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Higson L, O'Brien TJ, Rayner G, Alpitsis R, Winton-Brown T. Re-PROGRAM: The evaluation of a brief intervention program for patients with functional seizures in an outpatient hospital setting. Epilepsia 2024. [PMID: 39096302 DOI: 10.1111/epi.18073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 07/13/2024] [Accepted: 07/17/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVE Functional seizures (FS) account for 20%-25% of referrals to specialist epilepsy clinics. They are associated with major disability, increased mortality, and frequent and costly health care use. Current guidelines emphasize the importance of implementing clinical pathways to coordinate and deliver effective treatment, but there are few targeted evidence-based interventions that reliably improve patient outcomes, and treatment resources are limited. We conducted a retrospective evaluation of Re-PROGRAM, a novel, brief intervention for functional seizure patients, to assess its feasibility in an outpatient setting. METHODS Twenty-nine patients with FS undertook Re-PROGRAM between August 2020 and January 2022 at the Alfred Hospital Functional Seizures Clinic, Melbourne, Australia. The intervention comprised five 60-90-min consecutive weekly appointments via telehealth, where psychologists engaged patients in a structured program of seizure management skills, lifestyle modification, and behavioral activation strategies. Following the intervention, patient feedback was collected in routine clinical follow-up as well as with a 24-item self-report pre-/postintervention comparison questionnaire. RESULTS All 29 patients who enrolled in Re-PROGRAM completed the scheduled sessions. Of those who returned the postintervention questionnaire (n = 16), 15 reported a reduction in seizure frequency. Four patients were lost to follow-up. Of the remaining nine, eight reported seizure frequency reduction during clinical follow-up. Qualitative analysis of the feedback revealed the majority of patients reported reduced seizure duration, intensity, and bothersomeness, and patients felt improvements in their sense of control over seizures, confidence to use seizure control strategies, assertive communication, problem solving, coping skills, relationships with others, and their day-to-day functioning. SIGNIFICANCE This retrospective evaluation demonstrates the feasibility and acceptability of Re-PROGRAM as a brief intervention for individuals diagnosed with FS delivered in a clinical outpatient setting and warrants further investigation in larger scale, randomized controlled studies.
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Affiliation(s)
- Lana Higson
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Genevieve Rayner
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Rubina Alpitsis
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Toby Winton-Brown
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
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Serranová T, Slovák M, Forejtová Z, Sieger T, Dušek P, Srpová B, Mrázová K, Růžička E, Šonka K, Espay AJ, Nytrová P. Abnormal Cerebrospinal Fluid Cytology in Functional Movement Disorders. Psychosom Med 2024; 86:555-560. [PMID: 38573035 DOI: 10.1097/psy.0000000000001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE The role of inflammation and neuroimmune mechanisms, which have been documented in various neuropsychiatric disorders including the seizure subtype of functional neurological disorder, remains unclear in functional movement disorders (FMD). To explore these mechanisms, we analyzed selected inflammatory markers in cerebrospinal fluid (CSF) in patients with FMD. METHODS We compared CSF markers in 26 patients with clinically established FMD (20 females; mean [SD] age = 43.3 [10.9], disease duration = 3.9 [3], range = 0.1-11 years; mean follow-up after lumbar puncture = 4.3 [2] years, range = 0.5-7 years) and 26 sex- and age-matched clinical controls with noninflammatory nonneurodegenerative neurological disorders, mostly sleep disorders. RESULTS Sixty-five percent of FMD patients versus 15% of controls showed cytological abnormalities (i.e., increased white blood cells [WBC] count, signs of WBC activation, or both; odds ratio [OR] = 9.85, 95% confidence interval = 2.37-52.00, p < .01, corrected), with a significantly higher frequency of an isolated lymphocytic activation, 35% versus 0% (OR = ∞, 95% confidence interval = 2.53-∞, p < .05, corrected). There were no differences in CSF protein and albumin levels, quotient albumin, IgG index, and oligoclonal bands. CSF abnormalities were not associated with more severe motor symptoms or a higher frequency of depression in FMD. CONCLUSIONS Our results suggest a possible involvement of immune mechanisms in the pathophysiology of (at least a subtype of) FMD that deserves further investigation.
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Affiliation(s)
- Tereza Serranová
- From the Department of Neurology and Center of Clinical Neuroscience, Charles University (Serranová, Slovák, Forejtová, Sieger, Dušek, Srpová, Růžička, Šonka, Nytrová), 1st Faculty of Medicine and General University Hospital in Prague; Department of Cybernetics, Faculty of Electrical Engineering (Sieger), Czech Technical University in Prague; Institute of Medical Biochemistry and Laboratory Diagnostics (Mrázová), Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic; and James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology (Espay), University of Cincinnati, Cincinnati, Ohio
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Szaflarski JP, Szaflarski M. Traumatic Brain Injury Outcomes After Recreational Cannabis Use. Neuropsychiatr Dis Treat 2024; 20:809-821. [PMID: 38586307 PMCID: PMC10999198 DOI: 10.2147/ndt.s453616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/23/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose Basic science data indicate potential neuroprotective effects of cannabinoids in traumatic brain injury (TBI). We aimed to evaluate the effects of pre-TBI recreational cannabis use on TBI outcomes. Patients and Methods We used i2b2 (a scalable informatics framework; www.i2b2.org) to identify all patients presenting with acute TBI between 1/1/2014 and 12/31/2016, then conducted a double-abstraction medical chart review to compile basic demographic, urine drug screen (UDS), Glasgow Coma Scale (GCS), and available outcomes data (mortality, modified Rankin Scale (mRS), duration of stay, disposition (home, skilled nursing facility, inpatient rehabilitation, other)) at discharge and at specific time points thereafter. We conducted multivariable nested ordinal and logistic regression analyses to estimate associations between cannabis use, other UDS results, demographic factors, and selected outcomes. Results i2b2 identified 6396 patients who acutely presented to our emergency room with TBI. Of those, 3729 received UDS, with 22.2% of them testing positive for cannabis. Mortality was similar in patients who tested positive vs negative for cannabis (3.9% vs 4.8%; p = 0.3) despite more severe GCS on admission in the cannabis positive group (p = 0.045). Several discharge outcome measures favored the cannabis positive group who had a higher rate of discharge home vs other care settings (p < 0.001), lower discharge mRS (p < 0.001), and shorter duration of hospital stay (p < 0.001) than the UDS negative group. Multivariable analyses confirmed mostly independent associations between positive cannabis screen and these post-TBI short- and long-term outcomes. Conclusion This study adds evidence about the potentially neuroprotective effects of recreational cannabis for short- and long-term post-TBI outcomes. These results need to be confirmed via prospective data collections.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham (UAB), Heersink School of Medicine, Birmingham, AL, USA
| | - Magdalena Szaflarski
- Department of Sociology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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Byington CG, Goodman AM, Allendorfer JB, Correia S, LaFrance WC, Szaflarski JP. Decreased uncinate fasciculus integrity in functional seizures following traumatic brain injury. Epilepsia 2024; 65:1060-1071. [PMID: 38294068 DOI: 10.1111/epi.17896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The uncinate fasciculus (UF) has been implicated previously in contributing to the pathophysiology of functional (nonepileptic) seizures (FS). FS are frequently preceded by adverse life events (ALEs) and present with comorbid psychiatric symptoms, yet neurobiological correlates of these factors remain unclear. To address this gap, using advanced diffusion magnetic resonance imaging (dMRI), UF tracts in a large cohort of patients with FS and pre-existing traumatic brain injury (TBI + FS) were compared to those in patients with TBI without FS (TBI-only). We hypothesized that dMRI measures in UF structural connectivity would reveal UF differences when controlling for TBI status. Partial correlation tests assessed the potential relationships with psychiatric symptom severity measures. METHODS Participants with TBI-only (N = 46) and TBI + FS (N = 55) completed a series of symptom questionnaires and MRI scanning. Deterministic tractography via diffusion spectrum imaging (DSI) was implemented in DSI studio (https://dsi-studio.labsolver.org) with q-space diffeomorphic reconstruction (QSDR), streamline production, and manual segmentation to assess bilateral UF integrity. Fractional anisotropy (FA), radial diffusivity (RD), streamline counts, and their respective asymmetry indices (AIs) served as estimates of white matter integrity. RESULTS Compared to TBI-only, TBI + FS participants demonstrated decreased left hemisphere FA and RD asymmetry index (AI) for UF tracts (both p < .05, false discovery rate [FDR] corrected). Additionally, TBI + FS reported higher symptom severity in depression, anxiety, and PTSD measures (all p < .01). Correlation tests comparing UF white matter integrity differences to psychiatric symptom severity failed to reach criteria for significance (all p > .05, FDR corrected). SIGNIFICANCE In a large, well-characterized sample, participants with FS had decreased white matter health after controlling for the history of TBI. Planned follow-up analysis found no evidence to suggest that UF connectivity measures are a feature of group differences in mood or anxiety comorbidities for FS. These findings suggest that frontolimbic structural connectivity may play a role in FS symptomology, after accounting for prior ALEs and comorbid psychopathology severity.
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Affiliation(s)
- Caroline G Byington
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adam M Goodman
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane B Allendorfer
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Neurobiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Stephen Correia
- Departments of Psychiatry and Neurology, Veterans Affairs Providence Healthcare System, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Veterans Affairs Providence Healthcare System, Rhode Island Hospital, Brown University, Providence, Rhode Island, USA
| | - Jerzy P Szaflarski
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Departments of Neurobiology and Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Mueller C, Sharma AA, Szaflarski JP. Peripheral and Central Nervous System Biomarkers of Inflammation in Functional Seizures: Assessment with Magnetic Resonance Spectroscopy. Neuropsychiatr Dis Treat 2023; 19:2729-2743. [PMID: 38077237 PMCID: PMC10710262 DOI: 10.2147/ndt.s437063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/21/2023] [Indexed: 02/12/2024] Open
Abstract
Purpose Inflammation may link trauma to clinical symptoms in functional seizures (FS). We compared brain temperature and metabolites in FS, psychiatric (PCs) and healthy controls (HCs) and quantified their associations with serum biomarkers of inflammation and clinical symptoms. Patients and Methods Brain temperature and metabolites were measured with whole-brain magnetic resonance spectroscopic imaging (MRSI) and compared between groups in regions of interest and the whole brain. Relationships with inflammatory biomarkers and symptoms were assessed with Pearson correlations. Results Brain temperature was higher in FS than HCs in the orbitofrontal cortex (OFC) and anterior cingulate gyrus (ACG) and lower in the occipital cortex and frontal lobe. PCs showed lower temperatures than HCs in the frontal lobe including precentral gyrus and in the cerebellum. Myo-inositol (MINO) was higher in FS than HCs in the precentral gyrus, posterior temporal gyrus, ACG and OFC, and choline (CHO) was higher in the occipital lobe. CHO was higher in PCs than HCs in the ACG and OFC, and N-acetylaspartate (NAA) was higher in the ACG. There were no significant correlations with the serum inflammatory biomarkers. In FS, brain temperature correlated with depression, quality of life, psychological symptoms, and disability, CHO correlated with disability, and MINO correlated with hostility, disability, and quality of life. Conclusion Some of the previously identified neuroimaging abnormalities in FS may be related to comorbid psychiatric symptoms, while others, such as abnormalities in sensorimotor cortex, occipital regions, and the temporo-parietal junction may be specific to FS. Overlapping MINO and temperature increases in the ACG and OFC in FS suggest neuroinflammation.
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Affiliation(s)
- Christina Mueller
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ayushe A Sharma
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jerzy P Szaflarski
- Departments of Neurology, Neurobiology, and Neurosurgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Kozlowska K, Schollar-Root O, Savage B, Hawkes C, Chudleigh C, Raghunandan J, Scher S, Helgeland H. Illness-Promoting Psychological Processes in Children and Adolescents with Functional Neurological Disorder. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1724. [PMID: 38002815 PMCID: PMC10670544 DOI: 10.3390/children10111724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/26/2023]
Abstract
Previous studies suggest that subjective distress in children with functional neurological disorder (FND) is associated with stress-system dysregulation and modulates aberrant changes in neural networks. The current study documents illness-promoting psychological processes in 76 children with FND (60 girls and 16 boys, aged 10.00-17.08 years) admitted to the Mind-Body Program. The children completed a comprehensive family assessment and self-report measures, and they worked with the clinical team to identify psychological processes during their inpatient admission. A total of 47 healthy controls (35 girls and 12 boys, aged 8.58-17.92 years) also completed self-report measures, but were not assessed for illness-promoting psychological processes. Children with FND (vs. controls) reported higher levels of subjective distress (total DASS score, t(104.24) = 12.18; p ˂ 0.001) and more adverse childhood experiences across their lifespans (total ELSQ score, t(88.57) = 9.38; p ˂ 0.001). Illness-promoting psychological processes were identified in all children with FND. Most common were the following: chronic worries about schoolwork, friendships, or parental wellbeing (n = 64; 84.2%); attention to symptoms (n = 61; 80.3%); feeling sad (n = 58; 76.3%); experiencing a low sense of control (helplessness) in relation to symptoms (n = 44; 57.9%); pushing difficult thoughts out of mind (n = 44; 57.9%); self-critical rumination (n = 42; 55.3%); negative/catastrophic-symptom expectations (n = 40; 52.6%); avoidance of activities (n = 38; 50%); intrusive thoughts/feelings/memories associated with adverse events (n = 38, 50%); and pushing difficult feelings out of mind (n = 37; 48.7%). In children with FND-disabled enough to be admitted for inpatient treatment-illness-promoting psychological processes are part of the clinical presentation. They contribute to the child's ongoing sense of subjective distress, and if not addressed can maintain the illness process. A range of clinical interventions used to address illness-promoting psychological processes are discussed, along with illustrative vignettes.
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Affiliation(s)
- Kasia Kozlowska
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Child and Adolescent Heath and Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
- Brain Dynamics Centre, Westmead Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Olivia Schollar-Root
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Blanche Savage
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Golden Wattle Clinical Psychology, 20 Jarrett St, Leichhardt, NSW 2040, Australia
| | - Clare Hawkes
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Catherine Chudleigh
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
- Golden Wattle Clinical Psychology, 20 Jarrett St, Leichhardt, NSW 2040, Australia
| | - Jyoti Raghunandan
- Department of Psychological Medicine, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia; (O.S.-R.); (B.S.); (C.H.); (J.R.)
| | - Stephen Scher
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2050, Australia
| | - Helene Helgeland
- Department of Child and Adolescent Mental Health in Hospitals, Oslo University Hospital, 0424 Oslo, Norway;
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Malekpour M, Jafari A, Kashkooli M, Salarikia SR, Negahdaripour M. A systems biology approach for discovering the cellular and molecular aspects of psychogenic non-epileptic seizure. Front Psychiatry 2023; 14:1116892. [PMID: 37252132 PMCID: PMC10213457 DOI: 10.3389/fpsyt.2023.1116892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives Psychogenic non-epileptic seizure (PNES) is the most common non-epileptic disorder in patients referring to epilepsy centers. Contrary to common beliefs about the disease's harmlessness, the death rate of PNES patients is similar to drug-resistant epilepsy. Meanwhile, the molecular pathomechanism of PNES is unknown with very limited related research. Thus, the aim of this in silico study was to find different proteins and hormones associated with PNES via a systems biology approach. Methods Different bioinformatics databases and literature review were used to find proteins associated with PNES. The protein-hormone interaction network of PNES was constructed to discover its most influential compartments. The pathways associated with PNES pathomechanism were found by enrichment analysis of the identified proteins. Besides, the relationship between PNES-related molecules and psychiatric diseases was discovered, and the brain regions that could express altered levels of blood proteins were discovered. Results Eight genes and three hormones were found associated with PNES through the review process. Proopiomelanocortin (POMC), neuropeptide Y (NPY), cortisol, norepinephrine, and brain-derived neurotrophic factor (BDNF) were identified to have a high impact on the disease pathogenesis network. Moreover, activation of Janus kinase-signaling transducer and activator of transcription (JAK-STAT) and JAK, as well as signaling of growth hormone receptor, phosphatidylinositol 3-kinase /protein kinase B (PI3K/AKT), and neurotrophin were found associated with PNES molecular mechanism. Several psychiatric diseases such as depression, schizophrenia, and alcohol-related disorders were shown to be associated with PNES predominantly through signaling molecules. Significance This study was the first to gather the biochemicals associated with PNES. Multiple components and pathways and several psychiatric diseases associated with PNES, and some brain regions that could be altered during PNES were suggested, which should be confirmed in further studies. Altogether, these findings could be used in future molecular research on PNES patients.
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Affiliation(s)
- Mahdi Malekpour
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Aida Jafari
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Kashkooli
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Manica Negahdaripour
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Science, Shiraz, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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Chung J, Mukerji S, Kozlowska K. Cortisol and α-amylase awakening response in children and adolescents with functional neurological (conversion) disorder. Aust N Z J Psychiatry 2023; 57:115-129. [PMID: 35297291 DOI: 10.1177/00048674221082520] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Stress system dysregulation is considered to have an important role in the aetiology of paediatric functional neurological (conversion) disorder. This study examined salivary cortisol and α-amylase awakening responses in children with functional neurological disorder to determine activation patterns of the hypothalamic-pituitary-adrenal axis and sympathetic system. A healthy cortisol awakening response involves a robust increase in cortisol within 30 minutes of awakening. Alpha-amylase awakening response is variable in children. METHODS Cortisol and α-amylase were measured in saliva from 32 patients with functional neurological disorder (26 girls and 6 boys, aged 11.3-16.1 years) and 31 healthy controls (23 girls and 8 boys, aged 8.6-17.7 years). Saliva samples were collected using a Salivette sampling device at two time points - upon awakening and 30 minutes after awakening. RESULTS Patients with functional neurological disorder showed a decrease in cortisol awakening response (-4 nmol.min/L) and controls showed an increase (107 nmol.min/L), t(55) = -.4.6, p < 0.001. Within the functional neurological disorder group, 57% showed an attenuated cortisol awakening response and 43% showed an obliterated/reversed cortisol awakening response: Cortisol awakening response was negatively correlated with adverse childhood experiences, r(58) = -0.6, p = 0.002, and subjective distress (total Depression Anxiety and Stress Scales score), r(58) = -0.4, p = 0.050. In controls, cortisol awakening response showed no correlation with adverse childhood experiences and a positive correlation with subjective distress, r(56) = 0.4, p = 0.023. Total cortisol remained similar between the functional neurological disorder and control group. No significant differences were observed between the functional neurological disorder and control group in any of the α-amylase analyses. DISCUSSION The results suggest dysregulation of the hypothalamic-pituitary-adrenal axis in children with functional neurological disorder. Hypothalamic-pituitary-adrenal dysregulation in children with functional neurological disorder may contribute to comorbid symptoms of fatigue, sleep disturbance and subjective loss of well-being because circadian rhythms and energy metabolism are disrupted. Hypothalamic-pituitary-adrenal dysregulation - and changes in glucocorticoid (cortisol) signalling at the molecular level - may also contribute to increased vulnerability for functional neurological disorder symptoms because of epigenetically mediated changes to neural networks implicated in functional neurological disorder.
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Affiliation(s)
- Jason Chung
- Department of Clinical Biochemistry, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Shohini Mukerji
- Department of Clinical Biochemistry, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Chemical Pathology, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Kasia Kozlowska
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Psychological Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Brain Dynamics Centre, The Westmead Institute for Medical Research, Westmead, NSW, Australia
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Li Y, Abbas Q, Manthar S, Hameed A, Asad Z. Fear of COVID-19 and secondary trauma: Moderating role of self-efficacy. Front Psychol 2022; 13:838451. [PMID: 36160588 PMCID: PMC9490413 DOI: 10.3389/fpsyg.2022.838451] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
COVID-19 has affected millions of people around the globe. People's mental health, especially those of nurses, has been primarily affected by the fear of this virus. More focus has been paid to vaccination and treatment of the virus, but less attestation has been given to addressing the mental health of people affected by the virus. Empirical studies show that different external factors are not easily manageable and controllable by the individual. This study preliminarily explores the connection between fear of COVID-19 and secondary traumatic stress in nurses. Further, it examines the moderating effects of occupational self-efficacy on the relationship between fear of COVID-19 and secondary traumatic stress. Data for the study was collected from the nurses of six large hospitals in Karachi, Pakistan. The final analysis was performed on 243 samples. Studies on COVID-19 suggest that increased occupational self-efficacy decreases fear and its impact. This study offers insights for managers to develop stress management programs and provide proper training and counseling sessions to the nurses to motivate them emotionally. Theoretically, this study broadens the understanding of the theory of emotions by using the pandemic as a stressor. Future studies may explore different roles of occupational self-efficacy and study its influential role in managing different kinds of emotions explained by the theory of emotions. Managers at the workplace could design different self-efficacy training for nurses to increase their self-motivation to fight different types of stress they face at the workplace.
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Affiliation(s)
- Yaling Li
- Mental Health Education and Counseling Center, Shenzhen Technology University, Shenzhen, China
| | - Qamar Abbas
- Department of Management Science, Mohammad Ali Jinnah University, Karachi, Pakistan
| | - Shahjehan Manthar
- Department of Management Science, Mohammad Ali Jinnah University, Karachi, Pakistan
| | - Aftab Hameed
- Department of Management Science, Mohammad Ali Jinnah University, Karachi, Pakistan
| | - Zainab Asad
- Department of Management Science, Mohammad Ali Jinnah University, Karachi, Pakistan
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Szaflarski JP, Allendorfer JB, Goodman AM, Byington CG, Philip NS, Correia S, LaFrance WC. Diagnostic delay in functional seizures is associated with abnormal processing of facial emotions. Epilepsy Behav 2022; 131:108712. [PMID: 35526462 DOI: 10.1016/j.yebeh.2022.108712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE In patients with functional seizures (FS), delay in diagnosis (DD) may negatively affect outcomes. Altered brain responses to emotional stimuli have been shown in adults with FS. We hypothesized that DD would be associated with differential fMRI activation in emotion processing circuits. METHODS Fifty-two adults (38 females) with video-EEG confirmed FS prospectively completed assessments related to symptoms of depression (BDI-II), anxiety (BAI), post-traumatic stress disorder (PCL-S), a measure of how their symptoms affect day-to-day life (GAF), and fMRI at 3T with emotional faces task (EFT). During fMRI, subjects indicated "male" or "female" via button press while implicitly processing happy, sad, fearful, and neutral faces. Functional magnetic resonance imaging (FMRI) response to each emotion was modeled and group analyses were performed in AFNI within pre-specified regions-of-interest involved in emotion processing. A median split (507 days) defined short- (s-DD) and long-delay diagnosis (l-DD) groups. Voxelwise regression analyses were also performed to examine linear relationship between DD and emotion processing. FMRI signal was extracted from clusters showing group differences and Spearman's correlations assessed relationships with symptom scores. RESULTS Groups did not differ in FS age of onset, sex distribution, years of education, TBI characteristics, EFT in-scanner or post-test performance, or scores on the GAF, BDI-II, BAI, and PCL-S measures. The s-DD group was younger than l-DD (mean age 32.6 vs. 40.1; p = 0.022) at the time of study participation. After correcting for age, compared to s-DD, the l-DD group showed greater fMRI activation to sad faces in the bilateral posterior cingulate cortex (PCC) and to neutral faces in the right anterior insula. Within-group linear regression revealed that with increasing DD, there was increased fMRI activation to sad faces in the PCC and to happy faces in the right anterior insula/inferior frontal gyrus (AI/IFG). There were positive correlations between PCC response to sad faces and BDI-II scores in the l-DD group (rho = 0.48, p = 0.012) and the combined sample (rho = 0.30, p = 0.029). Increased PCC activation to sad faces in those in the l-DD group was associated with worse symptoms of depression (i.e. higher BDI-II score). CONCLUSIONS Delay in FS diagnosis is associated with fMRI changes in PCC and AI/IFG. As part of the default mode network, PCC is implicated in mood control, self-referencing, and other emotion-relevant processes. In our study, PCC changes are linked to depression. Future studies should assess the effects of interventions on these abnormalities.
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Affiliation(s)
- Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA.
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Adam M Goodman
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Caroline G Byington
- Department of Neurology, University of Alabama at Birmingham (UAB), UAB Epilepsy Center, Birmingham, AL, USA
| | - Noah S Philip
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA; Dept of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Stephen Correia
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
| | - W Curt LaFrance
- VA RR&D Center for Neurorestoration & Neurotechnology, VA Providence Healthcare System, Providence, RI, USA; Dept of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Special issue on the intersection between functional seizures and other functional neurological disorders. Epilepsy Behav Rep 2022; 18:100523. [PMID: 35198954 PMCID: PMC8844608 DOI: 10.1016/j.ebr.2021.100523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 11/22/2022] Open
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