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Affiliation(s)
- B Stanton
- Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, USA.
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Abstract
The concept of social capital has drawn much attention in social and behavioral epidemiology and health education research. The purpose of this study is to develop the 'Personal Social Capital Scale' for quantitative survey studies of social factors that are related to health and behavior. The instrument contained 10 composite items based on 42 items for assessing personally owned social capital, including bonding and bridging capitals. The instrument was assessed using cross-sectional survey data collected among 128 participants (64 women) with a participation rate of 95%. Results from correlation and confirmatory factor analysis indicated adequate reliability and internal consistency. The mean score of the scale was 25.9 (SD = 5.2) for total social capital, 15.2 (SD = 3.0) for bonding social capital and 10.8 (SD = 3.4) for bridging social capital. The scale scores significantly predicted a number of theoretically related factors, including people skills, being sociable, social capital investment, informational support, instrumental support, emotional support and collective efficacy. This instrument provides a new tool for cross-cultural research to assess personally owned social capital.
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Affiliation(s)
- X Chen
- Department of Pediatrics Prevention Research Center, Wayne State University, Detroit, MI 48201, USA.
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Affiliation(s)
- R Zhao
- a Department of Applied Psychology , Central University of Finance and Economics , Beijing , China , 100081
| | - B Wang
- b Department of Community Health Sciences , The University of Southern Mississippi , Hathesburg
| | - X Fang
- c Institute of Departmental Psychology , Beijing Normal University , Beijing , China
| | - X Li
- d Department of Pediatrics , Wayne State Universtiy , Detroit , US
| | - B Stanton
- d Department of Pediatrics , Wayne State Universtiy , Detroit , US
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Gaydos CA, Hsieh YH, Galbraith JS, Barnes M, Waterfield G, Stanton B. Focus-on-Teens, sexual risk-reduction intervention for high-school adolescents: impact on knowledge, change of risk-behaviours, and prevalence of sexually transmitted diseases. Int J STD AIDS 2008; 19:704-10. [PMID: 18824625 DOI: 10.1258/ijsa.2008.007291] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A community-based intervention, Focus-on-Kids (FOK) has demonstrated risk-behaviour reduction of urban youth. We modified FOK to Focus-on-Teens (FOT) for high schools. High school adolescents (n=1190) were enrolled over successive school semesters. The small-group sessions were presented during the school-lunch hours. Confidential surveys were conducted at baseline, immediate, six-, and 12-month postintervention for demographics, parental communication/monitoring, sexual risk behaviours and sexually transmitted diseases (STDs)/HIV/condom-usage knowledge. Sexually active participants were encouraged to volunteer for urine-based STDs testing at the School-Based Health Centres. Many (47.4%) students reported having had sexual intercourse at baseline. Overall behaviours changed towards 'safer' sex behaviours (intent-to-use and using condoms, communicating with partner/parents about sex/condoms/STDs) with time (P<0.05). Proportion of students with complete correct knowledge of STDs/HIV increased to 88% at time 4 from 80% at baseline after adjusting for age, gender and sexual activity (P<0.05). High prevalence of STDs was detected in 875 participants who reported for urine testing at time 1: trichomonas, 11.8%; chlamydia, 10.1% and gonorrhoea, 4.1%. Prevalence decreased significantly for 310 participants who re-tested; chlamydia: 27.4% to 6.1% and gonorrhoea: 11.3% to 3.2%. FOT was successfully implemented as an STDs/HIV risk-reduction intervention. Sustained improvements of knowledge about STDs/HIV/condom usage, decreases in sexual risk behaviours supported the effectiveness of this intervention.
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Affiliation(s)
- C A Gaydos
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD 21205, USA.
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Affiliation(s)
- R. Zhao
- a Institute of Departmental Psychology , Beijing Normal University , Beijing , China
| | - B. Wang
- b Department of Pediatrics , Wayne State University , Detroit , US
| | - X. Fang
- a Institute of Departmental Psychology , Beijing Normal University , Beijing , China
| | - X. Li
- b Department of Pediatrics , Wayne State University , Detroit , US
| | - B. Stanton
- b Department of Pediatrics , Wayne State University , Detroit , US
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Zhao G, Li X, Fang X, Zhao J, Yang H, Stanton B. Care arrangements, grief and psychological problems among children orphaned by AIDS in China. AIDS Care 2008; 19:1075-82. [PMID: 18058390 DOI: 10.1080/09540120701335220] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The China Ministry of Health has estimated that there are at least 100,000 AIDS orphans in China. The UNICEF China Office estimates that between 150,000 and 250,000 additional children will be orphaned by AIDS over the next five years. However, limited data are available regarding the sociodemographic characteristics, care arrangements, barriers to appropriate grief resolution and psychological problems among AIDS orphans in China. In this article, we review secondary data and reports from scientific literature, government, non-governmental organisations and public media regarding children orphaned by AIDS in China to address their living situation, bereavement process and psychological problems. Our review suggests that AIDS orphans in China are living in a stressful environment, with many orphans struggling with psychological problems and unmet basic needs such as food, shelter, education and medical care. Based on our review, we suggest that future studies should address the psychosocial needs of AIDS orphans in China and develop health promotion programmes to mitigate the negative impact of parental death on the physical and psychosocial well-being of these orphans.
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Affiliation(s)
- G Zhao
- Department of Psychology, Henan University, Kaifeng, China
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Abhinav K, Stanton B, Johnston C, Hardstaff J, Orrell RW, Howard R, Clarke J, Sakel M, Ampong MA, Shaw CE, Leigh PN, Al-Chalabi A. Amyotrophic Lateral Sclerosis in South-East England: A Population-Based Study. Neuroepidemiology 2007; 29:44-8. [PMID: 17898523 DOI: 10.1159/000108917] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS We aimed to estimate the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in the South East of England. The reported incidence of ALS varies between 0.44 and 3.2 per 100,000 person years. This can partly be explained by differences in design and diagnostic criteria used. There is little population data concerning England, particularly the South East. METHODS A population study of South-East England (total population: 2,890,482) was carried out and multiple sources including our tertiary centre and district general hospitals were used for complete case ascertainment. RESULTS Between 1 January 2002 and 30 June 2006 we identified 138 people (76 males; 62 females) with a new diagnosis of ALS, giving a crude incidence of 1.06 per 100,000 person years. The projected age- and gender-adjusted annual incidence rate for England and Wales was 1.10 (95% CI 0.80-1.40). 142 people were alive on 30 June 2006, giving a point prevalence of 4.91 per 100,000 population. CONCLUSION Our incidence and prevalence rates are similar to those reported in comparable studies from other countries. This argues against the role of a specific exogenous factor in the aetiology of ALS in South-East England.
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Affiliation(s)
- K Abhinav
- MRC Centre for Neurodegeneration Research, King's College London, Institute of Psychiatry, London, UK
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Abstract
Increasing HIV knowledge is a focus of many HIV education and prevention efforts. While the bivariate relationship of HIV serostatus disclosure with HIV-related knowledge and stigma has been reported in the literature, little is known about the mediation effect of stigma on the relationship of HIV knowledge with HIV serostatus disclosure. Data from 4,208 rural-to-urban migrants in China were analyzed to explore this issue. Overall, 70% of respondents reported willingness to disclose their HIV status if they were HIV-positive. Willingness to disclose was negatively associated with misconceptions about HIV transmission and stigma. Stigma mediated the relationship between misconceptions and willingness to disclose among women but not men. The mediation effect of stigma suggests that stigmatization reduction would be an important component of HIV prevention approaches. Gender inequality needs to be addressed in stigmatization reduction efforts.
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Affiliation(s)
- H Yang
- Carman and Ann Adams Department of Pediatrics, Wayne State University Prevention Research Center, Wayne State University School of Medicine, Detroit, MI 48201, USA.
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Yang H, Wu Z, Duan S, Li Z, Li X, Shen M, Mathur A, Stanton B. Living environment and schooling of children with HIV-infected parents in southwest China. AIDS Care 2007; 18:647-55. [PMID: 16971271 DOI: 10.1080/09540120500282896] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A cross-sectional household survey was conducted in Longchuan County, China, to study the lives of children with HIV-infected parents. Registered HIV-infected drug users and their households were approached and information about the living environment of children < or =15 years of age was collected. Of the 266 households interviewed, there were 213 children < or =15 years old. Forty percent of the children had lost at least one parent. Most of the children resided in a household with low economic status and a high dependency ratio. One-half of the children experienced discordant family relations, family anxiety and shame. Compared to orphans, non-orphans and their families were less likely to receive social support from the community. Orphans and older children were less likely to attend school and more likely to be truant if enrolled in school. Findings in the current study suggest that many children whose parents are infected with HIV or have died from HIV are living in stressful environments with minimal support from the community. Efforts should be taken to provide support and supervision to these children.
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Affiliation(s)
- H Yang
- Prevention Research Center, Carman and Ann Adams Department of Pediatrics, Wayne State University, Detriot, MI 48201, USA.
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Hu Z, Liu H, Li X, Stanton B, Chen X. HIV-related sexual behaviour among migrants and non-migrants in a rural area of China: role of rural-to-urban migration. Public Health 2006; 120:339-45. [PMID: 16473377 DOI: 10.1016/j.puhe.2005.10.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2005] [Revised: 09/09/2005] [Accepted: 10/18/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare human immunodeficiency virus (HIV)-related sexual risks between temporary rural-to-urban migrants and non-migrants, and to explore the role of migration in HIV transmission in a rural area of China. STUDY DESIGN A cross-sectional study was conducted among 605 (302.5 couples, one male missing) marriage licence applicants. METHODS A two-part anonymous questionnaire was used. The first part included non-sensitive questions including demographics and HIV knowledge. Sensitive questions related to sexual behaviours were administered in the second part of the questionnaire using a tape recorder, earphones and an answer sheet. RESULTS Sixty-six percent (399/605) of the study subjects had migrated to a city for a temporary job. The proportions of migrants who had premarital sex (62%, 247/399) and multiple sexual partners (12%, 47/399) were significantly higher than those of non-migrants (52 and 6%, respectively). Among those who had multiple sexual partners, only 9% (4/47) of migrants and 8% (1/12) of non-migrants reported often or always using condoms with sexual partners other than their spouse. A low level of knowledge regarding HIV and acquired immunodeficiency syndrome was observed in both groups. Very few migrants (15%, 61/399) and non-migrants (10%, 20/206) perceived themselves to be at risk of HIV infection. CONCLUSIONS As both migrants and non-migrants are at risk of HIV infection, intervention programmes targeting reduction of HIV sexual risk behaviour should cover both groups in rural areas of China.
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Affiliation(s)
- Z Hu
- Anhui Medical University, Hefei, China
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Yang H, Li X, Stanton B, Fang X, Lin D, Mao R, Liu H, Chen X, Severson R. Workplace and HIV-related sexual behaviours and perceptions among female migrant workers. AIDS Care 2005; 17:819-33. [PMID: 16120499 PMCID: PMC1949042 DOI: 10.1080/09540120500099902] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Data from 1,543 female migrants working in eight occupational clusters in Beijing and Nanjing, China were analysed to examine the association of workplace with HIV-related behaviours and perceptions. For sexually experienced women (n = 666, 43.2%), those working in entertainment establishments or personal service (e.g., nightclubs, dancing halls, barbershops, beauty salons, massage parlours, etc.) engaged in risky sexual practices twice as frequently as those working in non-entertainment establishments (e.g. restaurants, stalls, domestic service, factories, etc.). About 10% of women in the entertainment establishments reported having sold sex, 30% having multiple sexual partners and 40% having sex with men with multiple sexual partners. The rate of consistent condom use was less than 15%. They also tended to have a higher level of perceptions of both peer risk involvement and positive expectancy of risk behaviours, and lower perceptions of severity of STDs and HIV. For women who were not sexually experienced, those working in 'stalls' or 'domestic service' tended to perceive higher peer risk involvement, less severity of HIV infection, and less effectiveness of protective behaviour. The occupational pattern of sexual risk behaviours and perceptions observed in the current study indicates employment conditions are associated with HIV risk. Intervention strategies should be tailored to address occupational-related factors.
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Affiliation(s)
- H Yang
- Prevention Research Center the Carman and Ann Adams Department of Pediatrics, Wayne State University school of Medicine, Detroit, MI 48201, USA.
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Liu H, Li X, Stanton B, Fang X, Mao R, Chen X, Yang H. Relation of sexual risks and prevention practices with individuals' stigmatising beliefs towards HIV infected individuals: an exploratory study. Sex Transm Infect 2005; 81:511-6. [PMID: 16326857 PMCID: PMC1745054 DOI: 10.1136/sti.2005.014977] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate how an individual's stigmatising beliefs towards people living with HIV are related to his or her own sexual risk and protective behaviours. METHODS A cross sectional survey was conducted to assess HIV related stigmatising beliefs, risk sexual behaviours, and preventive practices among sexually experienced rural to urban migrants aged 18-30 years in 2002 in Beijing and Nanjing, two large Chinese cities. RESULTS Among 2153 migrants, 7.2% reported having had more than one sexual partner in the previous month, 9.9% had commercial sex partners, and 12.5% had an episode of a sexually transmitted disease (STD). Only 18% reported frequently or always using condoms, with 20% sometimes or occasionally using them. 57% of the Chinese migrants were willing to take a voluntary HIV test, and 65% had HIV related stigmatising beliefs towards people living with HIV. Multiple logistic regression analysis depicts that individual's stigmatising beliefs towards people with HIV were positively associated with having had an episode of an STD, having multiple sex partners, or having had commercial sex partners, and were negatively associated with condom use and the willingness to accept an HIV test. CONCLUSION The finding that one's own stigmatising belief is a potential barrier to HIV related preventive practices highlights the difficulties and challenges in implementing behavioural interventions.
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Affiliation(s)
- H Liu
- Prevention Research Center, School of Medicine, Wayne State University, 4201 St Antoine, UHC-6D, Detroit, MI 48201-2196, USA.
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Chen X, Stanton B, Li X, Fang X, Lin D. 416: Substance use among rural-to-urban migrants in china: a moderation effect model analysis. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s104c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- X Chen
- Wayne State University, Detroit, MI 48201
| | - B Stanton
- Wayne State University, Detroit, MI 48201
| | - X Li
- Wayne State University, Detroit, MI 48201
| | - X Fang
- Wayne State University, Detroit, MI 48201
| | - D Lin
- Wayne State University, Detroit, MI 48201
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Liu H, Li X, Stanton B, Chen X, Fang HYX, Mao R. 168: Relationship of Sexual Risks and Prevention Practices with Individuals’ Stigmatizing Beliefs Towards HIV-Infected Individuals: A Propensity Score Analysis. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s42c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Liu
- Wayne State University, Detroit, MI 48201
| | - X Li
- Wayne State University, Detroit, MI 48201
| | - B Stanton
- Wayne State University, Detroit, MI 48201
| | - X Chen
- Wayne State University, Detroit, MI 48201
| | | | - R Mao
- Wayne State University, Detroit, MI 48201
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Kaljee LM, Genberg BL, Minh TT, Tho LH, Thoa LTK, Stanton B. Alcohol use and HIV risk behaviors among rural adolescents in Khanh Hoa Province Viet Nam. Health Educ Res 2005; 20:71-80. [PMID: 15198997 DOI: 10.1093/her/cyg096] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Research suggests that youth are consuming more alcohol and at younger ages than in the past. Data also indicate that alcohol consumption is associated with participation in other risk behaviors including aggression and sexual behaviors. As part of a randomized control effectiveness trial for an HIV prevention program, 480 Vietnamese youth (15-20 years old) living in eight rural communes in Khanh Hoa Province were administered a paper and pencil baseline evaluation. The evaluation included items for actual and intended alcohol use, perceptions of peers' alcohol consumption, and attitudinal questions regarding alcohol. The tool included questions on engagement and intention to engage in sexual behaviors. In addition, 96 randomly selected youth participated in qualitative interviews on similar topics. Among the 480 surveyed youth, 29.2% had consumed alcohol. Among those youth, 17.6% reported intoxication in the past 6 months. While young men were significantly more likely to drink than young women (P < 0.00), those young women who did drink were as likely to report intoxication. Alcohol use was significantly associated with engagement in sexual behaviors (P < 0.00) and intention to engage in sexual behaviors (P < 0.02). The qualitative data provided information on the social contexts of drinking behaviors and more in-depth findings regarding associated risk behaviors. With limited information about alcohol consumption among Vietnamese youth, these findings suggest that there is a need for more extensive research on alcohol use and associated risk behaviors among this population, and for targeted alcohol prevention and harm-reduction programs.
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Affiliation(s)
- L M Kaljee
- Department of Pediatrics, School of Medicine, University of Maryland Baltimore, Baltimore, MD 21201, USA.
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Stanton B, Cuthill S, Amador C. Adolescence and poverty. Adolesc Med 2001; 12:525-38. [PMID: 11602451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Adolescents living in America suffer the triple burden of a disproportionate representation among the poor, a major conflict of developmental challenges and poverty-related challenges, and, frequently, additional challenges accompanying a minority heritage. At the same time, these individuals and the communities in which they live enjoy many strengths. This chapter reviews these and related issues.
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Affiliation(s)
- B Stanton
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown,26506-9214, USA
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Stanton B, Watkins S, German JB, Lasley B. Interaction of estrogen and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) with hepatic fatty acid synthesis and metabolism of male chickens (Gallus domesticus). Comp Biochem Physiol C Toxicol Pharmacol 2001; 129:137-50. [PMID: 11423386 DOI: 10.1016/s1532-0456(01)00195-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This study tested the hypothesis that 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) antagonizes estrogen-induced hepatic lipid synthesis and metabolism in birds. Twenty immature male chickens (Gallus domesticus) were divided evenly into four groups: (1) vehicle control; (2) estrogen alone (1.0 mg/kg estradiol cypionate injected on three consecutive days); (3) TCDD alone (50 microg/kg injected on the fourth day); and (4) a combination of the estrogen and TCDD treatments. On day 14, liver samples were collected for quantitative fatty acid analysis by capillary gas chromatography. Birds treated with estrogen alone had increased total triacylglyceride concentrations with specific increases in the Delta9 desaturase products 16:1n7, 18:1n7, 18:1n9, and 20:1n9. In addition, estrogen treatment specifically increased 22:6n3 concentrations in both triacylglycerides and phospholipids. However, these increases in Delta9 desaturase products or 22:6n3 did not occur for birds treated with estrogen in combination with TCDD. TCDD and estrogen plus TCDD treatments increased phospholipid concentrations of the diet-derived polyunsaturated fatty acids 18:2n6, 18:3n6, 20:3n6, 18:3n3, and 20:5n3, although only the estrogen plus TCDD group had significantly increased total phospholipids. In cholesterol esters, all three treatments decreased concentrations of total fatty acids, saturated fatty acids, and Delta9 desaturase products compared to the control group.
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Affiliation(s)
- B Stanton
- Institute of Toxicology and Environmental Health (ITEH), University of California Davis, One Shields Ave., 95616, Davis, CA, USA.
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Stanton B, Li X, Cottrell L, Kaljee L. Early initiation of sex, drug-related risk behaviors, and sensation-seeking among urban, low-income African-American adolescents. J Natl Med Assoc 2001; 93:129-38. [PMID: 12653400 PMCID: PMC2593992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The purpose of this study was to examine the relationship of early initiation of sex, drug-use, drug-trafficking, and sensation-seeking among urban, African-American adolescents. A longitudinal follow-up of 383 youth ages 9 to 15 years at baseline over four years with serial risk-assessments was used. Sexual experience and several drug-related risk behaviors increased significantly during the four-year study interval. Sensation-seeking scores were higher after the baseline assessment among youth reporting tobacco, alcohol, and marijuana use and were higher, both at baseline and through several follow-up assessments, among youth reporting drug-selling and sexual activity. At baseline, the correlations among drug-related risk behaviors were all strong, except those between initiation of sex and drug-related risk behaviors. However, over time, early initiators of sex were significantly more likely to report involvement in substance use and drug-delivery/sales than were late initiators. Youth reporting repeated involvement in drug-related activities were more likely to report intensive sexual involvement than they were to report experimental sex or no sex. Sensation-seeking scores were lower among youth reporting no involvement in risk behaviors. However, scores did not differ between youth exhibiting experimental behavior compared to youth demonstrating repeated risk involvement. These results support the need for alternative experiences for youth exhibiting high levels of sensation-seeking and the need for early drug/sexual risk prevention programs.
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Affiliation(s)
- B Stanton
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown West Virginia 26506-9214, USA
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Abstract
PURPOSE To examine the pattern of adolescent's involvement in drug-related behaviors and sexual initiation, and its relationship with: (a) age and gender, (b) sensation- seeking, (c) perceptions of peer and family risk involvement, and (d) involvement in high-risk sexual behavior. SUBJECTS Two hundred and sixty-one urban African-American youth, aged 9 to 15 years at baseline, who were sexually experienced by the end of the 4-year study interval. The longitudinal assessment (4 years) was focused on: (a) alcohol use, illicit drug use, and drug trafficking; (b) high-risk sex; (c) propensity to sensation seeking; and (d) perceived peer and family risk involvement. RESULTS Involvement increased over the 4-year study interval such that over half of the adolescents reported use of alcohol and/or use of marijuana in the final assessment period. For each of the three drug-related activities examined, the largest proportion of youth who engaged in sexual intercourse never engaged in drug-related activity, and the next largest proportion initiated sexual involvement before drug use. Sensation-seeking scores, which were relatively stable across time, were lower among girls, and also were lower among youth who remained uninvolved in drug-related behaviors. For all three drug-related behaviors, rates of high-risk sex were higher among youth who initiated both sex and drugs, and were lower among youth who reported engaging only in sex. Although youth who did eventually initiate drug use had higher perceived levels of family and peer drug use compared to those who remained uninvolved, these perceptions did not contribute directly to high-risk sexual behavior. CONCLUSIONS Youth who will become both sexually active and involved with drugs during adolescence are especially vulnerable to involvement in high-risk sexual behavior.
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Affiliation(s)
- X Li
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia 26506-9214, USA.
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