1
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Moore AIG, Golding JF, Alenova A, Castro P, Bronstein AM. Sense of direction in vestibular disorders. J Vestib Res 2024:VES230082. [PMID: 38489201 DOI: 10.3233/ves-230082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
BACKGROUND Our sense of direction (SOD) ability relies on the sensory integration of both visual information and self-motion cues from the proprioceptive and vestibular systems. Here, we assess how dysfunction of the vestibular system impacts perceived SOD in varying vestibular disorders, and secondly, we explore the effects of dizziness, migraine and psychological symptoms on SOD ability in patient and control groups. METHODS 87 patients with vestibular disorder and 69 control subjects were assessed with validated symptom and SOD questionnaires (Santa Barbara Sense of Direction scale and the Object Perspective test). RESULTS While patients with vestibular disorders performed significantly worse than controls at the group level, only central and functional disorders (vestibular migraine and persistent postural perceptual dizziness), not peripheral disorders (benign-paroxysmal positional vertigo, bilateral vestibular failure and Meniere's disease) showed significant differences compared to controls on the level of individual vestibular groups. Additionally, orientational abilities associated strongly with spatial anxiety and showed clear separation from general dizziness and psychological factors in both patient and control groups. CONCLUSIONS SOD appears to be less affected by peripheral vestibular dysfunction than by functional and/or central diagnoses, indicating that higher level disruptions to central vestibular processing networks may impact SOD more than reductions in sensory peripheral inputs. Additionally, spatial anxiety is highly associated with orientational abilities in both patients and control subjects.
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Affiliation(s)
- Alexander I G Moore
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
| | - John F Golding
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
- Department of Psychology, University of Westminster, London, UK
| | - Anastasia Alenova
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
| | - Patricia Castro
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
- Universidad del Desarrollo, Escuela de Fonoaudiologia, Facultad de Medicina Clinica Alemana, Santiago, Chile
| | - Adolfo M Bronstein
- Department of Brain Sciences, Neuro-otology Unit, Imperial College London, London, UK
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2
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Ellmers TJ, Kal EC. Exploring the role of attention towards balance in chronic dizziness: Development of the Balance Vigilance Questionnaire. Eur J Neurol 2024; 31:e16148. [PMID: 38015469 DOI: 10.1111/ene.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE Vigilance towards balance has been proposed to underpin various chronic dizziness disorders, including persistent postural-perceptual dizziness (PPPD). The objective of this study was to develop (through patient input) a validated balance-specific measure of vigilance that comprehensively assesses the varied ways in which this construct may manifest. METHODS We developed the Balance Vigilance Questionnaire (Balance-VQ) through patient and clinician feedback, designed to assess vigilance towards balance. We then validated the questionnaire in 497 participants consisting of patients diagnosed with chronic dizziness disorders (including 97 individuals diagnosed with PPPD) and healthy controls. RESULTS The final six-item Balance-VQ was shown to be a valid and reliable way to assess vigilance towards balance. Scores were significantly higher in individuals diagnosed with PPPD compared to controls. Although scores were also higher in the PPPD group compared to individuals with diagnosed vestibular disorders other than PPPD, Balance-VQ scores did not discriminate between the two groups when confounding factors (including dizziness severity) were controlled for. Scores did, however, independently discriminate between the PPPD group and individuals who experience dizziness in daily life, but who have not been diagnosed with a neuro-otological disorder. CONCLUSIONS Our findings confirm that the Balance-VQ is a valid and reliable instrument for assessing vigilance towards balance. As symptom vigilance has been identified as a key risk factor for developing chronic dizziness following acute vestibular symptoms or balance disruption, we recommend using the Balance-VQ as a screening tool in people presenting with such symptoms.
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Affiliation(s)
- Toby J Ellmers
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
| | - Elmar C Kal
- Centre for Cognitive Neuroscience, Department of Health Sciences, College of Health, Medicine, and Life Sciences, Brunel University London, Uxbridge, UK
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3
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Petzke TM, Weber K, Van den Bergh O, Witthöft M. Illustrating the pathway from affect to somatic symptom: the Affective Picture Paradigm. Cogn Emot 2024:1-17. [PMID: 38411187 DOI: 10.1080/02699931.2024.2319273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/09/2023] [Indexed: 02/28/2024]
Abstract
High levels of somatic symptom distress represent a core component of both mental and physical illness. The exact aetiology and pathogenesis of this transdiagnostic phenomenon remain largely unknown. The Affective Picture Paradigm (APP) represents an innovative experimental paradigm to study somatic symptom distress. Based on the HiTOP framework and a population-based sampling approach, associations between facets of somatic symptom distress and symptoms induced by the APP were explored in two studies (N1 = 201; N2 = 254) using structural equation bi-factor models. Results showed that the APP effect was significantly positively correlated with general somatic symptom distress (PHQ-15, HiTOP), cardio-respiratory symptoms (PHQ-15), as well as difficulties identifying feelings. In conclusion, negative affective cues in the APP can elicit somatic symptoms, particularly in people with higher levels of somatic symptom distress. Difficulties identifying feelings might contribute to this phenomenon. Results are compatible with a predictive processing account of somatic symptom perception.
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Affiliation(s)
- Tara M Petzke
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | - Kathrin Weber
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes-Gutenberg-University Mainz, Mainz, Germany
| | | | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes-Gutenberg-University Mainz, Mainz, Germany
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4
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Zloof Y, Peretz L, Braun M, Simchoni M, Tsur AM, Tzur D, Derazne E, Ben-Tov A, Pinhas-Hamiel O, Amarilyo G, Daher S, Shlaifer A, Braun-Moscovici Y. Hypermobility spectrum disorders and irritable bowel syndrome: A nationwide study of 1.6 million adolescents. J Gastroenterol Hepatol 2023; 38:2076-2082. [PMID: 37658800 DOI: 10.1111/jgh.16341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND AIM The association between hypermobility spectrum disorders/hypermobile type Ehlers-Danlos syndrome (HDS/hEDS) and irritable bowel syndrome (IBS) is yet to be clarified. We aimed to assess this association in a national sample of adolescents. METHODS A population-based cross-sectional study included 1 627 345 Israeli adolescents (58% male; mean age 17 years) who were medically assessed before compulsory military service during 1998-2020. Diagnoses of HSD/hEDS and IBS were confirmed by board-certified specialists. The prevalence and odds ratios (ORs) for IBS in adolescents with and without HSD/hEDS were computed. RESULTS A total of 4686 adolescents (2553 male) with HSD/hEDS were identified, of whom 71 were diagnosed with IBS (prevalence = 1.5%). Of the 1 621 721 adolescents in the control group, 8751 were diagnosed with IBS (prevalence = 0.5%). Unadjusted logistic regression revealed a significant association between HSD/hEDS and IBS (OR = 2.16 [95% confidence interval, CI, 1.90-2.45]), which persisted in multivariable adjusted models (OR = 2.58 [95% CI, 2.02-3.24]), and in several sensitivity analyses. The association was evident in both male and female adolescents with ORs of 2.60 (95% CI, 1.87-3.49), and 2.46 (95% CI, 1.66-3.49), respectively. The association was accentuated in a sensitivity analysis accounting for other medical and psychiatric comorbidities. CONCLUSIONS We found a significant association between HSD/hEDS and IBS in both male and female adolescents. Clinical awareness of the association can promote early diagnosis of IBS and appropriate multidisciplinary treatment. Further research is required to identify the common pathological pathways of the conditions and to develop new IBS treatment strategies for people with HSD/hEDS.
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Affiliation(s)
- Yair Zloof
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lidor Peretz
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Maya Braun
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Maya Simchoni
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Avishai M Tsur
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Preventive Medicine and Epidemiology, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
- Department of Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Dorit Tzur
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Ben-Tov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Sourasky Medical Center, Tel Aviv, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Gil Amarilyo
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Saleh Daher
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Institute of Gastroenterology and Liver Diseases, Department of Medicine, Hadassah-University Hospital, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Shlaifer
- Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University, Jerusalem, Israel
| | - Yolanda Braun-Moscovici
- B Shine Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Abstract
Retrograde cricopharyngeus dysfunction (R-CPD) causes an inability to belch. This case report describes the successful treatment of R-CPD with the use of hypnosis. Thereafter, the patient was able to burp small amounts of air, and was encouraged to continue his use of hypnosis as needed. Hypnosis and possibly other noninvasive treatments should be used for R-CPD before employment of more invasive and costly treatments such as botulinum toxin administration.
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Aregawi LG, Shokrolahi M, Gebremeskel TG, Zoltan C. The Effect of Ginger Supplementation on the Improvement of Dyspeptic Symptoms in Patients With Functional Dyspepsia. Cureus 2023; 15:e46061. [PMID: 37771933 PMCID: PMC10525921 DOI: 10.7759/cureus.46061] [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] [Accepted: 09/27/2023] [Indexed: 09/30/2023] Open
Abstract
Background Functional dyspepsia (FD) is a common gastrointestinal disorder with a higher occurrence in the Western world. Conventional medications are not effective for FD with patients turning to alternative herbal medicines such as ginger. This study aimed to evaluate the effect of ginger supplementation on the improvement of FD symptoms. Methodology A before-and-after clinical study was conducted at the University of Debrecen, Internal Medicine outpatient department over a period of four weeks. Two Swanson ginger supplements each at a dose of 540 mg/day before lunch and dinner were given to 51 FD patients. Wilcoxon signed-rank test was used to estimate the differences in FD symptoms after ginger supplementation and at the baseline. The p-value was determined to test the association between variables, with p-values <0.05 considered the cutoff for statistically significant association. Results In this study, after four weeks of ginger supplementation, we observed a significant change in most dyspepsia symptoms as follows: postprandial fullness (p = 0.033, 95% CI = 0.01-0.26), early satiety (p = 0.001, 95% CI = 0.10-0.37), epigastric pain (p = 0.000, 95% CI = 0.16-0.42), epigastric burning (p = 0.003, 95% CI = 0.10-0.45), and heartburn (p = 0.209, 95% CI = -0.04-0.20). Conclusions Based on our findings ginger can be considered as a promising alternative supplementary medicine for FD.
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Affiliation(s)
- Lemlem Gebremariam Aregawi
- Institute of Nutrition, Faculty of Medical Sciences, University of Debrecen, Debrecen, HUN
- Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, ETH
| | | | - Teferi Gebru Gebremeskel
- Flinders Health and Medical Research Institute (FHMRI), College of Medicine and Public Health, Flinders University, Adelaide, AUS
| | - Csiki Zoltan
- Internal Medicine, University of Debrecen, Debrecen, HUN
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Ansems SM, Berger MY, Pieterse E, Nanne S, Beugel GG, Couwenberg RPE, Holtman GA. Management of children with non-acute abdominal pain and diarrhea in Dutch primary care: a retrospective cohort study based on a routine primary care database (AHON). Scand J Prim Health Care 2023; 41:267-275. [PMID: 37427876 PMCID: PMC10478593 DOI: 10.1080/02813432.2023.2231054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 06/25/2023] [Indexed: 07/11/2023] Open
Abstract
OBJECTIVE To describe the testing, prescription, referral, and follow-up management by general practitioners (GPs) for children presenting with non-acute abdominal pain and/or diarrhea in primary care. DESIGN Retrospective cohort study with one-year follow-up. SETTING Registry data from a Dutch primary care database (AHON) between 2015 and 2019. SUBJECTS Children aged 4-18 years old who presented by face-to-face consultation in primary care for non-acute abdominal pain and/or diarrhea (>7 days). MAIN OUTCOME MEASURES We recorded the proportions of children who received (1) diagnostic testing, medicine prescriptions, follow-up consultations, and referrals at their first visit and (2) repeat consultations and referrals by one-year of follow-up. RESULTS Among the 2200 children (median age, 10.5 years; interquartile range, 7.0-14.6) presenting to a GP with non-acute abdominal pain and/or diarrhea, most reported abdominal pain (78.7%). At the first visit, GPs performed diagnostic testing for 32.2%, provided a prescription to 34.5%, and referred 2.5% to secondary care. Twenty-five percent of the children had a follow-up consultation within four weeks and 20.8% had a repeat consultation between four weeks and one year. Thirteen percent of the children were referred to secondary care by one year. However, only 1% of all children had documentation of an organic diagnosis needing management in secondary care. CONCLUSION One-third of children received diagnostic testing or a medicine prescription. Few had a follow-up consultation and >10% was referred to pediatric care. Future research should explore the motivations of GPs why and which children receive diagnostic and medical interventions.
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Affiliation(s)
- Sophie M. Ansems
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Marjolein Y. Berger
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Elaine Pieterse
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Sjaantje Nanne
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Gina G. Beugel
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Ria P. E. Couwenberg
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
| | - Gea A. Holtman
- Department of Primary and Long-term Care, University Medical Center Groningen, Groningen, the Netherlands
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8
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Mamo N, van de Klundert M, Tak L, Hartman TO, Hanssen D, Rosmalen J. Characteristics of collaborative care networks in functional disorders: A systematic review. J Psychosom Res 2023; 172:111357. [PMID: 37392482 DOI: 10.1016/j.jpsychores.2023.111357] [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] [Received: 03/10/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Functional disorders (FD) are complex conditions, for which multidisciplinary involvement is often recommended. Collaborative care networks (CCN) may unlock the potential of the multidisciplinary team (MDT) in FD care. To understand what characteristics should be part of CCNs in FD, we studied the composition and characteristics of existing CCNs in FD. METHODS We performed a systematic review following PRISMA guidelines. A search of PubMed, WebofScience, PsycInfo, SocINDEX, AMED and CINAHL was undertaken to select studies describing CCNs in FD. Two reviewers extracted characteristics of the different CCNs. Characteristics were classified as relating to structure and processes of networks. RESULTS A total of 62 studies were identified representing 39 CCNs across 11 countries. Regarding structural characteristics, we found that most networks are outpatient, secondary-care based, with teams of between two and 19 members. Medical specialists were most commonly involved and the typical team leads as well as main patient contacts were general practitioners (GPs) or nurses. Regarding processes, collaboration was demonstrated mostly during assessment, management and patient education, less often during rehabilitation and follow-up, mostly using MDT meetings. CCNs provided a wide range of treatment modalities, reflecting a biopsychosocial approach, including psychological therapies, physiotherapy and social and occupational therapy. CONCLUSION CCNs for FD are heterogeneous, showing a wide variety of structures as well as processes. The heterogeneity of results provides a broad framework, demonstrating considerable variation in how this framework is applied in different contexts. Better development of network evaluation, as well as professional collaboration and education processes is needed.
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Affiliation(s)
- Nick Mamo
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands; Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands.
| | - Manouk van de Klundert
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lineke Tak
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Denise Hanssen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands
| | - Judith Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands; Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, Netherlands
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9
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Byrne G, Connon G. The use of acceptance and commitment therapy in managing psychological symptoms in paediatric functional non-epileptic attacks: A clinical report. Clin Child Psychol Psychiatry 2022:13591045221143553. [PMID: 36448442 DOI: 10.1177/13591045221143553] [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: 12/05/2022]
Abstract
Functional non-epileptic attacks (FNEA) are seizure like activities that occur without any organic cause. Although a debilitating and costly disorder, there is much debate within the clinical literature on the causes and prognosis of FNEA, as well as possible effective psychological interventions. This is especially true for FNEA occurring in paediatric populations. Limited evidence to date suggests that acceptance and commitment therapy (ACT) shows promise and has pragmatic benefits in the context of functional disorders for adults. This case study provides information of a brief (8-session) ACT protocol targeting FNEA and associated emotional difficulties in a 12-year child. Treatment aimed to promote psychological flexibility and reduce functional interference of FNEA symptoms using ACT consistent techniques. Post-treatment, the child demonstrated reliable/clinical recovery in psychological flexibility, symptom interference and anxiety, as well as a marked reduction in the frequency of FNEA episodes. The majority of these gains were evidenced at 5-month follow-up. Such promising findings need to be tempered by methodological considerations.
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Affiliation(s)
- Gary Byrne
- Department of Primary Care Psychology, 8004Health Service Executive (HSE), Dublin South, Ireland
| | - Graham Connon
- Department of Psychology, 8004Health Service Executive (HSE), Dublin North, Ireland
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10
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Ren Y, Guo X, Cai Y, Huo X, Ying X, Lu Q, Jiang X, Jiang B. Difference in meal-related esophageal intraluminal impedance change between gastroesophageal reflux disease and functional disorders. Scand J Gastroenterol 2022; 58:443-447. [PMID: 36314511 DOI: 10.1080/00365521.2022.2141073] [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: 11/07/2022]
Abstract
OBJECTIVES Gastroesophageal reflux disease (GERD) has overlapping symptoms with functional disorders such as functional heart burn. Twenty-four-hour pH with impedance monitoring is useful for differentiation. The intraluminal impedance change with meal in distal esophagus is not investigated. METHODS We performed a retrospective investigation of clinical files, 24-hour pH with intraluminal impedance monitoring in patients with GERD and functional disorders. The post-reflux swallow induced peristaltic wave (PSPW) index as well as the impedance in distal esophagus before the first meal and 30 min and 60 min after the meal were measured and analyzed. RESULTS A significant decrease of intraluminal impedance in distal esophagus was noted at 30 min (ΔI30min -301.5 [747.5] Ω, p = 0.018) and recovered at 60 min (ΔI60min -194.6 [766.0] Ω, p = 0.126) after meals in GERD patients. On the other hand, there was no significant change of impedance in patients with functional disorders. There were positive correlations between ΔI30min and PSPW index (correlation = 0.232, p = 0.038). Comparing GERD to functional disorders, the best cut-off value for ΔI30min was -212Ω with 74.4% sensitivity and 60.5% specificity. CONCLUSIONS The intraluminal impedance in distal esophagus was lowered after meals in GERD patients other than functional disorders. This impedance change was correlated with PSPW index and could help differentiate GERD from functional disorders.
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Affiliation(s)
- Yutang Ren
- Department of Gastroenterology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Xiaojuan Guo
- Department of Gastroenterology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yunting Cai
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Xueru Huo
- Department of Gastroenterology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Xiaofang Ying
- Department of Gastroenterology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Qiuxiang Lu
- Department of Gastroenterology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Xuan Jiang
- Department of Gastroenterology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Bo Jiang
- Department of Gastroenterology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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11
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Sebaratnam G, Karulkar N, Calder S, Woodhead JS, Keane C, Carson DA, Varghese C, Du P, Waite SJ, Tack J, Andrews CN, Broadbent E, Gharibans AA, O’Grady G. Standardized system and App for continuous patient symptom logging in gastroduodenal disorders: Design, implementation, and validation. Neurogastroenterol Motil 2022; 34:e14331. [PMID: 35156270 PMCID: PMC9541247 DOI: 10.1111/nmo.14331] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/09/2022] [Accepted: 01/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Functional gastroduodenal disorders include functional dyspepsia, chronic nausea and vomiting syndromes, and gastroparesis. These disorders are common, but their overlapping symptomatology poses challenges to diagnosis, research, and therapy. This study aimed to introduce and validate a standardized patient symptom-logging system and App to aid in the accurate reporting of gastroduodenal symptoms for clinical and research applications. METHODS The system was implemented in an iOS App including pictographic symptom illustrations, and two validation studies were conducted. To assess convergent and concurrent validity, a diverse cohort with chronic gastroduodenal symptoms undertook App-based symptom logging for 4 h after a test meal. Individual and total post-prandial symptom scores were averaged and correlated against two previously validated instruments: PAGI-SYM (for convergent validity) and PAGI-QOL (for concurrent validity). To assess face and content validity, semi-structured qualitative interviews were conducted with patients. KEY RESULTS App-based symptom reporting demonstrated robust convergent validity with PAGI-SYM measures of nausea (rS =0.68), early satiation (rS =0.55), bloating (rS =0.48), heartburn (rS =0.47), upper gut pain (rS =0.40), and excessive fullness (rS =0.40); all p < 0.001 (n = 79). The total App-reported Gastric Symptom Burden Score correlated positively with PAGI-SYM (rS =0.56; convergent validity; p < 0.001), and negatively with PAGI-QOL (rS = -0.34; concurrent validity; p = 0.002). Interviews demonstrated that the pictograms had adequate face and content validity. CONCLUSIONS AND INFERENCES The continuous patient symptom-logging App demonstrated robust convergent, concurrent, face, and content validity when used within a 4-h post-prandial test protocol. The App will enable standardized symptom reporting and is anticipated to provide utility in both research and clinical practice.
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Affiliation(s)
| | | | - Stefan Calder
- The University of AucklandAucklandNew Zealand,Alimetry LtdAucklandNew Zealand
| | - Jonathan S.T. Woodhead
- Alimetry LtdAucklandNew Zealand,Maurice Wilkins Centre for Molecular BiodiscoveryAucklandNew Zealand
| | - Celia Keane
- The University of AucklandAucklandNew Zealand,Alimetry LtdAucklandNew Zealand
| | | | | | - Peng Du
- The University of AucklandAucklandNew Zealand,Alimetry LtdAucklandNew Zealand
| | | | - Jan Tack
- Department of GastroenterologyUniversity HospitalsLeuvenBelgium
| | - Christopher N. Andrews
- Alimetry LtdAucklandNew Zealand,Division of GastroenterologyCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | | | - Armen A. Gharibans
- The University of AucklandAucklandNew Zealand,Alimetry LtdAucklandNew Zealand
| | - Greg O’Grady
- The University of AucklandAucklandNew Zealand,Alimetry LtdAucklandNew Zealand
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12
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Assmann SL, Keszthelyi D, Breukink SO. Health aspects of faecal incontinence are complex and multi-layered. United European Gastroenterol J 2022; 10:603-604. [PMID: 35666023 DOI: 10.1002/ueg2.12261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sadé L Assmann
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Daniel Keszthelyi
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Stéphanie O Breukink
- Department of Internal Medicine, Division of Gastroenterology-Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
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13
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Ng QX, Lim YL, Loke W, Chee KT, Lim DY. Females with Eating Disorders and Urinary Incontinence: A Psychoanalytic Perspective. Int J Environ Res Public Health 2022; 19:ijerph19084874. [PMID: 35457741 PMCID: PMC9028028 DOI: 10.3390/ijerph19084874] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/28/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023]
Abstract
Eating disorders (EDs) are complicated mental illnesses with significant treatment resistance and dropout rates. For successful treatment, it is important for clinicians to better understand the patients’ narrative and their lived experiences. A thorough psychodynamic understanding of patients’ childhood attachment and primary relationships, personality traits and mental processes is, therefore, crucial for managing patients with ED. Interestingly, several studies have observed an association between functional urinary symptoms and individuals with ED. EDs such as anorexia nervosa are associated with an increased risk of all urinary symptoms, and functional incontinence was also more common in extreme female athletes with low energy availability and with disordered eating. There is, however, a dearth of literature describing this relationship, and the underlying mechanisms remain remote. In this paper, we present a psychoanalytic approach to the presence of urinary symptoms in females with EDs. We hypothesize that these symptoms are tied to specific traits or characteristics of ED patients, namely the overarching need for control, a pathological strive for perfection and the self-denial of basic bodily urges. This is discussed in relation to psychopathological processes, development and personality factors commonly seen in patients with ED.
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Affiliation(s)
- Qin Xiang Ng
- MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore; (Y.L.L.); (W.L.)
- Correspondence: ; Tel.: +65-6638-6979
| | - Yu Liang Lim
- MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore; (Y.L.L.); (W.L.)
| | - Wayren Loke
- MOH Holdings Pte Ltd., 1 Maritime Square, Singapore 099253, Singapore; (Y.L.L.); (W.L.)
| | - Kuan Tsee Chee
- Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore 539747, Singapore; (K.T.C.); (D.Y.L.)
| | - Donovan Yutong Lim
- Institute of Mental Health, 10 Buangkok View, Buangkok Green, Medical Park, Singapore 539747, Singapore; (K.T.C.); (D.Y.L.)
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14
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Ruschil V, Mazurak N, Hofmann M, Loskutova E, Enck P, Freilinger T, Weimer K. Decreased Autonomic Reactivity and Psychiatric Comorbidities in Neurological Patients With Medically Unexplained Sensory Symptoms: A Case-Control Study. Front Neurol 2021; 12:713391. [PMID: 34557148 PMCID: PMC8453010 DOI: 10.3389/fneur.2021.713391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/22/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022] Open
Abstract
Up to 48% of patients with medically unexplained symptoms seen in neurological practice suffer from sensory symptoms, which could be of functional nature or secondary to psychiatric disorders. These patients show high medical care utilization causing elevated healthcare costs. Despite the high prevalence, little is known about clinical characteristics and pathophysiological mechanisms. For functional disorders such as irritable bowel syndrome, a reduction of heart rate variability (HRV) has been shown, suggesting a dysfunction of the autonomic nervous system (ANS). The aim of this study was to investigate psychological data and functional changes of the ANS in patients with medically unexplained sensory symptoms (MUSS). In this exploratory pilot study, 16 patients (11 females, 31.6 ± 11.9 years) with MUSS, who were recruited at a single tertiary neurological center, underwent a structured clinical interview (SCID) to evaluate psychiatric comorbidities. Patients and age- and sex-matched healthy volunteers filled in questionnaires, and individual sensory thresholds (perception, pain) were detected by quantitative sensory testing (QST). HRV was assessed at baseline and under three different experimental conditions (tonic pain stimulus, placebo application, cold-face test). All tests were repeated after 6–8 weeks. SCID interviews revealed clinical or subclinical diagnoses of psychiatric comorbidities for 12 patients. Questionnaires assessing somatization, depression, anxiety, and perceived stress significantly discriminated between patients with MUSS and healthy controls. While there was no difference in QST, reduced ANS reactivity was found in patients during experimental conditions, particularly with regard to vagally mediated HRV. Our pilot study of neurological patients with MUSS reveals a high prevalence of psychiatric comorbidities and provides evidence for altered ANS function. Our data thus give insight in possible underlying mechanisms for these symptoms and may open the door for a better diagnostic and therapeutic approach for these patients in the future.
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Affiliation(s)
- Victoria Ruschil
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
| | - Martin Hofmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
| | - Ekaterina Loskutova
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
| | - Tobias Freilinger
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Neurology, Klinikum Passau, Passau, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
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15
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Orzechowska A, Maruszewska P, Gałecki P. Cognitive Behavioral Therapy of Patients with Somatic Symptoms-Diagnostic and Therapeutic Difficulties. J Clin Med 2021; 10:jcm10143159. [PMID: 34300324 PMCID: PMC8307926 DOI: 10.3390/jcm10143159] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 12/16/2022] Open
Abstract
In every somatic disease we can find a psychological element, just as it is not uncommon for numerous physical symptoms to occur in a mental disease. Nowadays, the patient is no longer just the “owner” of the sick organ but is considered and treated as a “whole”. The interpenetration of somatic manifestations with mental health problems forces patients who experience subjective suffering, including mental suffering, from current symptoms to visit specialists from different fields of medicine, and their treatment does not bring about any improvement. Cognitive behavioral psychotherapy (CBT) is one form of therapy that attempts to respond to the needs of an increasing—in recent years—number of patients who demonstrate somatic disorders of a multifaceted nature. The co-occurrence of physical and mental disorders repeatedly makes it impossible to determine which symptoms were the cause and which were the effect; hence, it is difficult to establish clear boundaries between the categories of these disorders and diseases. The therapist, to whom the patient with somatic diseases is eventually referred, may be faced with a diagnostic dilemma, the solution of which will give direction to further psychotherapeutic work. The common feature of this group of patients is a strong focus on physical ailments, while omitting or almost completely ignoring the psychological factors involved. The purpose of this paper is to present the causally diverse circumstances in which a patient with physical symptoms needs diagnosis and therapeutic support from the perspective of a cognitive behavioral approach.
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16
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Abstract
Patients presenting with symptoms suggestive of functional disorder are very frequent in practice. While it is always necessary to exclude treatable organic pathology, there are important clues in the presentation that can help the clinician. In particular, it is important to identify pathological health anxiety early in assessment, as failure to do so may lead to unnecessary investigations and the dangerous path of reinforcing reassurance. Because full assessment of functional symptoms takes time, it is suggested that a clinical support nurse with some training in psychological management should be available to guide the management of the patients with these disorders. Such support nurses, based in the clinic, offer a seamless way of providing care that is not achieved by external referral to psychologists or equivalent staff.
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17
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Abstract
Functional gastrointestinal (GI) disorders (eg irritable bowel syndrome and functional dyspepsia) are very common conditions which are associated with very poor quality of life and high healthcare utilisation. They are caused by disorders of GI functioning, namely altered gut sensitivity, motility, microbiota, immune functioning and central nervous system processing. They cause chronic symptoms throughout the gut (eg pain, dyspepsia and altered bowel habit), all of which are made worse by maladaptive patient behaviours, stress and psychological comorbidity. Management involves a biopsychosocial approach involving changes in lifestyle and diet, addressing coexisting psychological comorbidity and using medication to treat underlying pathophysiology. Pharmacological treatment with antispasmodics, neuromodulators, motility agents and antidepressants is effective. Psychotherapy in motivated individuals is equally effective. Success of treatment is increased by a good doctor-patient relationship and so this needs to be taken into account during the consultation.
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Affiliation(s)
- Asma Fikree
- Centre for Neuroscience, Surgery and Trauma, London, UK
| | - Peter Byrne
- honorary senior lecturer and associate registrar for public mental health, Royal London Hospital, London, UK, Centre for Neuroscience, Surgery and Trauma, London, UK and Royal College of Psychiatrists, London, UK
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18
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Kan YM, Chu SY, Loo CK. Diagnostic accuracy of fecal calprotectin in predicting significant gastrointestinal diseases. JGH Open 2021; 5:647-652. [PMID: 34124380 PMCID: PMC8171161 DOI: 10.1002/jgh3.12548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 12/22/2022]
Abstract
Background and Aim It is often unreliable to triage patients for timely endoscopic investigations based on symptoms alone. We need an objective assessment to differentiate between organic gastrointestinal diseases and functional bowel symptoms. We evaluated the diagnostic accuracy of fecal calprotectin (FC) in predicting organic gastrointestinal diseases. Methods In a prospective observational study, consecutive patients referred for colonoscopy to the Department of Medicine and Geriatrics at the Kwong Wah Hospital in Hong Kong were recruited. Stool samples were collected within 24 h before colonoscopy. FC was measured by a commercial kit. Upper endoscopy investigations were then proceeded if normal colonoscopy but elevated FC. Results Two hundred and seventy out of 429 patients had FC above 50 μg/g. Eighty‐six out of 270 with elevated FC had significant colonoscopy pathological findings. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FC test for diagnosing a significant organic colonoscopy or upper endoscopy disease were 91.7, 55.6, 57.0, and 91.2%, respectively. The NPV of FC for colorectal cancer, high risk polyp, and colon inflammation were 98.7, 96.2, and 98.1%, respectively. The NPV of FC in the condition of altered bowel habit or abdominal pain in predicting colorectal cancer and inflammation were 93.8 and 100%, respectively. Conclusions FC is a reliable marker of ruling out organic bowel diseases. A single negative FC test could be used as a triage tool to prioritize the need and urgency of further investigation, particularly in the setting of altered bowel habits and abdominal pain.
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Affiliation(s)
- Yee Man Kan
- Department of Medicine and Geriatrics Kwong Wah Hospital Kowloon Hong Kong
| | - Sin Yan Chu
- Department of Pathology Kwong Wah Hospital Kowloon Hong Kong
| | - Ching Kong Loo
- Department of Medicine and Geriatrics Kwong Wah Hospital Kowloon Hong Kong
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19
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Abstract
When radiation is focally delivered to brain tissue at sub-ablative doses, neural activity may be altered. When done at a specific brain circuit node or connection, this is referred to as “radiomodulation.” Radiation-induced effects on brain tissue, basic science, and clinical research that supports the radiomodulation hypothesis are reviewed in this article. We review progress in defining the necessary parameters in terms of dose, volumes, and anatomical location. It may be possible to deliver therapeutic neuromodulation that is non-invasive, non-destructive, and durable.
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Affiliation(s)
- M Bret Schneider
- Chief Medical Officer, Zap Surgical Systems, Inc., San Carlos, USA.,Department of Psychiatry, Stanford University School of Medicine, Stanford, USA
| | - Brian Walcott
- Neurosurgery, University of Chicago, Chicago, USA.,Neurosurgery, Northshore University HealthSystem, Evanston, USA
| | - John R Adler
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, USA
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20
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Miura K, Oshima T, Ito C, Horikawa T, Yamada M, Tomita T, Fukui H, Miwa H. Vitamin D receptor is overexpressed in the duodenum of patients with irritable bowel syndrome. J Gastroenterol Hepatol 2021; 36:951-958. [PMID: 32839988 DOI: 10.1111/jgh.15225] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/25/2020] [Revised: 07/21/2020] [Accepted: 08/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders, and bile acids are thought to be associated with the pathogenesis of IBS. Bile acid receptors are expressed on intestinal epithelial cells. However, no study has assessed bile acid receptor proteins in IBS. Therefore, we examined the intestinal mucosal expression of bile acid receptors in patients with IBS. METHODS Intestinal biopsies were performed in patients with IBS and controls. Mast cells, vitamin D receptor (VDR), and somatostatin were stained with specific antibodies. Levels of VDR, farnesoid X receptor (FXR), takeda-G-protein-receptor-5 (TGR5), claudins, and transient-receptor-potential-cation-channel-subfamily-V-member 6 (TRPV6) were assessed by western blotting. RESULTS 3Mast cell counts in the second part of the duodenum were significantly higher in patients with IBS than in controls. VDR protein levels were significantly elevated in the duodenum and terminal ileum of patients with IBS compared with controls, although this difference was not seen in the cecum or rectum. FXR and TGR5 protein levels did not differ in any part of the intestine. VDR-positive cryptal epithelia in IBS were distributed not only at basal crypt but also along the upper part of the basal crypt epithelial cells. In contrast, the pattern of gut somatostatin-positive cells, claudins, and TRPV6 levels did not differ. CONCLUSIONS The number of mast cells in the duodenum was significantly increased, and the protein expression levels of VDR, but not those of FXR or TGR5, were elevated in the duodenal epithelial crypt in patients with IBS.
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Affiliation(s)
- Ko Miura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Chiyomi Ito
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomoki Horikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Mayumi Yamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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21
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Kovacic K, Li BUK. Cyclic vomiting syndrome: A narrative review and guide to management. Headache 2021; 61:231-243. [PMID: 33619730 DOI: 10.1111/head.14073] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 11/18/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/BACKGROUND Cyclic vomiting syndrome (CVS) is a disabling disorder of gut-brain interaction manifested by stereotypical and severe episodes of nausea and vomiting. Prevalence data indicate that CVS affects 1-2% of children and there has been a recent dramatic rise in diagnosed adults. METHODS This narrative review summarizes relevant literature pertaining to pediatric and adult CVS and provides a guide to management based on extensive clinical experience. RESULTS More timely diagnosis is facilitated by an expert consensus diagnostic approach and limited testing. Some diagnostic tests of exclusion remain essential. These include an upper gastrointestinal (GI) contrast study to exclude intestinal malrotation and basic laboratory screening. An abdominal ultrasound is recommended to exclude renal hydronephrosis in children and biliary disease in adults. Exclusion of metabolic/genetic conditions is warranted in those with specific warning signs, presentation in infants/toddler age, and in those with refractory disease. In the absence of chronic GI symptoms, referral to a GI specialist for upper endoscopy is generally not necessary in children but recommended in adults. A large subset termed migraine-equivalent CVS display strong clinical and genetic features of migraine. A unifying pathophysiologic core concept involves neuronal hyperexcitability and aberrant central modulation of autonomic signals. This is coupled with multiple susceptibility factors including mitochondrial dysfunction/cellular energy deficits, a hyper-responsive hypothalamic-pituitary-adrenal axis and many comorbidities that increase vulnerability to triggering events. CVS episodes are frequently triggered by stressors and intercurrent illnesses. Lifestyle and non-pharmacological interventions thus play a pivotal role in successful management. Pharmacological therapies are categorized into abortive, supportive/rescue, and prophylactic treatments. The majority respond particularly well to migraine-focused treatment strategies. CONCLUSION Despite improved characterization and understanding, CVS remains classified as a functional disorder of brain-gut interaction that is often disjointly managed by generalists and subspecialists. Early recognition, evaluation, and management will facilitate care and improve outcomes. Further research into its natural history with common progression to migraine headaches, neuroendocrine mechanisms, and the pathophysiologic relation to migraine diathesis is much needed.
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Affiliation(s)
- Katja Kovacic
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B U K Li
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
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22
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Cattaneo D, Gervasoni E, Anastasi D, Di Giovanni R, Brichetto G, Carpinella I, Cavalla P, Confalonieri P, Groppo E, Prosperini L, Tacchino A, Rovaris M, Solaro C. Prevalence and patterns of subclinical motor and cognitive impairments in non-disabled individuals with early multiple sclerosis: a multicenter cross-sectional study. Ann Phys Rehabil Med 2021; 65:101491. [PMID: 33454397 DOI: 10.1016/j.rehab.2021.101491] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Motor and cognitive disorders appear early in the course of multiple sclerosis (MS) and develop gradually over time. OBJECTIVE To study the frequency and pattern of subtle functional disorders in people with MS (PwMS) with no overt signs of disability in an early phase of the disease and their association with walking impairments in daily activities. METHODS In this cross-sectional study, we recruited PwMS with an Expanded Disability Status Scale (EDSS) score ≤ 2.5 and disease duration ≤ 5 years. Participants were assessed with functional scales rating walking endurance (6-Min Walk Test), perceived walking ability (Twelve-item Multiple Sclerosis Walking Scale), balance (Fullerton Advanced Balance scale_short), manual dexterity (Nine Hole Peg Test), fatigue (Fatigue Severity Scale), and cognitive impairments (Brief International Cognitive Assessment). RESULTS About 90% of the 82 PwMS (mean [SD] EDSS score 1.5 [0.7] and disease duration 2.2 [1.7] years) showed endurance values below the expected score; almost 30% showed impairment, and for 57%, perceived walking ability score was abnormal. Balance was impaired in 48% of participants, as was manual dexterity (29%) and fatigue (24%), but only a few showed cognitive impairments. Only 11% of PwMS had no abnormal score on the scales used in the assessment. As compared with EDSS score 0 to 1.5, with EDSS score 2 to 2.5, performance was worse for endurance (difference ±61.0 m, p=0.016), perceived walking ability (-11 points, p=0.002), balance (+1.9 points, p=0.005), manual dexterity (-2.8 sec, p=0.004), and fatigue (-1.3 points, p=0.013). Factors that predicted perceived walking ability were balance (B = -1.37, p<0.001) and fatigue (B = 5.11, p<0.001) rather than endurance (B = -0.01, p=048). CONCLUSION Even PwMS with no clinical disability and classified as having "no problem walking" present walking and other functional deficits when assessed with specific functional tests. The addition of specific tools could better identify subtle motor and cognitive deficits. Finally, the assessment of balance disorders and fatigue is important to understand individuals' perceived walking impairments in daily activities.
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Affiliation(s)
- Davide Cattaneo
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Elisa Gervasoni
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy.
| | - Denise Anastasi
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Rachele Di Giovanni
- Rehabilitation Department, CRRF Mons L Novarese, 13040 Loc. Trompone, Moncrivello (VC), Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), via Operai 40, 16149 Genoa, Italy
| | - Ilaria Carpinella
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Paola Cavalla
- MS Center, Department of Neuroscience and Mental Health, City of Health and Science, University Hospital of Torino, via Cherasco 15, Turin, Italy
| | - Paolo Confalonieri
- Multiple Sclerosis Center, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
| | - Elisabetta Groppo
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy; Clinica Neurologica III, Università degli Studi di Milano, Polo Universitario San Paolo, ASST Santi Paolo e Carlo, Via Antonio di Rudinì, 820142 Milano, Italy
| | - Luca Prosperini
- Department of Neurosciences, S. Camillo-Forlanini Hospital, c.ne Gianicolense 87, 00152 Rome, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), via Operai 40, 16149 Genoa, Italy
| | - Marco Rovaris
- IRCSS Fondazione Don Carlo Gnocchi, Via Capecelatro 66, 20148 Milano, Italy
| | - Claudio Solaro
- Rehabilitation Department, CRRF Mons L Novarese, 13040 Loc. Trompone, Moncrivello (VC), Italy
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23
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Kaleycheva N, Cullen AE, Evans R, Harris T, Nicholson T, Chalder T. The role of lifetime stressors in adult fibromyalgia: systematic review and meta-analysis of case-control studies. Psychol Med 2021; 51:177-193. [PMID: 33602373 DOI: 10.1017/s0033291720004547] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain. Although accumulating evidence suggests that exposure to stressful events increases the risk for this complex disorder, this is the first meta-analysis to compare the impact of a full range of lifetime stressors (e.g. physical trauma through to emotional neglect) on adult fibromyalgia. METHODS This review was performed in accordance with PRISMA guidelines. Random-effects models examined associations between different stressor exposures and fibromyalgia status with meta-regression investigating the effects of publication year and study quality on effect sizes. RESULTS Nineteen studies were included in the meta-analysis. Significant associations with fibromyalgia status were observed for all six exposure types examined: odds ratios (OR) were highest for physical abuse (OR 3.23, 95% confidence interval 1.99-5.23) and total abuse (3.06, 1.71-5.46); intermediate for sexual abuse (2.65, 1.85-3.79) and smaller for medical trauma (1.80, 1.19-2.71), other lifetime stressors (1.70, 1.31-2.20), and emotional abuse (1.52, 1.27-1.81). Results were not significantly changed when childhood, as opposed to adult, exposures were used in studies that reported both. Meta-regression analyses demonstrated no effect of publication year or study quality on effect sizes. CONCLUSIONS This study confirmed a significant association between stressor exposure and adult fibromyalgia with the strongest associations observed for physical abuse. Limitations related to current available literature were identified; we provide several suggestions for how these can be addressed in future studies. Stressors are likely to be one of many risk factors for fibromyalgia which we argue is best approached from a biopsychosocial perspective.
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Affiliation(s)
- Nia Kaleycheva
- School of Psychology, University of Surrey, Guildford, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, King's College London, London, UK
| | - Robyn Evans
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Tirril Harris
- Department of Health Service and Population Research, King's College London, London, UK
| | - Timothy Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London, London, UK
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24
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Reed B, Buzenski J, van Tilburg MAL. Implementing psychological therapies for gastrointestinal disorders in pediatrics. Expert Rev Gastroenterol Hepatol 2020; 14:1061-1067. [PMID: 32749161 PMCID: PMC7577923 DOI: 10.1080/17474124.2020.1806055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The brain-gut axis refers to complex and reciprocal interactions that impact symptom presentation and disease course within the GI tract. Psychological therapies included in the treatment of functional gastrointestinal disorders (FGIDs) as well as chronic gut disorders including inflammatory bowel disease (IBD) address environmental and psychological factors impacting patients' symptoms and overall functioning. AREAS COVERED Employing a biopsychosocial approach, this review focuses on the evidence for and implementation of psychological therapies across pediatric gastrointestinal disorders. EXPERT OPINION By developing a working knowledge of evidence-based psychological therapies applicable to pediatric gastrointestinal disorders, clinicians have the opportunity to comprehensively treat patients' symptoms and distress. Regular communication and coordination between pediatric gastroenterology clinicians and providers of psychological therapies offers the greatest likelihood for successfully implementing psychological therapies into treatment plans.
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Affiliation(s)
- Bonney Reed
- Department of Pediatrics, Division of Gastroenterology, Hepatology, & Nutrition, Emory+Children's Pediatric Institute , Atlanta, Georgia
| | - Jessica Buzenski
- Department of Pediatrics, Division of Gastroenterology, Hepatology, & Nutrition, Emory+Children's Pediatric Institute , Atlanta, Georgia
| | - Miranda A L van Tilburg
- College of Pharmacy & Health Sciences, Campbell University , Buies Creek, NC, USA
- School of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina , Chapel Hill, NC, USA
- School of Social Work, University of Washington , Seattle, WA, USA
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25
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Abstract
Jean-Martin Charcot started his main work on hysteria around 1870, until his death in 1893. Désiré Bourneville had triggered Charcot's interest in hysteria during his stay as an interne in his department, while Charles Richet's 1875 article on somnambulism was the trigger for Charcot to develop hypnotism. Charcot's collaborators Paul Richer, Georges Gilles de la Tourette, Paul Sollier, Joseph Babinski, Sigmund Freud and Pierre Janet subsequently became most famous in hysteria. In 1908, a "quarrel of hysteria" opposed several of Charcot's pupils, from which Babinski, who had developed the concept of "pithiatism", was considered victorious against Charcot's first successor Fulgence Raymond. There was a surge of interest in hysteria associated with war psycho-neuroses in 1914-1918, and Babinski's pupil Clovis Vincent developed a treatment called torpillage (torpedoing) against war hysteria, associating painful galvanic current discharges with "persuasion". After World War I, the neurological and psychiatric interest in hysteria again faded away, before a renewed interest at the turn of the last century. Contrary to a common view, the modernity of several of Charcot's concepts in hysteria is remarkable, still today, mainly for: (1) his traumatic theory, which encompassed psychological and certain sexual factors several years before Freud; (2) his personal evolution towards the role of emotional factors, which opened the way to Janet and Freud; (3) his claim of specific differences vs. similarities in mental states such as hypnotism, hysteria, and simulation, which has recently been confirmed by functional imaging; and (4) his "dynamic lesion" theory, which now correlates well with recently established neurophysiological mechanisms.
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Affiliation(s)
- Julien Bogousslavsky
- Department of Neurology and Neuro-rehabilitation, Swiss Medical Network Neurocenter, Montreux, Switzerland
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Drozdov VN, Astapovskiy AA, Serebrova SY, Lazareva NB, Shikh EV. [Clinical efficacy of probiotic strains of the Bifidobacterium and Lactobacillus]. Vopr Pitan 2020; 89:107-115. [PMID: 32459910 DOI: 10.24411/0042-8833-2020-10021] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/16/2020] [Indexed: 06/11/2023]
Abstract
The article analyzes the effectiveness of the most studied probiotic strains that are used for prophylactic or therapeutic purposes. The requirements for probiotic microorganisms are described, depending on the form in which they are used. However, their scope most often covers both prevention and treatment of various functional disorders and diseases of the gastrointestinal tract. At the same time, a lot of data has been accumulated on the effectiveness of probiotics for the treatment and prevention of diseases of other organs and organism systems. Most strains are successfully used as dietary supplements, and some of them have found their application in food industry.
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Affiliation(s)
- V N Drozdov
- I.M. Sechenov First Moscow State Medical University of Ministry of Healthcare of the Russian Federation (Sechenov University), 119991, Moscow, Russian Federation
| | - A A Astapovskiy
- I.M. Sechenov First Moscow State Medical University of Ministry of Healthcare of the Russian Federation (Sechenov University), 119991, Moscow, Russian Federation
| | - S Yu Serebrova
- I.M. Sechenov First Moscow State Medical University of Ministry of Healthcare of the Russian Federation (Sechenov University), 119991, Moscow, Russian Federation
| | - N B Lazareva
- I.M. Sechenov First Moscow State Medical University of Ministry of Healthcare of the Russian Federation (Sechenov University), 119991, Moscow, Russian Federation
| | - E V Shikh
- I.M. Sechenov First Moscow State Medical University of Ministry of Healthcare of the Russian Federation (Sechenov University), 119991, Moscow, Russian Federation
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Onofrj M, Espay AJ, Bonanni L, Delli Pizzi S, Sensi SL. Hallucinations, somatic- functional disorders of PD-DLB as expressions of thalamic dysfunction. Mov Disord 2019; 34:1100-1111. [PMID: 31307115 DOI: 10.1002/mds.27781] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 01/02/2019] [Revised: 04/30/2019] [Accepted: 05/24/2019] [Indexed: 12/12/2022] Open
Abstract
Hallucinations, delusions, and functional neurological manifestations (conversion and somatic symptom disorders) of Parkinson's disease (PD) and dementia with Lewy bodies increase in frequency with disease progression, predict the onset of cognitive decline, and eventually blend with and are concealed by dementia. These symptoms share the absence of reality constraints and can be considered comparable elements of the PD-dementia with Lewy bodies psychosis. We propose that PD-dementia with Lewy bodies psychotic disorders depend on thalamic dysfunction promoting a theta burst mode and subsequent thalamocortical dysrhythmia with focal cortical coherence to theta electroencephalogram rhythms. This theta electroencephalogram activity, also called fast-theta or pre-alpha, has been shown to predict cognitive decline and fluctuations in Parkinson's disease with dementia and dementia with Lewy bodies. These electroencephalogram alterations are now considered a predictive marker for progression to dementia. The resulting thalamocortical dysrhythmia inhibits the frontal attentional network and favors the decoupling of the default mode network. As the default mode network is involved in integration of self-referential information into conscious perception, unconstrained default mode network activity, as revealed by recent imaging studies, leads to random formation of connections that link strong autobiographical correlates to trivial stimuli, thereby producing hallucinations, delusions, and functional neurological disorders. The thalamocortical dysrhythmia default mode network decoupling hypothesis provides the rationale for the design and testing of novel therapeutic pharmacological and nonpharmacological interventions in the context of PD, PD with dementia, and dementia with Lewy bodies. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Alberto J Espay
- Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Stefano Delli Pizzi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Italy.,Departments of Neurology and Pharmacology, Institute for Mind Impairments and Neurological Disorders, University of California - Irvine, Irvine, California, USA
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Tesio V, Goerlich KS, Hosoi M, Castelli L. Editorial: Alexithymia: State of the Art and Controversies. Clinical and Neuroscientific Evidence. Front Psychol 2019; 10:1209. [PMID: 31178809 PMCID: PMC6543916 DOI: 10.3389/fpsyg.2019.01209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/07/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Katharina S Goerlich
- Department of Biomedical Sciences, Behavioural and Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Masako Hosoi
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Lorys Castelli
- Department of Psychology, University of Turin, Turin, Italy
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Abstract
Delusional health beliefs can be difficult and costly for practitioners to diagnose and manage. Patients often deny that mental distress is the cause of their illness, when it may be the most significant factor. Such patients can be relentless in their pursuit of a physical cause and go from doctor to doctor to find one who agrees with them, using up significant NHS resources. The number of negative investigations increases year on year, with the patient being referred back to their general practitioner without a working diagnosis. The recent publication of Susanne O'Sullivan's book, "It's All in your Head - True Stories of Imaginary Illness", shines a bright and necessary light on the difficulties of getting these patients to accept that their problems originate in their minds. Doctors, alerted by fat files, may be well advised to question any previous diagnosis, if it is not borne out by physical evidence and does not conform to known diagnostic criteria and disease patterns. In this context, it is timely to consider the true cause of Stephen Hawking's illness, which he has called into question in his last book, published after his death. Allegedly, he had been suffering from motor neurone disease, diagnosed when he was a very young man.Yet he survived to the age of 76, albeit in his later years in an increasingly crippled and distressed state. Such longevity is totally inconsistent with MND. What then was the cause of Hawking's illness? Is there any firm evidence that a consultant neurologist ever made that diagnosis, and on what grounds? The interplay between mind and body is mysterious and complex, but we need to question every symptom, if it is not grounded in objective reality.
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Schindler V, Giezendanner S, Bütikofer S, Murray F, Runggaldier D, Schnurre L, Zweig A, Fried M, Pohl D. Differentiation of functional gastrointestinal disorders from healthy volunteers by lactulose hydrogen breath test and test meal. J Gastroenterol Hepatol 2019; 34:843-851. [PMID: 30562837 DOI: 10.1111/jgh.14551] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Functional dyspepsia (FD) is a common disorder of gut-brain interaction with incompletely understood pathophysiology. Consequently, heterogeneous expert opinions on diagnostic tests and assessment of treatment efficacies exist. So far, no consensus about the most relevant diagnostic and outcome tool has been reached. In this study, we aimed to analyze the significance of a combined lactulose hydrogen breath test (LHBT) and liquid meal, yet representing a standardized test in irritable bowel syndrome (IBS), in FD. METHODS We analyzed data of 146 FD, 204 IBS patients, and 50 healthy volunteers (HV). All patients underwent LHBT with a meal-drink consisting of 30-g Lactulose and 400-mL Ensure®. Effect of abdominal symptom generation in FD/IBS compared with HV was assessed on a patient-reported Likert-scale. RESULTS There was a significant difference between FD/IBS patients and HV in LHBT-induced abdominal pain (odds ratio [OR] 246.9, 95% confidence interval [CI] 26.6-2290.7; OR 161.2, 95% CI 16.9-1534.8), abdominal bloating (OR 384.8, 95% CI 92.9-2135.4; OR 524.1, 95% CI 114.7-3432.3), borborygmi (OR 9.9, 95% CI 2.2-46.9; OR 17.7, 95% CI 4.7-67.4), nausea only in FD (OR 174.4, 95% CI 15.5-5375.5), and diarrhea in IBS only (OR 25.8, 95% CI 2.0-7012.6). Hydrogen production was not significantly different in FD/IBS and HV. CONCLUSIONS In this study, we demonstrated significant differences in postprandial symptom generation in FD and IBS compared with HV after LHBT. This does not only allow us to discriminate FD/IBS from HV but may also represent a diagnostic and monitoring tool for FD/IBS in the future, including monitoring of treatment effects.
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Affiliation(s)
- Valeria Schindler
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | | | - Simon Bütikofer
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Fritz Murray
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Runggaldier
- Department of Otorhinolaryngology, University Hospital Zürich, Zürich, Switzerland
| | - Larissa Schnurre
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Annina Zweig
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Michael Fried
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
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Abstract
With increasing survival after esophagectomy for cancer, a growing number of individuals living with the functional results of a surgically altered anatomy calls for attention to the effects of delayed gastric conduit emptying (DGCE) on health-related quality of life and nutritional impairment. We here give an overview of the currently available literature on DGCE, in terms of epidemiology, pathophysiology, diagnostics, prevention and treatment. Attention is given to controversies in the current literature and obstacles related to general applicability of study results, as well as knowledge gaps that may be the focus for future research initiatives. Finally, we propose that measures are taken to reach international expert agreement regarding diagnostic criteria and a symptom grading tool for DGCE, and that functional radiological methods are established for the diagnosis and severity grading of DGCE.
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Affiliation(s)
- Magnus Konradsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) and Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC) and Karolinska University Hospital, Stockholm, Sweden
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32
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Stasi C, Caserta A, Nisita C, Cortopassi S, Fani B, Salvadori S, Pancetti A, Bertani L, Gambaccini D, de Bortoli N, Dell'Osso L, Blandizzi C, Marchi S, Bellini M. The complex interplay between gastrointestinal and psychiatric symptoms in irritable bowel syndrome: A longitudinal assessment. J Gastroenterol Hepatol 2019; 34:713-719. [PMID: 29971822 DOI: 10.1111/jgh.14375] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 04/17/2018] [Revised: 06/04/2018] [Accepted: 06/20/2018] [Indexed: 12/12/2022]
Abstract
AIMS The aims of this study were to better define the relationship between irritable bowel syndrome (IBS) and psychiatric disorders and to examine the efficacy of paroxetine in the treatment of IBS patients. METHODS One hundred fifty subjects with diagnosis of IBS (Roma III criteria) and relative sub-classification (constipated, diarrhea, and mixed) were assessed for psychopathological features and gastrointestinal symptoms using IBS Symptom Severity Score and were consecutively enrolled. Fifty patients assumed paroxetine for 16 weeks and were longitudinally evaluated. RESULTS The entire sample had a moderate/severe gastrointestinal symptomatology (IBS-SSS 285.1 ± 98.6). The IBS subtypes were diarrhea (47.3%), constipated (32%), and mixed (20.7%). Panic disorder was found in 17.4% and major depressive episode in 14.7%. More than 50% of the patients showed "psychopathological features." This group showed more severe gastrointestinal symptoms and worse quality of life than the group without any psychiatric comorbidity (44%). Psychiatric patients also showed a significant impairment of physical state, subjective feeling of well-being, and leisure activities when compared with no psychiatric patients. When the IBS-SSS > 300 group was subgrouped in psychiatric (67.2%) and no psychiatric (32.8%), we found significant differences in all clinician-administered and self-reported scales with more severe psychopathological features in psychiatric group (P < 0.01). Among the patients treated with paroxetine, 34 (68%) completed the longitudinal evaluation showing a significant improvement of both psychiatric and gastrointestinal symptoms. CONCLUSIONS This study confirms a high presence of psychiatric comorbidities, emphasizing the need for psychiatric screening in all patients with IBS; moreover, the longitudinal evaluation of patients treated with paroxetine showed a significant improvement of both psychiatric and gastrointestinal symptoms.
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Affiliation(s)
- Cristina Stasi
- Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Anna Caserta
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cristiana Nisita
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sonia Cortopassi
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Bernardo Fani
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Andrea Pancetti
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Bertani
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Dario Gambaccini
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola de Bortoli
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Corrado Blandizzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Santino Marchi
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Adamczyk M, Kornacki J, Wirstlein P, Szczepanska M, Wender-Ozegowska E. Follow-up of children with antenatally diagnosed idiopathic polyhydramnios. Ginekol Pol 2019; 90:93-99. [PMID: 30860276 DOI: 10.5603/gp.2019.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/24/2018] [Accepted: 01/29/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The aim of our work was to assess the development of children with antenatally diagnosed idiopathic poly- hydramnios, over 12 months from the end of pregnancy. MATERIAL AND METHODS The study included 91 healthy pregnant patients with idiopathic polyhydramnios. Diagnostic tests results and perinatal medical history were obtained retrospectively. Parents of children were contacted by phone and by mail. The answers were obtained from 64 (70%) parents. For statistical analysis SigmaStat3.5 software was used. RESULTS Ninety six percent of parents declared that in their opinion the development of children was normal. Abnormali- ties were found in 44% of the children. Thirty percent of neonates demonstrated mild abnormalities which may be due to organic or functional neuromuscular disorders: abnormal muscle tone, speech apparatus and development disorders, swallowing and breathing problems (manifested as vomiting, excessive regurgitation, idiopathic apnoeas). Isolated small malformations were diagnosed in 12 (19%) children. Two children (3%) with SGA were diagnosed with genetic syndromes. More than one of the abnormalities described above were diagnosed in 14% of children. Gestational age at the time of polyhydramnios diagnosis and its severity were not prognostic factors for abnormalities. Seventy percent of newborns were male. CONCLUSIONS Despite the subjectively positive assessment of the development of children by the majority of parents, groups of common disorders requiring long-term follow-up have been identified. Functional disorders of the gastrointestinal tract, CNS and the group of neuromuscular disorders may be responsible for idiopathic polyhydramnios. SGA with co-existing idiopathic polyhydramnios is associated with the risk of genetic diseases. The more frequent incidence of idiopathic poly- hydramnios in male fetuses requires further research.
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Affiliation(s)
- Magdalena Adamczyk
- Division of Reproduction, Department of Gynecology and Obstetrics, Poznan University of Medical Sciences, Poland.
| | - Jakub Kornacki
- Division of Reproduction, Department of Gynecology and Obstetrics, Poznan University of Medical Sciences, Poland
| | - Przemyslaw Wirstlein
- Division of Reproduction, Department of Gynecology and Obstetrics, Poznan University of Medical Sciences, Poland
| | - Malgorzata Szczepanska
- Division of Reproduction, Department of Gynecology and Obstetrics, Poznan University of Medical Sciences, Poland
| | - Ewa Wender-Ozegowska
- Division of Reproduction, Department of Gynecology and Obstetrics, Poznan University of Medical Sciences, Poland
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Abstract
Functional neurological disorders (FND)-also called psychogenic, nonorganic, conversion, and dissociative disorders-constitute one of the commonest problems in neurological practice. An occupational therapist (OT) is commonly involved in management, but there is no specific literature or guidance for these professionals. Classification now emphasizes the importance of positive diagnosis of FND based on physical signs, more than psychological features. Studies of mechanism have produced new clinical and neurobiological ways of thinking about these disorders. Evidence has emerged to support the use of physiotherapy and occupational therapy as part of a multidisciplinary team for functional movement disorders (FMD) and psychotherapy for dissociative (nonepileptic) attacks. The diagnosis and management of FND has entered a new evidence-based era and deserves a standard place in the OT neurological curriculum. We discuss specific management areas relevant to occupational therapy and propose a research agenda.
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van der Feltz-Cornelis CM, Elfeddali I, Werneke U, Malt UF, Van den Bergh O, Schaefert R, Kop WJ, Lobo A, Sharpe M, Söllner W, Löwe B. A European Research Agenda for Somatic Symptom Disorders, Bodily Distress Disorders, and Functional Disorders: Results of an Estimate-Talk-Estimate Delphi Expert Study. Front Psychiatry 2018; 9:151. [PMID: 29867596 PMCID: PMC5961475 DOI: 10.3389/fpsyt.2018.00151] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 01/23/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe. Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective. Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings. Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation. Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe.
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Affiliation(s)
- Christina M. van der Feltz-Cornelis
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, Netherlands
- Tranzo Department, Tilburg University, Tilburg, Netherlands
| | - Iman Elfeddali
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, Netherlands
- Tranzo Department, Tilburg University, Tilburg, Netherlands
| | - Ursula Werneke
- Sunderby Research Unit, Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Ulrik F. Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Section for Psychosomatic Medicine, Division of Mental Health and Dependency, University Hospital Oslo, Oslo, Norway
| | | | - Rainer Schaefert
- Division of Internal Medicine, Department of Psychosomatic Medicine, University and University Hospital Basel, Basel, Switzerland
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Willem J. Kop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Antonio Lobo
- Department of Medicine and Psychiatry, University of Zaragoza, Zaragoza, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), CIBERSAM, National Institute of Health Carlos III, Zaragoza, Spain
| | | | - Wolfgang Söllner
- Department of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Bernd Löwe
- Institute for Psychosomatic Medicine and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
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Zemlyanaya AA, Radchenko GS, Fedotchev AI. [Music therapy procedures controlled by the brain potentials in treatment of functional disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:103-106. [PMID: 29652315 DOI: 10.17116/jnevro201811831103-106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Twenty years ago, the Korsakov's Journal of Neurology and Psychiatry has published the article of Ya.I. Levin 'Brain music in the treatment of patients with insomnia'. This publication was the starting point for an innovative approach to preventing and correcting functional disorders of a person via musical or music-like stimuli that are controlled by the brain potentials of patient's. This approach called 'Music of the brain' is fully consistent with modern ideas about preventive neuroscience as a new field of scientific research at the intersection of neuroscience and preventive medicine. In this review, the authors analyze initial studies on the effects of music on the brain and discuss their limitations. To increase the effectiveness of the approach, a unique combination of musical therapy with the neurofeedback method, the technology of musical neurofeedback, has been developed. Results of the application of developed technology for treatment of human functional disorders are presented, and promising directions for further research are outlined.
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Affiliation(s)
- A A Zemlyanaya
- Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | - G S Radchenko
- Lobachevsky State University, Nizhni Novgorod, Russia
| | - A I Fedotchev
- Institute of Cell Biophysics, Russian Academy of Sciences, Pushchino, Moscow Region, Russia
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Potter MDE, Brienesse SC, Walker MM, Boyle A, Talley NJ. Effect of the gluten-free diet on cardiovascular risk factors in patients with coeliac disease: A systematic review. J Gastroenterol Hepatol 2018; 33:781-791. [PMID: 29105146 DOI: 10.1111/jgh.14039] [Citation(s) in RCA: 38] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/23/2017] [Accepted: 10/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS A gluten-free diet (GFD), the mainstay of treatment for celiac disease, is being increasingly adopted by people without this condition. The long-term health effects of this diet, apart from its beneficial effect on enteropathy in celiac disease, are unclear. Concerns exist that the GFD may result in micronutrient deficiencies, increased exposure to toxins such as arsenic, and an increased cardiovascular risk. This systematic review addresses the effect of the GFD on several modifiable cardiovascular risk factors. METHODS A systematic search of the literature addressing the GFD and blood pressure, glycaemia, body mass index, waist circumference, and serum lipids in patients before and after adoption of a GFD was conducted using the MEDLINE, EMBASE, PSYCInfo, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. Two authors performed abstract and full text screening, and quality assessment. RESULTS A total of 5372 articles were identified, from which 27 were included. Lack of control groups in all but one study prevented meta-analysis of results. Overall study quality was low and restricted to patients with celiac disease. Consistent findings across studies included an increase in total cholesterol, high density lipoprotein, fasting glycaemia, and body mass index (while remaining within the healthy weight range). Significant changes in low density lipoprotein, triglycerides, and blood pressure were not consistently reported. CONCLUSIONS A GFD alters certain cardiovascular risk factors in patients with celiac disease, but the overall effect on cardiovascular risk is unclear. Further studies are warranted.
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Affiliation(s)
- Michael D E Potter
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Stephen C Brienesse
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Marjorie M Walker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Andrew Boyle
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,John Hunter Hospital, Newcastle, New South Wales, Australia
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Poděbradská R, Šarmírová M, Procházka M. [Musculoskeletal system functional disorders in pregnancy]. Ceska Gynekol 2018; 83:138-144. [PMID: 29869514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To bring about a comprehensive summary of the occurrence principle and the clinical manifestations of the musculoskeletal system functional disorders, focusing on those occurring most frequently during pregnancy. DESIGN Overview study. SETTING Department of Health Promotion, Faculty of Sport Studies, Masaryk University, Brno; Rehabilitation department Lipova-lazne; Department of Midwifery, Faculty of Health Sciences, Olomouc. METHODS Analysis of literary sources and database Medline (1998-2017). CONCLUSION The lack of movement activities within the framework of sedentary lifestyle correlates with the musculoskeletal system disorders, which may influence both the adaptation mechanisms in general, and the bodys ability to adapt to the changes in pregnancy. High prevalence of the musculoskeletal system functional disorders in pregnancy may only represent a reflection of the state of female musculoskeletal system at present, and pregnancy, being the period of increased burden placed on the musculoskeletal system, only reflects its dysfunction. Physiotherapy shows a way to resolve the musculoskeletal system functional disorders during pregnancy.
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Talley NJ, Holtmann G, Nguyen QN, Gibson P, Bampton P, Veysey M, Wong J, Philcox S, Koloski N, Bunby L, Jones M. Undiagnosed pancreatic exocrine insufficiency and chronic pancreatitis in functional GI disorder patients with diarrhea or abdominal pain. J Gastroenterol Hepatol 2017; 32:1813-1817. [PMID: 28332731 DOI: 10.1111/jgh.13791] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 12/20/2016] [Revised: 02/19/2017] [Accepted: 03/20/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM A previous UK study showed that 6.1% of patients with diarrhea-predominant irritable bowel syndrome (IBS-D) had evidence of severe pancreatic exocrine insufficiency (PEI), but these findings need replication. We aimed to identify the prevalence of PEI based on fecal elastase stool testing in consecutive outpatients presenting with chronic unexplained abdominal pain and/or diarrhea and/or IBS-D. METHODS Patients aged over 40 years presenting to hospital outpatient clinics from six sites within Australia with unexplained abdominal pain and/or diarrhea for at least 3 months and/or IBS-D were studied. Patients completed validated questionnaires and donated a stool sample in which elastase concentration was measured by ELISA. A concentration of < 100 mcg/g stool represented severe and < 200 mcg/g mild to moderate PEI. Patients whose fecal elastase was < 200 mcg/g underwent testing for pancreatic pathology with an endoscopic ultrasound or abdominal CT. RESULTS Two hundred eighteen patients (mean age of 60 years, 29.4% male) were studied. PEI was found in 4.6% (95% CI 2.2-8.3%) (n = 10), with five patients (2.3% (95% CI 0.8-5.3%) having severe PEI. Only male sex and heavy alcohol use were significantly associated with abnormal versus normal pancreatic functioning. Of seven patients who underwent endoscopic ultrasound or CT, two had features indicative of chronic pancreatitis. CONCLUSION One in 50 patients with IBS-D or otherwise unexplained abdominal pain or diarrhea have an abnormal fecal elastase, but unexpected pancreatic insufficiency was detected in only a minority of these. This study failed to confirm the high prevalence of PEI among patients with unexplained GI symptoms previously reported.
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Affiliation(s)
- Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Department of Gastroenterology, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Quoc Nam Nguyen
- Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Peter Gibson
- Department of Gastroenterology, Monash University and Alfred Hospital, Melbourne, Victoria, Australia
| | - Peter Bampton
- Department of Gastroenterology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Martin Veysey
- Teaching & Research Unit, Gosford & Wyong Hospital, Gosford, New South Wales, Australia
| | - James Wong
- Mylan EPD, Macquarie, New South Wales, Australia
| | - Stephen Philcox
- Department of Gastroenterology, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Natasha Koloski
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Department of Gastroenterology, John Hunter Hospital, New Lambton, New South Wales, Australia.,Department of Gastroenterology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Lisa Bunby
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael Jones
- Department of Psychology, Macquarie University, Ryde, New South Wales, Australia
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Englund H, Lidén K K, Lind T, Sundström T, Karling P. Radiation exposure in patients with inflammatory bowel disease and irritable bowel syndrome in the years 2001-2011. Scand J Gastroenterol 2017; 52:300-305. [PMID: 27832710 DOI: 10.1080/00365521.2016.1252945] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/07/2023]
Abstract
OBJECTIVES To compare cumulative ionizing radiation in patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) for the years 2001-2011. To study how radiation exposure change over time in patients with newly diagnosed IBD and factors associated with radiation exposure. MATERIAL AND METHODS All radiological investigations performed between 1 January 2001 and 31 December 2011 were retrospectively recorded in patients with Crohn's disease (CD) (n = 103), ulcerative colitis (UC) (n = 304) and IBS (n = 149). Analyses were done with Mann-Whitney and Chi-Square test. RESULTS The median total cumulative radiation exposure in mSv for CD (20.0, inter quartile range (IQR) 34.8), UC (7.01, IQR 23.8), IBS (2.71, IQR 9.15) and the proportion of patients who had been exposed for more than 50 mSv during the study period (CD 19%, UC 11%, IBS 3%) were significantly higher in the patients with CD compared to patients with UC (p < .001) and IBS (p < .001), respectively. In turn, patients with UC had significantly higher doses than patients with IBS (p = .005). Risk factors for radiation exposure were female gender (CD), early onset (UC), ileocolonic location (CD), previous surgery (CD and UC), depression (IBS) and widespread pain (IBS). In newly diagnosed CD, there was a significant decline in median cumulative radiation dose in mSv (17.2 vs. 12.0; p = .048) during the study period. CONCLUSIONS Patients with CD are at greatest risk for high cumulative radiation exposure, but there is a decline in exposure during the late 2000s. Non-colectomized patients with UC and patients with IBS have a relatively low risk of cumulative radiation exposure.
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Affiliation(s)
- Hanna Englund
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Katarina Lidén K
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Torbjörn Lind
- b Department of Clinical Sciences, Pediatrics , Umeå University , Umeå , Sweden
| | - Torbjörn Sundström
- c Department of Radiation Sciences, Diagnostic Radiology , Umeå University , Umeå , Sweden
| | - Pontus Karling
- a Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
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Harvie R, Walmsley R, Schultz M. "We are what our bacteria eat": The role of bacteria in personalizing nutrition therapy in gastrointestinal conditions. J Gastroenterol Hepatol 2017; 32:352-357. [PMID: 27248703 DOI: 10.1111/jgh.13462] [Citation(s) in RCA: 6] [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] [Accepted: 05/25/2016] [Indexed: 12/11/2022]
Abstract
The theme for the 2016 World Digestive Health Day is "Your Diet and Gut Health". The World Gastroenterology Organization thereby wishes to raise awareness of the relationship between what we eat and gastrointestinal symptoms. World Digestive Health Day (WDHD) is celebrated each year on May 29. This brief review article on behalf of the New Zealand Society of Gastroenterology will highlight recent developments in this highly active area of research with a special emphasis on gastrointestinal disorders.
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Affiliation(s)
- Ruth Harvie
- Lawson Health Research Institute, Western University, London, Ontario, Canada.,Department of Medicine, Dunedin School of Medicine, Dunedin, New Zealand
| | - Russell Walmsley
- Gastroenterology Department, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Michael Schultz
- Department of Medicine, Dunedin School of Medicine, Dunedin, New Zealand
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Sharma VD, Jones R, Factor SA. Psychodynamic Psychotherapy for Functional (Psychogenic) Movement Disorders. J Mov Disord 2016; 10:40-44. [PMID: 28122424 PMCID: PMC5288661 DOI: 10.14802/jmd.16038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/21/2016] [Accepted: 11/29/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE As the literature for the treatment of functional (psychogenic) movement disorders (FMD) is sparse, we assessed clinical outcomes in patients with FMD who underwent treatment with psychodynamic psychotherapy (PDP). METHODS A retrospective analysis of the data of patients with FMD who were referred for PDP from 2008-2014 at Emory University Medical Center was performed. RESULTS Thirty patients were included, mean age at presentation was 50 years (SD 13.9) and majority were female (27/30). Most common movement disorder was involuntary shaking/jerky movements (50%) and tremor (43%). Mean duration of symptoms was 3.2 years and mean number of PDP visits was 4.9. PDP lead to good outcomes in 10, modest in 8, and poor in 9. Three patients lost to follow up. Mean duration of symptoms between two groups (good vs. poor) was not statistically significant (p = 0.11), mean number of PDP visits showed a trend towards significance (p = 0.053). In all cases of good outcomes precipitants of the movement disorder were identified and a majority (60%) was receptive of the diagnosis and had good insight. CONCLUSION PDP lead to improvement in 60% of the patients which is encouraging as the treatment is challenging. This study supports heterogeneous causes of FMD including varied roles of past/recent events and demonstrates importance of psychological approaches such as PDP. Treatment with PDP should be considered in some patients with FMD but predicting who will respond remains a challenge. Further long term prospective studies with large sample size and placebo control are needed.
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Affiliation(s)
- Vibhash D Sharma
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Randi Jones
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Stewart A Factor
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional Disorders: Children and Adolescents. Gastroenterology 2016; 150:S0016-5085(16)00181-5. [PMID: 27144632 DOI: 10.1053/j.gastro.2016.02.015] [Citation(s) in RCA: 677] [Impact Index Per Article: 84.6] [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: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 02/07/2023]
Abstract
Characterization of childhood and adolescent functional gastrointestinal disorders (FGIDs) has evolved during the two decade long Rome process now culminating in Rome IV. The era of diagnosing a FGID only when organic disease has been excluded is waning,as we now have evidence to support symptom-based diagnosis. In child/adolescent Rome IV we extend this concept by removing the dictum that there was "no evidence for organic disease" in all definitions and replacing it with "after appropriate medical evaluation the symptoms cannot be attributed to another medical condition". This change allows the clinician to perform selective or no testing to support a positive diagnosis of a FGID. We also point out that FGIDs can coexist with other medical conditions that themselves result in gastrointestinal symptoms (e.g., inflammatory bowel disease). In Rome IV functional nausea and functional vomiting are now described. Rome III "abdominal pain related functional gastrointestinal disorders" (AP-FGID) has been changed to functional abdominal pain disorders (FAPD) and we have derived a new term, "functional abdominal pain -not otherwise specified", to describe children who do not fit a specific disorder such as irritable bowel, functional dyspepsia, or abdominal migraine. Rome IV FGID definitions should enhance clarity for both clinicians and researchers.
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Affiliation(s)
- Jeffrey S Hyams
- Head, Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06101
| | - Carlo Di Lorenzo
- Head, Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Miguel Saps
- Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205
| | - Robert J Shulman
- Baylor College of Medicine, Children's Nutrition Research Center, Texas Children's Hospital, 1100 Bates Street, Houston, TX 77030
| | - Annamaria Staiano
- Department of Translational Science, Section of Pediatrics, University of Naples, Federico II, Via S. Pansini, 5 80131 Naples, Italy
| | - Miranda van Tilburg
- University of North Carolina at Chapel Hill Department of Gastroenterology and Hepatology 130 Mason Farm rd, #4106 CB 7080 Chapel Hill NC
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Olofsson Å, Taube K, Ahl A. Academic Achievement of University Students with Dyslexia. Dyslexia 2015; 21:338-349. [PMID: 26459832 DOI: 10.1002/dys.1517] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/23/2015] [Accepted: 09/10/2015] [Indexed: 06/05/2023]
Abstract
Broadened recruitment to higher education is on the agenda in many countries, and it is also widely recognized that the number of dyslexic students entering higher education is increasing. In Sweden, as in many other European countries, higher education institutions are required to accommodate students with dyslexia. The present study focuses on the study outcome for 50 students with diagnosed dyslexia, mainly in teacher education and nurses' training, at three universities in Northern Sweden. The students trusted their own ability to find information on the Internet but mistrusted their own abilities in reading course books and articles in English and in taking notes. The mean rate of study was 23.5 European Credit Transfer and Accumulation System credits per semester, which is slightly below the national baseline of 26.7. The results show that more than half of the students are examined at a normal rate of study but that about one fifth have a very low rate of study. Messages Most students with dyslexia can compensate for their reading problems. Taking notes during lessons and reading in foreign language may be especially difficult for students with dyslexia. Diagnoses should distinguish between reading comprehension and word decoding. More than half of the students with dyslexia can achieve at a normal rate of study. One-fifth of the students with dyslexia may need a longer period of study than other students.
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Affiliation(s)
- Åke Olofsson
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Karin Taube
- Department of Language Studies, Umeå University, Umeå, Sweden
| | - Astrid Ahl
- Department of Applied Educational Science, Umeå University, Umeå, Sweden
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Abstract
Nordic research on gastrointestinal motility has since 1965 made substantial contributions to our current understanding of gastrointestinal function. During the last decade, the term neurogastroenterology has widened the concept of motility research into the study of gastrointestinal sensory-motor function, including the complex central nervous system interaction. The discovery of a non-adrenergic non-cholinergic (NANC) innervation of the gut in the sixties was made by considerable contributions from the Nordic countries with the Martinson group in Sweden as central innovators. Important discoveries regarding the intramural nerve ganglia as mediators of the autonomic nervous input has also been produced from this research. In clinical motility research, the study of the migrating motor complex in the small bowel has revealed its ability to act as a retroperistaltic pump in the proximal duodenum (Sweden) and its important role for gut microbial homeostasis (Norway). Also in the development of methodology to study gut sensory-motor function, the Nordic countries has contributed. Examples are the physical characteristics of the esophageal manometry catheter (Denmark), the use of ultrasound for assessment of gastric function (Norway), a temporary electrical stimulation method in patients with severe nausea and vomiting (Sweden), a rectal barostat method for clinical evaluation of recto-anal function and a colonic transit time method utilizing radio-opaque markers (Sweden). In later years, the research collaborations have increasingly become worldwide in a manner making it less easy to define pure Nordic contributions.
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Affiliation(s)
- Hans Törnblom
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
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Hoeritzauer I, Stone J, Fowler C, Elneil-Coker S, Carson A, Panicker J. Fowler's syndrome of urinary retention: A retrospective study of co-morbidity. Neurourol Urodyn 2015; 35:601-3. [PMID: 25865606 DOI: 10.1002/nau.22758] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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: 11/09/2014] [Accepted: 02/02/2015] [Indexed: 12/30/2022]
Abstract
AIMS To study the frequency of pain, psychological, or functional disorders in patients with Fowler's syndrome. METHODS We carried out a retrospective chart review of patients with a diagnosis of Fowler's syndrome attending the Uro-Neurology centre at the National Hospital for Neurology and Neurosurgery between 2009 and 2013 looking at triggering events, physical and psychological comorbidities. RESULTS Of 62 patients with clinical and electromyographic diagnosis of Fowler's syndrome, 31 (50%) had unexplained chronic pain syndromes, 12 (19%) of these were taking opiates. Fifteen (24%) had "functional" neurological symptoms. Abdominopelvic surgery with general anesthesia was the leading trigger (n = 21, 35%). CONCLUSIONS We found high levels of co-morbidity with patients having some form of pain (50%), a probable functional disorder (24%), or psychological symptoms (31%). There are several potential explanations for this association including the effect of developing an apparently unexplained distressing condition, confounding effect of opiate use or referral bias. The findings suggest a need for prospective systematic study of comorbidity for this disabling condition. Neurourol. Urodynam. 35:601-603, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Ingrid Hoeritzauer
- Department of Neurosciences, Royal Victoria Hospital, Belfast, United Kingdom
| | - Jon Stone
- Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, United Kingdom
| | - Clare Fowler
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Suzy Elneil-Coker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Alan Carson
- Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Rd, Edinburgh, United Kingdom
| | - Jalesh Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, United Kingdom
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Abstract
The authors undertook the analysis of the literature data on the functional state of the vegetative nervous system (VNS) in the patients presenting with otorhinolaryngological pathology. These data suggest the participation of VNS in the origin and development of many ENT diseases. Moreover, they demonstrate the absence of commonly accepted approaches to the study of VNS and the assessment of clinical manifestations of vegetative dysfunction syndrome. The necessity of the further investigationsinto this problem is emphasized taking into consideration various types of vegetative constitution in the patients suffering from diseases of the upper respiratory tract.
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Affiliation(s)
- M N Gilyalov
- Kazan State Medical University, Russian Ministry of Heath, Kazan, Russia, 420012
| | - Sh M Ismagilov
- Kazan State Medical University, Russian Ministry of Heath, Kazan, Russia, 420012
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Azpiroz F, Hernandez C, Guyonnet D, Accarino A, Santos J, Malagelada JR, Guarner F. Effect of a low-flatulogenic diet in patients with flatulence and functional digestive symptoms. Neurogastroenterol Motil 2014; 26:779-85. [PMID: 24548289 DOI: 10.1111/nmo.12324] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 11/22/2013] [Accepted: 01/30/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Diets rich in fermentable residues increase intestinal gas production. Our aim was to demonstrate the potential effects of diet on gas-related symptoms. METHODS The effect of a low-flatulogenic test diet (restricted to foodstuffs low in fermentable residues; n = 15) was compared to that of a balanced control diet (Mediterranean type; n = 15) in 30 patients complaining of flatulence and other abdominal symptoms using a randomized parallel design. The following outcomes were measured daily: number of anal gas evacuations by an event marker, severity of gas-related symptoms by 0-10 scales, and sensation of digestive comfort by a -5 (unpleasant) to +5 (pleasant) scale. Measurements were taken pretreatment for 3 days on their habitual diet and for 7 days during the treatment phase. KEY RESULTS No pretreatment differences were detected between patients allocated to the control or test diets. The test diet significantly reduced the number of gas evacuations (by 54 ± 10%; p = 0.002 vs basal diet) whereas the control diet had a lesser effect (reduction by 28 ± 9%; p = 0.059 vs basal diet; p = 0.089 vs test diet). Compared to the control diet, the test diet significantly reduced flatulence (by 48 ± 7% vs 27 ± 8%, respectively; p = 0.018), abdominal distension (by 48 ± 4% vs 22 ± 12%, respectively; p = 0.038), and enhanced digestive well-being (by 149 ± 18% vs 58 ± 22%, respectively; p = 0.006). CONCLUSIONS & INFERENCES In patients with gas-related symptoms, a low-flatulogenic diet produces immediate beneficial effects with digestive, cognitive, and emotive dimensions. The number of gas evacuations is an objective biological marker of response to dietary treatment.
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Affiliation(s)
- F Azpiroz
- Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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Guglani L, Atkinson S, Hosanagar A, Guglani L. A systematic review of psychological interventions for adult and pediatric patients with vocal cord dysfunction. Front Pediatr 2014; 2:82. [PMID: 25152871 PMCID: PMC4126208 DOI: 10.3389/fped.2014.00082] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 02/01/2014] [Accepted: 07/20/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vocal cord dysfunction (VCD) or paradoxical vocal-fold motion (PVFM) is a functional disorder of the vocal cords that requires multidisciplinary treatment. Besides relaxation techniques, the use of psychological interventions can help treat the underlying psychological co-morbidities. There is currently no literature that examines the effectiveness of psychological interventions for VCD/PVFM. OBJECTIVES To review the evidence for psychological interventions used for the treatment of patients with VCD/PVFM. DATA SOURCES We searched electronic databases for English medical literature using Pubmed (Medline), PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Registry of Controlled Trials, and Clinicaltrials.gov. The date range for our search is from June 1964 to June 2014. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS We included studies that reported the use of psychological interventions in both adults and children diagnosed with VCD/PVFM. We included randomized controlled trials, case-control studies, retrospective chart reviews, prospective case series, and individual case reports. RESULTS Most reported studies are small case series or individual case reports that have described the use of interventions such as psychotherapy, behavioral therapy, use of anti-anxiety and anti-depressant medications, and hypnotherapy in conjunction with breathing exercises taught by speech therapists for symptomatic relief. Among the various psychological interventions that have been reported, there is no data regarding effectiveness and/or superiority of one approach over another in either adult or pediatric patients. CONCLUSIONS Psychological interventions have a role to play in the management of adult and pediatric patients with VCD/PVFM. Future prospective studies using uniform approaches for treatment of associated psychopathology may help address this question.
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Affiliation(s)
- Loveleen Guglani
- Department of Communication Disorders, Wayne State University , Detroit, MI , USA
| | - Sarah Atkinson
- Wayne State University School of Medicine , Detroit, MI , USA
| | - Avinash Hosanagar
- Department of Psychiatry, Veterans Affairs Medical Center, University of Michigan Medical School , Ann Arbor, MI , USA
| | - Lokesh Guglani
- Division of Pulmonary Medicine, The Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan , Detroit, MI , USA
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Abstract
World War I witnessed the admission of large numbers of German soldiers with neurological symptoms for which there was no obvious organic cause. This posed a considerable challenge for the military and medical authorities and resulted in an active discussion on the etiology and treatment of these disorders. Current historiography is reliant on published physician accounts, and this represents the first study of treatment approaches based on original case notes. We analyzed patient records from two leading departments of academic psychiatry in Germany, those at Berlin and Jena, in conjunction with the contemporaneous medical literature. Treatment, which can be broadly classified into reward and punishment, suggestion, affective shock, cognitive learning, and physiological methods, was developed in the context of the emerging fields of animal learning and neurophysiology. A further innovative feature was the use of quantitative methods to assess outcomes. These measures showed good response rates, though most cured patients were not sent back to battle because of their presumed psychopathic constitution. While some treatments appear unnecessarily harsh from today's perspective and were also criticized by leading psychiatrists of the time, the concentration of effort and involvement of so many senior doctors led to the development of psychotherapeutic methods that were to influence the field of psychiatric therapy for decades to come.
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Affiliation(s)
| | - Edgar Jones
- Kings College London, King's Centre for Military Health Research, Institute of Psychiatry, London, UK.
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