1
|
Bulbena A, Rosado S, Cabaleiro M, Martinez M, Baeza-Velasco C, Martin LM, Batlle S, Bulbena-Cabré A. Validation of the neuroconnective endophenotype questionnaire (NEQ): a new clinical tool for medicine and psychiatry resulting from the contribution of Ehlers-Danlos syndrome. Front Med (Lausanne) 2023; 10:1039223. [PMID: 37234249 PMCID: PMC10206165 DOI: 10.3389/fmed.2023.1039223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/22/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction The link between anxiety disorders and joint hypermobility syndrome (now under hypermobility spectrum disorders, which include hypermobile Ehlers-Danlos syndrome) has been widely replicated over the past 30 years and has grown beyond the initial nosological limits. To integrate clinical and research progress in this field, a new neuroconnective endophenotype (NE) and its corresponding instrument, the Neuroconnective Endophenotype Questionnaire (NEQ), have been developed. This new clinical construct, created with the active participation of patients, includes both somatic and psychological dimensions and symptoms and resilience items. Methods The NE includes five dimensions: (1) sensorial sensitivity, (2) body signs and symptoms, (3) somatic conditions, (4) polar behavioral strategies, and (5) psychological and psychopathological dimensions. The NEQ information is collected through four self-administered questionnaires (sensorial sensitivity, body signs and symptoms, polar behavioral strategies, and psychological characteristics) and a structured diagnostic part that should be completed by a trained observer. This hetero-administered part incorporates (a) psychiatric diagnoses (using structured criteria, e.g., MINI), (b) somatic disorders diagnosis, using structured criteria, and (c) assessment of joint hypermobility criteria. Results In a sample of 36 anxiety cases with 36 matched controls, the NEQ obtained high scores for test-retest, inter-rater reliability, and internal consistency. As for predictive validity, cases and controls significantly differed in all five dimensions and hypermobility measurements. Discussion We can conclude that the NEQ has achieved acceptable reliability and validity values and, therefore, is ready to be used and tested in different samples. This original and consistent construct including somatic and mental items may improve clinical specificity, the search for more comprehensive therapies, and their genetic and neuroimaging bases.
Collapse
Affiliation(s)
- Antonio Bulbena
- Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
- Anxiety Unit, Hospital del Mar, Institute Neuropsychiatry and Addictions (INAD) CIBERSAM, Barcelona, Spain
| | - Silvia Rosado
- Anxiety Unit, Hospital del Mar, Institute Neuropsychiatry and Addictions (INAD) CIBERSAM, Barcelona, Spain
- Doctorate Program in Psychiatry, Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
| | - Marina Cabaleiro
- Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
- Anxiety Unit, Hospital del Mar, Institute Neuropsychiatry and Addictions (INAD) CIBERSAM, Barcelona, Spain
| | - María Martinez
- Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona, Barcelona, Spain
- Anxiety Unit, Hospital del Mar, Institute Neuropsychiatry and Addictions (INAD) CIBERSAM, Barcelona, Spain
| | - Carolina Baeza-Velasco
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, Paris, France
- Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Luis-Miguel Martin
- Anxiety Unit, Hospital del Mar, Institute Neuropsychiatry and Addictions (INAD) CIBERSAM, Barcelona, Spain
| | - Santiago Batlle
- Anxiety Unit, Hospital del Mar, Institute Neuropsychiatry and Addictions (INAD) CIBERSAM, Barcelona, Spain
| | | |
Collapse
|
2
|
Fairweather D, Bruno KA, Darakjian AA, Bruce BK, Gehin JM, Kotha A, Jain A, Peng Z, Hodge DO, Rozen TD, Munipalli B, Rivera FA, Malavet PA, Knight DRT. High overlap in patients diagnosed with hypermobile Ehlers-Danlos syndrome or hypermobile spectrum disorders with fibromyalgia and 40 self-reported symptoms and comorbidities. Front Med (Lausanne) 2023; 10:1096180. [PMID: 37181352 PMCID: PMC10166812 DOI: 10.3389/fmed.2023.1096180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Background Joint pain is a common symptom in patients with hypermobile Ehlers-Danlos Syndrome (hEDS), hypermobility spectrum disorders (HSD) and fibromyalgia. The goal of this study was to determine whether symptoms and comorbidities overlap in patients diagnosed with hEDS/HSD and/or fibromyalgia. Methods We retrospectively examined self-reported data from an EDS Clinic intake questionnaire in patients diagnosed with hEDS/HSD, fibromyalgia, or both vs. controls with an emphasis on joint issues. Results From 733 patients seen at the EDS Clinic, 56.5% (n = 414) were diagnosed with hEDS/HSD and fibromyalgia (Fibro), 23.8% (n = 167) hEDS/HSD, 13.3% (n = 98) fibromyalgia, or 7.4% (n = 54) none of these diagnoses. More patients were diagnosed with HSD (76.6%) than hEDS (23.4%). Patients were primarily White (95%) and female (90%) with a median age in their 30s (controls 36.7 [18.0, 70.0], fibromyalgia 39.7 [18.0, 75.0], hEDS/HSD 35.0 [18.0, 71.0], hEDS/HSD&Fibro 31.0 [18.0, 63.0]). There was high overlap in all 40 symptoms/comorbidities that we examined in patients diagnosed with fibromyalgia only or hEDS/HSD&Fibro, regardless of whether they had hEDS or HSD. Patients that only had hEDS/HSD without fibromyalgia had far fewer symptoms/comorbidities than patients with hEDS/HSD&Fibro. The top self-reported issues in patients that only had fibromyalgia were joint pain, hand pain when writing or typing, brain fog, joint pain keeping from daily activities, allergy/atopy and headache. Five issues that significantly and uniquely characterized patients diagnosed with hEDS/HSD&Fibro were subluxations (dislocations in hEDS patients), joint issues like sprains, the need to stop sports due to injuries, poor wound healing, and migraine. Conclusion The majority of patients seen at the EDS Clinic had a diagnosis of hEDS/HSD plus fibromyalgia that was associated with more severe disease. Our findings indicate that fibromyalgia should be routinely assessed in patients with hEDS/HSD and vis-a-versa to improve patient care.
Collapse
Affiliation(s)
- DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States
| | - Ashley A. Darakjian
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Barbara K. Bruce
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL, United States
| | - Jessica M. Gehin
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Archana Kotha
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Angita Jain
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Zhongwei Peng
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States
| | - David O. Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, United States
| | - Todd D. Rozen
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Bala Munipalli
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Fernando A. Rivera
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Pedro A. Malavet
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Dacre R. T. Knight
- Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| |
Collapse
|
3
|
Guinchat V, Baeza-Velasco C, Bulbena A, Castori M. Editorial: Neurodevelopmental, neuropsychiatric and psychosocial correlates of joint hypermobility and related disorders. Front Psychiatry 2022; 13:1109515. [PMID: 36578299 PMCID: PMC9791253 DOI: 10.3389/fpsyt.2022.1109515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Vincent Guinchat
- Psychiatric Section of Mental Development, Psychiatric University Clinic, Lausanne University Hospital, Lausanne, Switzerland
| | - Carolina Baeza-Velasco
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Cité, Boulogne-Billancourt, France.,Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.,Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Antonio Bulbena
- Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.,Anxiety Unit, Hospital del Mar, Institute Neuropsychiatry and Addictions, Barcelona, Spain
| | - Marco Castori
- Division of Medical Genetics, Fondazione IRCCS-Casa Sollievo della Sofferenza, Foggia, Italy
| |
Collapse
|
4
|
Gastrointestinal and eating problems in women with Ehlers-Danlos syndromes. Eat Weight Disord 2021; 26:2645-2656. [PMID: 33582971 DOI: 10.1007/s40519-021-01146-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Ehlers-Danlos syndromes (EDS) are a group of heritable conditions in which abnormal collagen synthesis leads to features such as joint hypermobility, skin abnormalities, and tissue fragility. Gastrointestinal (GI) symptoms are common among those affected. These may negatively impact eating behaviors, leading to weight/nutritional problems. We aimed to compare GI symptoms, disordered eating, and body mass index (BMI) between EDS patients and healthy controls, and to explore the link between these variables in EDS patients. METHOD In this cross-sectional study, women with EDS and healthy controls responded to an online survey assessing GI symptoms (heartburn/regurgitations, early satiety, nausea/vomiting, bloating, abdominal pain, dysphagia), food allergies/intolerances, disordered eating, history of eating disorders (ED), and BMI. We performed intergroup comparisons as well as multivariate analyses to explore the associations between disordered eating, GI symptoms, and BMI in the EDS group. RESULTS Sixty-six women with EDS and 39 healthy controls were included in the study. The EDS patients showed significantly more GI symptoms and food allergies/intolerances, increased prevalence of ED history, higher risk of current ED, and lower BMI than the controls. In the EDS group, the risk for ED was associated with GI symptoms; restricted eating was associated with GI symptoms, food allergies/intolerances, and dysphagia; uncontrolled eating was associated with GI symptoms; and BMI was associated with GI symptoms and food allergies/intolerances. DISCUSSION Our results are concordant with that of previous reports highlighting the high level of GI problems and disordered eating in women with EDS. In addition, and for the first-time, the association between both is evidenced in this specific population. LEVEL OF EVIDENCE III Case-control analytic study.
Collapse
|
5
|
Sharp HEC, Critchley HD, Eccles JA. Connecting brain and body: Transdiagnostic relevance of connective tissue variants to neuropsychiatric symptom expression. World J Psychiatry 2021; 11:805-820. [PMID: 34733643 PMCID: PMC8546774 DOI: 10.5498/wjp.v11.i10.805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/12/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
The mind is embodied; thoughts and feelings interact with states of physiological arousal and physical integrity of the body. In this context, there is mounting evidence for an association between psychiatric presentations and the expression variant connective tissue, commonly recognised as joint hypermobility. Joint hypermobility is common, frequently under-recognised, significantly impacts quality of life, and can exist in isolation or as the hallmark of hypermobility spectrum disorders (encompassing joint hypermobility syndrome and hypermobile Ehlers-Danlos syndrome). In this narrative review, we appraise the current evidence linking psychiatric disorders across the lifespan, beginning with the relatively well-established connection with anxiety, to hypermobility. We next consider emerging associations with affective illnesses, eating disorders, alongside less well researched links with personality disorders, substance misuse and psychosis. We then review related findings relevant to neurodevelopmental disorders and stress-sensitive medical conditions. With growing understanding of mind-body interactions, we discuss potential aetiopathogenetic contributions of dysautonomia, aberrant interoceptive processing, immune dysregulation and proprioceptive impairments in the context of psychosocial stressors and genetic predisposition. We examine clinical implications of these evolving findings, calling for increased awareness amongst healthcare professionals of the transdiagnostic nature of hypermobility and related disorders. A role for early screening and detection of hypermobility in those presenting with mental health and somatic symptoms is further highlighted, with a view to facilitate preventative approaches alongside longer-term holistic management strategies. Finally, suggestions are offered for directions of future scientific exploration which may be key to further delineating fundamental mind-body-brain interactions.
Collapse
Affiliation(s)
- Harriet Emma Clare Sharp
- Department of Medical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, East Sussex, United Kingdom
- Department of Psychiatry, Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, West Sussex, United Kingdom
| | - Hugo D Critchley
- Department of Medical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, East Sussex, United Kingdom
- Department of Psychiatry, Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, West Sussex, United Kingdom
| | - Jessica A Eccles
- Department of Medical Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton BN1 9PX, East Sussex, United Kingdom
- Department of Psychiatry, Sussex Partnership NHS Foundation Trust, Worthing, BN13 3EP, West Sussex, United Kingdom
| |
Collapse
|
6
|
Poli A, Maremmani AGI, Chiorri C, Mazzoni GP, Orrù G, Kolacz J, Porges SW, Conversano C, Gemignani A, Miccoli M. Item Reduction, Psychometric and Biometric Properties of the Italian Version of the Body Perception Questionnaire-Short Form (BPQ-SF): The BPQ-22. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3835. [PMID: 33917552 PMCID: PMC8038843 DOI: 10.3390/ijerph18073835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
Body awareness disorders and reactivity are mentioned across a range of clinical problems. Constitutional differences in the control of the bodily state are thought to generate a vulnerability to psychological symptoms. Autonomic nervous system dysfunctions have been associated with anxiety, depression, and post-traumatic stress. Though interoception may be a transdiagnostic mechanism promoting the improvement of clinical symptomatology, few psychometrically sound, symptom-independent, self-report measures, informed by brain-body circuits, are available for research and clinical use. We validated the Italian version of the body perception questionnaire (BPQ)-short form and found that response categories could be collapsed from five to three and that the questionnaire retained a three-factor structure with items reduced from 46 to 22 (BPQ-22). The first factor was loaded by body awareness items; the second factor comprised some items from the body awareness scale and some from the subdiaphragmatic reactivity scale (but all related to bloating and digestive issues), and the third factor by supradiaphragmatic reactivity items. The BPQ-22 had sound psychometric properties, good convergent and discriminant validity and test-retest reliability and could be used in clinical and research settings in which the body perception assessment is of interest. Psychometric findings in light of the polyvagal theory are discussed.
Collapse
Affiliation(s)
- Andrea Poli
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.O.); (C.C.); (A.G.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
- Verdi Clinical Center, 59100 Prato, Italy
- Florence Cognitive School, 50144 Florence, Italy;
| | - Angelo Giovanni Icro Maremmani
- Department of Psychiatry, North-Western Tuscany Region NHS Local Health Unit, Versilia Zone, 55049 Viareggio, Italy;
- Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Pietrasanta, Italy
- G. De Lisio Institute of Behavioral Sciences, 56100 Pisa, Italy
| | - Carlo Chiorri
- Department of Educational Sciences, University of Genova, 16121 Genova, Italy;
| | | | - Graziella Orrù
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.O.); (C.C.); (A.G.)
| | - Jacek Kolacz
- Traumatic Stress Research Consortium at the Kinsey Institute, Indiana University, Bloomington, IN 47405, USA; (J.K.); (S.W.P.)
| | - Stephen W. Porges
- Traumatic Stress Research Consortium at the Kinsey Institute, Indiana University, Bloomington, IN 47405, USA; (J.K.); (S.W.P.)
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27514, USA
| | - Ciro Conversano
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.O.); (C.C.); (A.G.)
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and of Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (G.O.); (C.C.); (A.G.)
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
| |
Collapse
|
7
|
Singh D, Rocio Martinez W, Anand N, Pinkhasov A, Calixte R, Bulbena A, Coplan JD. The ALPIM (Anxiety, Laxity, Pain, Immune, and Mood) Syndrome in Adolescents and Young Adults: A Cohort Study. J Neuropsychiatry Clin Neurosci 2020; 31:239-245. [PMID: 30791805 DOI: 10.1176/appi.neuropsych.18080174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE ALPIM (anxiety, laxity, pain, immune, and mood) syndrome has been previously described in adults. The authors aimed to identify its occurrence in adolescents and confirm its existence in adults. Given the association of the disorder with somatic symptoms, separation anxiety disorder (SAD) was explored as an ALPIM comorbidity. METHODS Medical records of patients aged 11-34 with a diagnosis of depression or anxiety (panic disorder, SAD, social anxiety or generalized anxiety disorder) seen during a 1-year period were reviewed. Data were collected on the presence of ALPIM comorbidities. Analyses were conducted to detect their co-occurrence and evaluate possible predictors of the ALPIM syndrome. RESULTS Inclusion criteria were met by 185 patient charts. A significant association was observed between the ALPIM comorbidities with 20 study subjects (10.8%) meeting criteria for ALPIM syndrome (patients with one or more diagnoses from each ALPIM domain). Patients with SAD had increased odds of being diagnosed with ALPIM (odds ratio=7.14, 95% CI=2.48-20.54, p<0.001). Neither major depression nor generalized anxiety disorder was found to be predictive of ALPIM syndrome. There was no difference in the prevalence of ALPIM-related comorbidities between study subjects <18 years old compared with those ≥18 years old. CONCLUSIONS These findings reestablish the association of distinct psychiatric and nonpsychiatric conditions described as the ALPIM syndrome. Furthermore, the syndrome may present during adolescence. SAD may be an independent predictive factor for the occurrence of ALPIM syndrome. Patients with individual ALPIM comorbidities should be assessed for the syndrome, especially if they have a history of SAD.
Collapse
Affiliation(s)
- Deepan Singh
- The Department of Behavioral Health, NYU Winthrop Hospital, Mineola, New York (Singh, Pinkhasov); the Department of Psychiatry, Nassau University Medical Center, East Meadow, New York (Rocio Martinez); the Department of Psychology, College of Arts and Science, Stony Brook University, New York (Anand); the Department of Community Health and Social Medicine, CUNY School of Medicine, New York (Calixte); the Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona. Institute of Neuropsychiatry and Addictions, IMIM Parc de Salut Mar, Barcelona, Spain (Bulbena); and the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York (Coplan)
| | - Wendy Rocio Martinez
- The Department of Behavioral Health, NYU Winthrop Hospital, Mineola, New York (Singh, Pinkhasov); the Department of Psychiatry, Nassau University Medical Center, East Meadow, New York (Rocio Martinez); the Department of Psychology, College of Arts and Science, Stony Brook University, New York (Anand); the Department of Community Health and Social Medicine, CUNY School of Medicine, New York (Calixte); the Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona. Institute of Neuropsychiatry and Addictions, IMIM Parc de Salut Mar, Barcelona, Spain (Bulbena); and the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York (Coplan)
| | - Niyati Anand
- The Department of Behavioral Health, NYU Winthrop Hospital, Mineola, New York (Singh, Pinkhasov); the Department of Psychiatry, Nassau University Medical Center, East Meadow, New York (Rocio Martinez); the Department of Psychology, College of Arts and Science, Stony Brook University, New York (Anand); the Department of Community Health and Social Medicine, CUNY School of Medicine, New York (Calixte); the Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona. Institute of Neuropsychiatry and Addictions, IMIM Parc de Salut Mar, Barcelona, Spain (Bulbena); and the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York (Coplan)
| | - Aaron Pinkhasov
- The Department of Behavioral Health, NYU Winthrop Hospital, Mineola, New York (Singh, Pinkhasov); the Department of Psychiatry, Nassau University Medical Center, East Meadow, New York (Rocio Martinez); the Department of Psychology, College of Arts and Science, Stony Brook University, New York (Anand); the Department of Community Health and Social Medicine, CUNY School of Medicine, New York (Calixte); the Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona. Institute of Neuropsychiatry and Addictions, IMIM Parc de Salut Mar, Barcelona, Spain (Bulbena); and the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York (Coplan)
| | - Rose Calixte
- The Department of Behavioral Health, NYU Winthrop Hospital, Mineola, New York (Singh, Pinkhasov); the Department of Psychiatry, Nassau University Medical Center, East Meadow, New York (Rocio Martinez); the Department of Psychology, College of Arts and Science, Stony Brook University, New York (Anand); the Department of Community Health and Social Medicine, CUNY School of Medicine, New York (Calixte); the Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona. Institute of Neuropsychiatry and Addictions, IMIM Parc de Salut Mar, Barcelona, Spain (Bulbena); and the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York (Coplan)
| | - Antonio Bulbena
- The Department of Behavioral Health, NYU Winthrop Hospital, Mineola, New York (Singh, Pinkhasov); the Department of Psychiatry, Nassau University Medical Center, East Meadow, New York (Rocio Martinez); the Department of Psychology, College of Arts and Science, Stony Brook University, New York (Anand); the Department of Community Health and Social Medicine, CUNY School of Medicine, New York (Calixte); the Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona. Institute of Neuropsychiatry and Addictions, IMIM Parc de Salut Mar, Barcelona, Spain (Bulbena); and the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York (Coplan)
| | - Jeremy D Coplan
- The Department of Behavioral Health, NYU Winthrop Hospital, Mineola, New York (Singh, Pinkhasov); the Department of Psychiatry, Nassau University Medical Center, East Meadow, New York (Rocio Martinez); the Department of Psychology, College of Arts and Science, Stony Brook University, New York (Anand); the Department of Community Health and Social Medicine, CUNY School of Medicine, New York (Calixte); the Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona. Institute of Neuropsychiatry and Addictions, IMIM Parc de Salut Mar, Barcelona, Spain (Bulbena); and the Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, New York (Coplan)
| |
Collapse
|
8
|
Bulbena-Cabre A, Duñó L, Almeda S, Batlle S, Camprodon-Rosanas E, Martín-Lopez LM, Bulbena A. Joint hypermobility is a marker for anxiety in children. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 12:68-76. [PMID: 30926372 DOI: 10.1016/j.rpsm.2019.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/12/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Joint hypermobility syndrome (JHS) has been found to be associated with anxiety disorders in clinical and nonclinical populations, but to date no studies have evaluated this association in children. The main goal of this study is to evaluate JHS along with anxiety, somatic and behavioral measures in children to clarify if JHS is associated with any of these variables in this age range. METHODS A sample of 160 children (74 girls and 86 boys) ranging from 5 to 17 o were recruited from a Child-Adolescent Mental Health clinic to participate in the study. All children underwent a diagnostic interview using the Mini International Neuropsychiatric Interview for Children and Adolescents. Instruments used include the Child Behavior Checklist (CBCL), the Screening Questionnaire to detect Hypermobility (SQ-CH) and the Children Manifested Anxiety Scale (CMAS-R). RESULTS The prevalence of JHS in this sample was 22%, and this was significantly higher in girls (31%) than in boys (14%) (χ2=6.83; P=.001). The JHS group scored significantly higher in the CMAS-R total anxiety (F=4.51; P=.035), CMAS-R Physiological anxiety (F=7.19; P=.008) and the CBCL somatic complaints (F=8.46; 0.004) and regression analyses showed that these 3 variables were predictors of JHS (χ2=36.77; P<.001; r2=0.22). The JHS group also scored higher in some behavioral measures. CONCLUSION Children with JHS have higher frequency of anxiety disorders and higher intensity of physiological anxiety, somatic complaints, and therefore, JHS might be used as marker for this anxiety phenotype in youngsters.
Collapse
Affiliation(s)
- Andrea Bulbena-Cabre
- Universidad Autónoma de Barcelona, Departamento de Psiquiatría y Medicina Forense (UAB), España; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, EE. UU.; Department of Psychiatry, New York Medical College, Nueva York, EE. UU.
| | - Lourdes Duñó
- Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España
| | - Sara Almeda
- Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España
| | - Santiago Batlle
- Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España
| | - Ester Camprodon-Rosanas
- Children and Adolescent Mental Health Research Group. Institut de Recerca Sant Joan de Déu Child and Adolescent Psychiatry and Psychology Department of Hospital Sant Joan de Déu of Barcelona, Spain
| | - Luis Miguel Martín-Lopez
- Universidad Autónoma de Barcelona, Departamento de Psiquiatría y Medicina Forense (UAB), España; Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España; Centro de Investigación en red de Salud Mental (CIBERSAM), España
| | - Antonio Bulbena
- Universidad Autónoma de Barcelona, Departamento de Psiquiatría y Medicina Forense (UAB), España; Mar Health Park, Instituto de Neuropsiquiatría y Adicciones (INAD), Barcelona, España; Centro de Investigación en red de Salud Mental (CIBERSAM), España
| |
Collapse
|
9
|
Scariot R, Corso PFCL, Sebastiani AM, Vieira AR. The many faces of genetic contributions to temporomandibular joint disorder: An updated review. Orthod Craniofac Res 2018; 21:186-201. [PMID: 30204294 DOI: 10.1111/ocr.12239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/07/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim was to review the literature regarding genetic contributions to temporomandibular joint disorder (TMD) after our 2008 publication. SETTING AND SAMPLE POPULATION Literature review. MATERIAL AND METHODS PubMed and MEDLINE were used to obtain literature in any language regarding genes and TMD, using the keywords "temporomandibular joint disorder" and "temporomandibular joint dysfunction" for studies published from 2009 to 2017. RESULTS In our search, 274 studies were found. We excluded 76 studies from animal models, 22 studies that were in vitro and 120 reports that were not cohort or case-control studies. Of the 274 results, 56 articles were selected for this review. Genes that are suggested to contribute to TMD included the ones related to disc and bone alterations as well as pain sensation. CONCLUSION Currently, no evidence of associated genetic variants, which can determine the development of TMD in individuals, could be translated to novel clinical management and public health strategies for patients suffering from TMD.
Collapse
Affiliation(s)
- Rafaela Scariot
- Department of Oral and Maxillofacial Surgery, Universidade Positivo, Curitiba, Brazil.,Department of Oral and Maxillofacial Surgery, Universidade Federal do Paraná, Curitiba, Brazil
| | - Paola F C L Corso
- Department of Oral and Maxillofacial Surgery, Universidade Positivo, Curitiba, Brazil
| | - Aline M Sebastiani
- Department of Oral and Maxillofacial Surgery, Universidade Positivo, Curitiba, Brazil
| | - Alexandre R Vieira
- Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
10
|
Both anxiety and joint laxity determine the olfactory features in panic disorder. Psychiatry Res 2018; 262:420-426. [PMID: 28923431 DOI: 10.1016/j.psychres.2017.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 07/26/2017] [Accepted: 09/08/2017] [Indexed: 12/23/2022]
Abstract
Previous research showed a high sensitivity in sensorial modalities in panic disorder (PD). This disorder has been consistently associated to the joint hypermobility syndrome (JHS). In non-clinical samples, this collagen alteration has been also related to an enhanced sensitivity in some sensorial modalities. The main aim of this study is to explore the olfactory functioning in PD in relation to JHS. Sixty patients with PD and sixty healthy controls performed the Sniffin' Sticks Test (SST) (threshold subtest), and completed the Affective Impact of Odors scale (AIO), the Relational Scale of Olfaction (EROL), and the Odor Awareness Scale (OAS). Clinical symptom rating scales and JHS assessment were also obtained. PD patients showed enhanced odor acuity, greater reactivity to smells and also increased odor awareness compared to the healthy controls. Within the patients group, those suffering from JHS displayed higher functioning in all olfactory domains compared to the non-JHS ones. The JHS and anxiety measures emerged as predictor variables of the olfactory function. The present findings highlight the importance of the olfactory function in PD and underline that both, JHS and anxiety, determine the olfactory characteristics in this disorder.
Collapse
|
11
|
Baeza-Velasco C, Bourdon C, Montalescot L, de Cazotte C, Pailhez G, Bulbena A, Hamonet C. Low- and high-anxious hypermobile Ehlers-Danlos syndrome patients: comparison of psychosocial and health variables. Rheumatol Int 2018; 38:871-878. [PMID: 29497845 DOI: 10.1007/s00296-018-4003-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/26/2018] [Indexed: 12/19/2022]
Abstract
Despite the frequent co-ocurrence of hypermobile Ehler-Danlos syndrome (hEDS) and pathological anxiety, little is known about the psychosocial and health implications of such comorbidity. Our aim was to explore the association between high levels of anxiety and psychosocial (catastrophizing, kinesiophobia, somatosensory amplification, social support and functioning), health (pain, fatigue, BMI, tobacco/alcohol use, depression, diagnosis delay, general health), and sociodemographic factors in people with hEDS. In this cross-sectional study, 80 hEDS patients were divided into two groups according to self-reported anxiety levels: low and high. Psychosocial, sociodemographic and health variables were compared between the groups. Forty-one participants reported a high level of anxiety (51.2%). No differences were found in the sociodemographic variables between high-anxious and low-anxious patients. The percentage of participants with severe fatigue and high depressive symptomatology was significantly higher in the high-anxious group (80.5 vs 56.4; 26.8 vs 12.8%, respectively). High-anxious hEDS patients also showed significantly higher levels of pain catastrophizing, somatosensory amplification as well as a poorer social functioning and general health. Multivariate analyses showed that somatosensory amplification, pain catastrophizing and poor social functioning are variables that increase the probability of belonging to the high-anxious group. Despite limitations, this first study comparing high-anxious versus low-anxious hEDS patients with respect to health aspects, highlight the importance of considering the psychosocial factors (many susceptible to modification), to improve the adjustment to this chronic condition and provide support to those affected through a biopsychosocial approach.
Collapse
Affiliation(s)
- Carolina Baeza-Velasco
- Laboratory of Psychopathology and Health Processes, Institut de Psychologie, University Paris Descartes-Sorbonne Paris Cité, 71 Avenue Édouard Vaillant, 92100, Boulogne-Billancourt, France. .,INSERM U1061, Neuropsychiatry: Epidemiological and Clinical Research, Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France.
| | | | - Lucile Montalescot
- Laboratory of Psychopathology and Health Processes, Institut de Psychologie, University Paris Descartes-Sorbonne Paris Cité, 71 Avenue Édouard Vaillant, 92100, Boulogne-Billancourt, France
| | - Cécile de Cazotte
- Laboratory of Psychopathology and Health Processes, Institut de Psychologie, University Paris Descartes-Sorbonne Paris Cité, 71 Avenue Édouard Vaillant, 92100, Boulogne-Billancourt, France
| | - Guillem Pailhez
- Department of Psychiatry, Autonoma University of Barcelona, Barcelona, Spain
| | - Antonio Bulbena
- Department of Psychiatry, Autonoma University of Barcelona, Barcelona, Spain
| | - Claude Hamonet
- Department of Physical Medicine and Rehabilitation, Hôtel-Dieu Hospital, Paris, France.,University Paris-Est Créteil, Créteil, France
| |
Collapse
|
12
|
Baeza-Velasco C, Bulbena A, Polanco-Carrasco R, Jaussaud R. Cognitive, emotional, and behavioral considerations for chronic pain management in the Ehlers–Danlos syndrome hypermobility-type: a narrative review. Disabil Rehabil 2018; 41:1110-1118. [DOI: 10.1080/09638288.2017.1419294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Carolina Baeza-Velasco
- Laboratory of Psychopathology and Health Processes, University Paris Descartes - Sorbonne Paris Cité, Boulogne Billancourt, France
- Inserm U1061, La Colombière Hospital, Montpellier, France
| | - Antonio Bulbena
- Department of Psychiatry, Autonoma University of Barcelona, Barcelona, Spain
| | | | - Roland Jaussaud
- Department of Internal Medicine and Clinical Immunology, Medicine School, University of Lorraine, CHRU Nancy, Nancy, France
| |
Collapse
|
13
|
Bulbena-Cabré A, Rojo C, Pailhez G, Buron Maso E, Martín-Lopez LM, Bulbena A. Joint hypermobility is also associated with anxiety disorders in the elderly population. Int J Geriatr Psychiatry 2018; 33:e113-e119. [PMID: 28543732 DOI: 10.1002/gps.4733] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/05/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Anxiety disorders (AD) are very prevalent in the elderly, tend to compromise quality of life, and generate substantial costs. Considering that the prevention and early detection of anxiety may be relevant to increase health gains in older adults, it would be of great interest to identify whether the joint hypermobility syndrome (JHS) is also related to anxiety disorders in this age range. METHODS Cross-sectional data was collected in a sample of 108 subjects in a rural town in Spain. Instruments included Spielberger STAI, a modified Wolpe Fear Survey Schedule, General health Questionnaire (GHQ)-28, and the anxiety and mood disorders section of the SCID, to assess past year prevalence of anxiety disorders. JHS was evaluated by trained examiners using the "Hospital del Mar criteria". RESULTS Among the 108 subjects (55% women, 45% men) over 60 years old, 21.3% meet criteria for JHS. These subjects scored significantly higher in both State (F = 5.53; p = 0.02) and Trait (F = 4.68; p = 0.03) anxiety and the GHQ 28 (F = 6.29; p = 0.01). Compared with non JHS subjects, they had more AD (34.8% vs. 11.8%; x2 = 6.90; p = 0.02) and mood disorders (30.4% vs. 10.6%; x2 = 5.65; p = 0.041) in the past year prevalence. A multiple logistic regression analysis showed that both JHS (β = 0.196; p = 0.04) and fears (β = 0.34; p = 0.001) are predictors of AD (r2 = 188; p = 0.001) in this population. CONCLUSIONS Joint hypermobility syndrome is associated with anxiety in the elderly population, and it may be used as a physical marker for AD among subjects within this age range. Copyright © 2017 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Andrea Bulbena-Cabré
- Department of Psychiatry and Forensic Medicine (UAB), Autonomous University of Barcelona, Barcelona, Spain.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,VA Bronx Health Care System, Mental Illness Research Education and Clinical Centers, New York, NY, USA.,Doctorate Program, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Conxita Rojo
- Department of Psychiatry and Forensic Medicine (UAB), Autonomous University of Barcelona, Barcelona, Spain
| | - Guillem Pailhez
- Department of Psychiatry and Forensic Medicine (UAB), Autonomous University of Barcelona, Barcelona, Spain.,Mar Health Park, Neuropsychiatry and Drug Addiction Institute (INAD), Barcelona, Spain
| | - Emma Buron Maso
- Department of Psychiatry and Forensic Medicine (UAB), Autonomous University of Barcelona, Barcelona, Spain.,Doctorate Program, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Luis Miguel Martín-Lopez
- Department of Psychiatry and Forensic Medicine (UAB), Autonomous University of Barcelona, Barcelona, Spain.,Mar Health Park, Neuropsychiatry and Drug Addiction Institute (INAD), Barcelona, Spain.,Centro de Investigación en red de Salud Mental, (CIBERSAM), Spain
| | - Antonio Bulbena
- Department of Psychiatry and Forensic Medicine (UAB), Autonomous University of Barcelona, Barcelona, Spain.,Mar Health Park, Neuropsychiatry and Drug Addiction Institute (INAD), Barcelona, Spain.,Centro de Investigación en red de Salud Mental, (CIBERSAM), Spain
| |
Collapse
|
14
|
Bulbena A, Baeza-Velasco C, Bulbena-Cabré A, Pailhez G, Critchley H, Chopra P, Mallorquí-Bagué N, Frank C, Porges S. Psychiatric and psychological aspects in the Ehlers-Danlos syndromes. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:237-245. [PMID: 28186381 DOI: 10.1002/ajmg.c.31544] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
There is increasing amount of evidence pointing toward a high prevalence of psychiatric conditions among individuals with hypermobile type of Ehlers-Danlos syndrome (JHS/hEDS). A literature review confirms a strong association between anxiety disorders and JHSh/hEDS, and there is also limited but growing evidence that JHSh/hEDS is also associated with depression, eating, and neuro-developmental disorders as well as alcohol and tobacco misuse. The underlying mechanisms behind this association include genetic risks, autonomic nervous system dysfunction, increased exteroceptive and interoceptive mechanisms and decreased proprioception. Recent neuroimaging studies have also shown an increase response in emotion processing brain areas which could explain the high affective reactivity seen in JHS/hEDS. Management of these patients should include psychiatric and psychological approaches, not only to relieve the clinical conditions but also to improve abilities to cope through proper drug treatment, psychotherapy, and psychological rehabilitation adequately coupled with modern physiotherapy. A multidimensional approach to this "neuroconnective phenotype" should be implemented to ensure proper assessment and to guide for more specific treatments. Future lines of research should further explore the full dimension of the psychopathology associated with JHS/hEDS to define the nature of the relationship. © 2017 Wiley Periodicals, Inc.
Collapse
|
15
|
Tinkle B, Castori M, Berglund B, Cohen H, Grahame R, Kazkaz H, Levy H. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:48-69. [PMID: 28145611 DOI: 10.1002/ajmg.c.31538] [Citation(s) in RCA: 237] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The hypermobile type of Ehlers-Danlos syndrome (hEDS) is likely the most common hereditary disorder of connective tissue. It has been described largely in those with musculoskeletal complaints including joint hypermobility, joint subluxations/dislocations, as well as skin and soft tissue manifestations. Many patients report activity-related pain and some go on to have daily pain. Two undifferentiated syndromes have been used to describe these manifestations-joint hypermobility syndrome and hEDS. Both are clinical diagnoses in the absence of other causation. Current medical literature further complicates differentiation and describes multiple associated symptoms and disorders. The current EDS nosology combines these two entities into the hypermobile type of EDS. Herein, we review and summarize the literature as a better clinical description of this type of connective tissue disorder. © 2017 Wiley Periodicals, Inc.
Collapse
|
16
|
Södersten P, Bergh C, Leon M, Zandian M. Dopamine and anorexia nervosa. Neurosci Biobehav Rev 2016; 60:26-30. [DOI: 10.1016/j.neubiorev.2015.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/30/2015] [Accepted: 11/01/2015] [Indexed: 01/13/2023]
|
17
|
Scheper MC, de Vries JE, Verbunt J, Engelbert RHH. Chronic pain in hypermobility syndrome and Ehlers-Danlos syndrome (hypermobility type): it is a challenge. J Pain Res 2015; 8:591-601. [PMID: 26316810 PMCID: PMC4548768 DOI: 10.2147/jpr.s64251] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Generalized joint hypermobility (GJH) is highly prevalent among patients diagnosed with chronic pain. When GJH is accompanied by pain in ≥4 joints over a period ≥3 months in the absence of other conditions that cause chronic pain, the hypermobility syndrome (HMS) may be diagnosed. In addition, GJH is also a clinical sign that is frequently present in hereditary diseases of the connective tissue, such as the Marfan syndrome, osteogenesis imperfecta, and the Ehlers-Danlos syndrome. However, within the Ehlers-Danlos spectrum, a similar subcategory of patients having similar clinical features as HMS but lacking a specific genetic profile was identified: Ehlers-Danlos syndrome hypermobility type (EDS-HT). Researchers and clinicians have struggled for decades with the highly diverse clinical presentation within the HMS and EDS-HT phenotypes (Challenge 1) and the lack of understanding of the pathological mechanisms that underlie the development of pain and its persistence (Challenge 2). In addition, within the HMS/EDS-HT phenotype, there is a high prevalence of psychosocial factors, which again presents a difficult issue that needs to be addressed (Challenge 3). Despite recent scientific advances, many obstacles for clinical care and research still remain. To gain further insight into the phenotype of HMS/EDS-HT and its mechanisms, clearer descriptions of these populations should be made available. Future research and clinical care should revise and create consensus on the diagnostic criteria for HMS/EDS-HT (Solution 1), account for clinical heterogeneity by the classification of subtypes within the HMS/EDS-HT spectrum (Solution 2), and create a clinical core set (Solution 3).
Collapse
Affiliation(s)
- Mark C Scheper
- School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Janneke E de Vries
- School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Jeanine Verbunt
- Department of Rehabilitation Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Adelante, Center of expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Raoul HH Engelbert
- School of Physiotherapy, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|