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Pick S, Millman LM, Ward E, Short E, Stanton B, Reinders AS, Winston JS, Nicholson TR, Edwards MJ, Goldstein LH, David AS, Chalder T, Hotopf M, Mehta MA. Unravelling the influence of affective stimulation on functional neurological symptoms: a pilot experiment examining potential mechanisms. J Neurol Neurosurg Psychiatry 2024; 95:461-470. [PMID: 37963722 DOI: 10.1136/jnnp-2023-332364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Differences in affective processing have previously been shown in functional neurological disorder (FND); however, the mechanistic relevance is uncertain. We tested the hypotheses that highly arousing affective stimulation would result in elevated subjective functional neurological symptoms (FNS), and this would be associated with elevated autonomic reactivity. The possible influence of cognitive detachment was also explored. METHOD Individuals diagnosed with FND (motor symptoms/seizures; n=14) and healthy controls (n=14) viewed Positive, Negative and Neutral images in blocks, while passively observing the stimuli ('Watch') or detaching themselves ('Distance'). The FND group rated their primary FNS, and all participants rated subjective physical (arousal, pain, fatigue) and psychological states (positive/negative affect, dissociation), immediately after each block. Skin conductance (SC) and heart rate (HR) were monitored continuously. RESULTS FNS ratings were higher after Negative compared with Positive and Neutral blocks in the FND group (p=0.002, ηp 2=0.386); however, this effect was diminished in the Distance condition relative to the Watch condition (p=0.018, ηp 2=0.267). SC and/or HR correlated with FNS ratings in the Negative-Watch and Neutral-Distance conditions (r values=0.527-0.672, p values=0.006-0.035). The groups did not differ in subjective affect or perceived arousal (p values=0.541-0.919, ηp 2=<0.001-0.015). CONCLUSIONS Emotionally significant events may exert an influence on FNS which is related to autonomic activation rather than altered subjective affect or perceived arousal. This influence may be modulated by cognitive detachment. Further work is needed to determine the relevance and neural bases of these processes in specific FND phenotypes.
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Affiliation(s)
- Susannah Pick
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ls Merritt Millman
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Emily Ward
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Eleanor Short
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Biba Stanton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Aat Simone Reinders
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Joel S Winston
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Timothy R Nicholson
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mark J Edwards
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Laura H Goldstein
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Trudie Chalder
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Matthew Hotopf
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mitul A Mehta
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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De Aveiro B, Winsor A, Davies J, Nicholson TR, Pal DK, Richardson MP, Pick S. Mental health and neurodevelopmental patient-reported outcome measures (PROMs) for children and young people with epilepsy: A systematic review. Epilepsy Behav 2024; 153:109671. [PMID: 38368788 DOI: 10.1016/j.yebeh.2024.109671] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024]
Abstract
Children and young people with epilepsy are at higher risk of mental health disorders and atypical neurodevelopmental outcomes compared to the general population. It is essential to detect such comorbidities early in children with epilepsy and provide appropriate interventions, to improve clinical outcomes. We aimed to identify and evaluate the measurement properties of Patient-Reported Outcome Measures (PROMs) that have been validated specifically to measure mental health and neurodevelopmental outcomes in children and/or young people with epilepsy. We searched Embase, Medline, and PsycINFO in May 2023 for relevant studies. Mental health was defined as psychological symptoms (e.g., anxiety, depression, psychosis) and/or behavioural difficulties (e.g., conduct disorders). Neurodevelopmental outcomes included neurodevelopmental disorder traits such as attention-deficit hyperactivity disorder (ADHD) and autistic spectrum disorders. We assessed methodological quality using Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidance. Twelve papers were identified that psychometrically evaluated 13 relevant PROMs (two epilepsy-specific, eleven generic). The appraisal of the PROMs was limited by the availability of only one or two published articles for each, and incomplete psychometric evaluations in some cases. The tool demonstrating the strongest evidence was The Neurological Disorders Depression Inventory-Epilepsy for Youth. The ADHD Rating Scale-IV and The Paediatric Symptom Checklist -17 demonstrated good evidence in favour of at least two measurement properties. This review identified only a small number of mental health and neurodevelopmental PROMs evaluated specifically in paediatric epilepsy. There is a need for further validation of mental health and neurodevelopmental PROMs in children with epilepsy.
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Affiliation(s)
- Bianca De Aveiro
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alice Winsor
- Department of Basic and Clinical Neuroscience and MRC Centre for Neurodevelopmental Disorders Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jessica Davies
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Deb K Pal
- Department of Basic and Clinical Neuroscience and MRC Centre for Neurodevelopmental Disorders Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark P Richardson
- Department of Basic and Clinical Neuroscience and MRC Centre for Neurodevelopmental Disorders Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susannah Pick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Millman LSM, Short E, Ward E, Stanton B, Bradley-Westguard A, Goldstein LH, Winston JS, Mehta MA, Nicholson TR, Reinders AATS, David AS, Edwards MJ, Chalder T, Hotopf M, Pick S. Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures: A Pilot Investigation. J Neuropsychiatry Clin Neurosci 2024:appineuropsych20230103. [PMID: 38481167 DOI: 10.1176/appi.neuropsych.20230103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE This study examined etiological factors and symptom triggers of functional motor symptoms (FMS) or functional seizures (FS) and assessed potential relationships with relevant clinical features (i.e., functional symptoms, quality of life, and general functioning). METHODS Seventeen participants with FMS or FS and 17 healthy control participants underwent an in-depth clinical interview and completed questionnaires assessing adverse life events, psychological and physical symptoms, alexithymia, autistic traits, illness perceptions, health-related quality of life (HRQoL), and work and social functioning. RESULTS Participants with FMS or FS perceived various causes of the disorder, including physical symptoms (65%), emotional problems (53%), adverse life events (47%), and work-related factors (29%). Triggers of FMS and FS included physical activity or exertion (59%), stress and emotions (59%), sensory experiences (47%), and fatigue (41%). Compared with healthy control participants, participants with FMS or FS reported more adverse events during adolescence and higher levels of alexithymia, somatoform dissociation, psychological dissociation (disengagement, depersonalization, and derealization), anxiety, depression, and physical symptoms. Participants with FMS or FS had worse HRQoL than healthy control participants and impaired work and social functioning. There were inverse associations between HRQoL scores and somatoform dissociation, anxiety, and adverse life events. CONCLUSIONS Participants with FMS or FS reported diverse biopsychosocial etiological factors and symptom triggers. Ongoing psychological symptoms and lifetime adverse experiences were associated with worse HRQoL. Future studies will examine these factors in larger samples of individuals with FMS or FS to better understand their shared and distinct etiological underpinnings.
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Affiliation(s)
- L S Merritt Millman
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Eleanor Short
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Emily Ward
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Biba Stanton
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Abigail Bradley-Westguard
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Joel S Winston
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Mitul A Mehta
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Antje A T S Reinders
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Anthony S David
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Mark J Edwards
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Trudie Chalder
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
| | - Susannah Pick
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Millman, Short, Ward, Stanton, Bradley-Westguard, Goldstein, Winston, Mehta, Nicholson, Reinders, Edwards, Chalder, Hotopf, Pick); University College London Institute of Mental Health, London (David); South London and Maudsley National Health Service Foundation Trust, London (Hotopf)
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Seylanova N, Chernyavskaya A, Degtyareva N, Mursalova A, Ajam A, Xiao L, Aktulaeva K, Roshchin P, Bobkova P, Aiyegbusi OL, Anbu AT, Apfelbacher C, Asadi-Pooya AA, Ashkenazi-Hoffnung L, Brackel C, Buonsenso D, de Groote W, Diaz JV, Dona D, Dunn Galvin A, Genuneit J, Goss H, Hughes SE, Jones CJ, Kuppalli K, Malone LA, McFarland S, Needham DM, Nekliudov N, Nicholson TR, Oliveira CR, Schiess N, Segal TY, Sigfrid L, Thorne C, Vijverberg S, Warner JO, Were WM, Williamson PR, Munblit D. Core outcome measurement set for research and clinical practice in post-COVID-19 condition (long COVID) in children and young people: an international Delphi consensus study "PC-COS Children". Eur Respir J 2024; 63:2301761. [PMID: 38359962 PMCID: PMC10938351 DOI: 10.1183/13993003.01761-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic substantially impacted different age groups, with children and young people not exempted. Many have experienced enduring health consequences. Presently, there is no consensus on the health outcomes to assess in children and young people with post-COVID-19 condition. Furthermore, it is unclear which measurement instruments are appropriate for use in research and clinical management of children and young people with post-COVID-19. To address these unmet needs, we conducted a consensus study, aiming to develop a core outcome set (COS) and an associated core outcome measurement set (COMS) for evaluating post-COVID-19 condition in children and young people. Our methodology comprised of two phases. In phase 1 (to create a COS), we performed an extensive literature review and categorisation of outcomes, and prioritised those outcomes in a two-round online modified Delphi process followed by a consensus meeting. In phase 2 (to create the COMS), we performed another modified Delphi consensus process to evaluate measurement instruments for previously defined core outcomes from phase 1, followed by an online consensus workshop to finalise recommendations regarding the most appropriate instruments for each core outcome. In phase 1, 214 participants from 37 countries participated, with 154 (72%) contributing to both Delphi rounds. The subsequent online consensus meeting resulted in a final COS which encompassed seven critical outcomes: fatigue; post-exertion symptoms; work/occupational and study changes; as well as functional changes, symptoms, and conditions relating to cardiovascular, neuro-cognitive, gastrointestinal and physical outcomes. In phase 2, 11 international experts were involved in a modified Delphi process, selecting measurement instruments for a subsequent online consensus workshop where 30 voting participants discussed and independently scored the selected instruments. As a result of this consensus process, four instruments met a priori consensus criteria for inclusion: PedsQL multidimensional fatigue scale for "fatigue"; PedsQL gastrointestinal symptom scales for "gastrointestinal"; PedsQL cognitive functioning scale for "neurocognitive" and EQ-5D for "physical functioning". Despite proposing outcome measurement instruments for the remaining three core outcomes ("cardiovascular", "post-exertional malaise", "work/occupational and study changes"), a consensus was not achieved. Our international, consensus-based initiative presents a robust framework for evaluating post-COVID-19 condition in children and young people in research and clinical practice via a rigorously defined COS and associated COMS. It will aid in the uniform measurement and reporting of relevant health outcomes worldwide.
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Affiliation(s)
- Nina Seylanova
- Independent researcher, London, UK
- Authors contributed equally to the study; apart from the two joint first authors, who contributed equally, the primary study team members and the last author, authors are listed in alphabetical order
| | - Anastasia Chernyavskaya
- Department of Paediatrics and Paediatric Rheumatology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- National Medical Research Center for Children's Health, Moscow, Russia
- Authors contributed equally to the study; apart from the two joint first authors, who contributed equally, the primary study team members and the last author, authors are listed in alphabetical order
| | - Natalia Degtyareva
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Ali Ajam
- University of Birmingham, Birmingham, UK
| | - Lin Xiao
- University of Birmingham, Birmingham, UK
| | | | | | | | | | | | | | - Ali Akbar Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Caroline Brackel
- Department of Paediatric Pulmonology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands
| | - Danilo Buonsenso
- Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Janet V Diaz
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Daniele Dona
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Krutika Kuppalli
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Laura A Malone
- Kennedy Krieger Institute, Baltimore, MD, USA
- Departments of Neurology and Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Sammie McFarland
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
- Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nikita Nekliudov
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Carlos R Oliveira
- Yale University School of Medicine, Department of Pediatrics, Section of Infectious Diseases, New Haven, CT, USA
- Yale University School of Public Health, Department of Biostatistics, Division of Health Informatics, New Haven, CT, USA
- Yale New Haven Children's Hospital, New Haven, CT, USA
| | - Nicoline Schiess
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Geneva, Switzerland
| | - Terry Y Segal
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Claire Thorne
- Population, Policy and Practice Research and Teaching Dept, University College London GOS Institute of Child Health, London, UK
| | | | | | - Wilson Milton Were
- Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Paula R Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Division of Care in Long Term Conditions, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
- Authors contributed equally to the study; apart from the two joint first authors, who contributed equally, the primary study team members and the last author, authors are listed in alphabetical order
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5
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Fanshawe JB, Sargent BF, Badenoch JB, Saini A, Watson CJ, Pokrovskaya A, Aniwattanapong D, Conti I, Nye C, Burchill E, Hussain ZU, Said K, Kuhoga E, Tharmaratnam K, Pendered S, Mbwele B, Taquet M, Wood GK, Rogers JP, Hampshire A, Carson A, David AS, Michael BD, Nicholson TR, Paddick SM, Leek CE. Cognitive domains affected post-COVID-19; a systematic review and meta-analysis. Eur J Neurol 2024:e16181. [PMID: 38375608 DOI: 10.1111/ene.16181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/23/2023] [Accepted: 11/29/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE This review aims to characterize the pattern of post-COVID-19 cognitive impairment, allowing better prediction of impact on daily function to inform clinical management and rehabilitation. METHODS A systematic review and meta-analysis of neurocognitive sequelae following COVID-19 was conducted, following PRISMA-S guidelines. Studies were included if they reported domain-specific cognitive assessment in patients with COVID-19 at >4 weeks post-infection. Studies were deemed high-quality if they had >40 participants, utilized healthy controls, had low attrition rates and mitigated for confounders. RESULTS Five of the seven primary Diagnostic and Statistical Manual of Mental Disorders (DSM-5) cognitive domains were assessed by enough high-quality studies to facilitate meta-analysis. Medium effect sizes indicating impairment in patients post-COVID-19 versus controls were seen across executive function (standardised mean difference (SMD) -0.45), learning and memory (SMD -0.55), complex attention (SMD -0.54) and language (SMD -0.54), with perceptual motor function appearing to be impacted to a greater degree (SMD -0.70). A narrative synthesis of the 56 low-quality studies also suggested no obvious pattern of impairment. CONCLUSIONS This review found moderate impairments across multiple domains of cognition in patients post-COVID-19, with no specific pattern. The reported literature was significantly heterogeneous, with a wide variety of cognitive tasks, small sample sizes and disparate initial disease severities limiting interpretability. The finding of consistent impairment across a range of cognitive tasks suggests broad, as opposed to domain-specific, brain dysfunction. Future studies should utilize a harmonized test battery to facilitate inter-study comparisons, whilst also accounting for the interactions between COVID-19, neurological sequelae and mental health, the interplay between which might explain cognitive impairment.
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Affiliation(s)
- Jack B Fanshawe
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Brendan F Sargent
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - James B Badenoch
- Barts Health NHS Trust, London, UK
- Preventive Neurology Unit, Queen Mary University of London, London, UK
| | - Aman Saini
- School of Life and Medical Sciences, University College London, London, UK
| | - Cameron J Watson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Daruj Aniwattanapong
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Isabella Conti
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charles Nye
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Ella Burchill
- Division of Psychiatry, University College London, London, UK
| | - Zain U Hussain
- NHS Greater Glasgow and Clyde, Glasgow, UK
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Khanafi Said
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Elinda Kuhoga
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Kukatharmini Tharmaratnam
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Sophie Pendered
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Bernard Mbwele
- Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania
| | - Maxime Taquet
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Greta K Wood
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | | | - Adam Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Anthony S David
- Division of Psychiatry, University College London, London, UK
| | - Benedict D Michael
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Charles E Leek
- Department of Psychology, University of Liverpool, Liverpool, UK
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6
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Perez DL, Nicholson TR, Asadi-Pooya AA, Butler M, Carson AJ, David AS, Deeley Q, Diez I, Edwards MJ, Espay AJ, Gelauff JM, Jungilligens J, Hallett M, Kanaan RAA, Tijssen MAJ, Kozlowska K, LaFrance WC, Marapin RS, Maurer CW, Reinders AATS, Sojka P, Staab JP, Stone J, Szaflarski JP, Aybek S. Response to the Letter Concerning the Publication: Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda. Perez DL et al. Neuroimage Clin. 2021;30:102623. Neuroimage Clin 2024; 41:103573. [PMID: 38309187 PMCID: PMC10847796 DOI: 10.1016/j.nicl.2024.103573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/05/2024]
Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Timothy R Nicholson
- Neuropsychiatry Research & Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Centre, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew Butler
- Neuropsychiatry Research & Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Anthony S David
- Division of Psychiatry, Institute of Mental Health, University College London, London, UK
| | - Quinton Deeley
- South London and Maudsley NHS Foundation Trust, London UK Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ibai Diez
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark J Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King's College 16 De Crespigny Park, London, SE5 8AF, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | | | - Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Germany
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Australia
| | - Marina A J Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, the Netherlands
| | - Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead Institute of Medical Research, University of Sydney Medical School, Sydney, NSW, Australia
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Ramesh S Marapin
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, the Netherlands
| | - Carine W Maurer
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Petr Sojka
- Department of Neurology and Centre of Clinical Neuroscience, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Jeffrey P Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Rochester, MN, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham Epilepsy Center, Department of Neurology, University of Alabama at Birmingham, AL, USA
| | - Selma Aybek
- Faculté des Sciences et de Médecine, Université de Fribourg, Chemin du Musée 5, 1700 Fribourg, Suisse
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Butler M, Abdat Y, Zandi M, Michael BD, Coutinho E, Nicholson TR, Easton A, Pollak TA. Mental health outcomes of encephalitis: An international web-based study. Eur J Neurol 2024; 31:e16083. [PMID: 37797295 DOI: 10.1111/ene.16083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND PURPOSE Acute encephalitis is associated with psychiatric symptoms. Despite this, the extent of mental health problems following encephalitis has not been systematically reported. METHODS We recruited adults who had been diagnosed with encephalitis of any aetiology to complete a web-based questionnaire. RESULTS In total, 445 respondents from 31 countries (55.1% UK, 23.1% USA) responded. Infectious encephalitis constituted 65.4% of cases, autoimmune 29.7%. Mean age was 50.1 years, 65.8% were female, and median time since encephalitis diagnosis was 7 years. The most common self-reported psychiatric symptoms were anxiety (75.2%), sleep problems (64.4%), mood problems (62.2%), and unexpected crying (35.2%). Self-reported psychiatric diagnoses were common: anxiety (44.0%), depression (38.6%), panic disorder (15.7%), and posttraumatic stress disorder (PTSD; 21.3%). Severe mental illnesses such as psychosis (3.3%) and bipolar affective disorder (3.1%) were reported. Self-reported diagnosis rates were broadly consistent with results from the Psychiatric Diagnostic Screening Questionnaire. Many respondents also reported they had symptoms of anxiety (37.5%), depression (28.1%), PTSD (26.8%), or panic disorder (20.9%) that had not been diagnosed. Rates of psychiatric symptoms did not differ between autoimmune and infectious encephalitis. In total, 37.5% respondents had thought about suicide, and 4.4% had attempted suicide, since their encephalitis diagnosis. More than half of respondents (53.5%) reported they had no, or substandard, access to appropriate mental health care. High rates of sensory hypersensitivities (>75%) suggest a previously unreported association. CONCLUSIONS This large international survey indicates that psychiatric symptoms following encephalitis are common and that mental health care provision may be inadequate. We highlight a need for proactive psychiatric input.
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Affiliation(s)
- Matt Butler
- Neuropsychiatry Research and Education Group, King's College London, London, UK
| | - Yasmin Abdat
- Neuropsychiatry Research and Education Group, King's College London, London, UK
| | - Michael Zandi
- Department of Neuroinflammation, University College London Queen Square Institute of Neurology, London, UK
| | - Benedict D Michael
- Department of Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, UK
| | - Ester Coutinho
- Neuropsychiatry Research and Education Group, King's College London, London, UK
- Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, King's College London, London, UK
| | - Ava Easton
- Department of Clinical Infection, Microbiology, and Immunology, University of Liverpool, Liverpool, UK
- Encephalitis Society, Malton, UK
| | - Thomas A Pollak
- Neuropsychiatry Research and Education Group, King's College London, London, UK
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Pick S, Millman LM, Sun Y, Short E, Stanton B, Winston JS, Mehta MA, Nicholson TR, Reinders AA, David AS, Edwards MJ, Goldstein LH, Hotopf M, Chalder T. Objective and subjective neurocognitive functioning in functional motor symptoms and functional seizures: preliminary findings. J Clin Exp Neuropsychol 2023; 45:970-987. [PMID: 37724767 PMCID: PMC11057846 DOI: 10.1080/13803395.2023.2245110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/30/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION This study aimed to provide a preliminary assessment of objective and subjective neurocognitive functioning in individuals with functional motor symptoms (FMS) and/or functional seizures (FS). We tested the hypotheses that the FMS/FS group would display poorer objective attentional and executive functioning, altered social cognition, and reduced metacognitive accuracy. METHOD Individuals with FMS/FS (n = 16) and healthy controls (HCs, n = 17) completed an abbreviated CANTAB battery, and measures of intellectual functioning, subjective cognitive complaints, performance validity, and comorbid symptoms. Subjective performance ratings were obtained to assess local metacognitive accuracy. RESULTS The groups were comparable in age (p = 0.45), sex (p = 0.62), IQ (p = 0.57), and performance validity (p-values = 0.10-0.91). We observed no impairment on any CANTAB test in this FMS/FS sample compared to HCs, although the FMS/FS group displayed shorter reaction times on the Emotional Bias task (anger) (p = 0.01, np2 = 0.20). The groups did not differ in subjective performance ratings (p-values 0.15). Whilst CANTAB attentional set-shifting performance (total trials/errors) correlated with subjective performance ratings in HCs (p-values<0.005, rs = -0.85), these correlations were non-significant in the FMS/FS sample (p-values = 0.10-0.13, rs-values = -0.46-0.50). The FMS/FS group reported more daily cognitive complaints than HCs (p = 0.006, g = 0.92), which were associated with subjective performance ratings on CANTAB sustained attention (p = 0.001, rs = -0.74) and working memory tests (p < 0.001, rs = -0.75), and with depression (p = 0.003, rs = 0.70), and somatoform (p = 0.003, rs = 0.70) and psychological dissociation (p-values<0.005, rs-values = 0.67-0.85). CONCLUSIONS These results suggest a discordance between objective and subjective neurocognitive functioning in this FMS/FS sample, reflecting intact test performance alongside poorer subjective cognitive functioning. Further investigation of neurocognitive functioning in FND subgroups is necessary.
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Affiliation(s)
- Susannah Pick
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - L.S. Merritt Millman
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Yiqing Sun
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Eleanor Short
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Biba Stanton
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Joel S. Winston
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Mitul A. Mehta
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Timothy R. Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | | | | | - Mark J. Edwards
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Laura H. Goldstein
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
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9
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Gorst SL, Seylanova N, Dodd SR, Harman NL, O'Hara M, Terwee CB, Williamson PR, Needham DM, Munblit D, Nicholson TR. Core outcome measurement instruments for use in clinical and research settings for adults with post-COVID-19 condition: an international Delphi consensus study. Lancet Respir Med 2023; 11:1101-1114. [PMID: 37926103 DOI: 10.1016/s2213-2600(23)00370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 07/04/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
Post-COVID-19 condition (also known as long COVID) is a new, complex, and poorly understood disorder. A core outcome set (COS) for post-COVID-19 condition in adults has been developed and agreement is now required on the most appropriate measurement instruments for these core outcomes. We conducted an international consensus study involving multidisciplinary experts and people with lived experience of long COVID. The study comprised a literature review to identify measurement instruments for the core outcomes, a three-round online modified Delphi process, and an online consensus meeting to generate a core outcome measurement set (COMS). 594 individuals from 58 countries participated. The number of potential instruments for the 12 core outcomes was reduced from 319 to 19. Consensus was reached for inclusion of the modified Medical Research Council Dyspnoea Scale for respiratory outcomes. Measures for two relevant outcomes from a previously published COS for acute COVID-19 were also included: time until death, for survival, and the Recovery Scale for COVID-19, for recovery. Instruments were suggested for consideration for the remaining nine core outcomes: fatigue or exhaustion, pain, post-exertion symptoms, work or occupational and study changes, and cardiovascular, nervous system, cognitive, mental health, and physical outcomes; however, consensus was not achieved for instruments for these outcomes. The recommended COMS and instruments for consideration provide a foundation for the evaluation of post-COVID-19 condition in adults, which should help to optimise clinical care and accelerate research worldwide. Further assessment of this COMS is warranted as new data emerge on existing and novel measurement instruments.
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Affiliation(s)
- Sarah L Gorst
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Susanna R Dodd
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Nicola L Harman
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Caroline B Terwee
- Methodology Program, Amsterdam Public Health Research Institute, and Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | - Paula R Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery Research Group, Pulmonary and Critical Care Medicine, Department of Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; Research and Clinical Center for Neuropsychiatry, Moscow, Russia; Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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Bugaeva P, Arkusha I, Bikaev R, Kamenskiy I, Pokrovskaya A, El-Taravi Y, Caso V, Avedisova A, Chu DK, Genuneit J, Torbahn G, Nicholson TR, Baimukhambetova D, Mursalova A, Kolotilina A, Gadetskaya S, Kondrikova E, Zinchuk M, Akzhigitov R, Boyle RJ, Guekht A, Munblit D. Association of breastfeeding with mental disorders in mother and child: a systematic review and meta-analysis. BMC Med 2023; 21:393. [PMID: 37840122 PMCID: PMC10577970 DOI: 10.1186/s12916-023-03071-7] [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: 03/07/2023] [Accepted: 09/06/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Breastfeeding has long been associated with numerous benefits for both mothers and infants. While some observational studies have explored the relationship between breastfeeding and mental health outcomes in mothers and children, a systematic review of the available evidence is lacking. The purpose of this study is to systematically evaluate the association between breastfeeding and mental health disorders in mothers and children. METHODS We systematically searched MEDLINE and EMBASE from inception to June 2, 2023. The inclusion criteria consisted of all studies evaluating links between breastfeeding and development of mental health disorders in children and mothers. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) while grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the certainty of evidence. A random-effects meta-analysis was used if possible, to estimate the odds ratio for the association between breastfeeding and mental health outcomes. The Mantel-Haenszel method was utilised for pooling ORs across studies. Study heterogeneity was assessed using the I2 statistic. RESULTS Our review identified twenty-one original study. Of these, 18 focused on the association between breastfeeding and child health, assessing depressive disorders, schizophrenia, anxiety disorders, eating disorders and borderline personality disorder. Three studies evaluated the associations between breastfeeding and maternal mental health disorders. Three studies looking at outcomes in children showed no significant association between breastfeeding and occurrence of schizophrenia later in life (OR 0.98; 95% CI 0.57-1.71; I2 = 29%). For depressive disorders (5 studies) and anxiety disorders (3 studies), we found conflicting evidence with some studies showing a small protective effect while others found no effect. The GRADE certainty for all these findings was very low due to multiple limitations. Three studies looking at association between breastfeeding and maternal mental health, were too heterogeneous to draw any firm conclusions. CONCLUSIONS We found limited evidence to support a protective association between breastfeeding and the development of mental health disorders in children later in life. The data regarding the association between breastfeeding and maternal mental health beyond the postnatal period is also limited. The methodological limitations of the published literature prevent definitive conclusions, and further research is needed to better understand the relationship between breastfeeding and mental health in mothers and children.
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Affiliation(s)
- Polina Bugaeva
- Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences, Berlin, Germany
| | - Inna Arkusha
- V. Serbsky Federal Medical Research Center for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
- Moscow Research and Clinical Centre for Neuropsychiatry, Moscow, Russia
| | - Rinat Bikaev
- Moscow Research and Clinical Centre for Neuropsychiatry, Moscow, Russia
| | - Igor Kamenskiy
- Moscow City Clinical Hospital After V.M. Buyanov, Moscow, Russia
| | - Aleksandra Pokrovskaya
- Department of Brain Sciences, Faculty of Medicine, Dementia Research Institute UK, Imperial College London, London, UK
| | | | - Valeria Caso
- Stroke Unit, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Alla Avedisova
- V. Serbsky Federal Medical Research Center for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Derek K Chu
- Division of Clinical Immunology & Allergy, Department of Medicine, and Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada
| | - Jon Genuneit
- Department of Pediatrics, Pediatric Epidemiology, Medical Faculty, Leipzig University, Leipzig, Germany
- German Center for Child and Youth Health, Leipzig, Germany
| | - Gabriel Torbahn
- Department of Pediatrics, Paracelsus Medical University, Klinikum Nürnberg, Universitätsklinik Der Paracelsus Medizinischen Privatuniversität Nürnberg, Nuremberg, Germany
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dina Baimukhambetova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Aigun Mursalova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Anastasia Kolotilina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Svetlana Gadetskaya
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Elena Kondrikova
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Mikhail Zinchuk
- Moscow Research and Clinical Centre for Neuropsychiatry, Moscow, Russia
| | - Renat Akzhigitov
- Moscow Research and Clinical Centre for Neuropsychiatry, Moscow, Russia
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, UK.
| | - Alla Guekht
- Moscow Research and Clinical Centre for Neuropsychiatry, Moscow, Russia
| | - Daniel Munblit
- National Heart and Lung Institute, Imperial College London, London, UK.
- Care for Long Term Conditions Division, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
- I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia.
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom.
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Winsor AA, Ebelthite C, Onih J, Nicholson TR, Pal DK, Richardson M. Study protocol for a case series: implementation and evaluation of an integrated mental and physical healthcare programme to screen for mental health symptoms in people with epilepsy. BMJ Open 2023; 13:e075043. [PMID: 37788926 PMCID: PMC10551954 DOI: 10.1136/bmjopen-2023-075043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION The prevalence of mental health symptoms in people with epilepsy (PWE) is elevated compared with that of the general population. These symptoms can negatively impact epilepsy management and patient outcomes but can be treated once recognised. It is, therefore, important to screen for these symptoms to identify needs and put in place appropriate support. Unfortunately, mental health symptoms are rarely addressed in epilepsy services due to time constraints, lack of resources and communication between psychological and medical professionals. These barriers can result in diagnostic overshadowing, where symptoms may be attributed to the disease and reduce the level of support PWE receive. Implementing an online screening tool embedded in the electronic health record (EHR) platform with supported referral pathways may remove some of these barriers. METHODS AND ANALYSIS We will follow the Integrating Mental and Physical Healthcare: Research Training and Services framework, which is a routine clinical data collection tool used by clinical teams to electronically screen psychological symptoms among patients with long-term physical health conditions. Patient outcomes including mental health, physical health and psychosocial outcomes will be collected and uploaded to the EHR platform in real-time. An appropriate referral pathway will be recommended depending on severity of the outcome scores. We will initially pilot the tool for individuals aged 13 years and above through epilepsy clinics at King's College Hospital. Following this, the acceptability and feasibility of the tool will be assessed at baseline, 6 and 12 months. ETHICS AND DISSEMINATION Ethics approval was obtained from the National Health Service Research Ethics Committee of South Central-Oxford C, reference: 21/EM/0205. This study is expected to inform the use of integrated electronic mental health screening for youth in epilepsy clinics and improve access to psychological support. The findings will be disseminated through academic peer-reviewed journals, poster presentations and scientific meetings.
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Affiliation(s)
- Alice Afua Winsor
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's College london, London, UK
| | | | - Jemima Onih
- King's Health Partners, Mind & Body Programme, London, UK
| | - Timothy R Nicholson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Deb K Pal
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's College london, London, UK
| | - Mark Richardson
- School of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, King's College london, London, UK
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12
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Millman LSM, Short E, Stanton B, Winston JS, Nicholson TR, Mehta MA, Reinders AATS, Edwards MJ, Goldstein LH, David AS, Hotopf M, Chalder T, Pick S. Interoception in functional motor symptoms and functional seizures: Preliminary evidence of intact accuracy alongside reduced insight and altered sensibility. Behav Res Ther 2023; 168:104379. [PMID: 37516011 PMCID: PMC10788481 DOI: 10.1016/j.brat.2023.104379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/14/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
Altered interoception may be a pathophysiological mechanism in functional neurological disorder (FND). However, findings have been inconsistent across interoceptive dimensions in FND including functional motor symptoms (FMS) and seizures (FS). Here, individuals with FMS/FS (n = 17) and healthy controls (HC, n = 17) completed measures of interoceptive accuracy and insight (adapted heartbeat tracking task [HTT] with confidence ratings), a time estimation control task (TET) and the Multidimensional Assessment of Interoceptive Awareness-2 (MAIA-2) to assess interoceptive sensibility. The groups did not differ in interoceptive accuracy (p = 1.00, g = 0.00) or confidence (p = .99, g = 0.004), although the FMS/FS group displayed lower scores on the "Not-Distracting" (p < .001, g = 1.42) and "Trusting" (p = .005, g = 1.17) MAIA-2 subscales, relative to HCs. The groups did not differ in TET performance (p = .82, g = 0.08). There was a positive relationship between HTT accuracy and confidence (insight) in HCs (r = .61, p = .016) but not in FMS/FS (r = 0.11, p = .69). HTT confidence was positively correlated with MAIA-2 "Self-Regulation" (r = 0.77, p = .002) and negatively correlated with FND symptom severity (r = -0.84, p < .001) and impact (r = -0.86, p < .001) in FMS/FS. Impaired interoceptive accuracy may not be a core feature in FMS/FS, but reduced insight and altered sensibility may be relevant. Reduced certainty in self-evaluations of bodily experiences may contribute to the pathogenesis of FND symptoms.
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Affiliation(s)
- L S Merritt Millman
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Eleanor Short
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Biba Stanton
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Joel S Winston
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Mitul A Mehta
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Antje A T S Reinders
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Mark J Edwards
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | | | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Susannah Pick
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.
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13
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Tamborska AA, Wood GK, Westenberg E, Garcia-Azorin D, Webb G, Schiess N, Netravathi M, Baykan B, Dervaj R, Helbok R, Lant S, Özge A, Padovani A, Saylor D, Schmutzhard E, Easton A, Lilleker JB, Jackson T, Beghi E, Ellul MA, Frontera JA, Pollak T, Nicholson TR, Wood N, Thakur KT, Solomon T, Stark RJ, Winkler AS, Michael BD. Corrigendum to "Global uncertainty in the diagnosis of neurological complications of SARS-CoV-2 infection by both neurologists and non-neurologists: An international inter-observer variability study" [Journal of the Neurological Sciences. 2023 Jun 15;449:120646]. J Neurol Sci 2023; 451:120709. [PMID: 37385027 PMCID: PMC10294702 DOI: 10.1016/j.jns.2023.120709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- A A Tamborska
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - G K Wood
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological sciences, University of Liverpool, Liverpool, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - E Westenberg
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Germany
| | - D Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - G Webb
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - N Schiess
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, USA
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - B Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkiye; EMAR Medical Center, Macka Istanbul, Turkiye
| | - R Dervaj
- Department of Neurology, Apollo Specialty Hospital, Bangalore, Karnataka, India
| | - R Helbok
- Department of Neurology, Division Neuro-Critical Care, Medical University Innsbruck, Austria
| | - S Lant
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological sciences, University of Liverpool, Liverpool, UK
| | - A Özge
- Mersin University Medical Faculty, Department of Neurology, Mersin, Turkey
| | - A Padovani
- Clinical and Experimental Sciences Department, Neurology Unit, University and SpedaliCivili, Brescia, Italy
| | - D Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Schmutzhard
- Department of Neurology, Division Neuro-Critical Care, Medical University Innsbruck, Austria
| | - A Easton
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological sciences, University of Liverpool, Liverpool, UK; Encephalitis Society, United Kingdom
| | - J B Lilleker
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK; Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - T Jackson
- Institute of Inflammation and Ageing, University of Birmingham, UK; Geriatric Medicine, University Hospitals Birmingham, Birmingham, UK
| | - E Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M A Ellul
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - J A Frontera
- Department of Neurology, New York University Grossman School of Medicine, NY, New York, USA
| | - T Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - T R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N Wood
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
| | - K T Thakur
- Columbia University Irving Medical Center-New York Presbyterian Hospital, NY, New York, USA
| | - T Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; The Pandemic Institute, Liverpool, UK
| | - R J Stark
- Department of Neurology, Alfred Hospital, Melbourne, Australia; Department of Neuroscience, Monash University, Melbourne, Australia
| | - A S Winkler
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Germany; Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - B D Michael
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK.
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14
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Alam AM, Easton A, Nicholson TR, Irani SR, Davies NWS, Solomon T, Michael BD. Encephalitis: diagnosis, management and recent advances in the field of encephalitides. Postgrad Med J 2023; 99:815-825. [PMID: 37490360 DOI: 10.1136/postgradmedj-2022-141812] [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: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 11/03/2022]
Abstract
Encephalitis describes inflammation of the brain parenchyma, typically caused by either an infectious agent or through an autoimmune process which may be postinfectious, paraneoplastic or idiopathic. Patients can present with a combination of fever, alterations in behaviour, personality, cognition and consciousness. They may also exhibit focal neurological deficits, seizures, movement disorders and/or autonomic instability. However, it can sometimes present non-specifically, and this combined with its many causes make it a difficult to manage neurological syndrome. Despite improved treatments in some forms of encephalitides, encephalitis remains a global concern due to its high mortality and morbidity. Prompt diagnosis and administration of specific and supportive management options can lead to better outcomes. Over the last decade, research in encephalitis has led to marked developments in the understanding, diagnosis and management of encephalitis. In parallel, the number of autoimmune encephalitis syndromes has rapidly expanded and clinically characteristic syndromes in association with pathogenic autoantibodies have been defined. By focusing on findings presented at the Encephalitis Society's conference in December 2021, this article reviews the causes, clinical manifestations and management of encephalitis and integrate recent advances and challenges of research into encephalitis.
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Affiliation(s)
- Ali M Alam
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Unit for Emerging and Zoonotic Infection, Liverpool, UK
- Department of Clinical Infection, Microbiology, & Immunology, University of Liverpool, Liverpool, UK
| | - Ava Easton
- Department of Clinical Infection, Microbiology, & Immunology, University of Liverpool, Liverpool, UK
- Encephalitis Society, Malton, UK
| | | | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford, UK
| | | | - Tom Solomon
- NIHR Health Protection Unit for Emerging and Zoonotic Infection, Liverpool, UK
- The Pandemic Institute, Liverpool, UK
| | - Benedict D Michael
- NIHR Health Protection Unit for Emerging and Zoonotic Infection, Liverpool, UK
- Department of Clinical Infection, Microbiology, & Immunology, University of Liverpool, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
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15
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Tamborska AA, Wood GK, Westenberg E, Garcia-Azorin D, Webb G, Schiess N, Netravathi M, Baykan B, Dervaj R, Helbok R, Lant S, Özge A, Padovani A, Saylor D, Schmutzhard E, Easton A, Lilleker JB, Jackson T, Beghi E, Ellul MA, Frontera JA, Pollak T, Nicholson TR, Wood N, Thakur KT, Solomon T, Stark RJ, Winkler AS, Michael BD. Global uncertainty in the diagnosis of neurological complications of SARS-CoV-2 infection by both neurologists and non-neurologists: An international inter-observer variability study. J Neurol Sci 2023; 449:120646. [PMID: 37100018 PMCID: PMC10085971 DOI: 10.1016/j.jns.2023.120646] [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: 02/08/2023] [Revised: 03/26/2023] [Accepted: 04/08/2023] [Indexed: 04/28/2023]
Abstract
INTRODUCTION Uniform case definitions are required to ensure harmonised reporting of neurological syndromes associated with SARS-CoV-2. Moreover, it is unclear how clinicians perceive the relative importance of SARS-CoV-2 in neurological syndromes, which risks under- or over-reporting. METHODS We invited clinicians through global networks, including the World Federation of Neurology, to assess ten anonymised vignettes of SARS-CoV-2 neurological syndromes. Using standardised case definitions, clinicians assigned a diagnosis and ranked association with SARS-CoV-2. We compared diagnostic accuracy and assigned association ranks between different settings and specialties and calculated inter-rater agreement for case definitions as "poor" (κ ≤ 0.4), "moderate" or "good" (κ > 0.6). RESULTS 1265 diagnoses were assigned by 146 participants from 45 countries on six continents. The highest correct proportion were cerebral venous sinus thrombosis (CVST, 95.8%), Guillain-Barré syndrome (GBS, 92.4%) and headache (91.6%) and the lowest encephalitis (72.8%), psychosis (53.8%) and encephalopathy (43.2%). Diagnostic accuracy was similar between neurologists and non-neurologists (median score 8 vs. 7/10, p = 0.1). Good inter-rater agreement was observed for five diagnoses: cranial neuropathy, headache, myelitis, CVST, and GBS and poor agreement for encephalopathy. In 13% of vignettes, clinicians incorrectly assigned lowest association ranks, regardless of setting and specialty. CONCLUSION The case definitions can help with reporting of neurological complications of SARS-CoV-2, also in settings with few neurologists. However, encephalopathy, encephalitis, and psychosis were often misdiagnosed, and clinicians underestimated the association with SARS-CoV-2. Future work should refine the case definitions and provide training if global reporting of neurological syndromes associated with SARS-CoV-2 is to be robust.
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Affiliation(s)
- A A Tamborska
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - G K Wood
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - E Westenberg
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Germany
| | - D Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - G Webb
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - N Schiess
- Brain Health Unit, Mental Health and Substance Use Department, World Health Organization, Switzerland
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - B Baykan
- Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkiye; EMAR Medical Center, Macka Istanbul, Turkiye
| | - R Dervaj
- Department of Neurology, Apollo Specialty Hospital, Bangalore, Karnataka, India
| | - R Helbok
- Department of Neurology, Division Neuro-Critical Care, Medical University Innsbruck, Austria
| | - S Lant
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - A Özge
- Mersin University Medical Faculty, Department of Neurology, Mersin, Turkey
| | - A Padovani
- Clinical and Experimental Sciences Department, Neurology Unit, University and SpedaliCivili, Brescia, Italy
| | - D Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E Schmutzhard
- Department of Neurology, Division Neuro-Critical Care, Medical University Innsbruck, Austria
| | - A Easton
- Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Encephalitis Society, UK
| | - J B Lilleker
- Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK; Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - T Jackson
- Institute of Inflammation and Ageing, University of Birmingham, UK; Geriatric Medicine, University Hospitals Birmingham, Birmingham, UK
| | - E Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - M A Ellul
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - J A Frontera
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - T Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - T R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - N Wood
- Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, London, UK
| | - K T Thakur
- Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, NY, USA
| | - T Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; The Pandemic Institute, Liverpool, UK
| | - R J Stark
- Department of Neurology, Alfred Hospital, Melbourne, Australia; Department of Neuroscience, Monash University, Melbourne, Australia
| | - A S Winkler
- Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Germany; Centre for Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - B D Michael
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Clinical Infection, Microbiology & Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK.
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16
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Alam AM, Easton A, Nicholson TR, Irani SR, Davies NWS, Solomon T, Michael BD. Encephalitis: diagnosis, management and recent advances in the field of encephalitides. Postgrad Med J 2023:7111273. [PMID: 37036001 DOI: 10.1136/postmj/postgradmedj-2022-141812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 04/11/2023]
Abstract
Encephalitis describes inflammation of the brain parenchyma, typically caused by either an infectious agent or through an autoimmune process which may be postinfectious, paraneoplastic or idiopathic. Patients can present with a combination of fever, alterations in behaviour, personality, cognition and consciousness. They may also exhibit focal neurological deficits, seizures, movement disorders and/or autonomic instability. However, it can sometimes present non-specifically, and this combined with its many causes make it a difficult to manage neurological syndrome. Despite improved treatments in some forms of encephalitides, encephalitis remains a global concern due to its high mortality and morbidity. Prompt diagnosis and administration of specific and supportive management options can lead to better outcomes. Over the last decade, research in encephalitis has led to marked developments in the understanding, diagnosis and management of encephalitis. In parallel, the number of autoimmune encephalitis syndromes has rapidly expanded and clinically characteristic syndromes in association with pathogenic autoantibodies have been defined. By focusing on findings presented at the Encephalitis Society's conference in December 2021, this article reviews the causes, clinical manifestations and management of encephalitis and integrate recent advances and challenges of research into encephalitis.
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Affiliation(s)
- Ali M Alam
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Unit for Emerging and Zoonotic Infection, Liverpool, UK
- Department of Clinical Infection, Microbiology, & Immunology, University of Liverpool, Liverpool, UK
| | - Ava Easton
- Department of Clinical Infection, Microbiology, & Immunology, University of Liverpool, Liverpool, UK
- Encephalitis Society, Malton, UK
| | | | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford, UK
| | | | - Tom Solomon
- NIHR Health Protection Unit for Emerging and Zoonotic Infection, Liverpool, UK
- The Pandemic Institute, Liverpool, UK
| | - Benedict D Michael
- NIHR Health Protection Unit for Emerging and Zoonotic Infection, Liverpool, UK
- Department of Clinical Infection, Microbiology, & Immunology, University of Liverpool, Liverpool, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
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17
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Rogers JP, Pollak TA, Begum N, Griffin A, Carter B, Pritchard M, Broadbent M, Kolliakou A, Ke J, Stewart R, Patel R, Bomford A, Amad A, Zandi MS, Lewis G, Nicholson TR, David AS. Catatonia: demographic, clinical and laboratory associations. Psychol Med 2023; 53:2492-2502. [PMID: 35135642 PMCID: PMC10123832 DOI: 10.1017/s0033291721004402] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Catatonia, a severe neuropsychiatric syndrome, has few studies of sufficient scale to clarify its epidemiology or pathophysiology. We aimed to characterise demographic associations, peripheral inflammatory markers and outcome of catatonia. METHODS Electronic healthcare records were searched for validated clinical diagnoses of catatonia. In a case-control study, demographics and inflammatory markers were compared in psychiatric inpatients with and without catatonia. In a cohort study, the two groups were compared in terms of their duration of admission and mortality. RESULTS We identified 1456 patients with catatonia (of whom 25.1% had two or more episodes) and 24 956 psychiatric inpatients without catatonia. Incidence was 10.6 episodes of catatonia per 100 000 person-years. Patients with and without catatonia were similar in sex, younger and more likely to be of Black ethnicity. Serum iron was reduced in patients with catatonia [11.6 v. 14.2 μmol/L, odds ratio (OR) 0.65 (95% confidence interval (CI) 0.45-0.95), p = 0.03] and creatine kinase was raised [2545 v. 459 IU/L, OR 1.53 (95% CI 1.29-1.81), p < 0.001], but there was no difference in C-reactive protein or white cell count. N-Methyl-d-aspartate receptor antibodies were significantly associated with catatonia, but there were small numbers of positive results. Duration of hospitalisation was greater in the catatonia group (median: 43 v. 25 days), but there was no difference in mortality after adjustment. CONCLUSIONS In the largest clinical study of catatonia, we found catatonia occurred in approximately 1 per 10 000 person-years. Evidence for a proinflammatory state was mixed. Catatonia was associated with prolonged inpatient admission but not with increased mortality.
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Affiliation(s)
- Jonathan P. Rogers
- Division of Psychiatry, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Thomas A. Pollak
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychosis Studies, King's College London, London, UK
| | - Nazifa Begum
- GKT School of Medical Education, King's College London, London, UK
| | - Anna Griffin
- GKT School of Medical Education, King's College London, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | | | | | - Anna Kolliakou
- Department of Psychological Medicine, King's College London, London, UK
| | - Jessie Ke
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Rashmi Patel
- Department of Psychosis Studies, King's College London, London, UK
| | - Adrian Bomford
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, UK
| | - Ali Amad
- Department of Neuroimaging, King's College London, London, UK
- Univ. Lille, Inserm, CHU Lille, U1172 – LilNCog – Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Michael S. Zandi
- UCL Queen Square Institute of Neurology, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | | | - Anthony S. David
- UCL Queen Square Institute of Neurology, University College London, London, UK
- Institute of Mental Health, University College London, London, UK
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18
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Gibson LL, Pollak TA, Hart M, Heslegrave A, Hye A, Church AJ, Lakdawala N, Nicholson TR, Batzu L, Rota S, Trivedi D, Zetterberg H, Chaudhuri KR, Aarsland D. NMDA Receptor Antibodies and Neuropsychiatric Symptoms in Parkinson's Disease. J Neuropsychiatry Clin Neurosci 2023:appineuropsych20220107. [PMID: 36710627 DOI: 10.1176/appi.neuropsych.20220107] [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: 01/31/2023]
Abstract
OBJECTIVE N-methyl-d-aspartate receptor (NMDAR) encephalitis is an autoantibody-mediated neurological syndrome with prominent cognitive and neuropsychiatric symptoms. The clinical relevance of NMDAR antibodies outside the context of encephalitis was assessed in this study. METHODS Plasma from patients with Parkinson's disease (PD) (N=108) and healthy control subjects (N=89) was screened at baseline for immunoglobulin A (IgA), IgM, and IgG NMDAR antibodies, phosphorylated tau 181 (p-tau181), and the neuroaxonal injury marker neurofilament light (NfL). Clinical assessment of the patients included measures of cognition (Mini-Mental State Examination [MMSE]) and neuropsychiatric symptoms (Hospital Anxiety and Depression Scale; Non-Motor Symptoms Scale for Parkinson's Disease). A subgroup of patients (N=61) was followed annually for up to 6 years. RESULTS Ten (9%) patients with PD tested positive for NMDAR antibodies (IgA, N=5; IgM, N=6; IgG, N=0), and three (3%) healthy control subjects had IgM NMDAR antibodies; IgA NMDAR antibodies were detected significantly more commonly among patients with PD than healthy control subjects (χ2=4.23, df=1, p=0.04). Age, gender, and disease duration were not associated with NMDAR antibody positivity. Longitudinally, antibody-positive patients had significantly greater decline in annual MMSE scores when the analyses were adjusted for education, age, disease duration, p-tau181, NfL, and follow-up duration (adjusted R2=0.26, p=0.01). Neuropsychiatric symptoms were not associated with antibody status, and no associations were seen between NMDAR antibodies and p-tau181 or NfL levels. CONCLUSIONS NMDAR antibodies were associated with greater cognitive impairment over time in patients with PD, independent of other pathological biomarkers, suggesting a potential contribution of these antibodies to cognitive decline in PD.
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Affiliation(s)
- Lucy L Gibson
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Thomas A Pollak
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Melanie Hart
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Amanda Heslegrave
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Abdul Hye
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Andrew J Church
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Neghat Lakdawala
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Timothy R Nicholson
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Lucia Batzu
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Silvia Rota
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Dhaval Trivedi
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Henrik Zetterberg
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Kallol Ray Chaudhuri
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
| | - Dag Aarsland
- Department of Old Age Psychiatry (Gibson, Hye, Aarsland) and Department of Psychosis Studies, Neuropsychiatry Research and Education Group (Pollak, Nicholson), Institute of Psychiatry, Psychology and Neuroscience, King's College London; Neuroimmunology and CSF Laboratory, Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, London (Hart, Church, Lakdawala); Departments of Neuroinflammation (Hart) and Neurodegenerative Disease (Heslegrave, Zetterberg), Institute of Neurology, University College London; UK Dementia Research Institute, University College London (Heslegrave, Zetterberg); Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, King's College Hospital and King's College London (Batzu, Rota, Trivedi, Chaudhuri); Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (Zetterberg); Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway (Aarsland)
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Michael BD, Walton D, Westenberg E, García-Azorín D, Singh B, Tamborska AA, Netravathi M, Chomba M, Wood GK, Easton A, Siddiqi OK, Jackson TA, Pollak TA, Nicholson TR, Nair S, Breen G, Prasad K, Thakur KT, Chou SHY, Schmutzhard E, Frontera JA, Helbok R, Padovani A, Menon DK, Solomon T, Winkler AS. Consensus Clinical Guidance for Diagnosis and Management of Adult COVID-19 Encephalopathy Patients. J Neuropsychiatry Clin Neurosci 2023; 35:12-27. [PMID: 35872617 DOI: 10.1176/appi.neuropsych.22010002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/17/2023]
Abstract
Encephalopathy, a common condition among patients hospitalized with COVID-19, can be a challenge to manage and negatively affect prognosis. While encephalopathy may present clinically as delirium, subsyndromal delirium, or coma and may be a result of systemic causes such as hypoxia, COVID-19 has also been associated with more prolonged encephalopathy due to less common but nevertheless severe complications, such as inflammation of the brain parenchyma (with or without cerebrovascular involvement), demyelination, or seizures, which may be disproportionate to COVID-19 severity and require specific management. Given the large number of patients hospitalized with severe acute respiratory syndrome coronavirus-2 infection, even these relatively unlikely complications are increasingly recognized and are particularly important because they require specific management. Therefore, the aim of this review is to provide pragmatic guidance on the management of COVID-19 encephalopathy through consensus agreement of the Global COVID-19 Neuro Research Coalition. A systematic literature search of MEDLINE, medRxiv, and bioRxiv was conducted between January 1, 2020, and June 21, 2021, with additional review of references cited within the identified bibliographies. A modified Delphi approach was then undertaken to develop recommendations, along with a parallel approach to score the strength of both the recommendations and the supporting evidence. This review presents analysis of contemporaneous evidence for the definition, epidemiology, and pathophysiology of COVID-19 encephalopathy and practical guidance for clinical assessment, investigation, and both acute and long-term management.
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Affiliation(s)
- Benedict D Michael
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Dean Walton
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Erica Westenberg
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - David García-Azorín
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Bhagteshwar Singh
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Arina A Tamborska
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - M Netravathi
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Mashina Chomba
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Greta K Wood
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Ava Easton
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Omar K Siddiqi
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Thomas A Jackson
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Thomas A Pollak
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Timothy R Nicholson
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Shalini Nair
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Gerome Breen
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Kameshwar Prasad
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Kiran T Thakur
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Sherry H-Y Chou
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Erich Schmutzhard
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Jennifer A Frontera
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Raimund Helbok
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Alessandro Padovani
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - David K Menon
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Tom Solomon
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | - Andrea S Winkler
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
| | -
- National Institute for Health and Care Research (NIHR) Health Protection Unit for Emerging and Zoonotic Infections, Liverpool, United Kingdom (Michael, Tamborska, Wood, Solomon); Department of Neurology, Walton Center National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom (Michael, Walton, Tamborska, Wood, Solomon); Clinical Infection Microbiology and Immunology, Veterinary and Ecological Sciences, Institute for Infection, University of Liverpool, United Kingdom (Michael, Singh, Tamborska, Wood, Easton, Solomon); Department of Neurology, Center for Global Health, Faculty of Medicine, Technical University of Munich, Germany (Westenberg, Winkler); Department of Neurology, Hospital Clínico Universitario de Valladolid, Spain (García-Azorín); Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, United Kingdom (Singh); Department of Infectious Diseases, Christian Medical College, Vellore, India (Singh); National Institute of Mental Health and Neurosciences, Bangalore, India (Netravathi); Department of Medicine, Neurology Division, University Teaching Hospital, Lusaka, Zambia (Chomba, Siddiqi); Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York (Chomba, Thakur); Encephalitis Society, Malton, United Kingdom (Easton); Department of Neurology, Global Neurology Program, Beth Israel Deaconess Medical Center, Boston (Siddiqi); Department of Internal Medicine, Center for Vaccines and Virology Research, Beth Israel Deaconess Medical Center, Boston (Siddiqi); College of Medical and Dental Sciences, Institute of Inflammation and Aging, University of Birmingham, United Kingdom (Jackson); Department of Geriatric Medicine, University Hospitals Birmingham, United Kingdom (Jackson); Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Pollak); Social, Genetic and Developmental Psychiatry Center, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (Nicholson, Breen); Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India (Nair); NIHR Maudsley Biomedical Research Center, South London and Maudsley NHS Trust and King's College London (Breen); Department of Neurology and Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India (Prasad); Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh (Chou); Department of Neurology, Northwestern Feinberg School of Medicine, Chicago (Chou); Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria (Schmutzhard, Helbok); New York University Grossman School of Medicine, New York (Frontera); Department of Clinical and Experimental Sciences, Institute of Neurology, University of Brescia, Italy (Padovani); Division of Anesthesia, University of Cambridge, United Kingdom (Menon); Faculty of Medicine, Center for Global Health, Institute of Health and Society, University of Oslo, Norway (Winkler)
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Badenoch J, Cross B, Hafeez D, Song J, Watson C, Butler M, Nicholson TR, Rooney AG. Post-traumatic symptoms after COVID-19 may (or may not) reflect disease severity. Psychol Med 2023; 53:295-296. [PMID: 33243309 PMCID: PMC7750651 DOI: 10.1017/s003329172000481x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/22/2020] [Accepted: 11/16/2020] [Indexed: 01/30/2023]
Affiliation(s)
- James Badenoch
- Medical School, University of Birmingham, Birmingham, UK
| | | | - Danish Hafeez
- School of Medicine, The University of Manchester, Manchester, UK
| | - Jia Song
- Deancross Personality Disorder Service, East London NHS Foundation Trust, London, UK
| | - Cameron Watson
- Preventive Neurology Unit, Queen Mary University London, London, UK
| | - Matthew Butler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timothy R. Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alasdair G. Rooney
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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Campbell MC, Smakowski A, Rojas-Aguiluz M, Goldstein LH, Cardeña E, Nicholson TR, Reinders AATS, Pick S. 30 Dissociation and its biological and clinical correlates in functional neurological disorder: a systematic review and meta-analysis. J Neurol Psychiatry 2022. [DOI: 10.1136/jnnp-2022-bnpa.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives/AimsDissociation is a potential mechanism in FND. Although scientific studies report elevated rates of dissociative symptoms in FND, a systematic assessment of the biological and clinical correlates of dissociation in FND is lacking. We aimed to systematically review the current evidence describing dissociative symptoms and disorders in functional neurological disorder (FND), and additionally conduct a meta-analysis of dissociative symptom severity in FND. We also aimed to synthesise the existing data on biological and clinical correlates of dissociation in FND.MethodsWe systematically searched Embase, PsycINFO, and Medline, combining terms for FND and dissociation. Studies were eligible for inclusion if reporting on dissociative symptom scale scores or rates of dissociative disorder in FND samples. Studies were appraised for methodological quality using modified Newcastle-Ottawa criteria. Findings pertaining to dissociative symptoms or disorders, as well as biological and clinical correlates of dissociation in FND samples, were synthesised qualitatively. Dissociative symptom scores were included in a meta-analysis using random and mixed effects models.ResultsTwo-thousand and eighty-eight records were screened and seventy-nine studies were included in the final review. Dissociative symptoms were elevated in FND. The meta-analysis demonstrated a significant elevation in dissociation in FND samples relative to neurological and healthy controls, but not psychiatric controls. Dissociative disorders were frequently co-morbid in FND samples. Psychoform (cognitive) dissociation was more prominent in FND-seizures, whereas somatoform (physical) dissociation tended to be more prominent in FND-motor symptom samples. Dissociation was associated with FND symptom severity or frequency, general psychopathology, and reduced quality of life. Biological correlates of elevated dissociation included structural and functional brain alterations in regions that have previously been implicated in FND, such as the anterior cingulate cortex.ConclusionsDissociative symptoms and disorders are common in FND, and different FND subgroups appear to endorse varying degrees of psychoform or somatoform dissociation. Presence of dissociative symptoms in FND is associated with adverse clinical features; there is therefore a clinical need to assess patients with FND for dissociative symptomatology and to address these symptoms during treatment. Future research should examine dissociation further in different FND subgroups, using measures that distinguish between different types of dissociation, alongside measures of underlying pathophysiology.
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Campbell MC, Smakowski A, Rojas-Aguiluz M, Goldstein LH, Cardeña E, Nicholson TR, Reinders AATS, Pick S. Dissociation and its biological and clinical associations in functional neurological disorder: systematic review and meta-analysis. BJPsych Open 2022; 9:e2. [PMID: 36451595 PMCID: PMC9798224 DOI: 10.1192/bjo.2022.597] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Studies have reported elevated rates of dissociative symptoms and comorbid dissociative disorders in functional neurological disorder (FND); however, a comprehensive review is lacking. AIMS To systematically review the severity of dissociative symptoms and prevalence of comorbid dissociative disorders in FND and summarise their biological and clinical associations. METHOD We searched Embase, PsycInfo and MEDLINE up to June 2021, combining terms for FND and dissociation. Studies were eligible if reporting dissociative symptom scores or rates of comorbid dissociative disorder in FND samples. Risk of bias was appraised using modified Newcastle-Ottawa criteria. The findings were synthesised qualitatively and dissociative symptom scores were included in a meta-analysis (PROSPERO CRD42020173263). RESULTS Seventy-five studies were eligible (FND n = 3940; control n = 3073), most commonly prospective case-control studies (k = 54). Dissociative disorders were frequently comorbid in FND. Psychoform dissociation was elevated in FND compared with healthy (g = 0.90, 95% CI 0.66-1.14, I2 = 70%) and neurological controls (g = 0.56, 95% CI 0.19-0.92, I2 = 67%). Greater psychoform dissociation was observed in FND samples with seizure symptoms versus healthy controls (g = 0.94, 95% CI 0.65-1.22, I2 = 42%) and FND samples with motor symptoms (g = 0.40, 95% CI -0.18 to 1.00, I2 = 54%). Somatoform dissociation was elevated in FND versus healthy controls (g = 1.80, 95% CI 1.25-2.34, I2 = 75%). Dissociation in FND was associated with more severe functional symptoms, worse quality of life and brain alterations. CONCLUSIONS Our findings highlight the potential clinical utility of assessing patients with FND for dissociative symptomatology. However, fewer studies investigated FND samples with motor symptoms and heterogeneity between studies and risk of bias were high. Rigorous investigation of the prevalence, features and mechanistic relevance of dissociation in FND is needed.
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Affiliation(s)
- Malcolm C Campbell
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and Central and North West London NHS Foundation Trust, London, UK
| | - Abigail Smakowski
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maya Rojas-Aguiluz
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Etzel Cardeña
- Center for Research on Consciousness and Anomalous Psychology (CERCAP), Department of Psychology, Lund University, Lund, Sweden
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Susannah Pick
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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23
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Jeyaventhan R, Thanikasalam R, Mehta MA, Solmi F, Pollak TA, Nicholson TR, Pritchard M, Jewell A, Kolliakou A, Amad A, Haroche A, Lewis G, Zandi MS, David AS, Rogers JP. Clinical Neuroimaging Findings in Catatonia: Neuroradiological Reports of MRI Scans of Psychiatric Inpatients With and Without Catatonia. J Neuropsychiatry Clin Neurosci 2022; 34:386-392. [PMID: 35414194 DOI: 10.1176/appi.neuropsych.21070181] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Catatonia is a debilitating psychomotor disorder. Previous neuroimaging studies have used small samples with inconsistent results. The authors aimed to describe the structural neuroradiological abnormalities in clinical magnetic resonance imaging (MRI) brain scans of patients with catatonia, comparing them with scans of psychiatric inpatients without catatonia. They report the largest study of catatonia neuroimaging to date. METHODS In this retrospective case-control study, neuroradiological reports of psychiatric inpatients who had undergone MRI brain scans for clinical reasons were examined. Abnormalities were classified by lateralization, localization, and pathology. The primary analysis was prediction of catatonia by presence of an abnormal MRI scan, adjusted for age, sex, Black race-ethnicity, and psychiatric diagnosis. RESULTS Scan reports from 79 patients with catatonia and 711 other psychiatric inpatients were obtained. Mean age was 36.4 (SD=17.3) for the cases and 44.5 (SD=19.9) for the comparison group. Radiological abnormalities were reported in 27 of 79 cases (34.2%) and in 338 of 711 in the comparison group (47.5%) (odds ratio [OR]=0.57, 95% confidence interval [CI]=0.35, 0.93; adjusted OR=1.11, 95% CI=0.58, 2.14). Among the cases, most abnormal scans had bilateral abnormalities (N=23, 29.1%) and involved the forebrain (N=25, 31.6%) and atrophy (N=17, 21.5%). CONCLUSIONS Patients with catatonia were commonly reported to have brain MRI abnormalities, which largely consisted of diffuse cerebral atrophy rather than focal lesions. No evidence was found that these abnormalities were more common than in other psychiatric inpatients undergoing neuroimaging, after adjustment for demographic variables. Study limitations included a heterogeneous control group and selection bias in requesting scans.
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Affiliation(s)
- Roshell Jeyaventhan
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Ramya Thanikasalam
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Mitul A Mehta
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Francesca Solmi
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Thomas A Pollak
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Timothy R Nicholson
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Megan Pritchard
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Amelia Jewell
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Anna Kolliakou
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Ali Amad
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Alexandre Haroche
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Glyn Lewis
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Michael S Zandi
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Anthony S David
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
| | - Jonathan P Rogers
- Faculty of Life Sciences and Medicine, King's College London, London (Jeyaventhan, Thanikasalam); Department of Neuroimaging (Mehta) and Department of Psychosis Studies (Pollak, Nicholson, Kolliakou), Institute of Psychiatry Psychology and Neuroscience, King's College London, London; Division of Psychiatry (Solmi, Lewis, Rogers), Queen Square Institute of Neurology (Zandi), and Institute of Mental Health (David), University College London, London; University College London Hospitals NHS Foundation Trust, London (Zandi); South London and Maudsley Mental Health NHS Trust, London (Pritchard, Jewell, Rogers); Psychiatrie and Neurosciences, Le Groupe Hospitalier Universitaire Paris, Paris (Haroche); CHRU de Lille Pôle Psychiatrie Médecine Légale et Médecine en Milieu Pénitentiaire, Lille, France (Amad)
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Baslet G, Aybek S, Ducharme S, Modirrousta M, Nicholson TR. Neuropsychiatry's Role in the Postacute Sequelae of COVID-19: Report From the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 2022; 34:341-350. [PMID: 35578802 DOI: 10.1176/appi.neuropsych.21080209] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Postacute sequelae of COVID-19 can occur in patients who had only mild acute disease. A comprehensive neuropsychiatric approach reviews historical factors, provides objective assessment of symptoms, considers potential etiologies, and offers a therapeutic approach aimed at restoring premorbid functioning.
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Affiliation(s)
- Gaston Baslet
- Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet); Bern University Hospital, Bern, Switzerland (Aybek); Department of Psychiatry, Douglas Mental Health University Institute, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal (Ducharme); University of Manitoba, Winnipeg (Modirrousta); Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Nicholson)
| | - Selma Aybek
- Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet); Bern University Hospital, Bern, Switzerland (Aybek); Department of Psychiatry, Douglas Mental Health University Institute, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal (Ducharme); University of Manitoba, Winnipeg (Modirrousta); Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Nicholson)
| | - Simon Ducharme
- Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet); Bern University Hospital, Bern, Switzerland (Aybek); Department of Psychiatry, Douglas Mental Health University Institute, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal (Ducharme); University of Manitoba, Winnipeg (Modirrousta); Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Nicholson)
| | - Mandana Modirrousta
- Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet); Bern University Hospital, Bern, Switzerland (Aybek); Department of Psychiatry, Douglas Mental Health University Institute, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal (Ducharme); University of Manitoba, Winnipeg (Modirrousta); Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Nicholson)
| | - Timothy R Nicholson
- Brigham and Women's Hospital, Harvard Medical School, Boston (Baslet); Bern University Hospital, Bern, Switzerland (Aybek); Department of Psychiatry, Douglas Mental Health University Institute, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal (Ducharme); University of Manitoba, Winnipeg (Modirrousta); Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Nicholson)
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25
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Badenoch JB, Conti I, Rengasamy ER, Watson CJ, Butler M, Hussain Z, Carter B, Rooney AG, Zandi MS, Lewis G, David AS, Houlihan CF, Easton A, Michael BD, Kuppalli K, Nicholson TR, Pollak TA, Rogers JP. Neurological and psychiatric presentations associated with human monkeypox virus infection: A systematic review and meta-analysis. EClinicalMedicine 2022; 52:101644. [PMID: 36246957 PMCID: PMC9533950 DOI: 10.1016/j.eclinm.2022.101644] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 12/24/2022] Open
Abstract
Background Neuropsychiatric presentations of monkeypox (MPX) infection have not been well characterised, despite evidence of nervous system involvement associated with the related smallpox infection. Methods In this pre-registered (PROSPERO ID 336649) systematic review and meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, AMED and the preprint server MedRxiv up to 31/05/2022. Any study design of humans infected with MPX that reported a neurological or psychiatric presentation was included. For eligible symptoms, we calculated a pooled prevalence using an inverse variance approach and corresponding 95% confidence intervals. The degree of variability that could be explained by between-study heterogeneity was assessed using the I 2 statistic. Risk of bias was assessed with the Newcastle Ottawa Scale and the Joanna Briggs Institute quality assessment tool. Findings From 1705 unique studies, we extracted data on 19 eligible studies (1512 participants, 1031 with confirmed infection using CDC criteria or PCR testing) most of which were cohort studies and case series with no control groups. Study quality was generally moderate. Three clinical features were eligible for meta-analysis: seizure 2.7% (95% CI 0.7-10.2%, I2 0%), confusion 2.4% (95% CI 1.1-5.2%, I2 0%) and encephalitis 2.0% (95% 0.5-8.2%, I2 55.8%). Other frequently reported symptoms included myalgia, headache and fatigue, where heterogeneity was too high for estimation of pooled prevalences, possibly as a result of differences in viral clades and study methodology. Interpretation There is preliminary evidence for a range of neuropsychiatric presentations including severe neurological complications (encephalitis and seizure) and nonspecific neurological features (confusion, headache and myalgia). There is less evidence regarding the psychiatric presentations or sequelae of MPX. This may warrant surveillance within the current MPX outbreak, with prospective longitudinal studies evaluating the mid- to long-term sequelae of the virus. Robust methods to evaluate the potential causality of MPX with these clinical features are required. More evidence is necessary to explain heterogeneity in prevalence estimates. Funding UKRI/MRC (MR/V03605X/1), MRC-CSF (MR/V007181/1), MRC/AMED (MR/T028750/1) and the Wellcome Trust (102186/B/13/Z) and (102186/B/13/Z) and UCLH BRC.
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Affiliation(s)
- James B. Badenoch
- Barts Health NHS Trust, Charterhouse Square, London EC1M 6BQ, UK
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of Medicine, London EC1M 6BQ, UK
| | - Isabella Conti
- Guy's and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK
| | - Emma R. Rengasamy
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Cameron J. Watson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of Medicine, London EC1M 6BQ, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, WC2R 2LS, UK
- South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
| | - Matthew Butler
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, WC2R 2LS, UK
| | - Zain Hussain
- Edinburgh Medical School, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, King's College London, London WC2R 2LS, UK
| | - Alasdair G. Rooney
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Michael S. Zandi
- UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Anthony S. David
- UCL Institute of Mental Health, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Catherine F. Houlihan
- UCL Department of Infection and Immunity, University College London Hospital, London NW1 2BU, UK
- Rare and Imported Pathogens Laboratory (RIPL), UKHSA, Porton Down SP4 0JG, UK
| | - Ava Easton
- Encephalitis Society, 32 Castlegate, Malton YO17 7DT, UK
- Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, L69 3BX, UK
| | - Benedict D. Michael
- Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, L69 3BX, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, L69 3BX, UK
| | - Krutika Kuppalli
- Emerging Diseases and Zoonoses Unit, Department of Epidemic and Pandemic Preparedness and Prevention, Health Emergencies Programme, World Health Organisation, Geneva, Switzerland
| | - Timothy R. Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, WC2R 2LS, UK
| | - Thomas A. Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 4AF, UK
| | - Jonathan P. Rogers
- South London and Maudsley NHS Foundation Trust, London BR3 3BX, UK
- Division of Psychiatry, University College London, London, UK
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26
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Singh B, Lant S, Cividini S, Cattrall JWS, Goodwin LC, Benjamin L, Michael BD, Khawaja A, Matos ADMB, Alkeridy W, Pilotto A, Lahiri D, Rawlinson R, Mhlanga S, Lopez EC, Sargent BF, Somasundaran A, Tamborska A, Webb G, Younas K, Al Sami Y, Babu H, Banks T, Cavallieri F, Cohen M, Davies E, Dhar S, Fajardo Modol A, Farooq H, Harte J, Hey S, Joseph A, Karthikappallil D, Kassahun D, Lipunga G, Mason R, Minton T, Mond G, Poxon J, Rabas S, Soothill G, Zedde M, Yenkoyan K, Brew B, Contini E, Cysique L, Zhang X, Maggi P, van Pesch V, Lechien J, Saussez S, Heyse A, Brito Ferreira ML, Soares CN, Elicer I, Eugenín-von Bernhardi L, Ñancupil Reyes W, Yin R, Azab MA, Abd-Allah F, Elkady A, Escalard S, Corvol JC, Delorme C, Tattevin P, Bigaut K, Lorenz N, Hornuss D, Hosp J, Rieg S, Wagner D, Knier B, Lingor P, Winkler AS, Sharifi-Razavi A, Moein ST, SeyedAlinaghi S, JamaliMoghadamSiahkali S, Morassi M, Padovani A, Giunta M, Libri I, Beretta S, Ravaglia S, Foschi M, Calabresi P, Primiano G, Servidei S, Biagio Mercuri N, Liguori C, Pierantozzi M, Sarmati L, Boso F, Garazzino S, Mariotto S, Patrick KN, Costache O, Pincherle A, Klok FA, Meza R, Cabreira V, Valdoleiros SR, Oliveira V, Kaimovsky I, Guekht A, Koh J, Fernández Díaz E, Barrios-López JM, Guijarro-Castro C, Beltrán-Corbellini Á, Martínez-Poles J, Diezma-Martín AM, Morales-Casado MI, García García S, Breville G, Coen M, Uginet M, Bernard-Valnet R, Du Pasquier R, Kaya Y, Abdelnour LH, Rice C, Morrison H, Defres S, Huda S, Enright N, Hassell J, D’Anna L, Benger M, Sztriha L, Raith E, Chinthapalli K, Nortley R, Paterson R, Chandratheva A, Werring DJ, Dervisevic S, Harkness K, Pinto A, Jillella D, Beach S, Gunasekaran K, Rocha Ferreira Da Silva I, Nalleballe K, Santoro J, Scullen T, Kahn L, Kim CY, Thakur KT, Jain R, Umapathi T, Nicholson TR, Sejvar JJ, Hodel EM, Tudur Smith C, Solomon T. Prognostic indicators and outcomes of hospitalised COVID-19 patients with neurological disease: An individual patient data meta-analysis. PLoS One 2022; 17:e0263595. [PMID: 35653330 PMCID: PMC9162376 DOI: 10.1371/journal.pone.0263595] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/21/2022] [Indexed: 01/08/2023] Open
Abstract
Background Neurological COVID-19 disease has been reported widely, but published studies often lack information on neurological outcomes and prognostic risk factors. We aimed to describe the spectrum of neurological disease in hospitalised COVID-19 patients; characterise clinical outcomes; and investigate factors associated with a poor outcome. Methods We conducted an individual patient data (IPD) meta-analysis of hospitalised patients with neurological COVID-19 disease, using standard case definitions. We invited authors of studies from the first pandemic wave, plus clinicians in the Global COVID-Neuro Network with unpublished data, to contribute. We analysed features associated with poor outcome (moderate to severe disability or death, 3 to 6 on the modified Rankin Scale) using multivariable models. Results We included 83 studies (31 unpublished) providing IPD for 1979 patients with COVID-19 and acute new-onset neurological disease. Encephalopathy (978 [49%] patients) and cerebrovascular events (506 [26%]) were the most common diagnoses. Respiratory and systemic symptoms preceded neurological features in 93% of patients; one third developed neurological disease after hospital admission. A poor outcome was more common in patients with cerebrovascular events (76% [95% CI 67–82]), than encephalopathy (54% [42–65]). Intensive care use was high (38% [35–41]) overall, and also greater in the cerebrovascular patients. In the cerebrovascular, but not encephalopathic patients, risk factors for poor outcome included breathlessness on admission and elevated D-dimer. Overall, 30-day mortality was 30% [27–32]. The hazard of death was comparatively lower for patients in the WHO European region. Interpretation Neurological COVID-19 disease poses a considerable burden in terms of disease outcomes and use of hospital resources from prolonged intensive care and inpatient admission; preliminary data suggest these may differ according to WHO regions and country income levels. The different risk factors for encephalopathy and stroke suggest different disease mechanisms which may be amenable to intervention, especially in those who develop neurological symptoms after hospital admission.
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Affiliation(s)
- Bhagteshwar Singh
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Department of Infectious Diseases, Christian Medical College, Vellore, India
| | - Suzannah Lant
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sofia Cividini
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan W. S. Cattrall
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Lynsey C. Goodwin
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Laura Benjamin
- Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Benedict D. Michael
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Ayaz Khawaja
- Department of Neurology, Wayne State University, Detroit, Michigan, United States of America
| | | | - Walid Alkeridy
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Andrea Pilotto
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Durjoy Lahiri
- Bangur Institute of Neurosciences, Institute of Post-Graduate Medical Education and Research, Kolkata, India
| | - Rebecca Rawlinson
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sithembinkosi Mhlanga
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Evelyn C. Lopez
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Brendan F. Sargent
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Anushri Somasundaran
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Arina Tamborska
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Glynn Webb
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Komal Younas
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Yaqub Al Sami
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Heavenna Babu
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Tristan Banks
- Department of Infection, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Matthew Cohen
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Emma Davies
- Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Shalley Dhar
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anna Fajardo Modol
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Hamzah Farooq
- Department of Virology, UK Health Security Agency, Manchester University NHS Foundation Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Jeffrey Harte
- Barts Health NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Samuel Hey
- Department of Infectious Diseases & Tropical Medicine, North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Albert Joseph
- Homerton University Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Dileep Karthikappallil
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Daniel Kassahun
- Warrington Hospital, Warrington and Halton Teaching Hospitals NHS Foundation Trust, Warrington, United Kingdom of Great Britain and Northern Ireland
| | - Gareth Lipunga
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rachel Mason
- Kingston Hospital NHS Foundation Trust, Kingston upon Thames, United Kingdom of Great Britain and Northern Ireland
| | - Thomas Minton
- Institute of Clinical Neurosciences, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Gabrielle Mond
- North Manchester General Hospital, Manchester University Foundation NHS Trust, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Joseph Poxon
- Epsom and St Helier University Hospitals NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Sophie Rabas
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Germander Soothill
- Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, United Kingdom of Great Britain and Northern Ireland
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Konstantin Yenkoyan
- Yerevan State Medical University named after Mkhitar Heratsi, Neuroscience Laboratory, Cobrain Center, Yerevan, Armenia
| | - Bruce Brew
- St Vincent’s Hospital, Sydney, Australia
| | | | | | - Xin Zhang
- St Vincent’s Hospital, Sydney, Australia
| | - Pietro Maggi
- Saint-Luc University Hospital, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | - Rong Yin
- The 940th Hospital of Joint Logistic Support Force of the People’s Liberation Army, Lanzhou, China
| | | | | | | | | | | | | | | | - Kévin Bigaut
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Norbert Lorenz
- Children’s Hospital, Dresden Municipal Hospital Teaching Hospital TUD, Dresden, Germany
| | - Daniel Hornuss
- Medical Center University of Freiburg, Freiburg, Germany
| | - Jonas Hosp
- Medical Center University of Freiburg, Freiburg, Germany
| | - Siegbert Rieg
- Medical Center University of Freiburg, Freiburg, Germany
| | - Dirk Wagner
- Medical Center University of Freiburg, Freiburg, Germany
| | - Benjamin Knier
- Department of Neurology, Technical University of Munich, Munich, Germany
| | - Paul Lingor
- Department of Neurology, Technical University of Munich, Munich, Germany
| | | | | | - Shima T. Moein
- Institute for Research in Fundamental Sciences (IPM), Tehran, Islamic Republic of Iran
| | | | | | - Mauro Morassi
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | | | | | - Simone Beretta
- San Gerardo Hospital ASST Monza, University of Milano Bicocca, Monza, Italy
| | | | - Matteo Foschi
- Santa Maria delle Croci Hospital, AUSL Romagna, Ravenna, Italy
| | - Paolo Calabresi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Primiano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | | | | | - Federica Boso
- Healthcare Trust of the Autonomous Region of Trento, Rovereto, Italy
| | - Silvia Garazzino
- Città della Salute e della Scienza di Torino, Regina Margherita Children’s Hospital, Turin, Italy
| | | | | | | | | | | | - Roger Meza
- Hospital Regional Docente de Trujillo, Trujillo, Peru
| | | | | | | | - Igor Kaimovsky
- Buyanov Moscow City Hospital, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry and Buyanov Moscow City Hospital, Moscow, Russian Federation
| | - Jasmine Koh
- National Neuroscience Institute, Singapore, Singapore
| | | | | | | | | | | | | | | | | | | | - Matteo Coen
- Hopitaux Universitaires de Genève, Geneva, Switzerland
| | | | | | | | - Yildiz Kaya
- Acibadem Mehmet Ali Aydinlar University Medical School, Istanbul, Turkey
| | - Loay H. Abdelnour
- Ulster Hospital, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Claire Rice
- University of Bristol and North Bristol NHS Trust, Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Hamish Morrison
- Gloucestershire Royal Hospital, Gloucester, United Kingdom of Great Britain and Northern Ireland
| | - Sylviane Defres
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Saif Huda
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Noelle Enright
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Jane Hassell
- Great Ormond Street Hospital for Children, London, United Kingdom of Great Britain and Northern Ireland
| | - Lucio D’Anna
- Imperial College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Matthew Benger
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Laszlo Sztriha
- King’s College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland
| | - Eamon Raith
- The National Hospital for Neurology & Neurosurgery, London, United Kingdom of Great Britain and Northern Ireland
| | - Krishna Chinthapalli
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ross Nortley
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Ross Paterson
- University College London, London, United Kingdom of Great Britain and Northern Ireland
| | - Arvind Chandratheva
- University College London Queen Square Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - David J. Werring
- University College London Queen Square Institute of Neurology, London, United Kingdom of Great Britain and Northern Ireland
| | - Samir Dervisevic
- Eastern Pathology Alliance Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom of Great Britain and Northern Ireland
| | - Kirsty Harkness
- Sheffield Teaching Hospitals Trust, Sheffield, United Kingdom of Great Britain and Northern Ireland
| | - Ashwin Pinto
- Wessex Neurological Centre, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Dinesh Jillella
- Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Scott Beach
- Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kulothungan Gunasekaran
- Yale New Haven Health Bridgeport Hospital, Bridgeport, Connecticut, United States of America
| | | | - Krishna Nalleballe
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Jonathan Santoro
- Children’s Hospital Los Angeles and Keck School of Medicine at the University of Southern California, Los Angeles, California, United States of America
| | - Tyler Scullen
- Ochsner Medical Center, New Orleans, Los Angeles, United States of America
| | - Lora Kahn
- Ochsner Medical Center, New Orleans, Los Angeles, United States of America
| | - Carla Y. Kim
- Columbia University Irving Medical Center, New York, New York, United States of America
| | - Kiran T. Thakur
- Columbia University Irving Medical Center, New York, New York, United States of America
| | - Rajan Jain
- New York University Grossman School of Medicine, New York, New York, United States of America
| | | | - Timothy R. Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - James J. Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eva Maria Hodel
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | | | - Catrin Tudur Smith
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Tom Solomon
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- * E-mail:
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27
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Kletenik I, Holden SK, Sillau SH, O'Connell N, MacGillivray L, Mack J, Haddock B, Ashworth Dirac M, David AS, Nicholson TR, Attaripour Isfahani SN, Maurer CW, Lidstone SC, Hallett M, LaFaver K, Berman BD, Stone J. Gender disparity and abuse in functional movement disorders: a multi-center case-control study. J Neurol 2022; 269:3258-3263. [PMID: 35098346 PMCID: PMC10202134 DOI: 10.1007/s00415-021-10943-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND To determine gender differences in rates of sexual and physical abuse in functional movement disorders compared to controls and evaluate if the gender disparity of functional movement disorders is associated with abuse history. METHODS We performed a retrospective case-control study of self-reported trauma data from 696 patients (512 women) with functional movement disorders from six clinical sites compared to 141 controls (98 women) and population data. Chi-square was used to assess gender and disorder associations; logistic regression was used to model additive effects of abuse and calculate the attributable fraction of abuse to disorder prevalence. RESULTS Higher rates of sexual abuse were reported by women (35.3%) and men (11.5%) with functional movement disorders compared to controls (10.6% of women; 5.6% of men). History of sexual abuse increased the likelihood of functional movement disorders among women by an odds ratio of 4.57 (95% confidence interval 2.31-9.07; p < 0.0001) and physical abuse by an odds ratio of 2.80 (95% confidence interval 1.53-5.12; p = 0.0007). Population attributable fraction of childhood sexual abuse to functional movement disorders in women was 0.12 (0.05-0.19). No statistically significant associations were found in men, but our cohort of men was underpowered despite including multiple sites. CONCLUSIONS Our study suggests that violence against women may account for some of the gender disparity in rates of functional movement disorders. Most people with functional movement disorders do not report a history of abuse, so it remains just one among many relevant risk factors to consider.
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Affiliation(s)
- Isaiah Kletenik
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA.
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA
- Movement Disorders Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicola O'Connell
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | - Lindsey MacGillivray
- Division of Psychiatry, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Joel Mack
- Department of Psychiatry, Northwest Parkinson's Disease Research, Education, and Clinical Center, Portland, OR, USA
- Department of Neurology, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Beatrix Haddock
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - M Ashworth Dirac
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Departments of Health Metrics and Family Medicine, University of Washington, Seattle, WA, USA
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Carine W Maurer
- Department of Neurology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, ON, Canada
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kathrin LaFaver
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Neurology, Movement Disorder Division, University of Louisville, Louisville, KY, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Movement Disorders Center, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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Ariño H, Heartshorne R, Michael BD, Nicholson TR, Vincent A, Pollak TA, Vogrig A. Neuroimmune disorders in COVID-19. J Neurol 2022; 269:2827-2839. [PMID: 35353232 PMCID: PMC9120100 DOI: 10.1007/s00415-022-11050-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 12/15/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the aetiologic agent of the coronavirus disease 2019 (COVID-19), is now rapidly disseminating throughout the world with 147,443,848 cases reported so far. Around 30-80% of cases (depending on COVID-19 severity) are reported to have neurological manifestations including anosmia, stroke, and encephalopathy. In addition, some patients have recognised autoimmune neurological disorders, including both central (limbic and brainstem encephalitis, acute disseminated encephalomyelitis [ADEM], and myelitis) and peripheral diseases (Guillain-Barré and Miller Fisher syndrome). We systematically describe data from 133 reported series on the Neurology and Neuropsychiatry of COVID-19 blog ( https://blogs.bmj.com/jnnp/2020/05/01/the-neurology-and-neuropsychiatry-of-covid-19/ ) providing a comprehensive overview concerning the diagnosis, and treatment of patients with neurological immune-mediated complications of SARS-CoV-2. In most cases the latency to neurological disorder was highly variable and the immunological or other mechanisms involved were unclear. Despite specific neuronal or ganglioside antibodies only being identified in 10, many had apparent responses to immunotherapies. Although the proportion of patients experiencing immune-mediated neurological disorders is small, the total number is likely to be underestimated. The early recognition and improvement seen with use of immunomodulatory treatment, even in those without identified autoantibodies, makes delayed or missed diagnoses risk the potential for long-term disability, including the emerging challenge of post-acute COVID-19 sequelae (PACS). Finally, potential issues regarding the use of immunotherapies in patients with pre-existent neuro-immunological disorders are also discussed.
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Affiliation(s)
- Helena Ariño
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosie Heartshorne
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Benedict D Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- The National Institute for Health Research Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Timothy R Nicholson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Alberto Vogrig
- Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France
- Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria Della Misericordia, Udine, Italy
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29
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Abstract
Many patients with COVID-19 will experience acute or longer-term neuropsychiatric complications. The neurobiological mechanisms behind these are beginning to emerge; however, the neurotropic hypothesis is not strongly supported by clinical data. The inflammatory response to SARS-CoV-2 is likely to be responsible for delirium and other common acute neuropsychiatric manifestations. Vascular abnormalities such as endotheliopathies contribute to stroke and cerebral microbleeds, with their attendant neuropsychiatric sequelae. Longer-term neuropsychiatric syndromes fall into 2 broad categories: neuropsychiatric deficits occurring after severe (hospitalized) COVID-19 and "long COVID," which occurs in many patients with a milder acute COVID-19 illness.
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Affiliation(s)
- Matthew Butler
- Institute of Psychiatry, Psychology and Neuroscience, King's College, 16 De Crespigny Park, SE5 8AF London.
| | - Benjamin Cross
- East Lancashire Hospitals NHS Trust, Casterton Ave, Burnley, BB10 2PQ
| | - Danish Hafeez
- School of Medical Sciences, The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Mao Fong Lim
- Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Hamilton Morrin
- Maidstone & Tunbridge Wells NHS Trust, Tonbridge Rd, Royal Tunbridge Wells, TN2 4QJ, UK
| | - Emma Rachel Rengasamy
- Cwm Taf Morgannwg University Health Board, Ynysmeurig House, Navigation Park, Abercynon, CF45 4SN, UK
| | - Tom Pollak
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, 16 De Crespigny Park, SE5 8AF London
| | - Timothy R. Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, 16 De Crespigny Park, SE5 8AF London
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30
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Munblit D, Nicholson TR, Needham DM, Seylanova N, Parr C, Chen J, Kokorina A, Sigfrid L, Buonsenso D, Bhatnagar S, Thiruvengadam R, Parker AM, Preller J, Avdeev S, Klok FA, Tong A, Diaz JV, Groote WD, Schiess N, Akrami A, Simpson F, Olliaro P, Apfelbacher C, Rosa RG, Chevinsky JR, Saydah S, Schmitt J, Guekht A, Gorst SL, Genuneit J, Reyes LF, Asmanov A, O'Hara ME, Scott JT, Michelen M, Stavropoulou C, Warner JO, Herridge M, Williamson PR. Studying the post-COVID-19 condition: research challenges, strategies, and importance of Core Outcome Set development. BMC Med 2022; 20:50. [PMID: 35114994 PMCID: PMC8813480 DOI: 10.1186/s12916-021-02222-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/20/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A substantial portion of people with COVID-19 subsequently experience lasting symptoms including fatigue, shortness of breath, and neurological complaints such as cognitive dysfunction many months after acute infection. Emerging evidence suggests that this condition, commonly referred to as long COVID but also known as post-acute sequelae of SARS-CoV-2 infection (PASC) or post-COVID-19 condition, could become a significant global health burden. MAIN TEXT While the number of studies investigating the post-COVID-19 condition is increasing, there is no agreement on how this new disease should be defined and diagnosed in clinical practice and what relevant outcomes to measure. There is an urgent need to optimise and standardise outcome measures for this important patient group both for clinical services and for research and to allow comparing and pooling of data. CONCLUSIONS A Core Outcome Set for post-COVID-19 condition should be developed in the shortest time frame possible, for improvement in data quality, harmonisation, and comparability between different geographical locations. We call for a global initiative, involving all relevant partners, including, but not limited to, healthcare professionals, researchers, methodologists, patients, and caregivers. We urge coordinated actions aiming to develop a Core Outcome Set (COS) for post-COVID-19 condition in both the adult and paediatric populations.
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Affiliation(s)
- Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. .,Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK. .,Research and Clinical Center for Neuropsychiatry, Moscow, Russia.
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.,Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nina Seylanova
- Sechenov Biomedical Science and Technology Park, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Callum Parr
- Faculty of Medicine, Imperial College London, London, UK
| | - Jessica Chen
- Faculty of Medicine, Imperial College London, London, UK
| | - Alisa Kokorina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Louise Sigfrid
- ISARIC Global Support Centre, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.,Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Shinjini Bhatnagar
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, Delhi, National Capital Region, India
| | - Ramachandran Thiruvengadam
- Maternal and Child Health Program, Translational Health Science and Technology Institute, Faridabad, Delhi, National Capital Region, India
| | - Ann M Parker
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA.,Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sergey Avdeev
- Department of Pulmonology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Janet V Diaz
- NCD Department, Rehabilitation Programme, WHO, Geneva, Switzerland
| | - Wouter De Groote
- NCD Department, Rehabilitation Programme, WHO, Geneva, Switzerland
| | | | - Athena Akrami
- Sainsbury Wellcome Centre, UCL, London, UK.,Patient-Led Research Collaborative, Washington, DC, USA
| | | | - Piero Olliaro
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Regis Goulart Rosa
- Critical Care Department, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
| | - Jennifer R Chevinsky
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sharon Saydah
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Respiratory Viruses Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Alla Guekht
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia.,Pirogov Russian National Research Medical University, Moscow, Russia
| | - Sarah L Gorst
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Jon Genuneit
- Paediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Luis Felipe Reyes
- Universidad de La Sabana, Chía, Colombia.,Clínica Universidad de La Sabana, Chía, Colombia
| | - Alan Asmanov
- The Research and Clinical Institute for Pediatrics named after Academician Yuri Veltischev of the Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Janet T Scott
- MRC-University of Glasgow, Centre for Virus Research, Glasgow, UK
| | - Melina Michelen
- ISARIC Global Support Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,School of Health Sciences, City, University of London, London, UK
| | | | - John O Warner
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - Margaret Herridge
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Paula R Williamson
- MRC/NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool (a member of Liverpool Health Partners), Liverpool, UK
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31
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Morsy SK, Aybek S, Carson A, Nicholson TR, Stone J, Kamal AM, Abdel-Fadeel NA, Hassan MA, Kanaan RAA. The relationship between types of life events and the onset of functional neurological (conversion) disorder in adults: a systematic review and meta-analysis. Psychol Med 2022; 52:401-418. [PMID: 34819179 DOI: 10.1017/s0033291721004669] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adverse life events precede the onset of functional neurological disorder (FND, also known as conversion disorder) more commonly than other neuropsychiatric conditions, but their aetiological role is unclear. We conducted a systematic review and quantitative analysis of the type, timing and number of life events preceding the onset of FND in adults, and a meta-analysis of the proportions of types of events in controlled studies. Fifty-one studies of different designs, covering 4247 patients, were eligible for inclusion. There was no clear majority of any type of preceding event. Family problems were the most common category of events, followed by relationship problems. Females were more likely to experience preceding family/relationship problems than males, who reported more work problems. Family problems were the commonest type of preceding event in studies in developing countries, whereas family and health problems were equally common in developed countries. Abuse was associated with early symptom onset, while patients with later onset were more likely to report family problems. The median number of events was one, and the events occurred closer to onset than in controls. Meta-analysis found that family, relationship and work events were all relatively more common in patients than pathological controls, as were events where symptoms might provide a solution to the stressor. In conclusion, although a range of events precede the onset of FND, they do not appear to do so uniformly. This may support a different aetiological role for stressors than in other disorders, although the support is indirect and the quality generally low.
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Affiliation(s)
- Shimaa K Morsy
- Department of Psychiatry, Faculty of Medicine, Minia University, Minia61519, Egypt
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia
| | - Selma Aybek
- Psychosomatic Medicine, Neurology Department, University Hospital Inselspital, Bern University, Bern, Switzerland
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Ahmed M Kamal
- Department of Psychiatry, Faculty of Medicine, Minia University, Minia61519, Egypt
| | | | - Maha A Hassan
- Department of Psychiatry, Faculty of Medicine, Minia University, Minia61519, Egypt
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, VIC 3084, Australia
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32
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Yeoh SY, Roberts E, Scott F, Nicholson TR, David AS, Rogers JP. Catatonic Episodes Related to Substance Use: A Cross-Sectional Study Using Electronic Healthcare Records. J Dual Diagn 2022; 18:52-58. [PMID: 35001837 DOI: 10.1080/15504263.2021.2016342] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Substance use has increasingly been linked to the onset of catatonic episodes; however, no large observational studies have examined this association. This study aimed to identify catatonic episodes temporally associated with acute intoxication, withdrawal or chronic substance use, investigate which substances were involved, and compare clinical characteristics of substance-related and non-substance-related catatonic episodes. Methods: This study retrospectively identified all catatonic episodes recorded in an electronic case register hosted at a large secondary mental health trust in London, UK. Episodes were categorized as substance-related if the clinical record reported either a positive urine drug screen, an ICD-10 diagnosis of a mental or behavioral disorder due to substance use, or documented substance use between two weeks prior to the catatonic episode and the date of the catatonic episode. Results: 108 of 2130 catatonic episodes (5.1%) were deemed substance-related. The number of contemporaneously reported substance-related episodes increased between 2007 and 2016 [r = 0.72, p = 0.02]. Episodes in the context of acute intoxication (n = 54) were most frequently related to cannabis (n = 31) or cocaine (n = 5) use, whilst those in the context of drug withdrawal (n = 8) were most commonly related to alcohol, opioids and benzodiazepines. There were 50 episodes of catatonia associated with chronic substance use without intoxication or withdrawal, of which the majority were related to cannabis use (n = 37). 21 episodes had overlapping intoxication, withdrawal and chronic use of different substances within an episode. Compared to catatonic episodes not related to substance use, episodes of substance-related catatonia occurred in individuals who were younger (mean age 31.3 years [SD 12.2] vs 35.7 years [SD 16.3], p = 0.01) and more likely to be men (74.0% vs 54.3%, p < 0.001). The clinical features of catatonia were similar between the two groups. Conclusions: A relatively small proportion of catatonic episodes were temporally associated with reported substance use within their electronic records. Substance-related catatonic episodes were mostly related to cannabis use, but other substances including cocaine, alcohol, opioids and benzodiazepines were sometimes implicated. This is likely an underestimate of substance-related catatonia use due to issues with documentation and appropriate investigation.
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Affiliation(s)
- Su Ying Yeoh
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emmert Roberts
- South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Fraser Scott
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Jonathan P Rogers
- South London and Maudsley NHS Foundation Trust, London, UK.,Division of Psychiatry, University College London, London, UK
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33
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Grant JE, Drummond L, Nicholson TR, Fagan H, Baldwin DS, Fineberg NA, Chamberlain SR. Obsessive-compulsive symptoms and the Covid-19 pandemic: A rapid scoping review. Neurosci Biobehav Rev 2022; 132:1086-1098. [PMID: 34740755 PMCID: PMC8570941 DOI: 10.1016/j.neubiorev.2021.10.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 07/03/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND There has been much speculation about untoward effects of the Covid-19 pandemic on psychological symptoms. OCD may be expected to be especially impacted. Our aim was to distil the current evidence base on relationships between the pandemic and obsessive-compulsive symptoms, in patients, and general population samples. METHODS We conducted a rapid scoping review, in the form of a systematic literature search, coupled with narrative review. 32 relevant papers were identified. RESULTS AND INTERPRETATION (1) A sizable proportion of people with OCD (but not all) experienced/reported symptom worsening during the pandemic, especially during initial restrictions (approximately 20-65 % of cases in longitudinal studies); (2) contamination/washing symptoms appeared particularly susceptible; and (3) OCD symptoms in general population samples were associated with trait compulsivity and pandemic-related-stress. The literature was heterogeneous with various methodological issues being commonplace. FUTURE DIRECTIONS The review identified important unaddressed issues: how should exposure based therapy be adapted during pandemics? How can we minimise harm from exacerbation of OCD in vulnerable individuals arising from public health messaging? Why do some but not all OCD patients experience worsening? And does Covid-19 infection affect (or lead to) OCD symptoms?
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Affiliation(s)
- Jon E. Grant
- Department of Psychiatry, University of Chicago, Chicago, USA
| | - Lynne Drummond
- South West London and St George’s NHS Trust and University of Hertfordshire, UK
| | - Timothy R. Nicholson
- Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Harry Fagan
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK,Southern Health NHS Foundation Trust, Southampton, UK
| | - David S. Baldwin
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK,Southern Health NHS Foundation Trust, Southampton, UK
| | - Naomi A. Fineberg
- National Treatment Service for OCD (England and Wales), Hertfordshire, UK
| | - Samuel R. Chamberlain
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK,Southern Health NHS Foundation Trust, Southampton, UK,Corresponding author at: Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK
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34
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Gibson LL, Pollak TA, Heslegrave A, Hye A, Batzu L, Rota S, Trivedi D, Nicholson TR, Ffytche D, Zetterberg H, Chaudhuri KR, Aarsland D. Plasma Neurofilament Light and p-tau181 and Risk of Psychosis in Parkinson's Disease. J Parkinsons Dis 2022; 12:1527-1538. [PMID: 35466956 DOI: 10.3233/jpd-223182] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms are common and important to people with Parkinson's disease (PD), but their etiology is poorly understood. Plasma neurofilament light (NfL) and p-tau181 are biomarkers of neuro-axonal degeneration and tau pathology respectively, which have yet to be explored in association with the affective and psychotic symptoms in PD. OBJECTIVE To investigate the relationship between plasma NfL and p-tau181 with the affective and psychotic symptoms in PD. METHODS We assessed the baseline concentration of plasma NfL and p-tau181 in a cohort of 108 patients with PD and 38 healthy controls. A subgroup of patients (n = 63) were assessed annually with clinical measures for up to 7 years. Psychotic symptoms were assessed using the Non-Motor Symptom Scale and affective symptoms were measured in the Hospital Anxiety and Depression Scale. RESULTS Baseline plasma NfL was a significant predictor of psychotic symptoms longitudinally across the study adjusted for age, Hoehn and Yahr stage, duration of follow up, duration of disease, baseline levodopa and dopamine agonist medication, and baseline cognition: (OR 8.15 [95% CI 1.40-47.4], p = 0.020). There was no association between NfL concentration and the cumulative prevalence of affective symptoms. Plasma p-tau181 concentration was not associated with psychotic or affective symptoms. CONCLUSION These findings suggest psychotic symptoms are associated with greater neurodegeneration in PD. Further studies are needed to explore NfL as a potential biomarker for psychosis in PD.
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Affiliation(s)
- Lucy L Gibson
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Thomas A Pollak
- Neuropsychiatry Research and Education Group, Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Amanda Heslegrave
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
| | - Abdul Hye
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucia Batzu
- Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, Kings College Hospital and Kings College London, London, UK
| | - Silvia Rota
- Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, Kings College Hospital and Kings College London, London, UK
| | - Dhaval Trivedi
- Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, Kings College Hospital and Kings College London, London, UK
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dominic Ffytche
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Henrik Zetterberg
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Salhgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - K Ray Chaudhuri
- Department of Basic and Clinical Neuroscience, Parkinson Foundation International Centre of Excellence, Kings College Hospital and Kings College London, London, UK
| | - Dag Aarsland
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Disease, Stavanger University Hospital, Stavanger, Norway
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35
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Badenoch JB, Rengasamy ER, Watson C, Jansen K, Chakraborty S, Sundaram RD, Hafeez D, Burchill E, Saini A, Thomas L, Cross B, Hunt CK, Conti I, Ralovska S, Hussain Z, Butler M, Pollak TA, Koychev I, Michael BD, Holling H, Nicholson TR, Rogers JP, Rooney AG. Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis. Brain Commun 2021; 4:fcab297. [PMID: 35169700 PMCID: PMC8833580 DOI: 10.1093/braincomms/fcab297] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/10/2021] [Accepted: 12/15/2021] [Indexed: 12/21/2022] Open
Abstract
The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery phase, we systematically determined the prevalence of neuropsychiatric symptoms in survivors of COVID-19. For this pre-registered systematic review and meta-analysis (PROSPERO ID CRD42021239750), we searched MEDLINE, EMBASE, CINAHL and PsycINFO to 20 February 2021, plus our own curated database. We included peer-reviewed studies reporting neuropsychiatric symptoms at post-acute or later time-points after COVID-19 infection and in control groups where available. For each study, a minimum of two authors extracted summary data. For each symptom, we calculated a pooled prevalence using generalized linear mixed models. Heterogeneity was measured with I 2. Subgroup analyses were conducted for COVID-19 hospitalization, severity and duration of follow-up. From 2844 unique titles, we included 51 studies (n = 18 917 patients). The mean duration of follow-up after COVID-19 was 77 days (range 14-182 days). Study quality was most commonly moderate. The most prevalent neuropsychiatric symptom was sleep disturbance [pooled prevalence = 27.4% (95% confidence interval 21.4-34.4%)], followed by fatigue [24.4% (17.5-32.9%)], objective cognitive impairment [20.2% (10.3-35.7%)], anxiety [19.1% (13.3-26.8%)] and post-traumatic stress [15.7% (9.9-24.1%)]. Only two studies reported symptoms in control groups, both reporting higher frequencies in COVID-19 survivors versus controls. Between-study heterogeneity was high (I 2 = 79.6-98.6%). There was little or no evidence of differential symptom prevalence based on hospitalization status, severity or follow-up duration. Neuropsychiatric symptoms are common and persistent after recovery from COVID-19. The literature on longer-term consequences is still maturing but indicates a particularly high prevalence of insomnia, fatigue, cognitive impairment and anxiety disorders in the first 6 months after infection.
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Affiliation(s)
- James B. Badenoch
- Barts Health NHS Trust, London, UK
- Queen Mary University of London, London, UK
| | - Emma R. Rengasamy
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Cameron Watson
- Barts Health NHS Trust, London, UK
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Katrin Jansen
- Department of Psychology, University of Münster, Münster, Germany
| | - Stuti Chakraborty
- Department of Physical Medicine and Rehabilitation, Christian Medical College and Hospital, Vellore, India
- Occupational Therapy Unit, Department of Physical Medicine and Rehabilitation, Christian Medical College and Hospital, Vellore, India
| | | | - Danish Hafeez
- Homerton University Hospitals Foundation Trust, London, UK
| | - Ella Burchill
- Faculty of Medicine and Life Sciences, King’s College London, London, UK
| | - Aman Saini
- Medical School, University College London, London, UK
| | - Lucretia Thomas
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Isabella Conti
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Sylvia Ralovska
- Sofia University ‘St Kliment Ohridski’, bul, ‘Tsar Osvoboditel’ 15, Sofia, Bulgaria
| | - Zain Hussain
- Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, UK
- School of Medicine, University of Dundee, Dundee, UK
| | - Matthew Butler
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Thomas A. Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychological Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Benedict D. Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, Liverpool, UK
- Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, Liverpool, UK
| | - Heinz Holling
- Department of Psychology, University of Münster, Münster, Germany
| | - Timothy R. Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jonathan P. Rogers
- Division of Psychiatry, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alasdair G. Rooney
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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36
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Butler M, Tamborska A, Wood GK, Ellul M, Thomas RH, Galea I, Pett S, Singh B, Solomon T, Pollak TA, Michael BD, Nicholson TR. Considerations for causality assessment of neurological and neuropsychiatric complications of SARS-CoV-2 vaccines: from cerebral venous sinus thrombosis to functional neurological disorder. J Neurol Neurosurg Psychiatry 2021; 92:1144-1151. [PMID: 34362855 DOI: 10.1136/jnnp-2021-326924] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Matt Butler
- Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Arina Tamborska
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Greta K Wood
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Mark Ellul
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Rhys H Thomas
- Department of Neuroscience, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.,Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Ian Galea
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sarah Pett
- MRC CTU at UCL, Institute for Global Health and Institute for Clinical Trials Methodology, University College London, London, UK
| | | | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Thomas Arthur Pollak
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - Benedict D Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
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37
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Paredes-Echeverri S, Maggio J, Bègue I, Pick S, Nicholson TR, Perez DL. Autonomic, Endocrine, and Inflammation Profiles in Functional Neurological Disorder: A Systematic Review and Meta-Analysis. J Neuropsychiatry Clin Neurosci 2021; 34:30-43. [PMID: 34711069 PMCID: PMC8813876 DOI: 10.1176/appi.neuropsych.21010025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Functional neurological disorder (FND) is a core neuropsychiatric condition. To date, promising yet inconsistently identified neural circuit profiles have been observed in patients with FND, suggesting that gaps remain in our systems-level neurobiological understanding. As such, other important physiological variables, including autonomic, endocrine, and inflammation findings, need to be contextualized for a more complete mechanistic picture. METHODS The investigators conducted a systematic review and meta-analysis of available case-control and cohort studies of FND. PubMed, PsycINFO, and Embase databases were searched for studies from January 1, 1900, to September 1, 2020, that investigated autonomic, endocrine, and inflammation markers in patients with FND. Sixty-six of 2,056 screened records were included in the review, representing 1,699 patients; data from 20 articles were used in the meta-analysis. RESULTS Findings revealed that children and adolescents with FND, compared with healthy control subjects (HCs), have increased resting heart rate (HR); there is also a tendency toward reduced resting HR variability in patients with FND across the lifespan compared with HCs. In adults, peri-ictal HR differentiated patients with functional seizures from those with epileptic seizures. Other autonomic and endocrine profiles for patients with FND were heterogeneous, with several studies highlighting the importance of individual differences. CONCLUSIONS Inflammation research in FND remains in its early stages. Moving forward, there is a need for the use of larger sample sizes to consider the complex interplay between functional neurological symptoms and behavioral, psychological, autonomic, endocrine, inflammation, neuroimaging, and epigenetic/genetic data. More research is also needed to determine whether FND is mechanistically (and etiologically) similar or distinct across phenotypes.
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Affiliation(s)
- Sara Paredes-Echeverri
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Julie Maggio
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - Indrit Bègue
- Adult Psychiatry Division, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Laboratory for Clinical and Experimental Psychopathology, Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Susannah Pick
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, United Kingdom
| | - Timothy R. Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, United Kingdom
| | - David L. Perez
- Functional Neurological Disorder Research Program, Cognitive Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Perez DL, Aybek S, Popkirov S, Kozlowska K, Stephen CD, Anderson J, Shura R, Ducharme S, Carson A, Hallett M, Nicholson TR, Stone J, LaFrance WC, Voon V. A Review and Expert Opinion on the Neuropsychiatric Assessment of Motor Functional Neurological Disorders. J Neuropsychiatry Clin Neurosci 2021; 33:14-26. [PMID: 32778007 DOI: 10.1176/appi.neuropsych.19120357] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Functional neurological (conversion) disorder (FND) is a prevalent and disabling condition at the intersection of neurology and psychiatry. Advances have been made in elucidating an emerging pathophysiology for motor FND, as well as in identifying evidenced-based physiotherapy and psychotherapy treatments. Despite these gains, important elements of the initial neuropsychiatric assessment of functional movement disorders (FND-movt) and functional limb weakness/paresis (FND-par) have yet to be established. This is an important gap from both diagnostic and treatment planning perspectives. In this article, the authors performed a narrative review to characterize clinically relevant variables across FND-movt and FND-par cohorts, including time course and symptom evolution, precipitating factors, medical and family histories, psychiatric comorbidities, psychosocial factors, physical examination signs, and adjunctive diagnostic tests. Thereafter, the authors propose a preliminary set of clinical content that should be assessed during early-phase patient encounters, in addition to identifying physical signs informing diagnosis and potential use of adjunctive tests for challenging cases. Although clinical history should not be used to make a FND diagnosis, characteristics such as acute onset, precipitating events (e.g., injury and surgery), and a waxing and waning course (including spontaneous remissions) are commonly reported. Active psychiatric symptoms (e.g., depression and anxiety) and ongoing psychosocial stressors also warrant evaluation. Positive physical examination signs (e.g., Hoover's sign and tremor entrainment) are key findings, as one of the DSM-5 diagnostic criteria. The neuropsychiatric assessment proposed emphasizes diagnosing FND by using "rule-in" physical signs while also considering psychiatric and psychosocial factors to aid in the development of a patient-centered treatment plan.
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Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Selma Aybek
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Stoyan Popkirov
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Kasia Kozlowska
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Christopher D Stephen
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jordan Anderson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Robert Shura
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Simon Ducharme
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Alan Carson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Mark Hallett
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Timothy R Nicholson
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Jon Stone
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - W Curt LaFrance
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
| | - Valerie Voon
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Massachusetts General Hospital, Harvard Medical School, Boston (Perez); Department of Neurology, Functional Neurological Disorders Clinic, University Hospital Inselspital and Clinical Neurosciences, Bern University, Bern, Switzerland (Aybek); Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany (Popkirov); Children's Hospital at Westmead, New South Wales, Australia (Kozlowska); Discipline of Psychiatry, University of Sydney Medical School, Sydney, Australia (Kozlowska); Department of Neurology, Movement Disorders Unit, Massachusetts General Hospital, Harvard Medical School, Boston (Stephen); Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, R.I. (Anderson, LaFrance); VA Mid-Atlantic Mental Illness, Research, Education, and Clinical Center, Salisbury, N.C. (Shura); Mental Health and Behavioral Sciences Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, N.C. (Shura); Department of Neurology, Wake Forest School of Medicine, Winston-Salem, N.C. (Shura); McConnell Brain Imaging Center, Montreal Neurological Institute, McGill University, Montreal (Ducharme); Department of Psychiatry, McGill University Health Center, Montreal (Ducharme); Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (Carson, Stone); Human Motor Control Section, National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Md. (Hallett); Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Nicholson); Behavioural and Clinical Neuroscience Institute, Cambridge, United Kingdom (Voon); and Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (Voon)
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Bègue I, Nicholson TR, Kozlowska K, LaFrance WC, Levenson JL, Rapaport MH, Carson AJ, Perez DL. Psychiatry's modern role in functional neurological disorder: join the renaissance. Psychol Med 2021; 51:1961-1963. [PMID: 34167595 DOI: 10.1017/s0033291721002038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Indrit Bègue
- Division of Adult Psychiatry, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Service of Neurology, Department of Clinical Neuroscience, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, Laboratory for Clinical and Experimental Psychopathology, University of Geneva, Geneva, Switzerland
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kasia Kozlowska
- Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Psychiatry and Discipline of Child & Adolescent Health, University of Sydney Medical School, Sydney, Australia
- Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown Medical School, Providence, RI, USA
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Mark H Rapaport
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Rogers JP, Watson CJ, Badenoch J, Cross B, Butler M, Song J, Hafeez D, Morrin H, Rengasamy ER, Thomas L, Ralovska S, Smakowski A, Sundaram RD, Hunt CK, Lim MF, Aniwattanapong D, Singh V, Hussain Z, Chakraborty S, Burchill E, Jansen K, Holling H, Walton D, Pollak TA, Ellul M, Koychev I, Solomon T, Michael BD, Nicholson TR, Rooney AG. Neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives. J Neurol Neurosurg Psychiatry 2021; 92:932-941. [PMID: 34083395 DOI: 10.1136/jnnp-2021-326405] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [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: 02/16/2021] [Accepted: 05/12/2021] [Indexed: 12/18/2022]
Abstract
There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations.We searched MEDLINE, Embase, PsycINFO and CINAHL up to 18 July 2020 for randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and case series. Studies reporting prevalences of neurological or neuropsychiatric symptoms were synthesised into meta-analyses to estimate pooled prevalence.13 292 records were screened by at least two authors to identify 215 included studies, of which there were 37 cohort studies, 15 case-control studies, 80 cross-sectional studies and 83 case series from 30 countries. 147 studies were included in the meta-analysis. The symptoms with the highest prevalence were anosmia (43.1% (95% CI 35.2% to 51.3%), n=15 975, 63 studies), weakness (40.0% (95% CI 27.9% to 53.5%), n=221, 3 studies), fatigue (37.8% (95% CI 31.6% to 44.4%), n=21 101, 67 studies), dysgeusia (37.2% (95% CI 29.8% to 45.3%), n=13 686, 52 studies), myalgia (25.1% (95% CI 19.8% to 31.3%), n=66 268, 76 studies), depression (23.0% (95% CI 11.8% to 40.2%), n=43 128, 10 studies), headache (20.7% (95% CI 16.1% to 26.1%), n=64 613, 84 studies), anxiety (15.9% (5.6% to 37.7%), n=42 566, 9 studies) and altered mental status (8.2% (95% CI 4.4% to 14.8%), n=49 326, 19 studies). Heterogeneity for most clinical manifestations was high.Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic's early phase are varied and common. The neurological and psychiatric academic communities should develop systems to facilitate high-quality methodologies, including more rapid examination of the longitudinal course of neuropsychiatric complications of newly emerging diseases and their relationship to neuroimaging and inflammatory biomarkers.
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Affiliation(s)
- Jonathan P Rogers
- Division of Psychiatry, University College London, London, UK .,South London and Maudsley NHS Foundation Trust, London, UK
| | - Cameron J Watson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - James Badenoch
- Medical School, University of Birmingham, Birmingham, UK
| | | | - Matthew Butler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jia Song
- East London NHS Foundation Trust, London, UK
| | - Danish Hafeez
- School of Medical Sciences, The University of Manchester, Manchester, UK
| | | | | | - Lucretia Thomas
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Silviya Ralovska
- Department of Neurology, Psychiatry, Physiotherapy and Rehabilitation, Preventive Medicine, and Public Health, Sofia University St Kliment Ohridski, Sofia, Bulgaria
| | | | | | | | - Mao Fong Lim
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Daruj Aniwattanapong
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Zain Hussain
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Stuti Chakraborty
- Department of Physical Medicine and Rehabilitation, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Ella Burchill
- Faculty of Medicine and Life Sciences, King's College London, London, UK
| | - Katrin Jansen
- Department of Psychology, University of Münster, Münster, Germany
| | - Heinz Holling
- Department of Psychology, University of Münster, Münster, Germany
| | - Dean Walton
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Thomas A Pollak
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark Ellul
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, Liverpool, UK.,Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, Liverpool, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychological Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tom Solomon
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, Liverpool, UK
| | - Benedict Daniel Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, Liverpool, UK.,Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, Liverpool, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alasdair G Rooney
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
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Ball HA, McWhirter L, Ballard C, Bhome R, Blackburn DJ, Edwards MJ, Fox NC, Howard R, Huntley J, Isaacs JD, Larner AJ, Nicholson TR, Pennington CM, Poole N, Price G, Price JP, Reuber M, Ritchie C, Rossor MN, Schott JM, Venneri A, Stone J, Carson AJ. Reply: Functional cognitive disorder: dementia's blind spot. Brain 2021; 144:e73. [PMID: 34398190 DOI: 10.1093/brain/awab305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Harriet A Ball
- Clinical Neurosciences, University of Bristol, BS10 5NB, UK
| | - Laura McWhirter
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, EX1 2LU, UK
| | - Rohan Bhome
- Division of Psychiatry, University College London, W1T 7NF, UK
| | - Daniel J Blackburn
- Department of Neuroscience, Medical School, University of Sheffield, S10 2TN, UK
| | - Mark J Edwards
- Neuroscience research Centre, St George's, University of London, SW17 0RE, UK
| | - Nick C Fox
- Dementia Research Centre, Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, WC1E 6BT, UK
| | - Robert Howard
- Division of Psychiatry, University College London, W1T 7NF, UK
| | | | - Jeremy D Isaacs
- Neuroscience research Centre, St George's, University of London, SW17 0RE, UK.,Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK
| | - A J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, L9 7LJ, UK
| | - Timothy R Nicholson
- Institute of Psychiatry Psychology & Neuroscience, King's College London, SE5 8AF, UK
| | | | - Norman Poole
- Neuropsychiatry Dept, St George's Hospital, London SW17 0QT, UK
| | - Gary Price
- Department of Neuropsychiatry, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, WC1N 3BG, UK
| | - J P Price
- Department of Neuropsychology, South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, TS4 3BW, UK
| | - Markus Reuber
- Department of Neuroscience, Medical School, University of Sheffield, S10 2TN, UK
| | - Craig Ritchie
- Centre for Dementia Prevention, The University of Edinburgh, EH16 4UX, UK
| | - Martin N Rossor
- Dementia Research Centre, Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, WC1E 6BT, UK
| | - Jonathan M Schott
- Dementia Research Centre, Department of Neurodegenerative Diseases, UCL Queen Square Institute of Neurology, WC1E 6BT, UK
| | - Annalena Venneri
- Department of Life Sciences, Brunel University London, UB8 3PH, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
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Ross Russell AL, Hardwick M, Jeyanantham A, White LM, Deb S, Burnside G, Joy HM, Smith CJ, Pollak TA, Nicholson TR, Davies NWS, Manji H, Easton A, Ray S, Zandi MS, Coles JP, Menon DK, Varatharaj A, McCausland B, Ellul MA, Thomas N, Breen G, Keddie S, Lunn MP, Burn JPS, Quattrocchi G, Dixon L, Rice CM, Pengas G, Al-Shahi Salman R, Carson A, Joyce EM, Turner MR, Benjamin LA, Solomon T, Kneen R, Pett S, Thomas RH, Michael BD, Galea I. Spectrum, risk factors and outcomes of neurological and psychiatric complications of COVID-19: a UK-wide cross-sectional surveillance study. Brain Commun 2021; 3:fcab168. [PMID: 34409289 PMCID: PMC8364668 DOI: 10.1093/braincomms/fcab168] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 01/06/2023] Open
Abstract
SARS-CoV-2 is associated with new-onset neurological and psychiatric conditions. Detailed clinical data, including factors associated with recovery, are lacking, hampering prediction modelling and targeted therapeutic interventions. In a UK-wide cross-sectional surveillance study of adult hospitalized patients during the first COVID-19 wave, with multi-professional input from general and sub-specialty neurologists, psychiatrists, stroke physicians, and intensivists, we captured detailed data on demographics, risk factors, pre-COVID-19 Rockwood frailty score, comorbidities, neurological presentation and outcome. A priori clinical case definitions were used, with cross-specialty independent adjudication for discrepant cases. Multivariable logistic regression was performed using demographic and clinical variables, to determine the factors associated with outcome. A total of 267 cases were included. Cerebrovascular events were most frequently reported (131, 49%), followed by other central disorders (95, 36%) including delirium (28, 11%), central inflammatory (25, 9%), psychiatric (25, 9%), and other encephalopathies (17, 7%), including a severe encephalopathy (n = 13) not meeting delirium criteria; and peripheral nerve disorders (41, 15%). Those with the severe encephalopathy, in comparison to delirium, were younger, had higher rates of admission to intensive care and a longer duration of ventilation. Compared to normative data during the equivalent time period prior to the pandemic, cases of stroke in association with COVID-19 were younger and had a greater number of conventional, modifiable cerebrovascular risk factors. Twenty-seven per cent of strokes occurred in patients <60 years. Relative to those >60 years old, the younger stroke patients presented with delayed onset from respiratory symptoms, higher rates of multi-vessel occlusion (31%) and systemic thrombotic events. Clinical outcomes varied between disease groups, with cerebrovascular disease conferring the worst prognosis, but this effect was less marked than the pre-morbid factors of older age and a higher pre-COVID-19 frailty score, and a high admission white cell count, which were independently associated with a poor outcome. In summary, this study describes the spectrum of neurological and psychiatric conditions associated with COVID-19. In addition, we identify a severe COVID-19 encephalopathy atypical for delirium, and a phenotype of COVID-19 associated stroke in younger adults with a tendency for multiple infarcts and systemic thromboses. These clinical data will be useful to inform mechanistic studies and stratification of patients in clinical trials.
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Affiliation(s)
- Amy L Ross Russell
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Marc Hardwick
- Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Athavan Jeyanantham
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Laura M White
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, L9 7AL, UK
| | - Saumitro Deb
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, L3 5TR, UK
| | - Girvan Burnside
- Department of Health Data Science, University of Liverpool, Liverpool, L69 3BX, UK
| | - Harriet M Joy
- Neuroradiology Department, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Craig J Smith
- Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Salford, M6 8HD, UK
- Division of Cardiovascular Sciences, Lydia Becker Institute for Immunology and Inflammation, University of Manchester, Manchester, M13 9PL, UK
| | - Thomas A Pollak
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, SE5 8AF, UK
| | | | - Hadi Manji
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology, London, WC1N 3BG, UK
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Ava Easton
- Encephalitis Society, Malton, Malton, YO17 7DT, UK
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, L7 3EA, UK
| | - Stephen Ray
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, L7 3EA, UK
- The National Institute for Health Research Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 7BE, UK
| | - Michael S Zandi
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Jonathan P Coles
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | - Aravinthan Varatharaj
- Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Beth McCausland
- Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
- Memory Assessment and Research Centre, Moorgreen Hospital, Southern Health Foundation Trust, Southampton, SO40 2RZ, UK
| | - Mark A Ellul
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, L7 3EA, UK
- The National Institute for Health Research Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 7BE, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Naomi Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle, NE1 7RU, UK
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle, NE2 4HH, UK
| | - Gerome Breen
- Department of Social Genetic and Developmental Psychiatry, King’s College London, London, SE5 8AF, UK
| | - Stephen Keddie
- Department of Neuromuscular Diseases, University College London, London, WC1N 3BG, UK
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, WC1N 3BG, UK
| | - Michael P Lunn
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology, London, WC1N 3BG, UK
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - John P S Burn
- Rehabilitation Department, Poole Hospital, University Hospitals Dorset NHS Foundation Trust, Poole, BH15 2JB, UK
| | - Graziella Quattrocchi
- Department of Neurology, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK
| | - Luke Dixon
- Department of Neuroradiology, Imperial College NHS Healthcare Trust, London, W2 1NY, UK
| | - Claire M Rice
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, S10 5NB, UK
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 1TH, UK
| | - George Pengas
- Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | | | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH16 4SB, UK
| | - Eileen M Joyce
- UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Laura A Benjamin
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, L7 3EA, UK
- The National Institute for Health Research Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 7BE, UK
- Laboratory of Molecular and Cell Biology, UCL, Gower St, King’s Cross, London, London, WC1E 6BT, UK
| | - Tom Solomon
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, L7 3EA, UK
- The National Institute for Health Research Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 7BE, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Rachel Kneen
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, L7 3EA, UK
- Department of Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool, Liverpool, L14 5AB, UK
| | - Sarah Pett
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, WC1V 6LJ, UK
- Institute for Global Health, University College London, London, WC1N 1EH, UK
| | - Rhys H Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle, NE1 7RU, UK
- Wellcome Centre for Mitochondrial Research, Newcastle University, Newcastle, NE2 4HH, UK
- Department of Neurology, Royal Victoria Infirmary, Newcastle, NE1 4LP, UK
| | - Benedict D Michael
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, L7 3EA, UK
- The National Institute for Health Research Health Protection Research Unit for Emerging and Zoonotic Infections, University of Liverpool, Liverpool, L69 7BE, UK
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ, UK
| | - Ian Galea
- Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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Butler M, Coebergh J, Safavi F, Carson A, Hallett M, Michael B, Pollak TA, Solomon T, Stone J, Nicholson TR. Functional Neurological Disorder After SARS-CoV-2 Vaccines: Two Case Reports and Discussion of Potential Public Health Implications. J Neuropsychiatry Clin Neurosci 2021; 33:345-348. [PMID: 34261345 PMCID: PMC8556318 DOI: 10.1176/appi.neuropsych.21050116] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew Butler
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Jan Coebergh
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Farinaz Safavi
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Alan Carson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Mark Hallett
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Benedict Michael
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Thomas A Pollak
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Tom Solomon
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Jon Stone
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Butler, Pollak, Nicholson); Ashford St. Peter's National Health Service (NHS) Foundation Trust and St. George's NHS Foundation Trust, London (Coebergh);Division of Intramural Research, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md. (Safavi, Hallett);Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom (Carson, Stone); and Department of Neurology, the Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (Michael, Solomon)
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44
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Affiliation(s)
- Ella Burchill
- Faculty of Life Sciences and Medicine, King's College London, London SE1 9RT, UK.
| | - Jonathan P Rogers
- Division of Psychiatry, University College London, South London and Maudsley NHS Foundation Trust, London, UK
| | - Dale Needham
- Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation, School of Medicine, John Hopkins University, Baltimore, MD, USA
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease, University Health Network and the Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London SE1 9RT, UK
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O'Connell N, Nicholson TR, Wessely S, David AS. Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case-control study - CORRIGENDUM. Psychol Med 2021; 51:1592. [PMID: 34193322 DOI: 10.1017/s0033291721002658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Perez DL, Nicholson TR, Asadi-Pooya AA, Bègue I, Butler M, Carson AJ, David AS, Deeley Q, Diez I, Edwards MJ, Espay AJ, Gelauff JM, Hallett M, Horovitz SG, Jungilligens J, Kanaan RAA, Tijssen MAJ, Kozlowska K, LaFaver K, LaFrance WC, Lidstone SC, Marapin RS, Maurer CW, Modirrousta M, Reinders AATS, Sojka P, Staab JP, Stone J, Szaflarski JP, Aybek S. Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda. Neuroimage Clin 2021; 30:102623. [PMID: 34215138 PMCID: PMC8111317 DOI: 10.1016/j.nicl.2021.102623] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023]
Abstract
Functional neurological disorder (FND) was of great interest to early clinical neuroscience leaders. During the 20th century, neurology and psychiatry grew apart - leaving FND a borderland condition. Fortunately, a renaissance has occurred in the last two decades, fostered by increased recognition that FND is prevalent and diagnosed using "rule-in" examination signs. The parallel use of scientific tools to bridge brain structure - function relationships has helped refine an integrated biopsychosocial framework through which to conceptualize FND. In particular, a growing number of quality neuroimaging studies using a variety of methodologies have shed light on the emerging pathophysiology of FND. This renewed scientific interest has occurred in parallel with enhanced interdisciplinary collaborations, as illustrated by new care models combining psychological and physical therapies and the creation of a new multidisciplinary FND society supporting knowledge dissemination in the field. Within this context, this article summarizes the output of the first International FND Neuroimaging Workgroup meeting, held virtually, on June 17th, 2020 to appraise the state of neuroimaging research in the field and to catalyze large-scale collaborations. We first briefly summarize neural circuit models of FND, and then detail the research approaches used to date in FND within core content areas: cohort characterization; control group considerations; task-based functional neuroimaging; resting-state networks; structural neuroimaging; biomarkers of symptom severity and risk of illness; and predictors of treatment response and prognosis. Lastly, we outline a neuroimaging-focused research agenda to elucidate the pathophysiology of FND and aid the development of novel biologically and psychologically-informed treatments.
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Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Timothy R Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz Iran; Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Indrit Bègue
- Division of Adult Psychiatry, Department of Psychiatry, University of Geneva, Geneva Switzerland; Service of Neurology Department of Clinical Neuroscience, University of Geneva, Geneva, Switzerland
| | - Matthew Butler
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Quinton Deeley
- South London and Maudsley NHS Foundation Trust, London UK Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ibai Diez
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark J Edwards
- Neurosciences Research Centre, St George's University of London, London, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Jeannette M Gelauff
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Silvina G Horovitz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Germany
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health Heidelberg, Australia
| | - Marina A J Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, The Netherlands
| | - Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead Institute of Medical Research, University of Sydney Medical School, Sydney, NSW, Australia
| | - Kathrin LaFaver
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Ramesh S Marapin
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, The Netherlands
| | - Carine W Maurer
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Mandana Modirrousta
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Petr Sojka
- Department of Psychiatry, University Hospital Brno, Czech Republic
| | - Jeffrey P Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Rochester, MN, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham Epilepsy Center, Department of Neurology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Selma Aybek
- Neurology Department, Psychosomatic Medicine Unit, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
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Hafeez D, Song J, Watson C, Rooney A, Nicholson TR. Increased ethnicity and socioeconomic data collection required in stroke associated with COVID-19. J Neurol Neurosurg Psychiatry 2021; 92:336-337. [PMID: 32948636 DOI: 10.1136/jnnp-2020-325057] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Danish Hafeez
- School of Medicine, The University of Manchester, Manchester, UK
| | - Jia Song
- Deancross Personality Disorder Service, East London NHS Foundation Trust, London, UK
| | - Cameron Watson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, London, London, UK
| | - Alasdair Rooney
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Edinburgh, UK
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Affiliation(s)
- Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Timothy R Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Watson CJ, Thomas RH, Solomon T, Michael BD, Nicholson TR, Pollak TA. COVID-19 and psychosis risk: Real or delusional concern? Neurosci Lett 2020; 741:135491. [PMID: 33220366 DOI: 10.1016/j.neulet.2020.135491] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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: 10/02/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
Historical epidemiological perspectives from past pandemics and recent neurobiological evidence link infections and psychoses, leading to concerns that COVID-19 will present a significant risk for the development of psychosis. But are these concerns justified, or mere sensationalism? In this article we review the historical associations between viral infection and the immune system more broadly in the development of psychosis, before critically evaluating the current evidence pertaining to SARS-CoV-2 and risk of psychosis as an acute or post-infectious manifestation of COVID-19. We review the 42 cases of psychosis reported in infected patients to date, and discuss the potential implications of in utero infection on subsequent neurodevelopment and psychiatric risk. Finally, in the context of the wider neurological and psychiatric manifestations of COVID-19 and our current understanding of the aetiology of psychotic disorders, we evaluate possible neurobiological and psychosocial mechanisms as well as the numerous challenges in ascribing a causal pathogenic role to the infection.
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Affiliation(s)
- Cameron J Watson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University London, UK.
| | - Rhys H Thomas
- Translational and Clinical Research Institute, University of Newcastle, UK; Royal Victoria Infirmary, Newcastle, UK
| | - Tom Solomon
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, UK; Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, UK
| | - Benedict Daniel Michael
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infection, University of Liverpool, UK; Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Zoological Science, University of Liverpool, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Thomas A Pollak
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Varatharaj A, Pollak TA, Nicholson TR, Coles JP, Benjamin LA, Carson A, Thomas RH, Michael BD. Characterising neuropsychiatric disorders in patients with COVID-19 - Authors' reply. Lancet Psychiatry 2020; 7:934-935. [PMID: 33069310 PMCID: PMC7561324 DOI: 10.1016/s2215-0366(20)30420-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Aravinthan Varatharaj
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Thomas A Pollak
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Laura A Benjamin
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Rhys H Thomas
- Department of Neurology, Royal Victoria Infirmary, Newcastle, UK; Translational and Clinical Research Institute, University of Newcastle, Newcastle, UK
| | - Benedict D Michael
- The National Institute for Health Research Health Protection Research Unit for Emerging and Zoonotic Infections, Liverpool, UK; Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK.
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