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Riches S, Nicholson SL, Fialho C, Little J, Ahmed L, McIntosh H, Kaleva I, Sandford T, Cockburn R, Odoi C, Azevedo L, Vasile R, Payne-Gill J, Fisher HL, van Driel C, Veling W, Valmaggia L, Rumball F. Integrating a virtual reality relaxation clinic within acute psychiatric services: A pilot study. Psychiatry Res 2023; 329:115477. [PMID: 37802013 DOI: 10.1016/j.psychres.2023.115477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 10/08/2023]
Abstract
People with acute psychiatric conditions experience heightened stress, which is associated with worsened symptoms and increased violence on psychiatric wards. Traditional stress management techniques can be challenging for patients. Virtual reality (VR) relaxation appears promising to reduce stress; however, research on VR for psychiatric wards is limited. This mixed-methods study investigated feasibility and acceptability of integrating a VR relaxation clinic within acute psychiatric services. The study evaluated a VR relaxation session for inpatients and outpatients with acute psychiatric conditions (N = 42) and therapists' (N = 6) experience facilitating VR sessions for patients. Self-report assessments of psychological wellbeing were completed by patients pre- and post-VR. Patients and therapists provided qualitative feedback. The number of violent incidents and restrictive practices on the wards in the 12 weeks before VR implementation was compared to the first 12 weeks of VR. Post-VR, there were statistically significant increases in patients' relaxation, happiness, and connectedness to nature, and decreases in stress, anxiety, and sadness. Qualitative findings indicate patients found sessions enjoyable, relaxing, and helpful. Therapists provided positive feedback but highlighted practical challenges. Violent incidents and restrictive practices halved during VR implementation. VR relaxation appears feasible and acceptable in acute services. Larger studies should evaluate potential impact on psychiatric wards.
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Affiliation(s)
- Simon Riches
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom.
| | - Sarah L Nicholson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Carolina Fialho
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom
| | - Jordan Little
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Lava Ahmed
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Harley McIntosh
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom
| | - Ina Kaleva
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom
| | - Tom Sandford
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Rebecca Cockburn
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Clarissa Odoi
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Lisa Azevedo
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Ruxandra Vasile
- The Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust and University of Oxford, Isis Education Centre, Warneford Hospital, Oxford OX3 7JX, United Kingdom
| | - James Payne-Gill
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom
| | - Helen L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; ESRC Centre for Society and Mental Health, King's College London, London WC2B 6NR, United Kingdom
| | - Catheleine van Driel
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, the Netherlands
| | - Lucia Valmaggia
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, United Kingdom; KU Leuven, Department of Clinical Psychiatry, Leuven, Belgium
| | - Freya Rumball
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom; Oxleas Adult Autism Service, Oxleas NHS Foundation Trust, Kent DA2 7WG, United Kingdom
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Simblett SK, Jilka S, Vitoratou S, Hayes C, Morris D, Wilson E, Odoi C, Mutepua M, Evans J, Negbenose E, Jansli SM, Hudson G, Adanijo A, Dawe-Lane E, Pinfold V, Wykes T. Investigating a psychological model of mental conditions and coping during the COVID-19 pandemic driven by participatory methods. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2491-2501. [PMID: 35727333 PMCID: PMC9211778 DOI: 10.1007/s00127-022-02316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is evidence of increased mental health problems during the early stages of the COVID-19 pandemic. We aimed to identify the factors that put certain groups of people at greater risk of mental health problems. METHODS We took a participatory approach, involving people with lived experience of mental health problems and/or carers, to generate a set of risk factors and potential moderators of the effects of COVID on mental health. An online cross-sectional survey was completed by 1464 United Kingdom residents between 24th April and 27th June 2020. The survey had questions on whether respondents were existing mental health service users and or carers, level of depression (PHQ9) and anxiety (GAD7), demographics, threat and coping appraisals, perceived resilience (BRS), and specific coping behaviours (validated as part of this study). The relationship between responses and coping strategies was measured using tetrachoric correlations. Structural equation modelling was used to test the model. RESULTS A model significantly fit our data (rel χ2 = 2.05, RMSEA = 0.029 95%, CI (0.016, 0.042), CFI = 0.99, TLI = 0.98, SRMR = 0.014). Age and coping appraisal predicted anxiety and depression. Whereas, threat appraisal and ethnicity only predicted anxiety, and resilience only predicted depression. Additionally, specific coping behaviours predicted anxiety and depression, with overlap on distraction. CONCLUSIONS Some, but not all, risk factors significantly predict anxiety and depression. While there is a relationship between anxiety and depression, different factors may put people at greater risk of one or the other during the pandemic.
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Affiliation(s)
- S K Simblett
- Psychology Department, King's College London, London, UK.
| | - S Jilka
- Psychology Department, King's College London, London, UK
| | - S Vitoratou
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - C Hayes
- Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - D Morris
- Psychology Department, King's College London, London, UK
| | - E Wilson
- Psychology Department, King's College London, London, UK
| | - C Odoi
- Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - M Mutepua
- Psychology Department, King's College London, London, UK
| | - J Evans
- Psychology Department, King's College London, London, UK
| | - E Negbenose
- Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - S M Jansli
- Psychology Department, King's College London, London, UK
| | - G Hudson
- Psychology Department, King's College London, London, UK
| | - A Adanijo
- Psychology Department, King's College London, London, UK
| | - E Dawe-Lane
- Psychology Department, King's College London, London, UK
| | | | - T Wykes
- Psychology Department, King's College London, London, UK
- Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Simblett S, Pennington M, Quaife M, Theochari E, Burke P, Brichetto G, Devonshire J, Lees S, Little A, Pullen A, Stoneman A, Thorpe S, Weyer J, Polhemus A, Novak J, Dawe-Lane E, Morris D, Mutepua M, Odoi C, Wilson E, Wykes T. Key Drivers and Facilitators of the Choice to Use mHealth Technology in People With Neurological Conditions: Observational Study. JMIR Form Res 2022; 6:e29509. [PMID: 35604761 PMCID: PMC9171601 DOI: 10.2196/29509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/21/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background There is increasing interest in the potential uses of mobile health (mHealth) technologies, such as wearable biosensors, as supplements for the care of people with neurological conditions. However, adherence is low, especially over long periods. If people are to benefit from these resources, we need a better long-term understanding of what influences patient engagement. Previous research suggests that engagement is moderated by several barriers and facilitators, but their relative importance is unknown. Objective To determine preferences and the relative importance of user-generated factors influencing engagement with mHealth technologies for 2 common neurological conditions with a relapsing-remitting course: multiple sclerosis (MS) and epilepsy. Methods In a discrete choice experiment, people with a diagnosis of MS (n=141) or epilepsy (n=175) were asked to select their preferred technology from a series of 8 vignettes with 4 characteristics: privacy, clinical support, established benefit, and device accuracy; each of these characteristics was greater or lower in each vignette. These characteristics had previously been emphasized by people with MS and or epilepsy as influencing engagement with technology. Mixed multinomial logistic regression models were used to establish which characteristics were most likely to affect engagement. Subgroup analyses explored the effects of demographic factors (such as age, gender, and education), acceptance of and familiarity with mobile technology, neurological diagnosis (MS or epilepsy), and symptoms that could influence motivation (such as depression). Results Analysis of the responses to the discrete choice experiment validated previous qualitative findings that a higher level of privacy, greater clinical support, increased perceived benefit, and better device accuracy are important to people with a neurological condition. Accuracy was perceived as the most important factor, followed by privacy. Clinical support was the least valued of the attributes. People were prepared to trade a modest amount of accuracy to achieve an improvement in privacy, but less likely to make this compromise for other factors. The type of neurological condition (epilepsy or MS) did not influence these preferences, nor did the age, gender, or mental health status of the participants. Those who were less accepting of technology were the most concerned about privacy and those with a lower level of education were prepared to trade accuracy for more clinical support. Conclusions For people with neurological conditions such as epilepsy and MS, accuracy (ie, the ability to detect symptoms) is of the greatest interest. However, there are individual differences, and people who are less accepting of technology may need far greater reassurance about data privacy. People with lower levels of education value greater clinician involvement. These patient preferences should be considered when designing mHealth technologies.
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Affiliation(s)
- Sara Simblett
- Psychology Department, King's College London, London, United Kingdom
| | - Mark Pennington
- Psychology Department, King's College London, London, United Kingdom
| | - Matthew Quaife
- Health Economics Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Patrick Burke
- Remote Assessment of Disease and Relapse in Central Nervous System Disorders Patient Advisory Board, King's College London, London, United Kingdom
| | - Giampaolo Brichetto
- Remote Assessment of Disease and Relapse in Central Nervous System Disorders Patient Advisory Board, King's College London, London, United Kingdom
- Italian Multiple Sclerosis Society and Foundation, Rome, Italy
| | - Julie Devonshire
- Remote Assessment of Disease and Relapse in Central Nervous System Disorders Patient Advisory Board, King's College London, London, United Kingdom
| | - Simon Lees
- Remote Assessment of Disease and Relapse in Central Nervous System Disorders Patient Advisory Board, King's College London, London, United Kingdom
| | - Ann Little
- Remote Assessment of Disease and Relapse in Central Nervous System Disorders Patient Advisory Board, King's College London, London, United Kingdom
- International Bureau for Epilepsy, Dublin, Ireland
| | - Angie Pullen
- Remote Assessment of Disease and Relapse in Central Nervous System Disorders Patient Advisory Board, King's College London, London, United Kingdom
- Epilepsy Action, Leeds, United Kingdom
| | - Amanda Stoneman
- Remote Assessment of Disease and Relapse in Central Nervous System Disorders Patient Advisory Board, King's College London, London, United Kingdom
- Epilepsy Action, Leeds, United Kingdom
| | - Sarah Thorpe
- Remote Assessment of Disease and Relapse in Central Nervous System Disorders Patient Advisory Board, King's College London, London, United Kingdom
| | - Janice Weyer
- Remote Assessment of Disease and Relapse in Central Nervous System Disorders Patient Advisory Board, King's College London, London, United Kingdom
| | - Ashley Polhemus
- Merck Sharp & Dohme Information Technology, Prague, Czech Republic
| | - Jan Novak
- Psychology Department, King's College London, London, United Kingdom
- Merck Sharp & Dohme Information Technology, Prague, Czech Republic
- Faculty of Science, Charles University, Prague, Czech Republic
| | - Erin Dawe-Lane
- Psychology Department, King's College London, London, United Kingdom
| | - Daniel Morris
- Psychology Department, King's College London, London, United Kingdom
| | - Magano Mutepua
- Psychology Department, King's College London, London, United Kingdom
| | - Clarissa Odoi
- Psychology Department, King's College London, London, United Kingdom
- South London and Maudsley Biomedical Research Centre, London, United Kingdom
| | - Emma Wilson
- Psychology Department, King's College London, London, United Kingdom
| | - Til Wykes
- Psychology Department, King's College London, London, United Kingdom
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4
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Simblett SK, Wilson E, Morris D, Evans J, Odoi C, Mutepua M, Dawe-Lane E, Jilka S, Pinfold V, Wykes T. Keeping well in a COVID-19 crisis: a qualitative study formulating the perspectives of mental health service users and carers. J Ment Health 2021; 30:138-147. [PMID: 33502941 DOI: 10.1080/09638237.2021.1875424] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND People with existing mental health conditions may be particularly vulnerable to the psychological effect of the COVID-19 pandemic. But their positive and negative appraisals, and coping behaviour could prevent or ameliorate future problems. OBJECTIVE To explore the emotional experiences, thought processes and coping behaviours of people with existing mental health problems and carers living through the pandemic. METHODS UK participants who identified as a mental health service user (N18), a carer (N5) or both (N8) participated in 30-minute semi-structured remote interviews (31 March 2020 to 9 April 2020). The interviews investigated the effects of social distancing and self-isolation on mental health and the ways in which people were coping. Data were analysed using a framework analysis. Three service user researchers charted data into a framework matrix (consisting of three broad categories: "emotional responses", "thoughts" and "behaviours") and then used an inductive process to capture other contextual themes. RESULTS Common emotional responses were fear, sadness and anger but despite negative emotions and uncertainty appraisals, participants described efforts to cope and maintain their mental wellbeing. This emphasised an increased reliance on technology, which enabled social contact and occupational or leisure activities. Participants also spoke about the importance of continued and adapted mental health service provision, and the advantages and disadvantages associated with changes in their living environment, life schedule and social interactions. CONCLUSION This study builds on a growing number of qualitative accounts of how mental health service users and carers experienced and coped with extreme social distancing measures early in the COVID-19 pandemic. Rather than a state of helplessness this study contains a clear message of resourcefulness and resilience in the context of fear and uncertainty.
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Affiliation(s)
- Sara K Simblett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Wilson
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Morris
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joanne Evans
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Clarissa Odoi
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Magano Mutepua
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Erin Dawe-Lane
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sagar Jilka
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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5
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Bruno E, Simblett S, Lang A, Biondi A, Odoi C, Schulze-Bonhage A, Wykes T, Richardson MP. Wearable technology in epilepsy: The views of patients, caregivers, and healthcare professionals. Epilepsy Behav 2018; 85:141-149. [PMID: 29940377 DOI: 10.1016/j.yebeh.2018.05.044] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE In recent years, digital technology and wearable devices applied to seizure detection have progressively become available. In this study, we investigated the perspectives of people with epilepsy (PWE), caregivers (CG), and healthcare professionals (HP). We were interested in their current use of digital technology as well as their willingness to use wearables to monitor seizures. We also explored the role of factors influencing engagement with technology, including demographic and clinical characteristics, data confidentiality, need for technical support, and concerns about strain or increased workload. METHODS An online survey drawing on previous data collected via focus groups was constructed and distributed via a web link. Using logistic regression analyses, demographic, clinical, and other factors identified to influence engagement with technology were correlated with reported use and willingness to use digital technology and wearables for seizure tracking. RESULTS Eighty-seven surveys were completed, fifty-two (59.7%) by PWE, 13 (14.4%) by CG, and 22 (25.3%) by HP. Responders were familiar with multiple digital technologies, including the Internet, smartphones, and personal computers, and the use of digital services was similar to the UK average. Moreover, age and disease-related factors did not influence access to digital technology. The majority of PWE were willing to use a wearable device for long-term seizure tracking. However, only a limited number of PWE reported current regular use of wearables, and nonusers attributed their choice to uncertainty about the usefulness of this technology in epilepsy care. People with epilepsy envisaged the possibility of understanding their condition better through wearables and considered, with caution, the option to send automatic emergency calls. Despite concerns around accuracy, data confidentiality, and technical support, these factors did not limit PWE's willingness to use digital technology. Caregivers appeared willing to provide support to PWE using wearables and perceived a reduction of their workload and anxiety. Healthcare professionals identified areas of application for digital technologies in their clinical practice, pending an appropriate reorganization of the clinical team to share the burden of data reviewing and handling. CONCLUSIONS Unlike people who have other chronic health conditions, PWE appeared not to be at risk of digital exclusion. This study highlighted a great interest in the use of wearable technology across epilepsy service users, carers, and healthcare professionals, which was independent of demographic and clinical factors and outpaced data security and technology usability concerns.
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Affiliation(s)
- Elisa Bruno
- Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, 5 Cutcombe Road, London SE5 9RX, UK
| | - Sara Simblett
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Alexandra Lang
- NIHR Mental Health MedTech Co-operative, Division of Psychiatry and Applied Psychology, Faculty of Medicine, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road, Nottingham NG7 2TU, UK
| | - Andrea Biondi
- Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, 5 Cutcombe Road, London SE5 9RX, UK
| | - Clarissa Odoi
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - Andreas Schulze-Bonhage
- Epilepsy Center, Department Presurgical Diagnostics, Faculty of Medicine, Medical Center, University of Freiburg, Breisacher Strasse 86b, 79110 Freiburg, Germany
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, De Crespigny Park, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Mark P Richardson
- Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King's College London, 5 Cutcombe Road, London SE5 9RX, UK; Centre for Epilepsy, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
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