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Kozlowska K, Scher S. Recent advances in understanding the neurobiology of pediatric functional neurological disorder. Expert Rev Neurother 2024; 24:497-516. [PMID: 38591353 DOI: 10.1080/14737175.2024.2333390] [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: 05/26/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Functional neurological disorder (FND) is a neuropsychiatric disorder that manifests in a broad array of functional motor, sensory, or cognitive symptoms, which arise from complex interactions between brain, mind, body, and context. Children with FND make up 10%-20% of presentations to neurology services in children's hospitals and up to 20% of adolescents admitted to hospital for the management of intractable seizures. AREAS COVERED The current review focuses on the neurobiology of pediatric FND. The authors present an overview of the small but growing body of research pertaining to the biological, emotion-processing, cognitive, mental health, physical health, and social system levels. EXPERT OPINION Emerging research suggests that pediatric FND is underpinned by aberrant changes within and between neuron-glial (brain) networks, with a variety of factors - on multiple system levels - contributing to brain network changes. In pediatric practice, adverse childhood experiences (ACEs) are commonly reported, and activation or dysregulation of stress-system components is a frequent finding. Our growing understanding of the neurobiology of pediatric FND has yielded important flow-on effects for assessing and diagnosing FND, for developing targeted treatment interventions, and for improving the treatment outcomes of children and adolescents with FND.
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Affiliation(s)
- Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead, NSW, Australia
- Brain Dynamics Centre, Westmead Institute of Medical Research, Westmead, NSW, Australia
- University of Sydney Medical School, Camperdown, NSW, Australia
| | - Stephen Scher
- University of Sydney Medical School, Camperdown, NSW, Australia
- Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
- McLean Hospital, Belmont, MA, USA
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Schiller D, Yu ANC, Alia-Klein N, Becker S, Cromwell HC, Dolcos F, Eslinger PJ, Frewen P, Kemp AH, Pace-Schott EF, Raber J, Silton RL, Stefanova E, Williams JHG, Abe N, Aghajani M, Albrecht F, Alexander R, Anders S, Aragón OR, Arias JA, Arzy S, Aue T, Baez S, Balconi M, Ballarini T, Bannister S, Banta MC, Barrett KC, Belzung C, Bensafi M, Booij L, Bookwala J, Boulanger-Bertolus J, Boutros SW, Bräscher AK, Bruno A, Busatto G, Bylsma LM, Caldwell-Harris C, Chan RCK, Cherbuin N, Chiarella J, Cipresso P, Critchley H, Croote DE, Demaree HA, Denson TF, Depue B, Derntl B, Dickson JM, Dolcos S, Drach-Zahavy A, Dubljević O, Eerola T, Ellingsen DM, Fairfield B, Ferdenzi C, Friedman BH, Fu CHY, Gatt JM, de Gelder B, Gendolla GHE, Gilam G, Goldblatt H, Gooding AEK, Gosseries O, Hamm AO, Hanson JL, Hendler T, Herbert C, Hofmann SG, Ibanez A, Joffily M, Jovanovic T, Kahrilas IJ, Kangas M, Katsumi Y, Kensinger E, Kirby LAJ, Koncz R, Koster EHW, Kozlowska K, Krach S, Kret ME, Krippl M, Kusi-Mensah K, Ladouceur CD, Laureys S, Lawrence A, Li CSR, Liddell BJ, Lidhar NK, Lowry CA, Magee K, Marin MF, Mariotti V, Martin LJ, Marusak HA, Mayer AV, Merner AR, Minnier J, Moll J, Morrison RG, Moore M, Mouly AM, Mueller SC, Mühlberger A, Murphy NA, Muscatello MRA, Musser ED, Newton TL, Noll-Hussong M, Norrholm SD, Northoff G, Nusslock R, Okon-Singer H, Olino TM, Ortner C, Owolabi M, Padulo C, Palermo R, Palumbo R, Palumbo S, Papadelis C, Pegna AJ, Pellegrini S, Peltonen K, Penninx BWJH, Pietrini P, Pinna G, Lobo RP, Polnaszek KL, Polyakova M, Rabinak C, Helene Richter S, Richter T, Riva G, Rizzo A, Robinson JL, Rosa P, Sachdev PS, Sato W, Schroeter ML, Schweizer S, Shiban Y, Siddharthan A, Siedlecka E, Smith RC, Soreq H, Spangler DP, Stern ER, Styliadis C, Sullivan GB, Swain JE, Urben S, Van den Stock J, Vander Kooij MA, van Overveld M, Van Rheenen TE, VanElzakker MB, Ventura-Bort C, Verona E, Volk T, Wang Y, Weingast LT, Weymar M, Williams C, Willis ML, Yamashita P, Zahn R, Zupan B, Lowe L. The Human Affectome. Neurosci Biobehav Rev 2024; 158:105450. [PMID: 37925091 PMCID: PMC11003721 DOI: 10.1016/j.neubiorev.2023.105450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/11/2022] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/06/2023]
Abstract
Over the last decades, theoretical perspectives in the interdisciplinary field of the affective sciences have proliferated rather than converged due to differing assumptions about what human affective phenomena are and how they work. These metaphysical and mechanistic assumptions, shaped by academic context and values, have dictated affective constructs and operationalizations. However, an assumption about the purpose of affective phenomena can guide us to a common set of metaphysical and mechanistic assumptions. In this capstone paper, we home in on a nested teleological principle for human affective phenomena in order to synthesize metaphysical and mechanistic assumptions. Under this framework, human affective phenomena can collectively be considered algorithms that either adjust based on the human comfort zone (affective concerns) or monitor those adaptive processes (affective features). This teleologically-grounded framework offers a principled agenda and launchpad for both organizing existing perspectives and generating new ones. Ultimately, we hope the Human Affectome brings us a step closer to not only an integrated understanding of human affective phenomena, but an integrated field for affective research.
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Affiliation(s)
- Daniela Schiller
- Department of Psychiatry, the Nash Family Department of Neuroscience, and the Friedman Brain Institute, at the Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Alessandra N C Yu
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
| | - Nelly Alia-Klein
- Department of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Susanne Becker
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany; Integrative Spinal Research Group, Department of Chiropractic Medicine, University Hospital Balgrist, University of Zurich, Balgrist Campus, Lengghalde 5, 8008 Zurich, Switzerland
| | - Howard C Cromwell
- J.P. Scott Center for Neuroscience, Mind and Behavior, Department of Psychology, Bowling Green State University, Bowling Green, OH 43403, United States
| | - Florin Dolcos
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Paul J Eslinger
- Departments of Neurology, Neural & Behavioral Science, Radiology, and Public Health Sciences, Penn State Hershey Medical Center and College of Medicine, Hershey, PA, United States
| | - Paul Frewen
- Departments of Psychiatry, Psychology and Neuroscience at the University of Western Ontario, London, Ontario, Canada
| | - Andrew H Kemp
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, United Kingdom
| | - Edward F Pace-Schott
- Harvard Medical School and Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Jacob Raber
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, United States; Departments of Neurology, Radiation Medicine, Psychiatry, and Division of Neuroscience, ONPRC, Oregon Health & Science University, Portland, OR, United States
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Elka Stefanova
- Faculty of Medicine, University of Belgrade, Serbia; Neurology Clinic, Clinical Center of Serbia, Serbia
| | - Justin H G Williams
- Griffith University, Gold Coast Campus, 1 Parklands Dr, Southport, QLD 4215, Australia
| | - Nobuhito Abe
- Institute for the Future of Human Society, Kyoto University, 46 Shimoadachi-cho, Yoshida Sakyo-ku, Kyoto, Japan
| | - Moji Aghajani
- Institute of Education & Child Studies, Section Forensic Family & Youth Care, Leiden University, the Netherlands; Department of Psychiatry, Amsterdam UMC, Location VUMC, GGZ InGeest Research & Innovation, Amsterdam Neuroscience, the Netherlands
| | - Franziska Albrecht
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Karolinska University Hospital, Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy & Physiotherapy, Stockholm, Sweden
| | - Rebecca Alexander
- Neuroscience Research Australia, Randwick, Sydney, NSW, Australia; Australian National University, Canberra, ACT, Australia
| | - Silke Anders
- Department of Neurology, University of Lübeck, Lübeck, Germany; Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Oriana R Aragón
- Yale University, 2 Hillhouse Ave, New Haven, CT, United States; Cincinnati University, Marketing Department, 2906 Woodside Drive, Cincinnati, OH 45221-0145, United States
| | - Juan A Arias
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, United Kingdom; Department of Statistics, Mathematical Analysis, and Operational Research, Universidade de Santiago de Compostela, Spain; The Galician Center for Mathematical Research and Technology (CITMAga), 15782 Santiago de Compostela, Spain
| | - Shahar Arzy
- Department of Medical Neurobiology, Hebrew University, Jerusalem, Israel
| | - Tatjana Aue
- Institute of Psychology, University of Bern, Fabrikstr. 8, 3012 Bern, Switzerland
| | | | - Michela Balconi
- International Research Center for Cognitive Applied Neuroscience, Catholic University of Milan, Milan, Italy
| | - Tommaso Ballarini
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Scott Bannister
- Durham University, Palace Green, DH1 RL3 Durham, United Kingdom
| | | | - Karen Caplovitz Barrett
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO, United States; Department of Community & Behavioral Health, Colorado School of Public Health, Denver, CO, United States
| | | | - Moustafa Bensafi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France
| | - Linda Booij
- Department of Psychology, Concordia University, Montreal, Canada; CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Jamila Bookwala
- Department of Psychology, Lafayette College, Easton, PA, United States
| | - Julie Boulanger-Bertolus
- Department of Anesthesiology and Center for Consciousness Science, University of Michigan, Ann Arbor, MI, United States
| | - Sydney Weber Boutros
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR 97239, United States
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Wallstr. 3, 55122 Mainz, Germany; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| | - Antonio Bruno
- Department of Biomedical, Dental Sciences and Morpho-Functional Imaging - University of Messina, Italy
| | - Geraldo Busatto
- Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lauren M Bylsma
- Departments of Psychiatry and Psychology; and the Center for Neural Basis of Cognition, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | | | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Nicolas Cherbuin
- Centre for Research on Ageing, Health, and Wellbeing, Australian National University, Canberra, ACT, Australia
| | - Julian Chiarella
- Department of Psychology, Concordia University, Montreal, Canada; CHU Sainte-Justine, University of Montreal, Montreal, Canada
| | - Pietro Cipresso
- Applied Technology for Neuro-Psychology Lab., Istituto Auxologico Italiano (IRCCS), Milan, Italy; Department of Psychology, University of Turin, Turin, Italy
| | - Hugo Critchley
- Psychiatry, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Sussex, United Kingdom
| | - Denise E Croote
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai and Friedman Brain Institute, New York, NY 10029, United States; Hospital Universitário Gaffrée e Guinle, Universidade do Rio de Janeiro, Brazil
| | - Heath A Demaree
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Thomas F Denson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Brendan Depue
- Departments of Psychological and Brain Sciences and Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, United States
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health, University of Tübingen, Tübingen, Germany
| | - Joanne M Dickson
- Edith Cowan University, Psychology Discipline, School of Arts and Humanities, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Sanda Dolcos
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Anat Drach-Zahavy
- The Faculty of Health and Welfare Sciences, University of Haifa, Haifa, Israel
| | - Olga Dubljević
- Neurology Clinic, Clinical Center of Serbia, Serbia; Institute for Biological Research "Siniša Stanković", National Institute of Republic of Serbia, Belgrade, Serbia
| | - Tuomas Eerola
- Durham University, Palace Green, DH1 RL3 Durham, United Kingdom
| | - Dan-Mikael Ellingsen
- Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Beth Fairfield
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy; UniCamillus, International Medical University, Rome, Italy
| | - Camille Ferdenzi
- Research Center in Neurosciences of Lyon, CNRS UMR5292, INSERM U1028, Claude Bernard University Lyon 1, Lyon, Centre Hospitalier Le Vinatier, 95 bd Pinel, 69675 Bron Cedex, France
| | - Bruce H Friedman
- Department of Psychology, Virginia Tech, Blacksburg, VA, United States
| | - Cynthia H Y Fu
- School of Psychology, University of East London, United Kingdom; Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Justine M Gatt
- Neuroscience Research Australia, Randwick, Sydney, NSW, Australia; School of Psychology, University of New South Wales, Randwick, Sydney, NSW, Australia
| | - Beatrice de Gelder
- Department of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Guido H E Gendolla
- Geneva Motivation Lab, University of Geneva, FPSE, Section of Psychology, CH-1211 Geneva 4, Switzerland
| | - Gadi Gilam
- The Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Systems Neuroscience and Pain Laboratory, Stanford University School of Medicine, CA, United States
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | | | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liege, Liege, Belgium
| | - Alfons O Hamm
- Department of Biological and Clinical Psychology/Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Jamie L Hanson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15206, United States
| | - Talma Hendler
- Tel Aviv Center for Brain Function, Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Cornelia Herbert
- Department of Applied Emotion and Motivation Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Stefan G Hofmann
- Department of Clinical Psychology, Philipps University Marburg, Germany
| | - Agustin Ibanez
- Universidad de San Andres, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile; Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), United States and Trinity Collegue Dublin (TCD), Ireland
| | - Mateus Joffily
- Groupe d'Analyse et de Théorie Economique (GATE), 93 Chemin des Mouilles, 69130 Écully, France
| | - Tanja Jovanovic
- Department of Psychiatry and Behavaioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Ian J Kahrilas
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Maria Kangas
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Yuta Katsumi
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Elizabeth Kensinger
- Department of Psychology and Neuroscience, Boston College, Boston, MA, United States
| | - Lauren A J Kirby
- Department of Psychology and Counseling, University of Texas at Tyler, Tyler, TX, United States
| | - Rebecca Koncz
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia; Specialty of Psychiatry, The University of Sydney, Concord, New South Wales, Australia
| | - Ernst H W Koster
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Sören Krach
- Social Neuroscience Lab, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Mariska E Kret
- Leiden University, Cognitive Psychology, Pieter de la Court, Waassenaarseweg 52, Leiden 2333 AK, the Netherlands
| | - Martin Krippl
- Faculty of Natural Sciences, Department of Psychology, Otto von Guericke University Magdeburg, Universitätsplatz 2, Magdeburg, Germany
| | - Kwabena Kusi-Mensah
- Department of Psychiatry, Komfo Anokye Teaching Hospital, P. O. Box 1934, Kumasi, Ghana; Department of Psychiatry, University of Cambridge, Darwin College, Silver Street, CB3 9EU Cambridge, United Kingdom; Behavioural Sciences Department, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Cecile D Ladouceur
- Departments of Psychiatry and Psychology and the Center for Neural Basis of Cognition (CNBC), University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness & Centre du Cerveau2, University and University Hospital of Liege, Liege, Belgium
| | - Alistair Lawrence
- Scotland's Rural College, King's Buildings, Edinburgh, Scotland; The Roslin Institute, University of Edinburgh, Easter Bush, Scotland
| | - Chiang-Shan R Li
- Connecticut Mental Health Centre, Yale University, New Haven, CT, United States
| | - Belinda J Liddell
- School of Psychology, University of New South Wales, Randwick, Sydney, NSW, Australia
| | - Navdeep K Lidhar
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Christopher A Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Kelsey Magee
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada; Research Center, Institut universitaire en santé mentale de Montréal, Montreal, Canada
| | - Veronica Mariotti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Loren J Martin
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
| | - Hilary A Marusak
- Department of Psychiatry and Behavaioral Neurosciences, Wayne State University, Detroit, MI, United States; Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, United States
| | - Annalina V Mayer
- Social Neuroscience Lab, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Amanda R Merner
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Jessica Minnier
- School of Public Health, Oregon Health & Science University, Portland, OR, United States
| | - Jorge Moll
- Cognitive Neuroscience and Neuroinformatics Unit, D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Robert G Morrison
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Matthew Moore
- Beckman Institute for Advanced Science & Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States; Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States; War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Anne-Marie Mouly
- Lyon Neuroscience Research Center, CNRS-UMR 5292, INSERM U1028, Universite Lyon, Lyon, France
| | - Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Andreas Mühlberger
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany
| | - Nora A Murphy
- Department of Psychology, Loyola Marymount University, Los Angeles, CA, United States
| | | | - Erica D Musser
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, United States
| | - Tamara L Newton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, United States
| | - Michael Noll-Hussong
- Psychosomatic Medicine and Psychotherapy, TU Muenchen, Langerstrasse 3, D-81675 Muenchen, Germany
| | - Seth Davin Norrholm
- Department of Psychiatry and Behavaioral Neurosciences, Wayne State University, Detroit, MI, United States
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, University of Ottawa Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Canada
| | - Robin Nusslock
- Department of Psychology and Institute for Policy Research, Northwestern University, 2029 Sheridan Road, Evanston, IL, United States
| | - Hadas Okon-Singer
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Thomas M Olino
- Department of Psychology, Temple University, 1701N. 13th St, Philadelphia, PA, United States
| | - Catherine Ortner
- Thompson Rivers University, Department of Psychology, 805 TRU Way, Kamloops, BC, Canada
| | - Mayowa Owolabi
- Department of Medicine and Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan; University College Hospital, Ibadan, Oyo State, Nigeria; Blossom Specialist Medical Center Ibadan, Oyo State, Nigeria
| | - Caterina Padulo
- Department of Psychological, Health and Territorial Sciences, University of Chieti, Chieti, Italy
| | - Romina Palermo
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Rocco Palumbo
- Department of Psychological, Health and Territorial Sciences, University of Chieti, Chieti, Italy
| | - Sara Palumbo
- Department of Surgical, Medical and Molecular Pathology and of Critical Care, University of Pisa, Pisa, Italy
| | - Christos Papadelis
- Jane and John Justin Neuroscience Center, Cook Children's Health Care System, Fort Worth, TX, United States; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, United States
| | - Alan J Pegna
- School of Psychology, University of Queensland, Saint Lucia, Queensland, Australia
| | - Silvia Pellegrini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Kirsi Peltonen
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland; INVEST Research Flagship, University of Turku, Turku, Finland
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Location VUMC, GGZ InGeest Research & Innovation, Amsterdam Neuroscience, the Netherlands
| | | | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Rosario Pintos Lobo
- Center for Children and Families, Department of Psychology, Florida International University, Miami, FL, United States
| | - Kelly L Polnaszek
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Maryna Polyakova
- Neurology Department, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Christine Rabinak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, United States
| | - S Helene Richter
- Department of Behavioural Biology, University of Münster, Badestraße 13, Münster, Germany
| | - Thalia Richter
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab., Istituto Auxologico Italiano (IRCCS), Milan, Italy; Humane Technology Lab., Università Cattolica del Sacro Cuore, Milan, Italy
| | - Amelia Rizzo
- Department of Biomedical, Dental Sciences and Morpho-Functional Imaging - University of Messina, Italy
| | | | - Pedro Rosa
- Laboratory of Psychiatric Neuroimaging (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, Australia
| | - Wataru Sato
- Psychological Process Research Team, Guardian Robot Project, RIKEN, 2-2-2 Hikaridai, Seika-cho, Soraku-gun, Kyoto, Japan
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Susanne Schweizer
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom; School of Psychology, University of New South Wales, Sydney, Australia
| | - Youssef Shiban
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany; Department of Psychology (Clinical Psychology and Psychotherapy Research), PFH - Private University of Applied Sciences, Gottingen, Germany
| | - Advaith Siddharthan
- Knowledge Media Institute, The Open University, Milton Keynes MK7 6AA, United Kingdom
| | - Ewa Siedlecka
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Robert C Smith
- Departments of Medicine and Psychiatry, Michigan State University, East Lansing, MI, United States
| | - Hermona Soreq
- Department of Biological Chemistry, Edmond and Lily Safra Center of Brain Science and The Institute of Life Sciences, Hebrew University, Jerusalem, Israel
| | - Derek P Spangler
- Department of Biobehavioral Health, The Pennsylvania State University, State College, PA, United States
| | - Emily R Stern
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States; New York University School of Medicine, New York, NY, United States
| | - Charis Styliadis
- Neuroscience of Cognition and Affection group, Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - James E Swain
- Departments of Psychiatry & Behavioral Health, Psychology, Obstetrics, Gynecology & Reproductive Medicine, and Program in Public Health, Renaissance School of Medicine at Stony Brook University, New York, United States
| | - Sébastien Urben
- Division of Child and Adolescent Psychiatry, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Jan Van den Stock
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Michael A Vander Kooij
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, Universitatsmedizin der Johannes Guttenberg University Medical Center, Mainz, Germany
| | | | - Tamsyn E Van Rheenen
- University of Melbourne, Melbourne Neuropsychiatry Centre, Department of Psychiatry, 161 Barry Street, Carlton, VIC, Australia
| | - Michael B VanElzakker
- Division of Neurotherapeutics, Massachusetts General Hospital, Boston, MA, United States
| | - Carlos Ventura-Bort
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Edelyn Verona
- Department of Psychology, University of South Florida, Tampa, FL, United States
| | - Tyler Volk
- Professor Emeritus of Biology and Environmental Studies, New York University, New York, NY, United States
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Leah T Weingast
- Department of Social Work and Human Services and the Department of Psychological Sciences, Center for Young Adult Addiction and Recovery, Kennesaw State University, Kennesaw, GA, United States
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany; Faculty of Health Sciences Brandenburg, University of Potsdam, Germany
| | - Claire Williams
- School of Psychology, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, United Kingdom; Elysium Neurological Services, Elysium Healthcare, The Avalon Centre, United Kingdom
| | - Megan L Willis
- School of Behavioural and Health Sciences, Australian Catholic University, Sydney, NSW, Australia
| | - Paula Yamashita
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, United States
| | - Roland Zahn
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Barbra Zupan
- Central Queensland University, School of Health, Medical and Applied Sciences, Bruce Highway, Rockhampton, QLD, Australia
| | - Leroy Lowe
- Neuroqualia (NGO), Truro, Nova Scotia, Canada.
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3
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Perez DL, Nicholson TR, Asadi-Pooya AA, Butler M, Carson AJ, David AS, Deeley Q, Diez I, Edwards MJ, Espay AJ, Gelauff JM, Jungilligens J, Hallett M, Kanaan RAA, Tijssen MAJ, Kozlowska K, LaFrance WC, Marapin RS, Maurer CW, Reinders AATS, Sojka P, Staab JP, Stone J, Szaflarski JP, Aybek S. Response to the Letter Concerning the Publication: Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda. Perez DL et al. Neuroimage Clin. 2021;30:102623. Neuroimage Clin 2024; 41:103573. [PMID: 38309187 PMCID: PMC10847796 DOI: 10.1016/j.nicl.2024.103573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Timothy R Nicholson
- Neuropsychiatry Research & Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Centre, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Butler
- Neuropsychiatry Research & Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Anthony S David
- Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Quinton Deeley
- South London and Maudsley NHS Foundation Trust, London UK Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ibai Diez
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark J Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King's College 16 De Crespigny Park, London, SE5 8AF, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | | | - Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Germany
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Marina A J Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, the Netherlands
| | - Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead Institute of Medical Research, University of Sydney Medical School, Sydney, NSW, Australia
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Ramesh S Marapin
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, the Netherlands
| | - Carine W Maurer
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Petr Sojka
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Jeffrey P Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Rochester, MN, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, AL, USA
| | - Selma Aybek
- Faculté des Sciences et de Médecine, Université de Fribourg, Chemin du Musée 5, 1700 Fribourg, Suisse
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Charney M, Foster S, Shukla V, Zhao W, Jiang SH, Kozlowska K, Lin A. Neurometabolic alterations in children and adolescents with functional neurological disorder. Neuroimage Clin 2023; 41:103557. [PMID: 38219534 PMCID: PMC10825645 DOI: 10.1016/j.nicl.2023.103557] [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: 09/23/2023] [Revised: 11/22/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES In vivo magnetic resonance spectroscopy (MRS) was used to investigate neurometabolic homeostasis in children with functional neurological disorder (FND) in three regions of interest: supplementary motor area (SMA), anterior default mode network (aDMN), and posterior default mode network (dDMN). Metabolites assessed included N-acetyl aspartate (NAA), a marker of neuron function; myo-inositol (mI), a glial-cell marker; choline (Cho), a membrane marker; glutamate plus glutamine (Glx), a marker of excitatory neurotransmission; γ-aminobutyric acid (GABA), a marker of inhibitor neurotransmission; and creatine (Cr), an energy marker. The relationship between excitatory (glutamate and glutamine) and inhibitory (GABA) neurotransmitter (E/I) balance was also examined. METHODS MRS data were acquired for 32 children with mixed FND (25 girls, 7 boys, aged 10.00 to 16.08 years) and 41 healthy controls of similar age using both short echo point-resolved spectroscopy (PRESS) and Mescher-Garwood point-resolved spectroscopy (MEGAPRESS) sequences in the three regions of interest. RESULTS In the SMA, children with FND had lower NAA/Cr, mI/Cr (trend level), and GABA/Cr ratios. In the aDMN, no group differences in metabolite ratios were found. In the pDMN, children with FND had lower NAA/Cr and mI/Cr (trend level) ratios. While no group differences in E/I balance were found (FND vs. controls), E/I balance in the aDMN was lower in children with functional seizures-a subgroup within the FND group. Pearson correlations found that increased arousal (indexed by higher heart rate) was associated with lower mI/Cr in the SMA and pDMN. CONCLUSIONS Our findings of multiple differences in neurometabolites in children with FND suggest dysfunction on multiple levels of the biological system: the neuron (lower NAA), the glial cell (lower mI), and inhibitory neurotransmission (lower GABA), as well as dysfunction in energy regulation in the subgroup with functional seizures.
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Affiliation(s)
- Molly Charney
- Department of Neurology, Columbia University Irving Medical Center, New York-Presbyterian, New York, NY, USA; Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sheryl Foster
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Radiology, Westmead Hospital, Westmead, NSW 2145, Australia
| | - Vishwa Shukla
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wufan Zhao
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sam H Jiang
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia; Brain Dynamics Centre, Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
| | - Alexander Lin
- Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Latka K, Kozlowska K, Waligora M, Kolodziej W, Latka D. Effect of DiscoGel treatment of the intervertebral disc at MRI. Clin Radiol 2023; 78:928-934. [PMID: 37633745 DOI: 10.1016/j.crad.2023.07.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/28/2023]
Abstract
AIM To determine the impact of ethanol gel chemonucleolysis (EGCh) on the radiological picture of the treated intervertebral disc, the relationship between the initial radiological status and the clinical status of the patient after EGCh treatment, and the optimal radiographic criteria for qualifying a patient for EGCh treatment. MATERIALS AND METHODS The study involved a group of 45 patients (25 men and 20 women) aged 23-68 years (46 ± 11) who underwent an EGCh procedure after qualification, radiography, and clinical questionnaire evaluation. RESULTS The results showed a decrease in the size of the protrusion and Gadolinium-Enhanced (GI) zone in the treated intervertebral disc. The presence of a high-intensity zone (HIZ) on baseline magnetic resonance imaging was found to be a good predictor of the timing and outcome of treatment, and an increase in disc height was observed in adjacent segments. CONCLUSION These findings suggest that EGCh is a promising treatment for spine diseases, and the HIZ on baseline magnetic resonance imaging can be used as a qualification criterion for this procedure.
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Affiliation(s)
- K Latka
- Department of Neurosurgery, University Hospital in Opole, 45-001, 26 Witosa Ave., Opole, Poland.
| | - K Kozlowska
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, 50-370, 27 Wybrzeze Wyspianskiego Str., Wroclaw, Poland
| | - M Waligora
- Clinical Department of Diagnostic Imaging, University of Opole, 45-040, 11a Kopernik Sq., Opole, Poland
| | - W Kolodziej
- Department of Neurosurgery, University Hospital in Opole, 45-001, 26 Witosa Ave., Opole, Poland
| | - D Latka
- Department of Neurosurgery, University Hospital in Opole, 45-001, 26 Witosa Ave., Opole, Poland
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6
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Finkelstein SA, Carson A, Edwards MJ, Kozlowska K, Lidstone SC, Perez DL, Polich G, Stone J, Aybek S. Setting up Functional Neurological Disorder Treatment Services: Questions and Answers. Neurol Clin 2023; 41:729-743. [PMID: 37775201 DOI: 10.1016/j.ncl.2023.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Functional neurologic disorder (FND) is commonly encountered across outpatient and inpatient medical settings. Given the potential for a high burden of disability in some patients and mounting evidence for the efficacy of FND-specific multidisciplinary treatment services, expanding clinical services for this population is a necessity. In this perspective article, we discuss considerations for creating FND services, including the types of services that exist, how to start, how to identify appropriate referrals, and how to develop and monitor individualized treatment plans. In addition, we discuss how this effort can be done sustainably - balancing patient needs with limited healthcare resources.
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Affiliation(s)
- Sara A Finkelstein
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
| | - Alan Carson
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, 50 Little France Cres, Edinburgh EH16 4SA, UK
| | - Mark J Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King's College 16 De Crespigny Park, London, SE5 8AF, UK
| | - Kasia Kozlowska
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead Institute for Medical Research, Psychological Medicine, The Children's Hospital at Westmead, Cn Hawkesbury Road, Hainsworth Street, Westmead, NSW 2145, Australia
| | - Sarah C Lidstone
- Integrated Movement Disorders Program, Toronto Rehabilitation Institute, University Centre, Room 3-131, 550 University Avenue, Toronto ON M5G 2A2, Canada
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ginger Polich
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Brigham and Women's Hospital, Harvard Medical School, 300 1st Avenue, Charlestown, MA 02129, USA
| | - Jon Stone
- Department of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, 50 Little France Cres, Edinburgh EH16 4SA, UK
| | - Selma Aybek
- Faculté des Sciences et de Médecine, Université de Fribourg, Bureau 2.106d, Chemin du Musée 5, 1700 Fribourg, Suisse
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Kozlowska K, Schollar-Root O, Savage B, Hawkes C, Chudleigh C, Raghunandan J, Scher S, Helgeland H. Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder. Children (Basel) 2023; 10:1724. [PMID: 38002815 PMCID: PMC10670544 DOI: 10.3390/children10111724] [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] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/26/2023]
Abstract
Previous studies suggest that subjective distress in children with functional neurological disorder (FND) is associated with stress-system dysregulation and modulates aberrant changes in neural networks. The current study documents illness-promoting psychological processes in 76 children with FND (60 girls and 16 boys, aged 10.00-17.08 years) admitted to the Mind-Body Program. The children completed a comprehensive family assessment and self-report measures, and they worked with the clinical team to identify psychological processes during their inpatient admission. A total of 47 healthy controls (35 girls and 12 boys, aged 8.58-17.92 years) also completed self-report measures, but were not assessed for illness-promoting psychological processes. Children with FND (vs. controls) reported higher levels of subjective distress (total DASS score, t(104.24) = 12.18; p ˂ 0.001) and more adverse childhood experiences across their lifespans (total ELSQ score, t(88.57) = 9.38; p ˂ 0.001). Illness-promoting psychological processes were identified in all children with FND. Most common were the following: chronic worries about schoolwork, friendships, or parental wellbeing (n = 64; 84.2%); attention to symptoms (n = 61; 80.3%); feeling sad (n = 58; 76.3%); experiencing a low sense of control (helplessness) in relation to symptoms (n = 44; 57.9%); pushing difficult thoughts out of mind (n = 44; 57.9%); self-critical rumination (n = 42; 55.3%); negative/catastrophic-symptom expectations (n = 40; 52.6%); avoidance of activities (n = 38; 50%); intrusive thoughts/feelings/memories associated with adverse events (n = 38, 50%); and pushing difficult feelings out of mind (n = 37; 48.7%). In children with FND-disabled enough to be admitted for inpatient treatment-illness-promoting psychological processes are part of the clinical presentation. They contribute to the child's ongoing sense of subjective distress, and if not addressed can maintain the illness process. A range of clinical interventions used to address illness-promoting psychological processes are discussed, along with illustrative vignettes.
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Affiliation(s)
- Kasia Kozlowska
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Child and Adolescent Heath and Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Brain Dynamics Centre, Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Olivia Schollar-Root
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Blanche Savage
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Golden Wattle Clinical Psychology, 20 Jarrett St, Leichhardt, NSW 2040, Australia
| | - Clare Hawkes
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Catherine Chudleigh
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Golden Wattle Clinical Psychology, 20 Jarrett St, Leichhardt, NSW 2040, Australia
| | - Jyoti Raghunandan
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Stephen Scher
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Helene Helgeland
- Department of Child and Adolescent Mental Health in Hospitals, Oslo University Hospital, 0424 Oslo, Norway;
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8
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Kozlowska K, Chudleigh C, Savage B, Hawkes C, Scher S, Nunn KP. Evidence-Based Mind-Body Interventions for Children and Adolescents with Functional Neurological Disorder. Harv Rev Psychiatry 2023; 31:60-82. [PMID: 36884038 PMCID: PMC9997641 DOI: 10.1097/hrp.0000000000000358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
LEARNING OBJECTIVES • Develop and implement treatment plans for children and adolescents with functional neurological disorder (FND)• Outline a plan to increase awareness and standardize the care for patients with FND using evidence-based interventions. ABSTRACT Functional neurological disorder (FND) in children and adolescents involves the biological embedding of lived experience in the body and brain. This embedding culminates in stress-system activation or dysregulation and in aberrant changes in neural network function. In pediatric neurology clinics, FND represents up to one-fifth of patients. Current research shows good outcomes with prompt diagnosis and treatment using a biopsychosocial, stepped-care approach. At present, however-and worldwide-FND services are scarce, the result of long-standing stigma and ingrained belief that patients with FND do not suffer from a real ("organic") disorder and that they therefore do not require, or even deserve, treatment. Since 1994, the Mind-Body Program for children and adolescents with FND at The Children's Hospital at Westmead in Sydney, Australia-run by a consultation-liaison team-has delivered inpatient care to hundreds of patients with FND and outpatient care to hundreds of others. For less-disabled patients, the program enables community-based clinicians to implement biopsychosocial interventions locally by providing a positive diagnosis (by a neurologist or pediatrician), a biopsychosocial assessment and formulation (by clinicians from the consultation-liaison team), a physical therapy assessment, and clinical support (from the consultation-liaison team and the physiotherapist). In this Perspective we describe the elements of a biopsychosocial mind-body program intervention capable of providing, as needed, effective treatment to children and adolescents with FND. Our aim is to communicate to clinicians and institutions around the world what is needed to establish effective community treatment programs, as well as hospital inpatient and outpatient interventions, in their own health care settings.
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Martino D, Hedderly T, Murphy T, Müller-Vahl KR, Dale RC, Gilbert DL, Rizzo R, Hartmann A, Nagy P, Anheim M, Owen T, Malik O, Duncan M, Heyman I, Liang H, McWilliams A, O'Dwyer S, Fremer C, Szejko N, Han VX, Kozlowska K, Pringsheim TM. The spectrum of functional tic-like behaviours: Data from an international registry. Eur J Neurol 2023; 30:334-343. [PMID: 36282623 DOI: 10.1111/ene.15611] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [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: 08/26/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Between 2019 and 2022, there was a marked rise in adolescents/young adults seeking urgent help for functional tic-like behaviours (FTLBs). Given the global scale of this phenomenon, we aimed to pool cases from different institutions in an international registry to better characterize this spectrum and facilitate future longitudinal observation. METHODS An international collaborative group from 10 tertiary referral centres for tic disorders collected retrospective data on FTLB patients who sought specialists' attention between the last quarter of 2019 and June 2022. An audit procedure was used for collection of data, which comprised demographics, course of presentation and duration, precipitating and predisposing factors, phenomenology, comorbidities, and pharmacological treatment outcome. RESULTS During the study period, we collected data on 294 patients with FTLBs, 97% of whom were adolescents and young adults and 87% of whom were female. FTLBs were found to have a peak of severity within 1 month in 70% of patients, with spontaneous remissions in 20%, and a very high frequency of complex movements (85%) and vocalizations (81%). Less than one-fifth of patients had pre-existing primary tic disorder, 66% had comorbid anxiety disorders, 28% comorbid depressive disorders, 24% autism spectrum disorder and 23% attention deficit/hyperactivity disorder. Almost 60% explicitly reported exposure to tic-related social media content. The vast majority of pharmacologically treated patients did not report benefit with tic-suppressing medications. CONCLUSIONS Our data from the largest multicentre registry of FTLBs to date confirm substantial clinical differences from primary tic disorders. Social modelling was the most relevant contributing factor during the pandemic. Future longitudinal analyses from this database may help understand treatment approaches and responsiveness.
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Affiliation(s)
- Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Tammy Hedderly
- TANDeM (Tics and Neurodevelopmental Movement Disorders Service) Department of Children's Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital; King's Health Partners Academic Health Science Centre, Guy's King's and Saint Thomas' School of Medicine, London, UK
| | - Tara Murphy
- Tic Disorder Service, Psychological and Mental Health Services, Great Ormond Street Hospital, London, UK
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Russell C Dale
- Children's Hospital at Westmead Clinical school, University of Sydney, Camperdown, Australia
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Renata Rizzo
- Child and Adolescent Neurology and Psychiatric Section, Department of Clinical and Experimental Medicinea, Catania University, Catania, Italy
| | - Andreas Hartmann
- Department of Neurology, APHP, Hôpital de la Pitié-Salpêtrière, Sorbonne University, Paris, France
| | - Peter Nagy
- Division of Neurodevelopmental Disorders, Bethesda Children's Hospital, Budapest, Hungary
| | - Mathieu Anheim
- Neurology department, Strasbourg University Hospital and Strasbourg Federation of Translational Medicine (FMTS), Strasbourg University, Strasbourg, France
- INSERM-U964; CNRS-UMR7104, University of Strasbourg, Illkirch-Graffenstaden, Strasbourg, France
| | - Tamsin Owen
- TANDeM (Tics and Neurodevelopmental Movement Disorders Service) Department of Children's Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital; King's Health Partners Academic Health Science Centre, Guy's King's and Saint Thomas' School of Medicine, London, UK
| | - Osman Malik
- TANDeM (Tics and Neurodevelopmental Movement Disorders Service) Department of Children's Neurosciences, Evelina London Children's Hospital, St Thomas' Hospital; King's Health Partners Academic Health Science Centre, Guy's King's and Saint Thomas' School of Medicine, London, UK
| | - Morvwen Duncan
- Psychological and Mental Health Services, Great Ormond Street Hospital, London, UK
| | - Isobel Heyman
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Holan Liang
- Psychological and Mental Health Services, Great Ormond Street Hospital, London, UK
| | - Andrew McWilliams
- Psychological and Mental Health Services, Great Ormond Street Hospital, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Shauna O'Dwyer
- Tic Disorder Service, Psychological and Mental Health Services, Great Ormond Street Hospital, London, UK
| | - Carolin Fremer
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Natalia Szejko
- Department of Neurology and Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Velda X Han
- Khoo-Teck Puat National University Children's Health Institute, National University Health System, Singapore, Singapore
- School of Medical Sciences, The University of Sydney, Sydney, Australia
| | - Kasia Kozlowska
- Children's Hospital at Westmead Clinical school, University of Sydney, Camperdown, Australia
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Chung J, Mukerji S, Kozlowska K. Cortisol and α-amylase awakening response in children and adolescents with functional neurological (conversion) disorder. Aust N Z J Psychiatry 2023; 57:115-129. [PMID: 35297291 DOI: 10.1177/00048674221082520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Stress system dysregulation is considered to have an important role in the aetiology of paediatric functional neurological (conversion) disorder. This study examined salivary cortisol and α-amylase awakening responses in children with functional neurological disorder to determine activation patterns of the hypothalamic-pituitary-adrenal axis and sympathetic system. A healthy cortisol awakening response involves a robust increase in cortisol within 30 minutes of awakening. Alpha-amylase awakening response is variable in children. METHODS Cortisol and α-amylase were measured in saliva from 32 patients with functional neurological disorder (26 girls and 6 boys, aged 11.3-16.1 years) and 31 healthy controls (23 girls and 8 boys, aged 8.6-17.7 years). Saliva samples were collected using a Salivette sampling device at two time points - upon awakening and 30 minutes after awakening. RESULTS Patients with functional neurological disorder showed a decrease in cortisol awakening response (-4 nmol.min/L) and controls showed an increase (107 nmol.min/L), t(55) = -.4.6, p < 0.001. Within the functional neurological disorder group, 57% showed an attenuated cortisol awakening response and 43% showed an obliterated/reversed cortisol awakening response: Cortisol awakening response was negatively correlated with adverse childhood experiences, r(58) = -0.6, p = 0.002, and subjective distress (total Depression Anxiety and Stress Scales score), r(58) = -0.4, p = 0.050. In controls, cortisol awakening response showed no correlation with adverse childhood experiences and a positive correlation with subjective distress, r(56) = 0.4, p = 0.023. Total cortisol remained similar between the functional neurological disorder and control group. No significant differences were observed between the functional neurological disorder and control group in any of the α-amylase analyses. DISCUSSION The results suggest dysregulation of the hypothalamic-pituitary-adrenal axis in children with functional neurological disorder. Hypothalamic-pituitary-adrenal dysregulation in children with functional neurological disorder may contribute to comorbid symptoms of fatigue, sleep disturbance and subjective loss of well-being because circadian rhythms and energy metabolism are disrupted. Hypothalamic-pituitary-adrenal dysregulation - and changes in glucocorticoid (cortisol) signalling at the molecular level - may also contribute to increased vulnerability for functional neurological disorder symptoms because of epigenetically mediated changes to neural networks implicated in functional neurological disorder.
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Affiliation(s)
- Jason Chung
- Department of Clinical Biochemistry, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Shohini Mukerji
- Department of Clinical Biochemistry, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Chemical Pathology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Kasia Kozlowska
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Brain Dynamics Centre, The Westmead Institute for Medical Research, Westmead, NSW, Australia
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11
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Lim N, Wood N, Prasad A, Waters K, Singh-Grewal D, Dale RC, Elkadi J, Scher S, Kozlowska K. COVID-19 Vaccination in Young People with Functional Neurological Disorder: A Case-Control Study. Vaccines (Basel) 2022; 10:2031. [PMID: 36560442 PMCID: PMC9782633 DOI: 10.3390/vaccines10122031] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The emergence of acute-onset functional neurological symptoms, the focus of this study, is one of three stress responses related to immunisation. This case-control study documents the experience of 61 young people with past or current functional neurological disorder (FND) in relation to the COVID-19 vaccination program in Australia. METHODS Information about the young person's/parent's choice and response pertaining to COVID-19 vaccination was collected as part of routine clinical care or FND research program follow-up. RESULTS 61 young people treated for FND (47 females, mean age = 16.22 years) and 46 healthy controls (34 females, mean age = 16.37 years) were included in the study. Vaccination rates were high: 58/61 (95.1%) in the FND group and 45/46 (97.8%) in the control group. In the FND group, 2 young people (2/61, 3.3%) presented with new-onset FND following COVID-19 vaccination; two young people with resolved FND reported an FND relapse (2/36, 5.56%); and two young people with unresolved FND (2/20, 10.0%) reported an FND exacerbation. In the control group no FND symptoms were reported. CONCLUSIONS Acute-onset FND symptoms following COVID-19 vaccination are uncommon in the general population. In young people prone to FND, COVID-19 vaccination can sometimes trigger new-onset FND, FND relapse, or FND exacerbation.
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Affiliation(s)
- Natalie Lim
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance, Kids Research, Sydney Children’s Hospitals Network, Westmead, NSW 2145, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Archana Prasad
- Department of General Medicine, The Children’s Hospital at Westmead Clinical School, Westmead, NSW 2145, Australia
| | - Karen Waters
- Sleep Medicine, The Children’s Hospital at Westmead, Westmead Clinical School, Westmead, NSW 2145, Australia
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Davinder Singh-Grewal
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Department of Rheumatology, Sydney Children’s Hospital Network, Westmead, NSW 2145, Australia
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - Russell C. Dale
- Kids Neuroscience Centre, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- The Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050, Australia
| | - Joseph Elkadi
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Stephen Scher
- McLean Hospital, Belmont, MA 02478, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
- Speciality of Psychiatry, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
- Brain Dynamics Centre at Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
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12
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Rajabalee N, Kozlowska K, Lee SY, Savage B, Hawkes C, Siciliano D, Porges SW, Pick S, Torbey S. Neuromodulation Using Computer-Altered Music to Treat a Ten-Year-Old Child Unresponsive to Standard Interventions for Functional Neurological Disorder. Harv Rev Psychiatry 2022; 30:303-316. [PMID: 35616609 PMCID: PMC9470039 DOI: 10.1097/hrp.0000000000000341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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13
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Han VX, Kozlowska K, Kothur K, Lorentzos M, Wong WK, Mohammad SS, Savage B, Chudleigh C, Dale RC. Rapid onset functional tic-like behaviours in children and adolescents during COVID-19: Clinical features, assessment and biopsychosocial treatment approach. J Paediatr Child Health 2022; 58:1181-1187. [PMID: 35247213 PMCID: PMC9115185 DOI: 10.1111/jpc.15932] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/20/2021] [Accepted: 02/02/2022] [Indexed: 12/16/2022]
Abstract
AIM To report the prevalence and clinical characteristics of children with rapid onset functional tic-like behaviours during the COVID-19 pandemic. METHODS Single centre, retrospective cohort study of children (<18 years) referred to the tic clinic from January 2018 to July 2021. We calculate the prevalence of newly diagnosed functional tics, and compare the clinical features to chronic tic disorder/Tourette syndrome (CTD/TS). RESULTS A total of 185 new patients were referred to the tic clinic between 2018 and 2021. There was a significant increase in the percentage of functional tics in 2020 and 2021 (2% in 2018, 5.6% in 2019, 10.6% in 2020 and 36% in 2021). Differences between functional tics (n = 22) and CTD/TS (n = 163) include female predominance (100 vs. 28%, P < 0.0001), later age of onset (mean age 13.8 vs. 6.8 years, P < 0.0001) and higher rates of anxiety/depression (95 vs. 41%, P < 0.0001). The functional tic group were more likely to present with coprolalia-like behaviours (77 vs. 10%, P < 0.0001), complex phrases (45 vs. 0.6%, P < 0.0001), copropraxia (45 vs. 2%, P < 0.0001), self-injury (50 vs. 4%, P < 0.0001), hospitalisation/emergency visits (36 vs. 2%, P < 0.0001) and school absenteeism (56 vs. 7%, P < 0.0001). A total of 18.2% of patients with functional tics reported preceding exposure to social media content involving tics. CONCLUSIONS There is an increase in adolescent females presenting with rapid onset functional tic-like behaviours during the COVID-19 pandemic. We highlight differences in clinical features between the functional tic group and CTD/TS to aid diagnosis and management in the community. Based on our findings, we propose a mixed model of neuropsychiatric vulnerability and social media contagion in this group of adolescents with functional tics.
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Affiliation(s)
- Velda X Han
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,Khoo‐Teck Puat National University Children's Medical InstituteNational University Health SystemSingapore
| | - Kasia Kozlowska
- Department of Psychological MedicineThe Children's Hospital at Westmead, Australia, University of Sydney Medical SchoolSydneyNew South WalesAustralia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,Brain Dynamics CentreWestmead Institute for Medical ResearchSydneyNew South WalesAustralia
| | - Kavitha Kothur
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Michelle Lorentzos
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Wui Kwan Wong
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Shekeeb S Mohammad
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Blanche Savage
- Department of Psychological MedicineThe Children's Hospital at Westmead, Australia, University of Sydney Medical SchoolSydneyNew South WalesAustralia
| | - Catherine Chudleigh
- Department of Psychological MedicineThe Children's Hospital at Westmead, Australia, University of Sydney Medical SchoolSydneyNew South WalesAustralia
| | - Russell C Dale
- Kids Neuroscience Centre, The Children's Hospital at Westmead, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,The Children's Hospital at Westmead Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,The Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
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14
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Hilton MN, Boulton KA, Kozlowska K, McClure G, Guastella AJ. The co-occurrence of neurodevelopmental disorders in gender dysphoria: Characteristics within a paediatric treatment-seeking cohort and factors that predict distress pertaining to gender. J Psychiatr Res 2022; 149:281-286. [PMID: 35306277 DOI: 10.1016/j.jpsychires.2022.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 12/22/2022]
Abstract
Gender dysphoria, characterised by distress associated with an incongruence between an individual's assigned and experienced gender, is encountered in 1%-2% of children and adolescents. Recent findings suggest neurodevelopmental disorders (NDDs), including Autism, are frequently reported among youth with Gender Dysphoria. This study aims to explore the frequency of NDDs in children and adolescents presenting to a hospital-based gender service, and to investigate the contribution of autistic traits and general psychological distress to distress pertaining to gender. Sixty-four participants (mean age = 12.91 years) with Gender Dysphoria were recruited to this study. Self- and caregiver-report questionnaires were used to evaluate psychological distress, autistic traits, and distress pertaining to gender. Relative to the rest of the participants, the 13 (20.31%) with a co-occurring NDD diagnosis reported elevated autistic traits (p < .001). They did not differ in terms of psychological distress or distress pertaining to gender. A hierarchical linear regression revealed autistic traits alone did not contribute to the variability in distress pertaining to gender, whereas general psychological distress accounted for 9.9% of the variability in distress pertaining to gender (p = .012). The current findings indicate that NDD diagnoses are common in children and adolescents with Gender Dysphoria who attend hospital-based services. Psychological distress, rather than autistic traits, contributes more variability in distress pertaining to gender. Taken together, these findings indicate the need to consider NDDs in treatment plans but also to focus on the important relationship between psychological distress and Gender Dysphoria.
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Affiliation(s)
- Makana N Hilton
- Autism Clinic for Translational Research, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Australia; Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Kelsie A Boulton
- Autism Clinic for Translational Research, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Australia; Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia
| | - Kasia Kozlowska
- Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department of Psychological Medicine, The Children's Hospital at Westmead, Australia; Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Georgia McClure
- Department of Psychological Medicine, The Children's Hospital at Westmead, Australia
| | - Adam J Guastella
- Autism Clinic for Translational Research, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Australia; Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Department of Psychological Medicine, The Children's Hospital at Westmead, Australia.
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15
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Barroca I, Santos CM, Velosa A, Cotovio G, Kozlowska K, Pinto I, Carvalho PS. Development of a Checklist of Potentially Traumatic Events in Children and Adolescents (CEPT-CA). Port J Public Health 2022. [DOI: 10.1159/000522221] [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: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> Since exposure to potentially traumatic events during childhood and adolescence has been shown to be very common, its screening is very important. Our aim was to develop a self-assessment checklist to perform screening of potentially traumatic events in childhood and adolescence. <b><i>Methods:</i></b> The development of the Checklist of Potentially Traumatic Events in Children and Adolescents (CEPT-CA) was based on: (a) the structure of Life Events Checklist that has been translated, back-translated, and adapted; (b) recommendations of renowned entities about trauma in childhood; (c) particularities of potentially traumatic events in childhood; (d) adapting the language to the target population’s age group; (e) Portugal’s sociocultural context. The preliminary version of the CEPT-CA was again discussed with the Review Committee. Subsequently, a pre-test was carried out with 30 children/adolescents between the ages of 7 and 18 years. <b><i>Results:</i></b> The CEPT-CA includes the assessment of 16 potentially traumatic events. It also includes a 17th item, in which “any other very difficult/stressful event” may be added. Each event can be selected according to “It happened to me,” “I saw it happen to someone else,” “They told me,” “I’m not sure,” and “Not applicable.” The mean time to complete the questionnaire was 9 min. <b><i>Conclusion:</i></b> This pioneering study presents a checklist of potentially traumatic events in childhood/adolescence. This tool is useful for tracking these traumatic events, thereby allowing an early and specific assessment and intervention.
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16
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Kim YN, Gray N, Jones A, Scher S, Kozlowska K. The Role of Physiotherapy in the Management of Functional Neurological Disorder in Children and Adolescents. Semin Pediatr Neurol 2022; 41:100947. [PMID: 35450664 DOI: 10.1016/j.spen.2021.100947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/17/2022]
Abstract
Children and adolescents with functional neurological (conversion) disorder (FND) present with symptoms of impaired motor and sensory function. FND involves complex interactions between the brain, mind, body, and lived experience of the child. The gold standard for treatment is therefore a holistic, biopsychosocial approach with multimodal interventions delivered by a multidisciplinary team. In this narrative review we examine the role of physiotherapy in managing FND in children. We searched Embase, Medline, PsycINFO, and PubMed (back to 2000) for relevant physiotherapy articles and also manually searched their reference lists. Two review articles and ten observational studies were identified. Data were extracted concerning the type of study, therapies involved, outcome measures, and comorbid mental health outcomes. FND symptoms resolved in 85% to 95% of the patients, and about two-thirds returned to full-time school after completing the multidisciplinary intervention. Ongoing mental health concerns at follow-up were associated with poorer functional outcomes. Key themes included the following: use of psychological interventions embedded in the physiotherapy intervention; integration of play, music, and dance; role of physical exercise in modulating physiological, neural, and endocrine systems; need for FND-specific outcome measures; ethical issues pertaining to randomized trials; and need to develop alternate study methodologies for assessing combined treatments. Clinical vignettes were included to highlight a range of physiotherapy interventions. In conclusion, the emerging literature suggests that physiotherapy for children with FND is a useful intervention for improving motor dysfunction and for addressing other concurrent issues such as physical deconditioning, neuroprotection, chronic pain, disturbed sleep, anxiety and depression, and resilience building.
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Affiliation(s)
- Yu-Na Kim
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Nicola Gray
- Department of Physiotherapy, Sydney Children's Hospital Network, NSW, Australia
| | - Anna Jones
- Advance Rehab Centre, Artarmon, NSW, Australia
| | - Stephen Scher
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA; University of Sydney Medical School, NSW, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia; University of Sydney Medical School, NSW, Australia; Westmead Institute for Medical Research, Westmead, NSW, Australia.
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17
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Kanaan RA, Kozlowska K, Lehn A. The regulation of driving with non-epileptic seizures must be made clearer. Aust N Z J Psychiatry 2022; 56:117-119. [PMID: 33887989 DOI: 10.1177/00048674211009621] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with epilepsy have their authorisation to drive restricted under detailed guidelines, but the rules for those with non-epileptic seizures are far less clear. We surveyed specialist clinicians in Australia and found little agreement as to whether such guidelines existed for non-epileptic seizures or what they might be. A number of possible interpretations of the Australian fitness to drive guidelines are explored, and these are often vague in themselves, as well as uncertain in their scope. This means clinicians making momentous driving decisions for their patients with non-epileptic seizures are doubly challenged, first in interpreting what guidelines exist, and second in what they mean. The International League Against Epilepsy proposed specific guidelines for driving with non-epileptic seizures, which reflect the range of presentations of non-epileptic seizures in a decision-making algorithm. We believe a specific algorithm such as this is essential in removing one level of uncertainty and responsibility for clinicians, and restoring equity for patients with non-epileptic seizures.
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Affiliation(s)
- Richard A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg Heights, VIC, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Discipline of Psychiatry and Discipline of Child & Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.,The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Alex Lehn
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Faculty of Medicine, The University of Queensland Princess Alexandra Hospital Clinical School, Woolloongabba, QLD, Australia
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18
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Wardrope A, Dworetzky BA, Barkley GL, Baslet G, Buchhalter J, Doss J, Goldstein LH, Hallett M, Kozlowska K, LaFrance WC, McGonigal A, Mildon B, Oto M, Perez DL, Riker E, Roberts NA, Stone J, Tolchin B, Reuber M. How to do things with words Two seminars on the naming of functional (psychogenic, non-epileptic, dissociative, conversion, …) seizures. Seizure 2021; 93:102-110. [PMID: 34740139 DOI: 10.1016/j.seizure.2021.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
Amongst the most important conditions in the differential diagnosis of epilepsy is the one that manifests as paroxysms of altered behaviour, awareness, sensation or sense of bodily control in ways that often resemble epileptic seizures, but without the abnormal excessive or synchronous electrical activity in the brain that defines these. Despite this importance, there remains little agreement - and frequent debate - on what to call this condition, known inter alia as psychogenic non-epileptic seizures (PNES), dissociative seizures (DS), functional seizures (FS), non-epileptic attack disorder (NEAD), pseudoseizures, conversion disorder with seizures, and by many other labels besides. This choice of terminology is not merely academic - it affects patients' response to and understanding of their diagnosis, and their ability to navigate health care systems.This paper summarises two recent discussions hosted by the American Epilepsy Society and Functional Neurological Disorders Society on the naming of this condition. These discussions are conceptualised as the initial step of an exploration of whether it might be possible to build consensus for a new diagnostic label.
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Affiliation(s)
- Alistair Wardrope
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom; Department of Clinical Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.
| | - Barbara A Dworetzky
- The Edward B. Bromfield Epilepsy Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Gregory L Barkley
- Department of Neurology, Henry Ford Hospital, Detroit, MI, United States; Department of Neurology, Wayne State University, Detroit, MI, United States
| | - Gaston Baslet
- Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jeffrey Buchhalter
- Section of Pediatric Neurology, University of Calgary, Calgary, Alberta, Canada
| | - Julia Doss
- Doss Clinic of Health Psychology, Minneapolis, MN, United States; Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, United States
| | - Laura H Goldstein
- King's College London Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Kasia Kozlowska
- Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Psychiatry and Discipline of Child & Adolescent Health, University of Sydney Medical School, Sydney, Australia; Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - W Curt LaFrance
- Alpert Medical School, Brown University, Providence, RI, United States; Department of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, RI, United States
| | - Aileen McGonigal
- Aix Marseille Univ, Inserm, INS, Institut de Neurosciences des Systèmes, Marseille, France; APHM, Timone Hospital, Clinical Neurophysiology, Marseille, France
| | | | - Maria Oto
- Scottish Epilepsy Centre, Glasgow, United Kingdom
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ellen Riker
- National Association of Epilepsy Centers, Washington, DC, United States
| | - Nicole A Roberts
- School of Social and Behavioural Sciences, Arizona State University, Phoenix, AZ, United States
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Benjamin Tolchin
- Yale New Haven Health System Center for Bioethics, Yale School of Medicine, New Haven, CT, United States
| | - Markus Reuber
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom; Department of Clinical Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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19
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Perez DL, Aybek S, Popkirov S, Kozlowska K, Stephen CD, Anderson J, Shura R, Ducharme S, Carson A, Hallett M, Nicholson TR, Stone J, LaFrance WC, Voon V. A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders. J Neuropsychiatry Clin Neurosci 2021; 33:14-26. [PMID: 32778007 DOI: 10.1176/appi.neuropsych.19120357] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of the initial neuropsychiatric assessment of functional movement disorders (FND-movt) and functional limb weakness/paresis (FND-par) have yet to be established. This is an important gap from both diagnostic and treatment planning perspectives. In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases. Although clinical history should not be used to make a FND diagnosis, characteristics such as acute onset, precipitating events (e.g., injury and surgery), and a waxing and waning course (including spontaneous remissions) are commonly reported. Active psychiatric symptoms (e.g., depression and anxiety) and ongoing psychosocial stressors also warrant evaluation. Positive physical examination signs (e.g., Hoover's sign and tremor entrainment) are key findings, as one of the DSM-5 diagnostic criteria. The neuropsychiatric assessment proposed emphasizes diagnosing FND by using "rule-in" physical signs while also considering psychiatric and psychosocial factors to aid in the development of a patient-centered treatment plan.
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Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Selma Aybek
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Stoyan Popkirov
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Kasia Kozlowska
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Christopher D Stephen
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jordan Anderson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Robert Shura
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Simon Ducharme
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Alan Carson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Mark Hallett
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Timothy R Nicholson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jon Stone
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - W Curt LaFrance
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Valerie Voon
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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Kozlowska K, Sawchuk T, Waugh JL, Helgeland H, Baker J, Scher S, Fobian AD. Changing the culture of care for children and adolescents with functional neurological disorder. Epilepsy Behav Rep 2021; 16:100486. [PMID: 34761194 PMCID: PMC8567196 DOI: 10.1016/j.ebr.2021.100486] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 07/27/2021] [Revised: 08/31/2021] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
As members of a multidisciplinary team of professionals who treat children and adolescents with functional neurological (conversion) disorder (FND), we highlight the pressing need to develop an FND-informed culture of care that takes into account recent advances in our understanding of this group of patients. Stories of clinical encounters in health care settings from around the world-told by children and adolescents with FND, their parents, and health professionals-portray an outdated culture of care characterized by iatrogenic stigma, erosion of empathy and compassion within the clinician-patient relationship, and a lack of understanding of FND and its complex neurobiology. After a brief exploration of the outdated culture, we share our counterstories: how we and our colleagues have worked, and continue to work, to create an FND-informed culture in the health systems where we practice. We discuss the therapeutic use of child-friendly language. We also discuss a range of structural, educational, and process interventions that can be used to promote FND-informed beliefs and attitudes, FND-informed clinician-patient encounters, and FND-informed referral processes, treatment pathways, and therapeutic interventions.
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Affiliation(s)
- Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
- University of Sydney Medical School, Sydney, NSW, Australia
- Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Tyson Sawchuk
- University of Calgary, Cumming School of Medicine, Department of Pediatrics, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Alberta Children's Hospital, Calgary, AB, Canada
| | - Jeff L Waugh
- Division of Child Neurology, Department of Pediatrics, University of Texas Southwestern, Dallas, TX, USA
- Division of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA
| | - Helene Helgeland
- Department of Child and Adolescent Mental Health in Hospitals, Oslo University Hospital, Oslo, Norway
| | - Janet Baker
- Speech Pathology, Flinders University, Adelaide, SA, Australia
- University of Technology Sydney, Sydney, NSW, Australia
| | - Stephen Scher
- University of Sydney Medical School, Sydney, NSW, Australia
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Aaron D Fobian
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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21
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Bègue I, Nicholson TR, Kozlowska K, LaFrance WC, Levenson JL, Rapaport MH, Carson AJ, Perez DL. Psychiatry's modern role in functional neurological disorder: join the renaissance. Psychol Med 2021; 51:1961-1963. [PMID: 34167595 DOI: 10.1017/s0033291721002038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Indrit Bègue
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Service of Neurology, Department of Clinical Neuroscience, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, Laboratory for Clinical and Experimental Psychopathology, University of Geneva, Geneva, Switzerland
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Psychiatry and Discipline of Child & Adolescent Health, University of Sydney Medical School, Sydney, Australia
- Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown Medical School, Providence, RI, USA
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Mark H Rapaport
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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22
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Gray N, Savage B, Scher S, Kozlowska K. Psychologically Informed Physical Therapy for Children and Adolescents With Functional Neurological Symptoms: The Wellness Approach. J Neuropsychiatry Clin Neurosci 2021; 32:389-395. [PMID: 32718273 DOI: 10.1176/appi.neuropsych.19120355] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Children with functional neurological disorder (FND) present with motor and sensory neurological symptoms that impair health and physical functioning and that create an ongoing clinical burden for caregivers and hospitals worldwide. Treatment programs for these children involve a multidisciplinary approach with physical therapy as a fundamental component. However, standard musculoskeletal approaches to physical therapy are ineffective or may even exacerbate symptoms because they are unresponsive to the biopsychosocial context in which FND emerges: FND typically occurs in the context of stress, either physical or emotional; symptoms are amplified by attention; and presentations are complicated by psychological factors. Informed, in part, by published guidelines for physical therapy with adult FND patients, this article examines common challenges that arise when working with children: overcoming previous negative encounters in the medical system; avoiding amplification of symptoms by drawing attention to them; and managing comorbid pain, falls, faints, nonepileptic seizures, dizziness, fatigue, and breathlessness, plus psychological symptoms such as anticipatory anxiety and panic attacks. What emerges is a psychologically informed therapeutic approach to physical therapy for children with functional neurological symptoms. This approach prioritizes interpersonal processes and physical therapy techniques that establish a therapeutic relationship and create a safe space for physical therapy, that use indirect physical therapy approaches redirecting the focus of attention away from symptoms and emphasizing the completion of tasks and activities engaging the sick body part indirectly, that tailor the intervention to address the needs and presentation of each particular child, and that integrate psychological interventions to manage common challenges.
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Affiliation(s)
- Nicola Gray
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
| | - Blanche Savage
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
| | - Stephen Scher
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
| | - Kasia Kozlowska
- Department of Physiotherapy (Gray) and Department of Psychological Medicine (Savage, Kozlowska), Children's Hospital at Westmead, Westmead, Australia; Department of Psychiatry, Harvard Medical School, Boston (Scher); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Scher, Kozlowska); and Brain Dynamics Center, Westmead Institute for Medical Research, Westmead, Australia (Kozlowska)
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Asadi-Pooya AA, Brigo F, Kozlowska K, Perez DL, Pretorius C, Sawchuk T, Saxena A, Tolchin B, Valente KD. Social aspects of life in patients with functional seizures: Closing the gap in the biopsychosocial formulation. Epilepsy Behav 2021; 117:107903. [PMID: 33740497 DOI: 10.1016/j.yebeh.2021.107903] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 01/20/2023]
Abstract
The human, as a biological system, is an open system embedded within larger systems -including the family, culture, and socio-political environment. In this context, a patient with functional seizures (FS) is embedded in relationships, educational/professional institutions, culture, and society. Both connection to these broader systems and the quality of these connections, as well as the soundness of each system in and of itself, influence the health and well-being of patients in positive or negative ways. The social aspects of life are important determinants of health and quality of life across the lifespan. The current narrative review brings out several overarching themes in patients with FS. Sections on attachment, marriage, social networking, and stigma highlight the central roles of supportive and affirmative relationships across the lifespan. The section on education underscores the importance of keeping children and youth with FS connected within their school environments, as well as managing any barriers - learning difficulties, school response to FS events, stigma, etc.-that can diminish this connection. Finally, the sections on employment and driving highlight the value of being an active participant in one's society. In summary, FS impacts patients across most social aspects of life domains regardless of age - factors that are important when developing biopsychosocial formulations. This review concludes that the multidisciplinary management of FS requires careful assessment of social aspects of life in patients which can then be targeted for treatment, to improve their quality of life, facilitating recovery, and reducing the risk of relapse.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead Institute of Medical Research, University of Sydney Medical School, Sydney, NSW, Australia.
| | - David L Perez
- Functional Neurological Disorder Clinical and Research Programs, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Chrisma Pretorius
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
| | - Tyson Sawchuk
- Department of Pediatrics, Cumming School of Medicine, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada.
| | - Aneeta Saxena
- Epilepsy Division, Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Functional Neurological Disorder Clinical and Research Program, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Benjamin Tolchin
- Yale Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil.
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24
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Perez DL, Edwards MJ, Nielsen G, Kozlowska K, Hallett M, LaFrance WC. Decade of progress in motor functional neurological disorder: continuing the momentum. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-323953. [PMID: 33722822 PMCID: PMC8440656 DOI: 10.1136/jnnp-2020-323953] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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] [Received: 12/30/2020] [Revised: 02/08/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
Functional neurological disorder (FND) is a prevalent, disabling and costly condition at the neurology-psychiatry intersection. After being marginalised in the late 20th century, there has been renewed interest in this field. In this article, we review advances that have occurred over the past decade (2011-2020) across diagnosis, mechanisms, aetiologies, treatments and stigma in patients with motor FND (mFND, that is, functional movement disorder and functional limb weakness). In each content area, we also discuss the implications of recent advances and suggest future directions that will help continue the momentum of the past decade. In diagnosis, a major advance has been the emphasis on rule-in physical signs that are specific for hyperkinetic and hypokinetic functional motor symptoms. Mechanistically, greater importance has been given to determining 'how' functional neurological symptoms develop, highlighting roles for misdirected attention, expectation and self-agency, as well as abnormal influences of emotion/threat processing brain areas on motor control circuits. Aetiologically, while roles for adverse life experiences remain of interest in mFND, there is recognition of other aetiologic contributors, and efforts are needed to investigate links between aetiological factors and mechanisms. This decade has seen the first randomised controlled trials for physiotherapy, multidisciplinary rehabilitation and psychotherapy performed in the field, with consensus recommendations for physiotherapy, occupational therapy and outcome measures also published. Across patients, clinicians, healthcare systems and society, stigma remains a major concern. While challenges persist, a patient-centred integrated clinical neuroscience approach is primed to carry forward the momentum of the past decade into the future.
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Affiliation(s)
- David L Perez
- Neurology and Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark J Edwards
- Neuroscience Research Centre, St George's University of London, London, UK
| | - Glenn Nielsen
- Neuroscience Research Centre, St George's University of London, London, UK
| | - Kasia Kozlowska
- Westmead Institute of Medical Research, The Children's Hospital at Westmead, Sydney Medical School, Westmead, New South Wales, Australia
| | | | - W Curt LaFrance
- Psychiatry and Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
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25
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Perez DL, Nicholson TR, Asadi-Pooya AA, Bègue I, Butler M, Carson AJ, David AS, Deeley Q, Diez I, Edwards MJ, Espay AJ, Gelauff JM, Hallett M, Horovitz SG, Jungilligens J, Kanaan RAA, Tijssen MAJ, Kozlowska K, LaFaver K, LaFrance WC, Lidstone SC, Marapin RS, Maurer CW, Modirrousta M, Reinders AATS, Sojka P, Staab JP, Stone J, Szaflarski JP, Aybek S. Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda. Neuroimage Clin 2021; 30:102623. [PMID: 34215138 PMCID: PMC8111317 DOI: 10.1016/j.nicl.2021.102623] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023]
Abstract
Functional neurological disorder (FND) was of great interest to early clinical neuroscience leaders. During the 20th century, neurology and psychiatry grew apart - leaving FND a borderland condition. Fortunately, a renaissance has occurred in the last two decades, fostered by increased recognition that FND is prevalent and diagnosed using "rule-in" examination signs. The parallel use of scientific tools to bridge brain structure - function relationships has helped refine an integrated biopsychosocial framework through which to conceptualize FND. In particular, a growing number of quality neuroimaging studies using a variety of methodologies have shed light on the emerging pathophysiology of FND. This renewed scientific interest has occurred in parallel with enhanced interdisciplinary collaborations, as illustrated by new care models combining psychological and physical therapies and the creation of a new multidisciplinary FND society supporting knowledge dissemination in the field. Within this context, this article summarizes the output of the first International FND Neuroimaging Workgroup meeting, held virtually, on June 17th, 2020 to appraise the state of neuroimaging research in the field and to catalyze large-scale collaborations. We first briefly summarize neural circuit models of FND, and then detail the research approaches used to date in FND within core content areas: cohort characterization; control group considerations; task-based functional neuroimaging; resting-state networks; structural neuroimaging; biomarkers of symptom severity and risk of illness; and predictors of treatment response and prognosis. Lastly, we outline a neuroimaging-focused research agenda to elucidate the pathophysiology of FND and aid the development of novel biologically and psychologically-informed treatments.
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Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Timothy R Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz Iran; Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Indrit Bègue
- Division of Adult Psychiatry, Department of Psychiatry, University of Geneva, Geneva Switzerland; Service of Neurology Department of Clinical Neuroscience, University of Geneva, Geneva, Switzerland
| | - Matthew Butler
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Quinton Deeley
- South London and Maudsley NHS Foundation Trust, London UK Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ibai Diez
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark J Edwards
- Neurosciences Research Centre, St George's University of London, London, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Jeannette M Gelauff
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Silvina G Horovitz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Germany
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health Heidelberg, Australia
| | - Marina A J Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, The Netherlands
| | - Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead Institute of Medical Research, University of Sydney Medical School, Sydney, NSW, Australia
| | - Kathrin LaFaver
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Ramesh S Marapin
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, The Netherlands
| | - Carine W Maurer
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Mandana Modirrousta
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Petr Sojka
- Department of Psychiatry, University Hospital Brno, Czech Republic
| | - Jeffrey P Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Rochester, MN, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham Epilepsy Center, Department of Neurology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Selma Aybek
- Neurology Department, Psychosomatic Medicine Unit, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
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26
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Kozlowska K, Chudleigh C, McClure G, Maguire AM, Ambler GR. Attachment Patterns in Children and Adolescents With Gender Dysphoria. Front Psychol 2021; 11:582688. [PMID: 33510668 PMCID: PMC7835132 DOI: 10.3389/fpsyg.2020.582688] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 07/15/2020] [Accepted: 11/25/2020] [Indexed: 01/18/2023] Open
Abstract
The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42–15.92 years; 24 birth-assigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) (χ2 = 52.66; p < 0.001) and had a high rate of unresolved loss/trauma (χ2 = 18.64; p < 0.001). Comorbid psychiatric diagnoses (n = 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25–95/100; mean = 54.88; SD = 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns (χ2 = 2.43; p = 0.30) and rates of unresolved loss and trauma (χ2 = 0.70; p = 0.40). Post hoc analyses showed that lower SES, family constellation (a non-traditional family unit), ACEs—including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)—increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs.
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Affiliation(s)
- Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Discipline of Child and Adolescent Health, University of Sydney Medical School, Darlington, NSW, Australia
| | - Catherine Chudleigh
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Georgia McClure
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Ann M Maguire
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Darlington, NSW, Australia.,Department of Endocrinology, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Geoffrey R Ambler
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Darlington, NSW, Australia.,Department of Endocrinology, The Children's Hospital at Westmead, Westmead, NSW, Australia
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Nicholson TR, Carson A, Edwards MJ, Goldstein LH, Hallett M, Mildon B, Nielsen G, Nicholson C, Perez DL, Pick S, Stone J, Aybek S, Baslet G, Bloem BR, Brown RJ, Chalder T, Damianova M, David AS, Epstein S, Espay AJ, Garcin B, Jankovic J, Joyce E, Kanaan RA, Kozlowska K, LaFaver K, LaFrance WC, Lang AE, Lehn A, Lidstone S, Maurer C, Morgante F, Myers L, Reuber M, Rommelfanger K, Schwingenshuh P, Serranova T, Shotbolt P, Stebbins G, Tijssen MAJ, Tinazzi M. Outcome Measures for Functional Neurological Disorder: A Review of the Theoretical Complexities. J Neuropsychiatry Clin Neurosci 2020; 32:33-42. [PMID: 31865871 DOI: 10.1176/appi.neuropsych.19060128] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The development and selection of optimal outcome measures is increasingly recognized as a key component of evidence-based medicine, particularly the need for the development of a standardized set of measures for use in clinical trials. This process is particularly complex for functional neurological disorder (FND) for several reasons. FND can present with a wide range of symptoms that resemble the full spectrum of other neurological disorders. Additional physical (e.g., pain, fatigue) and psychological (e.g., depression, anxiety) symptoms are commonly associated with FND, which also can be highly disabling with implications for prognosis, and warrant concurrent assessment, despite an unclear etiological relationship with FND. Furthermore, several unique clinical aspects of FND make it likely that the usual prioritization of "objective" (or clinician-rated) over "subjective" (or patient-rated) measures might not be appropriate. Self-report measures may be more clinically meaningful in this patient population. Despite being a common and disabling disorder, there has been little research into outcome measures in FND, and to date trials have largely used measures designed for the assessment of other disorders. An international FND Core Outcome Measure group (FND-COM) has been established to develop a consensus battery of outcomes for FND: a "core outcome set." In this perspective article, the authors reviewed the process of outcome measure development and selection before considering the specific features of FND affecting the development of a core outcome set, as well as a research agenda to optimize outcome measurement in this complex neuropsychiatric disorder.
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Affiliation(s)
- Timothy R Nicholson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Alan Carson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Mark J Edwards
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Laura H Goldstein
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Mark Hallett
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Bridget Mildon
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Glenn Nielsen
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Clare Nicholson
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - David L Perez
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Susannah Pick
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
| | - Jon Stone
- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
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- The Institute of Psychiatry, Psychology and Neuroscience, King's College London (T. Nicholson, Goldstein, Pick); the Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); the Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, United Kingdom (Carson); the Neuroscience Research Centre, St. George's University of London (Edwards, Nielsen); Human Motor Control Section, the National Institute of Neurological Disorders and Stroke, Bethesda, Md. (Hallett); FND Hope International, Banbury, United Kingdom (Mildon); the National Hospital for Neurology and Neurosurgery, University College London, and Hospitals National Health Service Foundation Trust, London (C. Nicholson); and the Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (Perez)
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Perez DL, Aybek S, Nicholson TR, Kozlowska K, Arciniegas DB, LaFrance WC. Functional Neurological (Conversion) Disorder: A Core Neuropsychiatric Disorder. J Neuropsychiatry Clin Neurosci 2020; 32:1-3. [PMID: 31964243 DOI: 10.1176/appi.neuropsych.19090204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- David L Perez
- The Departments of Neurology and Psychiatry, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); the Department of Neurology, Inselspital University Hospital and Clinical Neuroscience Bern Network, University of Bern, Bern, Switzerland (Aybek); the Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); The Children's Hospital at Westmead, Westmead, Australia, the Brain Dynamics Centre at Westmead Institute of Medical Research, Westmead, Australia, and Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia (Kozlowska); the Departments of Neurology and Psychiatry, and the Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, Colo. (Arciniegas); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, R.I. (LaFrance)
| | - Selma Aybek
- The Departments of Neurology and Psychiatry, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); the Department of Neurology, Inselspital University Hospital and Clinical Neuroscience Bern Network, University of Bern, Bern, Switzerland (Aybek); the Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); The Children's Hospital at Westmead, Westmead, Australia, the Brain Dynamics Centre at Westmead Institute of Medical Research, Westmead, Australia, and Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia (Kozlowska); the Departments of Neurology and Psychiatry, and the Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, Colo. (Arciniegas); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, R.I. (LaFrance)
| | - Timothy R Nicholson
- The Departments of Neurology and Psychiatry, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); the Department of Neurology, Inselspital University Hospital and Clinical Neuroscience Bern Network, University of Bern, Bern, Switzerland (Aybek); the Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); The Children's Hospital at Westmead, Westmead, Australia, the Brain Dynamics Centre at Westmead Institute of Medical Research, Westmead, Australia, and Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia (Kozlowska); the Departments of Neurology and Psychiatry, and the Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, Colo. (Arciniegas); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, R.I. (LaFrance)
| | - Kasia Kozlowska
- The Departments of Neurology and Psychiatry, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); the Department of Neurology, Inselspital University Hospital and Clinical Neuroscience Bern Network, University of Bern, Bern, Switzerland (Aybek); the Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); The Children's Hospital at Westmead, Westmead, Australia, the Brain Dynamics Centre at Westmead Institute of Medical Research, Westmead, Australia, and Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia (Kozlowska); the Departments of Neurology and Psychiatry, and the Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, Colo. (Arciniegas); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, R.I. (LaFrance)
| | - David B Arciniegas
- The Departments of Neurology and Psychiatry, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); the Department of Neurology, Inselspital University Hospital and Clinical Neuroscience Bern Network, University of Bern, Bern, Switzerland (Aybek); the Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); The Children's Hospital at Westmead, Westmead, Australia, the Brain Dynamics Centre at Westmead Institute of Medical Research, Westmead, Australia, and Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia (Kozlowska); the Departments of Neurology and Psychiatry, and the Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, Colo. (Arciniegas); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, R.I. (LaFrance)
| | - W Curt LaFrance
- The Departments of Neurology and Psychiatry, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); the Department of Neurology, Inselspital University Hospital and Clinical Neuroscience Bern Network, University of Bern, Bern, Switzerland (Aybek); the Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); The Children's Hospital at Westmead, Westmead, Australia, the Brain Dynamics Centre at Westmead Institute of Medical Research, Westmead, Australia, and Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia (Kozlowska); the Departments of Neurology and Psychiatry, and the Marcus Institute for Brain Health, University of Colorado School of Medicine, Aurora, Colo. (Arciniegas); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, R.I. (LaFrance)
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Asadi‐Pooya AA, Nicholson TR, Pick S, Baslet G, Benbadis SR, Beghi M, Brigo F, Buchhalter J, D'Alessio L, Dworetzky B, Gigineishvili D, Kanaan RA, Kozlowska K, LaFrance WC, Lehn A, Perez DL, Popkirov S, Pretorius C, Szaflarski JP, Tolchin B, Valente K, Stone J, Reuber M. Driving a motor vehicle and psychogenic nonepileptic seizures: ILAE Report by the Task Force on Psychogenic Nonepileptic Seizures. Epilepsia Open 2020; 5:371-385. [PMID: 32913946 PMCID: PMC7469780 DOI: 10.1002/epi4.12408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This International League Against Epilepsy (ILAE) Report: (a) summarizes the literature about "driving and psychogenic nonepileptic seizures (PNES)"; (b) presents the views of international experts; and (c) proposes an approach to assessing the ability of persons with PNES (PwPNES) to drive. METHODS Phase 1: Systematic literature review. Phase 2: Collection of international expert opinion using SurveyMonkey®. Experts included the members of the ILAE PNES Task Force and individuals with relevant publications since 2000. Phase 3: Joint analysis of the findings and refinement of conclusions by all participants using email. As an ILAE Report, the resulting text was reviewed by the Psychiatry Commission, the ILAE Task Force on Driving Guidelines, and Executive Committee. RESULTS Eight studies identified by the systematic review process failed to provide a firm evidence base for PNES-related driving regulations, but suggest that most health professionals think restrictions are appropriate. Twenty-six experts responded to the survey. Most held the view that decisions about driving privileges should consider individual patient and PNES characteristics and take account of whether permits are sought for private or commercial driving. Most felt that those with active PNES should not be allowed to drive unless certain criteria were met and that PNES should be thought of as "active" if the last psychogenic seizure had occurred within 6 months. SIGNIFICANCE Recommendations on whether PwPNES can drive should be made at the individual patient level. Until future research has determined the risk of accidents in PwPNES a proposed algorithm may guide decisions about driving advice.
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Affiliation(s)
- Ali A. Asadi‐Pooya
- Epilepsy Research CenterShiraz University of Medical SciencesShirazIran
- Department of NeurologyJefferson Comprehensive Epilepsy CenterThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Timothy R. Nicholson
- Section of Cognitive NeuropsychiatryInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Susannah Pick
- Section of Cognitive NeuropsychiatryInstitute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Gaston Baslet
- Department of PsychiatryBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Selim R. Benbadis
- Comprehensive Epilepsy ProgramUniversity of South Florida and Tampa General HospitalTampaFLUSA
| | | | | | | | - Luciana D'Alessio
- Epilepsy Center Ramos Mejía y el Cruce HospitalsBuenos Aires UniversityCONICETBuenos AiresArgentina
| | - Barbara Dworetzky
- Department of NeurologyThe Bromfield Epilepsy CenterBrigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - David Gigineishvili
- Department of Neurology & NeurosurgeryTbilisi State UniversityTbilisiGeorgia
| | - Richard A. Kanaan
- Department of PsychiatryUniversity of MelbourneAustin HealthHeidelbergAustralia
| | - Kasia Kozlowska
- The Children's Hospital at WestmeadWestmead Institute of Medical ResearchUniversity of Sydney Medical SchoolSydneyNSWAustralia
| | | | | | - David L. Perez
- Functional Neurology Research GroupDepartments of Neurology and PsychiatryMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Stoyan Popkirov
- Department of NeurologyUniversity Hospital Knappschaftskrankenhaus BochumRuhr University BochumBochumGermany
| | - Chrisma Pretorius
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
| | - Jerzy P. Szaflarski
- Department of Neurology and the UAB Epilepsy CenterUniversity of Alabama at BirminghamBirminghamALUSA
| | - Benjamin Tolchin
- Department of NeurologyYale Comprehensive Epilepsy CenterYale School of MedicineNew HavenCTUSA
| | - Kette Valente
- Laboratory of Clinical NeurophysiologyDepartment of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Jon Stone
- Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - Markus Reuber
- Academic Department of NeurosciencesUniversity of SheffieldRoyal Hallamshire HospitalSheffieldUK
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Radmanesh M, Jalili M, Kozlowska K. Activation of Functional Brain Networks in Children With Psychogenic Non-epileptic Seizures. Front Hum Neurosci 2020; 14:339. [PMID: 33192376 PMCID: PMC7477327 DOI: 10.3389/fnhum.2020.00339] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/11/2020] [Accepted: 08/03/2020] [Indexed: 02/03/2023] Open
Abstract
Objectives Psychogenic non-epileptic seizures (PNES) have been hypothesized to emerge in the context of neural networks instability. To explore this hypothesis in children, we applied a graph theory approach to examine connectivity in neural networks in the resting-state EEG in 35 children with PNES, 31 children with other functional neurological symptoms (but no PNES), and 75 healthy controls. Methods The networks were extracted from Laplacian-transformed time series by a coherence connectivity estimation method. Results Children with PNES (vs. controls) showed widespread changes in network metrics: increased global efficiency (gamma and beta bands), increased local efficiency (gamma band), and increased modularity (gamma and alpha bands). Compared to controls, they also had higher levels of autonomic arousal (e.g., lower heart variability); more anxiety, depression, and stress on the Depression Anxiety and Stress Scales; and more adverse childhood experiences on the Early Life Stress Questionnaire. Increases in network metrics correlated with arousal. Children with other functional neurological symptoms (but no PNES) showed scattered and less pronounced changes in network metrics. Conclusion The results indicate that children with PNES present with increased activation of neural networks coupled with increased physiological arousal. While this shift in functional organization may confer a short-term adaptive advantage-one that facilitates neural communication and the child's capacity to respond self-protectively in the face of stressful life events-it may also have a significant biological cost. It may predispose the child's neural networks to periods of instability-presenting clinically as PNES-when the neural networks are faced with perturbations in energy flow or with additional demands.
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Affiliation(s)
| | - Mahdi Jalili
- School of Engineering, RMIT University, Melbourne, VIC, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney School of Medicine, Sydney, NSW, Australia.,Westmead Institute for Medical Research, Sydney, NSW, Australia
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31
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Pick S, Anderson DG, Asadi-Pooya AA, Aybek S, Baslet G, Bloem BR, Bradley-Westguard A, Brown RJ, Carson AJ, Chalder T, Damianova M, David AS, Edwards MJ, Epstein SA, Espay AJ, Garcin B, Goldstein LH, Hallett M, Jankovic J, Joyce EM, Kanaan RA, Keynejad RC, Kozlowska K, LaFaver K, LaFrance WC, Lang AE, Lehn A, Lidstone S, Maurer CW, Mildon B, Morgante F, Myers L, Nicholson C, Nielsen G, Perez DL, Popkirov S, Reuber M, Rommelfanger KS, Schwingenshuh P, Serranova T, Shotbolt P, Stebbins GT, Stone J, Tijssen MA, Tinazzi M, Nicholson TR. Outcome measurement in functional neurological disorder: a systematic review and recommendations. J Neurol Neurosurg Psychiatry 2020; 91:638-649. [PMID: 32111637 PMCID: PMC7279198 DOI: 10.1136/jnnp-2019-322180] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [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: 10/07/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We aimed to identify existing outcome measures for functional neurological disorder (FND), to inform the development of recommendations and to guide future research on FND outcomes. METHODS A systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previous treatment studies. Searches of Embase, MEDLINE and PsycINFO were conducted between January 1965 and June 2019. The findings were discussed during two international meetings of the FND-Core Outcome Measures group. RESULTS Five FND-specific measures were identified-three clinician-rated and two patient-rated-but their measurement properties have not been rigorously evaluated. No single measure was identified for use across the range of FND symptoms in adults. Across randomised controlled trials (k=40) and observational treatment studies (k=40), outcome measures most often assessed core FND symptom change. Other domains measured commonly were additional physical and psychological symptoms, life impact (ie, quality of life, disability and general functioning) and health economics/cost-utility (eg, healthcare resource use and quality-adjusted life years). CONCLUSIONS There are few well-validated FND-specific outcome measures. Thus, at present, we recommend that existing outcome measures, known to be reliable, valid and responsive in FND or closely related populations, are used to capture key outcome domains. Increased consistency in outcome measurement will facilitate comparison of treatment effects across FND symptom types and treatment modalities. Future work needs to more rigorously validate outcome measures used in this population.
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Affiliation(s)
- Susannah Pick
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David G Anderson
- Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Republic of.,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Selma Aybek
- Department of Neurology, University Hospital Bern & University of Bern, Bern, Switzerland
| | - Gaston Baslet
- Department of Psychiatry, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Bastiaan R Bloem
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | | | - Richard J Brown
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Alan J Carson
- Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maria Damianova
- Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Mark J Edwards
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University, London, UK
| | - Steven A Epstein
- Department of Psychiatry, Georgetown University, Washington, District of Columbia, USA
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Béatrice Garcin
- Department of Neurology, Hopital Avicenne, Assistance Publique, Hôpitaux de Paris, Paris, Île-de-France, France
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Eileen M Joyce
- University College London Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Richard A Kanaan
- Department of Psychiatry, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Roxanne C Keynejad
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kasia Kozlowska
- Discipline of Psychiatry and Child and Adolescent Health, The Children's Hospital at Westmead, Sydney Medical School, Sydney, New South Wales, Australia
| | - Kathrin LaFaver
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown Medical School, Providence, RI, USA
| | - Anthony E Lang
- Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Ontario, Canada
| | - Alex Lehn
- Mater Neurosciences Centre, Brisbane, Queensland, Australia
| | - Sarah Lidstone
- Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Ontario, Canada
| | - Carine W Maurer
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
| | | | - Francesca Morgante
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University, London, UK
| | - Lorna Myers
- Northeast Regional Epilepsy Group, New York, New York, USA
| | - Clare Nicholson
- Therapy Services, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Glenn Nielsen
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St George's University, London, UK
| | - David L Perez
- Departments of Neurology and Psychiatry, Therapy Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Markus Reuber
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - Karen S Rommelfanger
- Departments of Neurology and Psychiatry and Behavioral Sciences, Emory Centre for Ethics, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Tereza Serranova
- Department of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Paul Shotbolt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Glenn T Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jon Stone
- Department of Clinical Neurosciences, School of Molecular and Clinical Medicine, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Marina Aj Tijssen
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Michele Tinazzi
- Department of Neuroscience, Biomedicine, and Movement, University of Verona, Verona, Italy
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Abstract
Accumulating evidence indicates that psychological and neurophysiological processes interconnect and interact to activate the body's stress system and to trigger and maintain functional somatic symptoms. This study used the Early Life Stress Questionnaire, Depression Anxiety Stress Scales and biological markers (heart rate, heart rate variability, skin conductance, C-reactive protein (CRP) titre, respiratory rate, and accuracy and reaction time in an emotion-face identification task), to examine childhood adversity, psychological distress and stress-system activation in 35 children and adolescents (23 girls and 12 boys, 9-17 years old) disabled by chronic pain (vs two groups of age- and sex-matched healthy controls). Patients reported more early-life stress (U = 798.5, p = .026) and more psychological distress (U = 978, p < .001). They showed activation of the autonomic system: elevated heart rate (U = 862.5, p = .003), elevated electrodermal activity (U = 804.5, p = .024) and lower heart rate variability in the time domain (U = 380.5, p = .007) and frequency domain (U = 409.5, p = .017). The group showed an upward shift of CRP titres (with 75th and 90th CRP percentiles of 4.5 and 10.5 mg/L, respectively), suggesting the activation of the immune-inflammatory system. Elevated CRP titres were associated with elevated heart rate (p = .028). There were no differences in respiratory rate or in accuracy and reaction time in the emotion-face identification task. The results indicate that interventions for children and adolescents with chronic pain need a multidisciplinary mind-body approach that concurrently addresses psychological distress, physical impairment and stress-system dysregulation.
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Affiliation(s)
- Peter M McInnis
- Department of Psychological Medicine, The Children's Hospital at Westmead, Australia
| | - Taylor A Braund
- Total Brain, Australia.,Brain Dynamics Centre, The Westmead Institute for Medical Research, Australia.,Sydney Medical School, University of Sydney, Australia
| | - Zhi Kai Chua
- Department of Psychological Medicine, The Children's Hospital at Westmead, Australia
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Australia.,Brain Dynamics Centre, The Westmead Institute for Medical Research, Australia.,Sydney Medical School, University of Sydney, Australia
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Knight S, Elders S, Rodda J, Harvey A, Lubitz L, Rowe K, Reveley C, Hennel S, Towns S, Kozlowska K, Payne DN, Marshall-Gradisnik S, Scheinberg A. Epidemiology of paediatric chronic fatigue syndrome in Australia. Arch Dis Child 2019; 104:733-738. [PMID: 30798255 DOI: 10.1136/archdischild-2018-316450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/16/2018] [Accepted: 02/01/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To estimate the paediatrician-diagnosed incidence of chronic fatigue syndrome (CFS) in Australia, and describe demographic and clinical features, as well as approaches to diagnosis and management. METHODS The Australian Paediatric Surveillance Unit facilitates monthly national surveillance of uncommon conditions seen by paediatricians. Data from young people aged <18 years diagnosed with CFS were collected. Incidence was estimated based on new cases reported from April 2015 to April 2016. RESULTS A total of 164 cases of newly diagnosed CFS in young people aged 4-17 years were identified for inclusion. The estimated national incidence for children aged 4-9 years was 0.25 per 100 000 per annum. In children aged 10-17 years, the estimated incidence of paediatrician-diagnosed cases for Victoria (17.48 per 100 000) was substantially greater than other Australian states (range 1.31-5.51 per 100 000). Most cases were female and Caucasian, most commonly presenting after an infectious illness with symptoms gradual in onset. The majority were diagnosed at least 13 months after symptom onset. Symptoms, associations, investigations and management strategies were highly variable. CONCLUSIONS Current findings suggest that, consistent with other countries, the Australian incidence of CFS in children aged <10 years is very low. In contrast, the national incidence of CFS in older children and adolescents (aged 10-17 years) is more unclear, with marked variability between geographical regions apparent. This may be due to variation in service accessibility and clinician understanding of CFS. Accordingly, national initiatives to improve equity of care for children with CFS may be required.
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Affiliation(s)
- Sarah Knight
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Shane Elders
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jill Rodda
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia
| | - Adrienne Harvey
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia
| | - Lionel Lubitz
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Kathy Rowe
- General Medicine, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Colette Reveley
- Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Sabine Hennel
- Victorian Paediatric Rehabilitation, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Susan Towns
- Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Kasia Kozlowska
- Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Donald N Payne
- Adolescent Medicine, Princess Margaret Hospital, Perth, Western Australia, Australia.,SPACH, UWA, Perth, Western Australia, Australia
| | | | - Adam Scheinberg
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Australia.,Victorian Paediatric Rehabilitation Service, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
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Pace-Schott EF, Amole MC, Aue T, Balconi M, Bylsma LM, Critchley H, Demaree HA, Friedman BH, Gooding AEK, Gosseries O, Jovanovic T, Kirby LA, Kozlowska K, Laureys S, Lowe L, Magee K, Marin MF, Merner AR, Robinson JL, Smith RC, Spangler DP, Van Overveld M, VanElzakker MB. Physiological feelings. Neurosci Biobehav Rev 2019; 103:267-304. [DOI: 10.1016/j.neubiorev.2019.05.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/27/2019] [Accepted: 05/03/2019] [Indexed: 12/20/2022]
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Kozlowska K, Chung J, Cruickshank B, McLean L, Scher S, Dale RC, Mohammad SS, Singh-Grewal D, Prabhuswamy MY, Patrick E. Blood CRP levels are elevated in children and adolescents with functional neurological symptom disorder. Eur Child Adolesc Psychiatry 2019; 28:491-504. [PMID: 30143887 DOI: 10.1007/s00787-018-1212-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/03/2018] [Indexed: 01/09/2023]
Abstract
There is accumulating evidence that patients with functional neurological symptom disorder (FND) show activation of multiple components of the stress system-the hypothalamic-pituitary-adrenal axis, autonomic nervous system, and brain regions involved in arousal- and emotion-processing. This study aims to examine whether the immune-inflammatory component of the stress system is also activated. C-reactive protein (CRP) blood titre levels were measured in 79 children and adolescents with FND. CRP values ≥ 2 mg/L suggest low-grade inflammation. CRP values > 10 mg/L suggest a disease process. Sixty-six percent of subjects (n = 52) had CRP titres ≥ 2 mg/L. The upward shift in the distribution of CRP levels suggested low-grade inflammation (median CRP concentration was 4.60 mg/L, with 75th and 90th percentiles of 6.1 and 10.3 mg/L, respectively). Elevated CRP titres were not explained by sex, pubertal status, BMI, or medical factors. Confounder analyses suggested that history of maltreatment (χ2 = 2.802, df = 1, p = 0.094, φ = 0.190; β = 2.823, p = 0.04) and a diagnosis of anxiety (χ2 = 2.731, df = 1, p = 0.098, φ = 0.187; β = 4.520, p = 0.061) contributed to elevated CRP levels. Future research will need to identify the origins and locations of immune cell activation and the pathways and systems contributing to their activation and modulation. Because functional activity in neurons and glial cells-the brain's innate effector immune cells-is tightly coupled, our finding of elevated CRP titres suggests activation of the immune-inflammatory component of the brain's stress system. A more direct examination of inflammation-related molecules in the brain will help clarify the role of immune-inflammatory processes in FND.
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Affiliation(s)
- Kasia Kozlowska
- Department Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia. .,Brain Dynamics Centre, Westmead Institute of Medical Research, Westmead, NSW, Australia. .,Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.
| | - Jason Chung
- Department of Clinical Biochemistry, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia
| | - Bronya Cruickshank
- Department Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Loyola McLean
- Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Building 112, Cumberland Hospital Campus, Parramatta BC, Locked Bag 7118, Parramatta, NSW, 2124, Australia.,Brain and Mind Centre, and Discipline of Psychiatry, University of Sydney Medical School, Sydney, NSW, Australia
| | - Stephen Scher
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,McLean Hospital, Belmont, MA, USA.,Discipline of Psychiatry, University of Sydney Medical School, Sydney, NSW, Australia
| | - Russell C Dale
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.,Movement Disorder and Clinical Neuroimmunology Group, Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Shekeeb S Mohammad
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.,Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia
| | - Davinder Singh-Grewal
- Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, NSW, Australia.,Department of Rheumatology, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Discipline of Child and Maternal Health, University of New South Wales, Sydney, NSW, Australia
| | - Mukesh Yajaman Prabhuswamy
- Department Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Ellis Patrick
- School of Mathematics and Statistics, University of Sydney, F07 - Carslaw Building, Sydney, NSW, 2006, Australia.,Westmead Institute for Medical Research, Sydney, NSW, Australia
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Chudleigh C, Savage B, Cruz C, Lim M, McClure G, Palmer DM, Spooner CJ, Kozlowska K. Use of respiratory rates and heart rate variability in the assessment and treatment of children and adolescents with functional somatic symptoms. Clin Child Psychol Psychiatry 2019; 24:29-39. [PMID: 30354283 DOI: 10.1177/1359104518807742] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Functional somatic symptoms (FSS) emerge when the stress system is activated in response to physical or emotional stress that is either chronic or especially intense. In such cases, the heightened state of physiological arousal and motor activation can be measured through biological markers. Our team have integrated the use of biological markers of body state - respiratory rate, heart rate (HR) and heart rate variability (HRV) measurements - as a way of helping families to understand how physical symptoms can signal activation of the body's stress systems. This study measured respiratory rates, HR and HRV in children and adolescents with FSS (and healthy controls) during baseline assessment to determine whether these biological markers were effective at differentiating patients with FSS. The study also implemented a biofeedback intervention during the assessment to determine whether patients with FSS were able to slow their respiratory rates and increase HRV. Patients with FSS had faster respiratory rates, faster HR, and lower HRV, suggesting activation of the autonomic nervous system coupled with activation of the respiratory motor system. Like controls, patients were able to slow their respiratory rates, but in contrast to controls, they were unable to increase their HRV. Our findings suggest that patients with FSS present in a state of physiological activation and struggle to regulate their body state. Patients with FSS are likely to need ongoing training and practice to regulate body state coupled with interventions that target regulatory capacity across multiple systems.
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Affiliation(s)
- Catherine Chudleigh
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Blanche Savage
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Catherine Cruz
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Melissa Lim
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Georgia McClure
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Donna M Palmer
- 2 Brain Dynamics Centre, The Westmead Institute for Medical Research, NSW, Australia.,3 The University of Sydney, NSW, Australia
| | | | - Kasia Kozlowska
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia.,2 Brain Dynamics Centre, The Westmead Institute for Medical Research, NSW, Australia.,3 The University of Sydney, NSW, Australia
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Brookes M, Sharpe L, Kozlowska K. Attentional and Interpretational Biases Toward Pain-Related Stimuli in Children and Adolescents: ASystematic Review of the Evidence. The Journal of Pain 2018; 19:1091-1101. [DOI: 10.1016/j.jpain.2018.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/15/2018] [Accepted: 04/18/2018] [Indexed: 01/04/2023]
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Mazur-Bialy AI, Kozlowska K, Pochec E, Bilski J, Brzozowski T. Myokine irisin-induced protection against oxidative stress in vitro. Involvement of heme oxygenase-1 and antioxidazing enzymes superoxide dismutase-2 and glutathione peroxidase. J Physiol Pharmacol 2018; 69:117-125. [PMID: 29769428 DOI: 10.26402/jpp.2018.1.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/26/2018] [Indexed: 11/03/2022]
Abstract
Irisin is a recently discovered myokine reported as protective protein released from exercising skeletal muscles. Although myokines were recently reported to possess the antioxidizing properties, the impact of irisin on the functions of macrophages with respect to its anti-inflammatory potential has not been fully elucidated. Here, we determined the ability of irisin to interact with reactive oxygen species (ROS) in RAW 264.7 murine macrophages. The macrophages were pre-incubated with irisin (0 - 50 nM), some of which had undergone additional co-incubation with bacterial lipopolysaccharide (LPS) (100 ng/ml). Cell viability, the reactive oxygen species scavenging potential as well as the mRNA and protein expression of key oxidative stress factors such as superoxide dismutase 1 (SOD-1), superoxide dismutase 2 (SOD-2), glutathione peroxidase (GSH-Px), catalase 9 (Cat-9), nuclear factor (erythroid-derived 2)-like 2-related factor (Nrf2) and heme oxygenase-1 (HO-1) were evaluated. We found that irisin applied in a concentration of 50 nM significantly attenuated the production of harmful H2O2 and this effect appears to be mediated by a significant increase in the expression of key enzymes involved with antioxidative stress pathways including SOD, GSH-Px and Cat-9 predominantly observed after stimulation of these cells with LPS. We conclude that 1) irisin exhibits a potent antioxidant and anti-inflammatory activities in non-stimulated and LPS-stimulated isolated murine macrophages in vitro, and 2) this protective and antioxidative activity of irisin in vitro might be considered as an important component of protective action of this peptide in vivo, especially under condition of exercise.
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Affiliation(s)
- A I Mazur-Bialy
- Department of Ergonomics and Exercise Physiology, Faculty of Health Science, Jagiellonian University Medical College, Cracow, Poland.
| | - K Kozlowska
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Jagiellonian University, Cracow, Poland
| | - E Pochec
- Department of Glycoconjugate Biochemistry, Institute of Zoology and Biomedical Research, Jagiellonian University, Cracow, Poland
| | - J Bilski
- Department of Ergonomics and Exercise Physiology, Faculty of Health Science, Jagiellonian University Medical College, Cracow, Poland
| | - T Brzozowski
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
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Kozlowska K, Spooner CJ, Palmer DM, Harris A, Korgaonkar MS, Scher S, Williams LM. "Motoring in idle": The default mode and somatomotor networks are overactive in children and adolescents with functional neurological symptoms. Neuroimage Clin 2018; 18:730-743. [PMID: 29876262 PMCID: PMC5987846 DOI: 10.1016/j.nicl.2018.02.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/19/2018] [Accepted: 02/02/2018] [Indexed: 12/20/2022]
Abstract
Objective Children and adolescents with functional neurological symptom disorder (FND) present with diverse neurological symptoms not explained by a disease process. Functional neurological symptoms have been conceptualized as somatoform dissociation, a disruption of the brain's intrinsic organization and reversion to a more primitive level of function. We used EEG to investigate neural function and functional brain organization in children/adolescents with FND. Method EEG was recorded in the resting eyes-open condition in 57 patients (aged 8.5-18 years) and 57 age- and sex-matched healthy controls. Using a topographical map, EEG power data were quantified for regions of interest that define the default mode network (DMN), salience network, and somatomotor network. Source localization was examined using low-resolution brain electromagnetic tomography (LORETA). The contributions of chronic pain and arousal as moderators of differences in EEG power were also examined. Results Children/adolescents with FND had excessive theta and delta power in electrode clusters corresponding to the DMN-both anteriorly (dorsomedial prefrontal cortex [dmFPC]) and posteriorly (posterior cingulate cortex [PCC], precuneus, and lateral parietal cortex)-and in the premotor/supplementary motor area (SMA) region. There was a trend toward increased theta and delta power in the salience network. LORETA showed activation across all three networks in all power bands and localized neural sources to the dorsal anterior cingulate cortex/dmPFC, mid cingulate cortex, PCC/precuneus, and SMA. Pain and arousal contributed to slow wave power increases in all three networks. Conclusions These findings suggest that children and adolescents with FND are characterized by overactivation of intrinsic resting brain networks involved in threat detection, energy regulation, and preparation for action.
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Affiliation(s)
- Kasia Kozlowska
- The Children's Hospital at Westmead, Psychological Medicine, Locked Bag 4001, Westmead, NSW 2145, Australia; The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
| | | | - Donna M Palmer
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
| | - Anthony Harris
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia; Westmead Hospital Psychiatry Department, Darcy Rd, Westmead, NSW 2145, Australia.
| | - Mayuresh S Korgaonkar
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
| | - Stephen Scher
- The University of Sydney, Sydney, Australia; Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, USA.
| | - Leanne M Williams
- Psychiatry and Behavioral Sciences, Stanford University, VA Palo Alto (Sierra-Pacific MIRECC) 401 Quarry Rd, United States.
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Kozlowska K, Chudleigh C, Cruz C, Lim M, McClure G, Savage B, Shah U, Cook A, Scher S, Carrive P, Gill D. Psychogenic non-epileptic seizures in children and adolescents: Part II - explanations to families, treatment, and group outcomes. Clin Child Psychol Psychiatry 2018; 23:160-176. [PMID: 28956479 PMCID: PMC5757408 DOI: 10.1177/1359104517730116] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Psychogenic non-epileptic seizures (PNES) - time-limited disturbances of consciousness and motor-sensory control, not accompanied by ictal activity on electroencephalogram (EEG) - are best conceptualized as atypical neurophysiological responses to emotional distress, physiological stressors and danger. Patients and families find the diagnosis of PNES difficult to understand; the transition from neurology (where the diagnosis is made) to mental health services (to which patients are referred for treatment) can be a bumpy one. This study reports how diagnostic formulations constructed for 60 consecutive children and adolescents with PNES were used to inform both the explanations about PNES that were given to them and their families and the clinical interventions that were used to help patients gain control over PNES. Families were able to accept the diagnosis of PNES and engage in treatment when it was explained how emotional distress, illness and states of high arousal could activate atypical defence responses in the body and brain - with PNES being an unwanted by-product of this process. Patients and their families made good use of therapeutic interventions. A total of 75% of children/adolescents (45/60) regained normal function and attained full-time return to school. Global Assessment of Functioning scores increased from 41 to 67 ( t(54) = 10.09; p < .001). Outcomes were less favourable in children/adolescents who presented with chronic PNES and in those with a chronic, comorbid mental health disorder that failed to resolve with treatment. The study highlights that prompt diagnosis, followed by prompt multidisciplinary assessment, engagement, and treatment, achieves improved outcomes in children/adolescents with PNES.
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Affiliation(s)
- Kasia Kozlowska
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia.,2 Brain Dynamics Centre at atWestmead Institute for Medical Research, NSW, Australia.,3 Sydney Medical School, The University of Sydney, NSW, Australia
| | - Catherine Chudleigh
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Catherine Cruz
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Melissa Lim
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Georgia McClure
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Blanche Savage
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Ubaid Shah
- 3 Sydney Medical School, The University of Sydney, NSW, Australia.,4 TY Nelson Department of Neurology, The Children's Hospital at Westmead, NSW, Australia.,5 Lady Cilento Children's Hospital, Queensland, Australia
| | - Averil Cook
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia.,6 Child and Adolescent Mental Health Service Macarthur (ICAMHS) Macarthur, NSW, Australia
| | - Stephen Scher
- 3 Sydney Medical School, The University of Sydney, NSW, Australia.,7 Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, USA
| | - Pascal Carrive
- 8 Department of Anatomy, School of Medical Sciences, University of NSW, Australia
| | - Deepak Gill
- 3 Sydney Medical School, The University of Sydney, NSW, Australia.,4 TY Nelson Department of Neurology, The Children's Hospital at Westmead, NSW, Australia
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Kozlowska K, Chudleigh C, Cruz C, Lim M, McClure G, Savage B, Shah U, Cook A, Scher S, Carrive P, Gill D. Psychogenic non-epileptic seizures in children and adolescents: Part I - Diagnostic formulations. Clin Child Psychol Psychiatry 2018; 23:140-159. [PMID: 28956448 PMCID: PMC5757410 DOI: 10.1177/1359104517732118] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Psychogenic non-epileptic seizures (PNES) are a nonspecific, umbrella category that is used to collect together a range of atypical neurophysiological responses to emotional distress, physiological stressors and danger. Because PNES mimic epileptic seizures, children and adolescents with PNES usually present to neurologists or to epilepsy monitoring units. After a comprehensive neurological evaluation and a diagnosis of PNES, the patient is referred to mental health services for treatment. This study documents the diagnostic formulations - the clinical formulations about the probable neurophysiological mechanisms - that were constructed for 60 consecutive children and adolescents with PNES who were referred to our Mind-Body Rehabilitation Programme for treatment. As a heuristic framework, we used a contemporary reworking of Janet's dissociation model: PNES occur in the context of a destabilized neural system and reflect a release of prewired motor programmes following a functional failure in cognitive-emotional executive control circuitry. Using this framework, we clustered the 60 patients into six different subgroups: (1) dissociative PNES (23/60; 38%), (2) dissociative PNES triggered by hyperventilation (32/60; 53%), (3) innate defence responses presenting as PNES (6/60; 10%), (4) PNES triggered by vocal cord adduction (1/60; 2%), (5) PNES triggered by activation of the valsalva manoeuvre (1/60; 1.5%) and (6) PNES triggered by reflex activation of the vagus (2/60; 3%). As described in the companion article, these diagnostic formulations were used, in turn, both to inform the explanations of PNES that we gave to families and to design clinical interventions for helping the children and adolescents gain control of their PNES.
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Affiliation(s)
- Kasia Kozlowska
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia.,2 Brain Dynamics Centre at at Westmead Institute for Medical Research, NSW, Australia.,3 Sydney Medical School, The University of Sydney, NSW, Australia
| | - Catherine Chudleigh
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Catherine Cruz
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Melissa Lim
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Georgia McClure
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Blanche Savage
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia
| | - Ubaid Shah
- 3 Sydney Medical School, The University of Sydney, NSW, Australia.,4 TY Nelson Department of Neurology, The Children's Hospital at Westmead, NSW, Australia.,5 Lady Cilento Children's Hospital, Queensland, Australia
| | - Averil Cook
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, NSW, Australia.,6 Child and Adolescent Mental Health Service Macarthur (ICAMHS) Macarthur, NSW, Australia
| | - Stephen Scher
- 3 Sydney Medical School, The University of Sydney, NSW, Australia.,7 Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA, USA
| | - Pascal Carrive
- 8 Department of Anatomy, School of Medical Sciences, University of NSW, Australia
| | - Deepak Gill
- 3 Sydney Medical School, The University of Sydney, NSW, Australia.,4 TY Nelson Department of Neurology, The Children's Hospital at Westmead, NSW, Australia
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Abstract
Pain is a signal of danger, and danger activates the attachment system. When a parent responds to a child's pain with appropriate protection and comfort, more often than not, the pain resolves. But what happens in families when a child's pain becomes chronic and continues to signal a danger that has long passed? This study explored patterns of attachment in 48 children and adolescents with chronic functional pain and 48 healthy controls using structured attachment interviews. Patterns of attachment were identified using the Dynamic Maturational Model of Attachment. Compared to controls, children and adolescents with chronic functional pain were classified into at-risk patterns of attachment (χ2 = 76.4, df = 2, p < .001) and had higher rates of unresolved loss and trauma (χ2 = 10.8, df = 1, p = .001), suggesting a long-standing history of relational stress and the disruption of nurturing relationships. The findings suggest that the quality of attachment relationships contribute to the development and maintenance of chronic functional pain. Ongoing anxiety within the attachment relationship, combined with unresolved loss and trauma, may function much like catastrophising, contributing to chronic functional pain by activating the body's arousal systems. The assessment process for chronic functional pain should include a family assessment to identify ruptures in attachment relationships, as well as unresolved loss and trauma events that need to be addressed through family interventions or individual therapy.
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Affiliation(s)
- Lux Ratnamohan
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, Australia.,2 Psychiatry Research & Teaching Unit, Liverpool Hospital, Australia
| | - Kasia Kozlowska
- 1 Department of Psychological Medicine, The Children's Hospital at Westmead, Australia.,3 Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Australia.,4 Brain Dynamics Centre, Westmead Institute of Medical Research, Australia
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Kozlowska K, Griffiths KR, Foster SL, Linton J, Williams LM, Korgaonkar MS. Grey matter abnormalities in children and adolescents with functional neurological symptom disorder. Neuroimage Clin 2017; 15:306-314. [PMID: 28560155 PMCID: PMC5440356 DOI: 10.1016/j.nicl.2017.04.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/28/2017] [Accepted: 04/12/2017] [Indexed: 11/18/2022]
Abstract
Objective Functional neurological symptom disorder refers to the presence of neurological symptoms not explained by neurological disease. Although this disorder is presumed to reflect abnormal function of the brain, recent studies in adults show neuroanatomical abnormalities in brain structure. These structural brain abnormalities have been presumed to reflect long-term adaptations to the disorder, and it is unknown whether child and adolescent patients, with illness that is typically of shorter duration, show similar deficits or have normal brain structure. Method High-resolution, three-dimensional T1-weighted magnetic resonance images (MRIs) were acquired in 25 patients (aged 10–18 years) and 24 healthy controls. Structure was quantified in terms of grey matter volume using voxel-based morphometry. Post hoc, we examined whether regions of structural difference related to a measure of motor readiness to emotional signals and to clinical measures of illness duration, illness severity, and anxiety/depression. Results Patients showed greater volumes in the left supplementary motor area (SMA) and right superior temporal gyrus (STG) and dorsomedial prefrontal cortex (DMPFC) (corrected p < 0.05). Previous studies of adult patients have also reported alterations of the SMA. Greater SMA volumes correlated with faster reaction times in identifying emotions but not with clinical measures. Conclusions The SMA, STG, and DMPFC are known to be involved in the perception of emotion and the modulation of motor responses. These larger volumes may reflect the early expression of an experience-dependent plasticity process associated with increased vigilance to others' emotional states and enhanced motor readiness to organize self-protectively in the context of the long-standing relational stress that is characteristic of this disorder. We used high-resolution MRI to investigate brain structure in children presenting with acute functional neurological symptom disorder (FND). Patients had multiple antecedent stressors, a long-standing history of relational stress and at-risk attachment strategies. Patients had greater volumes in the SMA—where motor-, cognitive-, and emotion-processing signals interact to influence motor function. FND may involve experience-dependent changes in brain structure alongside experience-dependent changes in brain function.
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Affiliation(s)
- Kasia Kozlowska
- The Children's Hospital at Westmead, Psychological Medicine, Locked Bag 4001, Westmead, NSW 2145, Australia; The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
| | - Kristi R Griffiths
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
| | - Sheryl L Foster
- The University of Sydney, Sydney, Australia; Westmead Hospital Radiology Department, Darcy Rd, Westmead, NSW 2145, Australia.
| | - James Linton
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia.
| | - Leanne M Williams
- Psychiatry and Behavioral Sciences, Stanford University, VA Palo Alto (Sierra-Pacific MIRECC) 401 Quarry Rd, United States.
| | - Mayuresh S Korgaonkar
- The Brain Dynamics Centre, Westmead Institute for Medical Research, 176 Hawkesbury Rd, Westmead, NSW 2145, Australia; The University of Sydney, Sydney, Australia.
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Kozlowska K, Elliott B. Don't forget the siblings: School-aged siblings of children presenting to mental health services show at-risk patterns of attachment. Clin Child Psychol Psychiatry 2017; 22:245-259. [PMID: 27324573 DOI: 10.1177/1359104516653993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Family therapists understand that children presenting for treatment are often bearers of symptoms signalling relational problems within the family system. Rather than addressing the children's symptoms in isolation, family therapists typically take those relational problems as their starting point in therapy. This study used the School-aged Assessment of Attachment (SAA) to assess the self-protective (attachment) strategies of the siblings of children presenting for psychiatric evaluation and also of the siblings of control children drawn from the normative population. Siblings of children in the clinical group were much more likely than siblings of control children to use at-risk self-protective strategies and to have markers suggestive of unresolved loss or trauma. School-aged siblings were found to use a broad range of strategies, and the pattern of change from first born to later born involved either a reversal of strategy or a shift to a more complex strategy. The study highlights that siblings of children presenting to mental health services are significantly affected by family relational stress. A family systems approach to assessment, one that enquires about the wellbeing of all family members, will ensure that the emotional needs of siblings are also addressed during the therapy process.
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Affiliation(s)
- Kasia Kozlowska
- 1 The Children's Hospital at Westmead, Westmead, Australia; Brain Dynamics Centre at Westmead Millennium Institute of Medical Research, Westmead, Australia; and Discipline of Psychiatry and Discipline of Child and Adolescent Health, University of Sydney Medical School, Australia
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Kozlowska K, Chudleigh C, Elliott B, Landini A. The body comes to family therapy: Treatment of a school-aged boy with hyperventilation-induced non-epileptic seizures. Clin Child Psychol Psychiatry 2016; 21:669-685. [PMID: 26733398 DOI: 10.1177/1359104515621960] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present the case of a 10-year-old boy, Evan, where a knock to the head activated memories of past bullying, causing intense distress, activation of the body's stress-regulation systems and recurrent hospital presentations with hyperventilation-induced non-epileptic seizures. We describe the initial assessment session that enabled Evan and his family to understand the context for Evan's non-epileptic seizures, to engage with the therapeutic team and to collaborate in the implementation of a mind-body multimodal family-based intervention. Once the physical symptoms had been addressed therapeutically, we explored possible dangers within the family and school systems and we worked with Evan and his family to increase his ability to access comfort and protection from his parents. Our short hospital intervention highlighted the importance of ongoing therapeutic work with Evan and the family and laid the foundation stones for the next part of the family's therapeutic journey.
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Affiliation(s)
- Kasia Kozlowska
- Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia .,Discipline of Paediatrics and Child Health and Discipline of Psychiatry, Sydney Medical School, University of Sydney, NSW, Australia.,Brain Dynamics Centre, Westmead Millennium Institute for Medical Research, NSW, Australia
| | - Catherine Chudleigh
- Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | | | - Andrea Landini
- Scuola Bolognese di Psicoterapia Cognitiva, Italy.,Family Relations Institute, USA/Italy
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Affiliation(s)
- Kasia Kozlowska
- Psychological Medicine, The Children's Hospital at Westmead, Westmead 2145, NSW, Australia; Disciplines of Psychiatry and of Paediatrics and Child Health, University of Sydney Medical School, Sydney, NSW, Australia.
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Kozlowska K, Durheim E. Is bullying in children and adolescents a modifiable risk factor for mental illness? Aust N Z J Psychiatry 2014; 48:288-9. [PMID: 24317153 DOI: 10.1177/0004867413515529] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kozlowska K, Palmer DM, Brown KJ, Scher S, Chudleigh C, Davies F, Williams LM. Conversion disorder in children and adolescents: A disorder of cognitive control. J Neuropsychol 2014; 9:87-108. [DOI: 10.1111/jnp.12037] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/28/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Kasia Kozlowska
- Psychological Medicine; The Children's Hospital at Westmead; New South Wales Australia
- Disciplines of Psychiatry and of Paediatrics and Child Health; University of Sydney Medical School; New South Wales Australia
- Brain Dynamics Centre at Westmead Hospital and Westmead Millennium Institute; Westmead New South Wales Australia
| | - Donna M. Palmer
- Brain Dynamics Centre at Westmead Hospital and Westmead Millennium Institute; Westmead New South Wales Australia
- University of Sydney Medical School; New South Wales Australia
| | - Kerri J. Brown
- Brain Dynamics Centre at Westmead Hospital and Westmead Millennium Institute; Westmead New South Wales Australia
- University of Sydney Medical School; New South Wales Australia
- NSW Institute of Psychiatry; Parramatta BC New South Wales Australia
| | - Stephen Scher
- Department of Psychiatry; Harvard Medical School; McLean Hospital; Belmont Massachusetts USA
| | - Catherine Chudleigh
- Psychological Medicine; The Children's Hospital at Westmead; New South Wales Australia
| | - Fiona Davies
- Psychological Medicine; The Children's Hospital at Westmead; New South Wales Australia
| | - Leanne M. Williams
- Brain Dynamics Centre at Westmead Hospital and Westmead Millennium Institute; Westmead New South Wales Australia
- University of Sydney Medical School; New South Wales Australia
- Psychiatry and Behavioral Sciences; Stanford University; California USA
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Abstract
In this article we outline the framework our consultation-liaison team has developed for interviewing families whose children present with medically unexplained symptoms. The framework was developed over many years in the context of our work with a large number of families, who collectively taught us to be more sensitive with regard to the experience of such families in the medical system, and who reacted strongly when we moved prematurely to the use of psychological language or to questions about family relationships or emotional functioning. Throughout the interview we maintain a focus on the body: the family history of illness and, in particular, the story of the child's symptoms. We take a detailed, temporally ordered history of the symptom and ask for collateral information - family illness, family life events, events at school, family emotional responses - all in relation to the story of the symptoms. In the assessment interview and in our work in general, we focus on the body. We move very carefully and very slowly from the physical to the psychological, from talking about the body to talking about relationships and about the mind.
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Affiliation(s)
- Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Australia.
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Kozlowska K, Brown KJ, Palmer DM, Williams LM. Specific biases for identifying facial expression of emotion in children and adolescents with conversion disorders. Psychosom Med 2013; 75:272-80. [PMID: 23440229 DOI: 10.1097/psy.0b013e318286be43] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 01/18/2023]
Abstract
OBJECTIVE This study aimed to assess how children and adolescents with conversion disorders identify universal facial expressions of emotion and to determine whether identification of emotion in faces relates to subjective emotional distress. METHODS Fifty-seven participants (41 girls and 16 boys) aged 8.5 to 18 years with conversion disorders and 57 age- and sex-matched healthy controls completed a computerized task in which their accuracy and reaction times for identifying facial expressions were recorded. To isolate the effect of individual emotional expressions, participants' reaction times for each emotion (fear, anger, sadness, disgust, and happiness) were subtracted from their reaction times for the neutral control face. Participants also completed self-report measures of subjective emotional distress. RESULTS Children/Adolescents with conversion disorders showed faster reaction times for identifying expressions of sadness (t(112) = -2.2, p = .03; 444 [609] versus 713 [695], p = .03) and slower reactions times for happy expressions (t(99.3) = 2.28, p ≤ .024; -33 [35] versus 174 [51], p = .024), compared with controls (F(33.75, 419.81) = 3.76, p < .001). There were no significant correlations (at the corrected p value of .01) between reaction times and subjective reports of perceived distress (r values ranged from 092 to 0.221; p > .018). There were also no differences in identification accuracy for any emotion (p > .82). CONCLUSIONS The observation of faster reaction times to sad faces in children and adolescents with conversion disorders suggests increased vigilance and motor readiness to emotional signals that are potential threats to self or to close others. These effects may occur before conscious processing.
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Affiliation(s)
- Kasia Kozlowska
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Sydney, Australia.
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