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Bateman JR, Josephy-Hernandez S, Apostolova LG, Benjamin S, Barrett AM, Boeve BF, Budson AE, Chemali Z, Lin CYR, Daffner KR, Geschwind MD, Heilman KM, Hillis AE, Holden SK, Jaffee MS, Kletenik I, Love MN, Moo LR, Pelak VS, Press DZ, Ramirez-Gomez L, Rosen HJ, Schmahmann JD, Vaishnavi SN, Windon CC, Hamilton RH, Perez DL. Promoting Growth in Behavioral Neurology: A Path Forward. Cogn Behav Neurol 2024; 37:49-56. [PMID: 38717325 DOI: 10.1097/wnn.0000000000000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 06/04/2024]
Abstract
Behavioral neurology & neuropsychiatry (BNNP) is a field that seeks to understand brain-behavior relationships, including fundamental brain organization principles and the many ways that brain structures and connectivity can be disrupted, leading to abnormalities of behavior, cognition, emotion, perception, and social cognition. In North America, BNNP has existed as an integrated subspecialty through the United Council for Neurologic Subspecialties since 2006. Nonetheless, the number of behavioral neurologists across academic medical centers and community settings is not keeping pace with increasing clinical and research demand. In this commentary, we provide a brief history of BNNP followed by an outline of the current challenges and opportunities for BNNP from the behavioral neurologist's perspective across clinical, research, and educational spheres. We provide a practical guide for promoting BNNP and addressing the shortage of behavioral neurologists to facilitate the continued growth and development of the subspecialty. We also urge a greater commitment to recruit trainees from diverse backgrounds so as to dismantle persistent obstacles that hinder inclusivity in BNNP-efforts that will further enhance the growth and impact of the subspecialty. With rapidly expanding diagnostic and therapeutic approaches across a range of conditions at the intersection of neurology and psychiatry, BNNP is well positioned to attract new trainees and expand its reach across clinical, research, and educational activities.
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Affiliation(s)
- James R Bateman
- Departments of Neurology, Psychiatry and Behavioral Medicine, and Internal Medicine Section on Geriatrics and Gerontology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Mental Illness Research, Education, and Clinical Center, Salisbury VA Medical Center, Salisbury, North Carolina
| | - Sylvia Josephy-Hernandez
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Mexico Hospital, Costa Rican Social Security, San José, Costa Rica
| | - Liana G Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sheldon Benjamin
- Departments of Neurology
- Psychiatry, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - A M Barrett
- Departments of Neurology
- Neurology Service Line, Veterans Affairs Medical Center, Central Western Massachusetts Worcester, Massachusetts
| | | | - Andrew E Budson
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Alzheimer's Disease Research Center, Boston University, Boston, Massachusetts
| | - Zeina Chemali
- McCance Center for Brain Health, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chi-Ying R Lin
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Kirk R Daffner
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael D Geschwind
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Kenneth M Heilman
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins, Baltimore, Maryland
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael S Jaffee
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Isaiah Kletenik
- Center for Brain Circuit Therapeutics, Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Lauren R Moo
- Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts
| | - Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Z Press
- Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Liliana Ramirez-Gomez
- Division of Memory Disorders, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Howie J Rosen
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Jeremy D Schmahmann
- Ataxia Center, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sanjeev N Vaishnavi
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Charles C Windon
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David L Perez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Joos A, Popkirov S, Lahmann C, Jöbges M, Herrmann C, Maner P, Schörner K, Birke G, Hartmann A. Illness perception in functional neurological disorder: low illness coherence and personal control. BMJ Neurol Open 2024; 6:e000648. [PMID: 38800069 PMCID: PMC11116876 DOI: 10.1136/bmjno-2024-000648] [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: 01/19/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Illness perception refers to patients' subjective representations and appraisals of somatic and mental symptoms. These are relevant for self-management and outcome. In clinical practice, patients with functional neurological disorder (FND) often encounter a fragmented biomedical attitude, which leaves them without clear concepts. In this context, illness perception is relevant. Methods Illness perception was assessed in FND patients and compared with samples of psychosomatic patients (PSM) as well as poststroke patients (STR). The three samples (FND, n=87; PSM, n=97 and STR, n=92) were almost all in inpatient treatment or rehabilitation. Illness perception was assessed with the revised German version of the Illness Perception Questionnaire (IPQ-R). For assessments of correlations, depressive symptoms were tested with the Patient Health Questionnaire-9, dissociative and functional neurological symptoms by the German adaption of the Dissociative Experiences Scale and biopsychosocial complexity by the INTERMED Self-Assessment questionnaire. Results Apart from the chronicity subscale, all dimensions of the IPQ-R differed between groups. FND patients perceived lower illness coherence and personal control than both other groups and attributed their illness more to chance than to behavioural risk factors. PSM patients had the strongest emotional representations. There were only few correlations with dissociative scores and biopsychosocial complexity. Conclusion Illness perception is an important issue in patients with FND with particular emphasis on low illness coherence and personal control. Missing associations with biopsychosocial complexity suggest that subjective illness perception is an important complementary but separate issue, which likely influences therapeutic alliance and self-management in FND. Future studies should assess its influences on outcome. Trial registration number DRKS00024685; German Clinical Trials Register; www.drks.de.
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Affiliation(s)
- Andreas Joos
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Claas Lahmann
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Michael Jöbges
- Kliniken Schmieder Konstanz, Konstanz, Baden-Württemberg, Germany
| | | | - Philipp Maner
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Kai Schörner
- Kliniken Schmieder Gailingen, Gailingen, Baden-Württemberg, Germany
| | - Gunnar Birke
- Kliniken Schmieder Gailingen, Gailingen, Baden-Württemberg, Germany
| | - Armin Hartmann
- Psychosomatic Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Hawkes C, Dale RC, Scher S, Cornish JL, Perez DL, Santoro JD, Fernandes S, Kozlowska K. Bridging the Divide: An Integrated Neurobio-Psycho-Social Approach to Treating Antibody Negative Inflammatory Encephalitis in a School-Aged Child. Harv Rev Psychiatry 2024; 32:101-116. [PMID: 38728570 DOI: 10.1097/hrp.0000000000000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Affiliation(s)
- Clare Hawkes
- From Kids Neuroscience Centre (Dr. Dale), The Children's Hospital at Westmead (Drs. Dale, Hawkes, and Kozlowska), Westmead, AUS; Faculty of Medicine and Health, The Children's Hospital at Westmead Clinical School (Drs. Dale and Kozlowska), and Brain and Mind Centre (Dr. Dale), University of Sydney, Sydney, AUS; Harvard Medical School (Drs. Scher, Perez, and Fernandes); McLean Hospital, Belmont, MA (Drs. Scher and Fernandes); Specialty in Psychiatry, University of Sydney School of Medicine, Sydney, AUS (Drs. Scher and Kozlowska); School of Psychological Sciences and Centre for Emotional Health, Macquarie University (Dr. Cornish); Department of Neurology and Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Dr. Perez); Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA (Dr. Santoro); Department of Neurology, Keck School of Medicine of the University of Southern California (Dr. Santoro); The Brain Dynamics Centre, The Westmead Institute for Medical Research, Westmead, AUS (Dr. Kozlowska)
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Mamtani HG. Is it time to incorporate the biopsychosocial model into medical practice: A call for action for medical practitioners across specialties. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:114. [PMID: 38726079 PMCID: PMC11081457 DOI: 10.4103/jehp.jehp_1667_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/28/2023] [Indexed: 05/12/2024]
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Spanos S, Hutchinson K, Ryder T, Rapport F, Goodwin N, Zurynski Y. Integrated Care in Epilepsy Management: A Scoping Review of the Models and Components of Health and Social Care Delivery. Int J Integr Care 2024; 24:18. [PMID: 38463746 PMCID: PMC10921962 DOI: 10.5334/ijic.7659] [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: 05/04/2023] [Accepted: 02/13/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Epilepsy is the most common neurological condition globally. Integrating health and social care is fundamental in epilepsy management, but the scope of progress in this area is unclear. This scoping review aimed to capture the range and type of integrated care components and models in epilepsy management. Methods Four databases were searched for articles published since 2010 that reported on integrated care in epilepsy. Data were extracted and synthesised into components of integrated care that had been implemented or recommended only. Models of integrated care were identified, and their components tabulated. Results Fifteen common and interrelated components of integrated care emerged that were aligned with four broad areas: healthcare staff and pathways (e.g., epilepsy nurses); tasks and services (e.g., care coordination); education and engagement (e.g., shared decision making); and technology for diagnosis and communication (e.g., telehealth). Twelve models of integrated care were identified; seven were implemented and five were recommended. Discussion There is a growing evidence-base supporting integrated, person-centred epilepsy care, but implementation is challenged by entrenched silos, underdeveloped pathways for care, and deficits in epilepsy education. Conclusion Integrating epilepsy care relies on changes to workforce development and policy frameworks to support whole-of-system vision for improving care.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Karen Hutchinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Tayhla Ryder
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- CanTeen Australia, Sydney, Australia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Nicholas Goodwin
- Central Coast Local Health District, Gosford, NSW, Australia
- Central Coast Research Institute for Integrated Care, University of Newcastle, Gosford, NSW, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Perez DL. Doubling Down on Combined Neurology-Psychiatry Residency Training and Behavioral Neurology & Neuropsychiatry Fellowship Training. J Neuropsychiatry Clin Neurosci 2024; 36:78-79. [PMID: 38226911 DOI: 10.1176/appi.neuropsych.20230065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Affiliation(s)
- David L Perez
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, and Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
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Lerario MP, Fusunyan M, Stave CD, Roldán V, Keuroghlian AS, Turban J, Perez DL, Maschi T, Rosendale N. Functional neurological disorder and functional somatic syndromes among sexual and gender minority people: A scoping review. J Psychosom Res 2023; 174:111491. [PMID: 37802674 DOI: 10.1016/j.jpsychores.2023.111491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To describe the current literature on functional neurological disorder and functional somatic syndromes among sexual and gender minority people (SGM). METHODS A search string with descriptors of SGM identity and functional disorders was entered into PubMed, Embase, Web of Science, PsycInfo, and CINAHL for articles published before May 24, 2022, yielding 3121 items entered into Covidence, where 835 duplicates were removed. A neurologist and neuropsychiatrist screened titles and abstracts based on predefined criteria, followed by full-text review. A third neurologist adjudicated discrepancies. Eligible publications underwent systematic data extraction and statistical description. RESULTS Our search identified 26 articles on functional disorders among SGM people. Most articles were case (13/26, 46%) or cross-sectional (4/26, 15%) studies. Gender minority people were represented in 50% of studies. Reported diagnoses included fibromyalgia (n = 8), functional neurological disorder (n = 8), somatic symptom disorder (n = 5), chronic fatigue syndrome (n = 3), irritable bowel syndrome (n = 2), and other functional conditions (n = 3). Three cohort studies of fibromyalgia or somatic symptom disorder reported an overrepresentation of gender minority people compared to cisgender cohorts or general population measures. Approximately half of case studies reported pediatric or adolescent onset (7/13, 54%), functional neurological disorder diagnosis (7/13, 54%), and symptom improvement coinciding with identity-affirming therapeutic interventions (7/13, 58%). CONCLUSION Despite a methodologically rigorous literature search, there are limited data on functional neurological disorder and functional somatic syndromes among SGM people. Several studies reported increased prevalence of select conditions among transgender people. More observational studies are needed regarding the epidemiology and clinical course of functional disorders among SGM people.
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Affiliation(s)
- Mackenzie P Lerario
- Fordham Graduate School of Social Service, New York, NY, United States of America; Greenburgh Pride, Westchester, NY, United States of America.
| | - Mark Fusunyan
- Department of Psychiatry, Santa Clara Valley Medical Center, San Jose, CA, United States of America
| | - Christopher D Stave
- Lane Medical Library, Stanford University, Stanford, CA, United States of America.
| | - Valeria Roldán
- Facultad de Medicina Alberto Hurtado, La Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - Alex S Keuroghlian
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America; The Fenway Institute, Boston, MA, United States of America.
| | - Jack Turban
- Division of Child & Adolescent Psychiatry, University of California San Francisco, United States of America.
| | - David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
| | - Tina Maschi
- Fordham Graduate School of Social Service, New York, NY, United States of America; Greenburgh Pride, Westchester, NY, United States of America.
| | - Nicole Rosendale
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States of America; Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States of America.
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Perez DL, Finkelstein S, Adams C, Saxena A. Toward a Precision Medicine Approach to the Outpatient Assessment and Treatment of Functional Neurological Disorder. Neurol Clin 2023; 41:681-693. [PMID: 37775198 DOI: 10.1016/j.ncl.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional neurological disorder (FND) is a neuropsychiatric condition. In this field, prospective psychotherapy trials and consensus recommendations for physiotherapy, occupational therapy, and speech language therapy have been published. However, significant clinical complexities remain. "Rule in" signs - while critical for making a positive diagnosis - do not equate to a personalized treatment plan in many instances. Here, we propose that the neuropsychiatric assessment and real-time development of a work-in-progress biopsychosocial clinical formulation aids the development of a patient-centered outpatient treatment plan. This precision medicine approach is based on the literature, expert opinions and our clinical experience working in an interdisciplinary FND service.
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Affiliation(s)
- David L Perez
- Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA.
| | - Sara Finkelstein
- Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Caitlin Adams
- Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA
| | - Aneeta Saxena
- Division of Behavioral Neurology, Functional Neurological Disorder Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Finkelstein SA, O'Neal MA, Gaston Baslet, Dworetzky BA, Godena E, Maggio J, Millstein D, Milligan T, Perez DL. Developing a Curriculum for Functional Neurological Disorder in Neurology Training: Questions and Answers. Neurol Clin 2023; 41:711-728. [PMID: 37775200 DOI: 10.1016/j.ncl.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Functional neurologic disorder (FND) is a common condition for which neurology residents often receive little to no formal teaching. Using a question-and-answer format, this article puts forward a case for why an FND curriculum is needed and aims to provide guidance on possible curricular content including medical knowledge, clinical skills, communication, and team-based collaboration. The authors also discuss methods for teaching and evaluating this knowledge and associated clinical skills, linking this to current Accreditation Council for Graduate Medical Education neurology milestones. Finally, the authors consider how to better engage and energize neurology trainees around this underserved yet challenging patient population.
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Affiliation(s)
- Sara A Finkelstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - M Angela O'Neal
- Division of General Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Gaston Baslet
- Division of Neuropsychiatry, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
| | - Barbara A Dworetzky
- Division of Epilepsy, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA
| | - Ellen Godena
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Julie Maggio
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Department of Physical Therapy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Daniel Millstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Tracey Milligan
- Department of Neurology, Westchester Medical Center Health Network, New York Medical College, Valhalla, NY, USA
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Behavioral Neurology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Lessons Learned in Outpatient Physical Therapy for Motor Functional Neurological Disorder. J Neurol Phys Ther 2023; 47:52-59. [PMID: 35980727 DOI: 10.1097/npt.0000000000000415] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Motor functional neurological disorder is a prevalent and costly condition at the intersection of neurology and psychiatry that is diagnosed using positive "rule-in" signs. Physical therapy is a first-line treatment and consensus recommendations exist to guide clinical care. Nonetheless, optimal outpatient treatment of adults with functional motor symptoms requires an expanded physical therapy tool kit to effectively guide care. SUMMARY OF KEY POINTS In this article, lessons learned from a physical therapist practicing in a multidisciplinary and interdisciplinary outpatient functional neurological disorder clinic are highlighted. In doing so, we discuss how use of the biopsychosocial model and neuroscience constructs can inform physical therapy interventions. The importance of team-based care and the delivery of physical therapy through video telehealth services are also outlined. RECOMMENDATIONS FOR CLINICAL PRACTICE Use of the biopsychosocial formulation to triage clinical challenges and guide longitudinal care, coupled with application of neuroscience to aid intervention selection, allows for patient-centered physical therapy treatment across the spectrum of functional motor symptoms.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A400 ).
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Entwistle VA, Cribb A, Mitchell P, Walter S. Unifying and universalizing Personalised Care? An analysis of a national curriculum with implications for policy and education relating to person-centred care. PATIENT EDUCATION AND COUNSELING 2022; 105:3422-3428. [PMID: 35965218 DOI: 10.1016/j.pec.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To examine the Curriculum of England's Personalised Care Institute as a national initiative to promote person-centred practice. METHOD Analysis of Curriculum content and discourse RESULTS: The Curriculum describes an educational framework which aspires to unify approaches and universalize provision of Personalised Care. It presents 8 "models and approaches" and 6 "components" within the "whole" of Personalised Care. It locates their unity in an underlying common core repertoire of professional capabilities and values and an anchoring belief in people's strengths, resourcefulness and ability to develop their own solutions with appropriate support. The Curriculum indicates some complexity in the provision of Personalised Care but leaves unanswered questions about the theoretical coherence of the concept. It also neglects some important aspects of person-centredness (especially values beyond empowerment and choice); the implications of entrenched social inequalities and systemic prejudices; and other practical-ethical implementation challenges that can be difficult for health professionals. CONCLUSION The Curriculum signals a national commitment to person-centred practice, but its practical potential is limited by its neglect of the value tensions and diverse situational challenges involved. PRACTICE IMPLICATIONS The Curriculum and similar policy-education initiatives could be strengthened by more explicit attention to the normative complexities of person-centred practice.
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Dhand A, Podury A, Choudhry N, Narayanan S, Shin M, Mehl MR. Leveraging Social Networks for the Assessment and Management of Neurological Patients. Semin Neurol 2022; 42:136-148. [PMID: 35675821 PMCID: PMC9256089 DOI: 10.1055/s-0042-1744532] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Social networks are the persons surrounding a patient who provide support, circulate information, and influence health behaviors. For patients seen by neurologists, social networks are one of the most proximate social determinants of health that are actually accessible to clinicians, compared with wider social forces such as structural inequalities. We can measure social networks and related phenomena of social connection using a growing set of scalable and quantitative tools increasing familiarity with social network effects and mechanisms. This scientific approach is built on decades of neurobiological and psychological research highlighting the impact of the social environment on physical and mental well-being, nervous system structure, and neuro-recovery. Here, we review the biology and psychology of social networks, assessment methods including novel social sensors, and the design of network interventions and social therapeutics.
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Affiliation(s)
- Amar Dhand
- Brigham and Women's Hospital, Harvard Medical School, Network Science Institute, Northeastern University, Boston, Massachusetts
| | - Archana Podury
- Harvard-MIT Health Sciences and Technology Program, Harvard Medical School, Boston, Massachusetts
| | - Niteesh Choudhry
- Harvard Medical School, Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shrikanth Narayanan
- Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California
| | - Min Shin
- Department of Computer Science, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Matthias R Mehl
- Department of Psychology, University of Arizona, Tucson, Arizona
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DeGrush E, LaFrance WC. Psychotherapeutic Tools to Enhance the Neurologist-Patient Interaction. Semin Neurol 2022; 42:107-113. [PMID: 35272353 DOI: 10.1055/s-0042-1742288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite providing care for patients with "disturbances of the same organ," the brain, the therapeutic approaches used by neurologists and psychiatrists are, to some extent, distinct. With recognition of the closely coupled relationship between physical health and mental health, there is increased awareness of the need to provide an integrated, neuropsychiatric approach to the care of patients in neurology. In this review article, we provide a broad overview of how neurologists can use psychotherapeutic principles to enhance patient-physician interactions in the neurological setting (e.g., developing a therapeutic alliance; frame/boundary setting; active, empathic listening; acknowledging affect). These practices relate to a broad range of conditions, including, but not necessarily limited to epilepsy, traumatic brain injury, and functional neurological (conversion) disorder. The authors provide practical approaches that a neurologist can learn to leverage psychotherapeutic tools to enhance clinical encounters.
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Affiliation(s)
- Elizabeth DeGrush
- Departments of Psychiatry and Neurology, UMASS Memorial Medical School, Worcester, Massachusetts
| | - W Curt LaFrance
- Department of Psychiatry, Rhode Island Hospital, Brown University, Providence, Rhode Island.,Department of Neurology, Rhode Island Hospital, Brown University, Providence, Rhode Island
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Finkelstein SA, Adams C, Tuttle M, Saxena A, Perez DL. Neuropsychiatric Treatment Approaches for Functional Neurological Disorder: A How to Guide. Semin Neurol 2022; 42:204-224. [PMID: 35189644 DOI: 10.1055/s-0042-1742773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There is a growing body of knowledge regarding management of functional neurological disorder (FND). The aim of this article is to guide the clinician through FND clinical management, from delivery of the diagnosis, to creation of a biopsychosocially-informed treatment plan, to troubleshooting common issues that arise throughout longitudinal care. We review the evidence and core principles of both rehabilitative therapies (physical therapy, occupational therapy, and speech and language therapy) and psychological therapies for the treatment of FND, and discuss the benefits of engaging a multidisciplinary and interdisciplinary team. The optimal timing of specific therapeutic interventions is also discussed, emphasizing a patient-centered perspective. Resources for further reading, for both patients and clinicians, are provided throughout. Additional research is needed to further optimize the therapeutic approach to patients with FND, including the need to develop novel treatments for those that do not positively respond to currently available interventions.
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Affiliation(s)
- Sara A Finkelstein
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Adams
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Inpatient Psychiatry, Department of Psychiatry, Mass General Brigham Salem Hospital, Salem, Massachusetts
| | - Margaret Tuttle
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Primary Care Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aneeta Saxena
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Epilepsy Division, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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