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Treufeldt H, Burton C. Stigmatisation in medical encounters for persistent physical symptoms/ functional disorders: Scoping review and thematic synthesis. Patient Educ Couns 2024; 123:108198. [PMID: 38367305 DOI: 10.1016/j.pec.2024.108198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To conduct a scoping review of stigma in medical encounters for persistent physical symptoms and functional disorders (PPS/FD). Stigma is a social attribute that links a person to an undesirable characteristic. It has been extensively studied in relation to mental illness but less so in relation to PPS/FD. METHODS We followed PRISMA-ScR reporting guidelines for scoping reviews. Searches for were designed using the SPIDER tool. We used descriptive and thematic analysis. RESULTS The searches identified 68 articles, of which 32 were eligible for inclusion. 31 out of the 32 studies used a qualitative methodology. 8 studies used an explicit definition of stigma, of which 6 used the Goffman (1963) definition. Only 2 studies directly examined clinical consultations, the remainder relied on recalled accounts by patients or professionals. Descriptive analysis identified the focus of the studies included: patient-physician interaction (n = 13); health care professionals' perceptions (n = 7); experiences of illness/stigma (n = 6); broader meaning of illness (n = 3); and patients' experiences of stigma in health care consultations (n = 3). CONCLUSION Patients experience stigmatisation in consultations for a wide range of PPS/FD. This suggests the presence of structural stigmatisation. PRACTICE IMPLICATIONS There is a need for effective stigma reduction strategies in consultations about persistent physical symptoms.
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Affiliation(s)
- Hõbe Treufeldt
- Division of Population Health, University of Sheffield, Samuel Fox House, Northern General Hospital, Sheffield S5 7AU, UK.
| | - Christopher Burton
- Division of Population Health, University of Sheffield, Samuel Fox House, Northern General Hospital, Sheffield S5 7AU, UK
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McGhie-Fraser B, McLoughlin C, Lucassen P, Ballering A, van Dulmen S, Brouwers E, Stone J, Olde Hartman T. Measuring persistent somatic symptom related stigmatisation: Development of the Persistent Somatic Symptom Stigma scale for Healthcare Professionals (PSSS-HCP). J Psychosom Res 2024:111689. [PMID: 38704347 DOI: 10.1016/j.jpsychores.2024.111689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/19/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE Persistent somatic symptoms (PSS) describe recurrent or continuously occurring symptoms such as fatigue, dizziness, or pain that have persisted for at least several months. These include single symptoms such as chronic pain, combinations of symptoms, or functional disorders such as fibromyalgia or irritable bowel syndrome. While stigmatisation by healthcare professionals is regularly reported, there are limited measurement instruments demonstrating content validity. This study develops a new instrument to measure stigmatisation by healthcare professionals, the Persistent Somatic Symptom Stigma scale for Healthcare Professionals (PSSS-HCP). METHODS Development was an iterative process consisting of research team review, item generation and cognitive interviewing. We generated a longlist of 60 items from previous reviews and qualitative research. We conducted 18 cognitive interviews with healthcare professionals in the United Kingdom (UK). We analysed the relevance, comprehensibility and comprehensiveness of items, including the potential for social desirability bias. RESULTS After research team consensus and initial feedback, we retained 40 items for cognitive interviewing. After our first round of interviews (n = 11), we removed 20 items, added three items and amended five items. After our second round of interviews (n = 7), we removed four items and amended three items. No major problems with relevance, comprehensibility, comprehensiveness or social desirability were found in remaining items. CONCLUSIONS The provisional version of the PSSS-HCP contains 19 items across three domains (stereotypes, prejudice, discrimination), demonstrating sufficient content validity. Our next step will be to perform a validation study to finalise item selection and explore the structure of the PSSS-HCP.
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Affiliation(s)
- Brodie McGhie-Fraser
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Caoimhe McLoughlin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Peter Lucassen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Aranka Ballering
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Sandra van Dulmen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Evelien Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands.
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom.
| | - Tim Olde Hartman
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, Netherlands.
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Mamo N, Tak LM, Olde Hartman TC, Rosmalen JGM, Hanssen DJC. Strategies to improve implementation of collaborative care for functional disorders and persistent somatic symptoms: A qualitative study using a Research World Café design. J Psychosom Res 2024:111665. [PMID: 38641506 DOI: 10.1016/j.jpsychores.2024.111665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/06/2024] [Accepted: 04/07/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Persistent somatic symptoms and functional disorders (PSS/FD) are often complex conditions requiring care from multiple disciplines. One way of bringing the different disciplines together is through collaborative care. Little is known about the implementation barriers faced and relevant strategies to tackle the barriers in this field. Therefore, using expert knowledge, we aim to develop realistic strategies for dealing with implementation barriers of collaborative care in PSS/FD. METHODS The Research World Café method is a single-session, expert-based method with multiple focus-groups forming and reforming to answer a set of inter-related questions, under the guidance of moderators. Using this method, participants involved in PSS/FD care across different areas of healthcare in the Netherlands developed several realistic strategies for dealing with ten implementation barriers for collaborative care in PSS/FD that were previously identified in a Delphi study. Strategies were grouped into strategy clusters using a card-sorting task. RESULTS Thirty-three participants took part, representing ten different disciplines, most commonly physiotherapists, psychologists, and physicians. In total, 54 strategies, identified in response to the ten barriers, were grouped into eight strategy clusters. The strategy clusters were professional education, communication, care coordination, care pathways, joint consults, funding, patient involvement, and prevention. CONCLUSION We identified a number of useful strategies for dealing with implementation barriers for collaborative care in PSS/FD. Many strategies provided ways to deal with multiple barriers at once. The effects of applying these strategies in collaborative care in PSS/FD will need testing through implementation studies, as well as in other areas needing multidisciplinary care.
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Affiliation(s)
- Nick Mamo
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands; Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands.
| | - Lineke M Tak
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands; Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, Netherlands
| | - Denise J C Hanssen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands
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Petzke TM, Köteles F, Pohl A, Witthöft M. Somatic symptom distress is not related to cardioceptive accuracy. J Psychosom Res 2024:111655. [PMID: 38609776 DOI: 10.1016/j.jpsychores.2024.111655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE (Cardiac) interoception was long considered a key mechanism behind symptom perception in persistent somatic symptoms (PSS). In this study, we aimed to extend earlier findings to clarify this potential interoceptive mechanisms of PSS. METHODS A cross-sectional sample of 251 participants (23.1% with self-reported functional somatic syndrome) completed a laboratory study with two cardioceptive accuracy tasks (Schandry task and a new cardiac signal detection task) and multiple questionnaires. Somatic symptom distress and associated constructs were assessed with the PHQ-15, as well as with a novel multidimensional questionnaire measure (HiTOP-SF1) derived from the somatoform spectrum of the Hierarchical Taxonomy of Psychopathology (HiTOP). Correlations (frequentist and Bayesian) and structural equation modelling (SEM) helped further investigate the interplay between these variables. RESULTS There were no significant correlations between measures of interoception and somatic symptom distress. Self-report and behavioral cardioceptive accuracy measures did not correlate significantly. No significant covariances emerged between diagnostic tools and cardioceptive accuracy; Bayesian analyses supported the lack of association between interoception and symptom perception. CONCLUSIONS Cardiac interoception (specifically cardioceptive accuracy) unlikely represents a key mechanism in PSS etiology. We recommend investigating other factors in PSS.
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Affiliation(s)
- Tara M Petzke
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes-Gutenberg-University Mainz, Wallstraße 3, 55122 Mainz, Germany.
| | - Ferenc Köteles
- Department of General Psychology and Methodology, Károli Gáspár University of the Reformed Church in Hungary, Kálvin tér 9, 1091 Budapest, Hungary.
| | - Anna Pohl
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, University of Cologne, Pohligstraße 1, 50969 Cologne, Germany.
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes-Gutenberg-University Mainz, Wallstraße 3, 55122 Mainz, Germany.
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Sirotiak Z, Thomas EBK, Wade NG, Brellenthin AG. Associations between forgiveness and physical and mental health in the context of long COVID. J Psychosom Res 2024; 178:111612. [PMID: 38367371 DOI: 10.1016/j.jpsychores.2024.111612] [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: 10/05/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Forgiveness has been positively associated with health in those with functional disorders. This cross-sectional study examined the relationships among dimensions of forgiveness and physical and mental health in individuals with and without long COVID. METHODS Adults (N = 4316) in the United States took part in an online survey study detailing long COVID presence, physical and mental health, and trait forgiveness. T-tests were performed to assess differences in types of trait forgiveness between individuals with and without long COVID. Linear regression models assessed the contribution of demographic covariates and forgiveness subscales to the physical and mental health of individuals with and without long COVID. RESULTS Of 4316 participants, 379 (8.8%) reported current long COVID. Participants were an average age of 43.7, and most identified as female (51.9%), white (87.8%), and non-Hispanic/Latino (86.6%). Individuals with long COVID reported significantly less forgiveness of self (p < 0.001, d = 0.33), forgiveness of others (p = 0.004, d = 0.16), and forgiveness of situations (p < 0.001, d = 0.34) than those without long COVID. Among the long COVID sample, forgiveness of self and situations were positively associated with mental health (p < 0.05), but not physical health (p > 0.05). Forgiveness of others was negatively associated with both physical and mental health (p < 0.05). CONCLUSION Forgiveness may be an important consideration in understanding health among individuals with long COVID, emphasizing the importance of developing a multifaceted understanding of the condition.
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Affiliation(s)
- Zoe Sirotiak
- Iowa State University, Department of Kinesiology, USA; University of Iowa, Department of Psychological and Brain Sciences, USA
| | - Emily B K Thomas
- University of Iowa, Department of Psychological and Brain Sciences, USA
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Corazza LA, Reis Rosa AB, Tonholo Silva TY, Rezende Filho FM, Maranhão-Filho PA, Pedroso JL, Barsottini OGP, Espay AJ. Functional ataxia in a specialized ataxia center. Parkinsonism Relat Disord 2024; 120:106006. [PMID: 38244461 DOI: 10.1016/j.parkreldis.2024.106006] [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: 10/10/2023] [Revised: 12/03/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Functional gait is a disorder of ambulation and balance internally inconsistent and incongruent with the phenotypic spectrum of neurological gait disorders. OBJECTIVES This paper aims to clinically characterize patients with functional ataxia. METHODS Patients with functional ataxia were analyzed out of 1350 patients in Ataxia Unit of the Federal University of São Paulo circa 2008 to 2022. RESULTS Thirteen patients (1 %) presented with functional ataxia; all female, with a median age of 34.8 years. Six (46.2 %) had psychiatric comorbidities and 7 (53.8 %) endorsed a trigger. Diagnostic features included variable base and stride (100 %), "huffing and puffing" (30.7 %), knee-buckling (30.7 %), uneconomic posturing (38.5 %), tightrope walking (23 %), and trembling gait (15.4 %). Remarkably, no falls were reported in any case. 53.8 % recovered fully or partially, despite no treatment. CONCLUSIONS Variability of base and stride are universal features of functional ataxia, yet falls are inconspicuous. Functional Ataxia is rare even in a specialized ataxia center.
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Affiliation(s)
- Luíza Alves Corazza
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Augusto Bragança Reis Rosa
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Thiago Yoshinaga Tonholo Silva
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Flávio Moura Rezende Filho
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - José Luiz Pedroso
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
| | - Orlando Graziani Povoas Barsottini
- Division of General Neurology and Ataxia Unit, Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Alberto J Espay
- Department of Neurology, James J and Joan A Gardner Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
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Mamo N, Tak LM, van de Klundert MAW, Olde Hartman TC, Rosmalen JGM, Hanssen DJC. Quality indicators for collaborative care networks in persistent somatic symptoms and functional disorders: a modified delphi study. BMC Health Serv Res 2024; 24:225. [PMID: 38383395 PMCID: PMC10882926 DOI: 10.1186/s12913-024-10589-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/10/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Care for persistent somatic symptoms and functional disorders (PSS/FD) is often fragmented. Collaborative care networks (CCNs) may improve care quality for PSS/FD. Effectiveness likely depends on their functioning, but we lack a straightforward quality evaluation system. We therefore aimed to develop quality indicators to evaluate CCNs for PSS/FD. METHOD Using an online three-round modified Delphi process, an expert panel provided, selected and ranked quality indicators for CCNs in PSS/FD. Recruited experts were diverse healthcare professionals with relevant experience in PSS/FD care in the Netherlands. RESULTS The expert panel consisted of 86 professionals representing 15 disciplines, most commonly physiotherapists, psychologists and medical specialists. 58% had more than 10 years experience in PSS/FD care. Round one resulted in 994 quotations, which resulted in 46 unique quality indicators. These were prioritised in round two and ranked in round three by the panel, resulting in a final top ten. The top three indicators were: "shared vision of care for PSS/FD", "pathways tailored to the individual patient", and "sufficiently-experienced caregivers for PSS/FD". CONCLUSIONS The identified quality indicators to evaluate CCNs in the field of PSS/FD can be implemented in clinical practice and may be useful in improving services and when assessing effectiveness.
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Affiliation(s)
- Nick Mamo
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands.
| | - Lineke M Tak
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands
| | - Manouk A W van de Klundert
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, Netherlands
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Denise J C Hanssen
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Brund RBK, Jensen LS, Gladvind KM, Fonager K. Sociodemographic and hospital characteristics for patients with severe functional disorder receiving specialized treatment at hospital. A regional register-based cross-sectional study from Denmark. J Psychosom Res 2024; 176:111561. [PMID: 38100895 DOI: 10.1016/j.jpsychores.2023.111561] [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: 10/08/2023] [Revised: 11/27/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE 10% of all adult Danish citizen has a functional disorder (FD). This study aimed to describe how patients referred to specialized treatment (CFD; Clinic for Functional Disorders) differentiate from those not referred to specialized treatment in terms of sex, comorbidty, different types of hospital contacts and affiliation to labour market 12 and 60 months prior discharged from the hospital with a FD-diagnosis between 2019 and 2021. METHODS The study was a register-based cross-sectional study of patients discharged with a FD in North Denmark Region between 2019 and 2021 (study period). Patients between 18 and 65 years of age with FD were identified in the regional patient administrative system. RESULTS A total of 6831 patients were discharged from the hospital with a FD, of which 160 were referred to CFD. Patients with FD were more likely to be referred to CFD, if they were female, had reduced or no affiliation to the labour market or most hospital contacts were as outpatient. Moreover, an increase in hospital contacts as outpatient and a reduction in affiliation to labour market over time increased the chance of being treated at CFD. CONCLUSION Patients referred to CFD differed from patients not referred to CFD. Patients referred to CFD were to a lesser extent affiliated to the labour market but had more often hospital contacts as outpatient prior to being discharged with FD. In addition, patients referred to CFD increased their contacts to the hospital as outpatient more than those not referred during the preceding 5 years from discharge with FD.
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Affiliation(s)
- René Børge Korsgaard Brund
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Denmark.
| | | | | | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ahmed I, Udawat HP, Ansari M, Yadav R, Vaishnav S, Agrawal D, Govil A, Purohit S. Impaired gastric accommodation in patients with postprandial distress syndrome type of functional dyspepsia assessed by 2D ultrasonography. Indian J Gastroenterol 2023; 42:824-832. [PMID: 37814116 DOI: 10.1007/s12664-023-01436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/24/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND AND PURPOSE The pathophysiology of postprandial distress syndrome includes impaired gastric accommodation, hypersensitivity to gastric distension and delayed gastric emptying. 2D-ultrasonography is one of the methods to assess gastric accommodation by measuring proximal gastric area and we evaluated its role in calculating proximal gastric area and thus assessing gastric accommodation in Indian patients with postprandial distress syndrome. METHODS In a hospital-based comparative analysis, proximal gastric area was measured with 2D-ultrasonography of postprandial distress syndrome (PDS) patients and compared with healthy controls. Five readings were measured every five minutes till 25 minutes after 400 mL of vegetable soup. The Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life (PAGI-QOL score) and diets aggravating PDS symptoms were studied through detailed questionnaires. Sample size was calculated at 80% study power and alpha error of 0.05 to be 30 subjects in each group. RESULTS The mean age of patients (18 males) vs. 30 healthy controls (25 males) was 40.8 ± 11.50 years vs. 36.37 ± 7.58, respectively, (p = 0.084). Proximal gastric area was significantly lower in patients versus healthy controls at five minutes (22.54 ± 2.77 vs. 30.66 ± 2.55 cm2), 10 minutes (23.03 ± 2.45 vs. 31.10 ± 2.06 cm2), 15 minutes (23.06 ± 2.27 vs. 30.31 ± 2.11 cm2), 20 minutes (22.21 ± 2.31 vs. 29.73 ± 1.71 cm2) and 25 minutes (22.02 ± 2.33 vs. 28.39 ± 1.55 cm2); p < 0.001 at all intervals of time, indicating impaired gastric accommodation. The QOL was poor in all patients with PDS with mean PAGI-QOL score of 31.30 ± 15.05, median of 30, minimum score of 12 and maximum score of 66. CONCLUSIONS Measurement of proximal gastric area with 2D-ultrasonography is simple and non-invasive. Proximal gastric area in patients was lower than controls, indicating impaired gastric accommodation. Poor quality of life was universal in patients with postprandial distress syndrome.
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Affiliation(s)
- Ishtkhar Ahmed
- Santokba Institute of Gastroenterology, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, A-111, Shri Ram Marg, Shyam Nagar, Sodala, Jaipur, 302 019, India
| | - Harsh Prasad Udawat
- Santokba Institute of Gastroenterology, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, A-111, Shri Ram Marg, Shyam Nagar, Sodala, Jaipur, 302 019, India.
| | - Mohsin Ansari
- Department of Radiodiagnosis, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Bhawani Singh Marg, Jaipur, 302 015, India
| | - Rajeev Yadav
- Department of PSM, S M S Medical College, Jaipur, 302 004, India
| | - Sandeep Vaishnav
- Santokba Institute of Gastroenterology, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, A-111, Shri Ram Marg, Shyam Nagar, Sodala, Jaipur, 302 019, India
| | - Dinesh Agrawal
- Santokba Institute of Gastroenterology, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, A-111, Shri Ram Marg, Shyam Nagar, Sodala, Jaipur, 302 019, India
| | - Anurag Govil
- Santokba Institute of Gastroenterology, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, A-111, Shri Ram Marg, Shyam Nagar, Sodala, Jaipur, 302 019, India
| | - Sunita Purohit
- Department of Radiodiagnosis, Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Bhawani Singh Marg, Jaipur, 302 015, India
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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] [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: 05/06/2023] [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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Andersen JH, Risør MB, Frostholm L, Rask MT, Rosendal M, Rask CU. Managing persistent physical symptoms when being social and active is the norm: a qualitative study among young people in Denmark. BMC Public Health 2023; 23:1949. [PMID: 37805452 PMCID: PMC10560405 DOI: 10.1186/s12889-023-16910-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND An increasing number of young people in Western countries report persistent physical symptoms (PPS). PPS may disturb everyday activities and they may have negative consequences for later adult mental and physical health. Still little is known about how young people handle PPS in their everyday lives. This study examines how young people with PPS attempt to manage their symptoms while staying engaged in their daily activities and what is at stake in these attempts. METHODS This qualitative study involved semi-structured interviews with 11 young people with PPS. Photo-elicitation was used to capture the participants' experiences as they occurred in their everyday lives. The data material was analysed using a thematic analysis approach, as well as theory on subjectivity and social acceleration. RESULTS The participants employed alleviating measures and tried to find patterns between their activities and the severity of their symptoms in order to adjust their activity level. Decisions not to participate in social activities were accompanied by feelings of missing out. The participants' attempts at adjusting their activity level was challenged by norms of being social and active, and they experienced difficulty prioritizing their activities and explaining their symptoms to others. CONCLUSION PPS shaped the participants' sense of how to act towards their bodies and social relationships in interaction with societal norms. The participants' subject formation and symptom experiences should thus be seen as a biosocial process.
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Affiliation(s)
- Julie Høgsgaard Andersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark.
- Research Clinic for Functional Disorders and Psychosomatics, Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark.
| | - Mette Bech Risør
- Department of Public Health, The Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
- General Practice Research Unit, Department of Community Medicine, UiT The Arctic University of Norway, Tromsoe, Norway
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Trøllund Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne Rosendal
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- The Research Unit for General Practice, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Butea-Bocu MC, Beyer B, Müller G. [Prehabilitation prior to radical prostatectomy : A useful concept?]. Urologie 2023; 62:1041-1047. [PMID: 37620505 DOI: 10.1007/s00120-023-02173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
Against the background of a continuous improvement of established treatment outcomes and the compatibility of health economic considerations, pre- and perioperative processes are constantly being developed and further optimized. In recent years, the concept of prehabilitation has gained increasing importance as a proactive approach to preparing patients for mostly surgical cancer treatment and improving their physical and mental health. Prehabilitation in oncology is a systematic process aimed at improving the physical, psychosocial, and nutritional condition of patients before and during cancer treatment. The goal of prehabilitation is to enhance patients' ability to cope with the physiological stress of cancer treatment and improve their overall health and well-being. In addition, prehabilitation has the potential to reduce costs for the healthcare system.
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Affiliation(s)
- Marius Cristian Butea-Bocu
- Urologisches Kompetenzzentrum für die Rehabilitation (UKR), Kliniken Hartenstein GmbH & Co. KG, Günter-Hartenstein-Str. 8, 34537, Bad Wildungen, Deutschland.
| | - Burkhard Beyer
- Urologisches Kompetenzzentrum für die Rehabilitation (UKR), Kliniken Hartenstein GmbH & Co. KG, Günter-Hartenstein-Str. 8, 34537, Bad Wildungen, Deutschland
| | - Guido Müller
- Urologisches Kompetenzzentrum für die Rehabilitation (UKR), Kliniken Hartenstein GmbH & Co. KG, Günter-Hartenstein-Str. 8, 34537, Bad Wildungen, Deutschland
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13
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Fryer K, Sanders T, Greco M, Mooney C, Deary V, Burton C. Recognition, explanation, action, learning: Teaching and delivery of a consultation model for persistent physical symptoms. Patient Educ Couns 2023; 115:107870. [PMID: 37441925 DOI: 10.1016/j.pec.2023.107870] [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] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/08/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To describe the teaching and delivery of an extended consultation model designed for clinicians to use with patients with persistent physical symptoms and functional disorders. The model is underpinned by current scientific knowledge about persistent physical symptoms and the communication problems that arise in dealing with them. METHODS Process evaluation of training and delivery of the Recognition, Explanation, Action, Learning (REAL) model within the Multiple Symptoms Study 3: a randomised controlled trial of an extended-role GP "Symptoms Clinic". Evaluation used clinician and patient interviews and consultation transcripts. RESULTS 7 GPs were trained in the intervention and 6 of them went on to deliver the REAL model in Symptoms Clinics either face-to-face or online. The Symptoms Clinic provided a set of 4 extended consultations to approximately 170 patients. Evaluation of training indicated that there was a considerable load in terms of new knowledge and skills. Evaluation of delivery found clinicians could adapt the model to individual patients while maintaining a high level of fidelity to its core components. CONCLUSION REAL is a teachable consultation model addressing specific clinical communication issues for people with persistent physical symptoms. PRACTICE IMPLICATIONS REAL enables clinicians to explain persistent physical symptoms in a beneficial way.
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Affiliation(s)
- Kate Fryer
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK
| | - Tom Sanders
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Monica Greco
- Department of Sociology, Goldsmiths, University of London, London, UK
| | - Cara Mooney
- School for Health & Related Research, University of Sheffield, Sheffield, UK
| | - Vincent Deary
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Christopher Burton
- Academic Unit of Primary Medical Care, University of Sheffield, Sheffield, UK.
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14
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Bianco F, Grassia S, Goglia M, Gallo G. Preliminary functional results after transanal irrigation in patients undergoing SHiP procedure for low rectal cancer. Updates Surg 2022. [PMID: 35843998 DOI: 10.1007/s13304-022-01334-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Abstract
The short-stump and high-anastomosis pull-through procedure (SHiP) is a newly introduced technique in the treatment of rectal cancer. This procedure does not involve the creation of a diverting ostomy with great improvement of the patients’ quality of life in the post-operative period. However, functional post-operative alterations such as low anterior rectal resection syndrome (LARS) may occur. In this context, trans-anal irrigation (TAI) may represent a viable option in the treatment and management of LARS symptoms. The aim of the present study is to investigate the role of TAI in patients operated on SHiP procedure for low rectal cancer. A prospective database of 17 patients who underwent a SHiP procedure was maintained from April 2019 to December 2021. Anal continence and functional outcomes were assessed through LARS score and Cleveland Clinic Incontinence Score (CCIS), respectively. All patients with a LARS score > 21 underwent TAI in the post-operative period. LARS median value was 36 (IQR = 8) and drastically improved after TAI treatment to 3 (IQR = 3), as the CCIS at a mean follow-up of 9 months (SD ± 5.02). Good functional result was reached in 12 out of 13 patients (92%). Our study confirms that patients with severe post-operative dysfunction could benefit from the use of TAI.
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15
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Hosseini M, Pierre K, Felisma P, Mampre D, Stein A, Fusco A, Reddy R, Chandra V, Lucke-Wold B. Focused ultrasound: Innovation in use for neurologic conditions. Trauma Emerg Med 2022; 1:1-12. [PMID: 36745142 PMCID: PMC9897206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Focused ultrasound has emerged as a key tool for neurologic disorders. In this focused review, we discuss the utility in disrupting the blood brain barrier to maximize treatment. This can facilitate creating direct coagulative lesions and aid in the administration of chemotherapy. Furthermore, it can facilitate neuromodulation when used in pulse sequencing. The current literature regarding brain tumors, essential tremor, and obsessive-compulsive disorder is reviewed. Additionally, concepts and experimental outcomes for neurodegenerative disease such as Alzheimer's is presented. Focused ultrasound as a tool is still in its infancy but the potential for adjuvant and direct therapy is promising. More clinical uses will become apparent in coming decades.
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Affiliation(s)
- Mohammad Hosseini
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Kevin Pierre
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Patrick Felisma
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - David Mampre
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Allison Stein
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Anna Fusco
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Ramya Reddy
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Vyshak Chandra
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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16
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Wolowski A, Schneider HJ, Eger T. [Dental disorders with a psychosocial background]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:951-958. [PMID: 34212207 PMCID: PMC8316243 DOI: 10.1007/s00103-021-03369-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
While the mouth and teeth play a lifelong central role in a person's development and wellbeing, psychosocial aspects of disease and health are still only reluctantly included in dental explanatory models. Only dental anxiety with its disease quality of a specific phobia is generally recognized as a mental disorder requiring intervention. It is interpreted as an emotional reaction to aspects of dental treatment, which results in distress for the affected person and appears to be unreasonably intense given the actual dangers involved. Apart from that, the tendency to provide a somatic explanation for symptoms in the dental context persists. This bears implications for the expectations of those affected as well as for interdisciplinary cooperation. In order to improve interdisciplinary support and mutual understanding, the following article introduces the clinical pictures of craniomandibular dysfunction, bruxism, occlusal dysaesthesia, and somatoform prosthesis intolerance alongside dental anxiety. Psychosocial factors can profoundly influence the development, course, and management of these conditions.
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Affiliation(s)
- Anne Wolowski
- Poliklinik für Prothetische Zahnmedizin & Biomaterialien, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
| | - Hans-Joachim Schneider
- Poliklinik für Prothetische Zahnmedizin & Biomaterialien, Zentrum für Zahn‑, Mund- und Kieferheilkunde, Universitätsklinikum Münster (UKM), Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - Thomas Eger
- Abt. XXIII Zahnmedizin, Parodontologie Bundeswehrzentralkrankenhaus Koblenz, Koblenz, Deutschland
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17
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Bingham PM. The Smile Sign. Pediatr Neurol 2021; 120:59-60. [PMID: 34020113 DOI: 10.1016/j.pediatrneurol.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/23/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Peter M Bingham
- Vermont Children's Hospital, Larner College of Medicine Department of Neurosciences, University of Vermont Medical Center, Burlington, Vermont.
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18
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Affiliation(s)
- H Arabi
- Service de médecine physique et réadaptation fonctionnelle, Faculty of Medicine and pharmacy, Cadi AAyad University, avenue de la Résistance, 40000 Gueliz- Marrakech, Morocco.
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19
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Drago L, Meroni G, Pistone D, Pasquale L, Milazzo G, Monica F, Aragona S, Ficano L, Vassallo R. Evaluation of main functional dyspepsia symptoms after probiotic administration in patients receiving conventional pharmacological therapies. J Int Med Res 2021; 49:300060520982657. [PMID: 33472489 PMCID: PMC7829611 DOI: 10.1177/0300060520982657] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective Postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) are
the two main forms of functional dyspepsia (FD). Probiotics are a promising
therapy for FD, but current data remains heterogeneous. This work aims to
evaluate a probiotic combination of Lacticaseibacillus
rhamnosus LR04 (DSM 16605), Lactiplantibacillus
pentosus LPS01 (DSM 21980), Lactiplantibacillus
plantarum LP01 (LMG P-21021), and Lactobacillus
delbrueckii subsp. delbruekii LDD01 (DMS
22106), alone or together with other pharmacological therapies, for clinical
improvement of symptoms associated with FD. Methods Patients with FD were enrolled and divided into two groups: PDS and EPS.
Probiotic alone or combined with prokinetics, antacids, or
proton-pump-inhibitors were administered for 30 days. A progressive-score
scale was used to evaluate symptoms in all patients at the beginning of the
trial and at 15 days after the end of treatment. Results A cohort of 2676 patients were enrolled (1 357 with PDS; 1 319 with EPS). All
patients showed significant improvements in dyspeptic symptoms following
treatment. In patients with PDS, probiotic alone resulted in the lowest
prevalence of symptoms following treatment, while patients with EPS showed
no clear between-treatment differences. Conclusions Dyspeptic symptoms were reduced following treatment in all patients.
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Affiliation(s)
- Lorenzo Drago
- Department of Biomedical Sciences for Health, 9304University of Milan, Milan, Italy
| | - Gabriele Meroni
- Department of Biomedical Sciences for Health, 9304University of Milan, Milan, Italy
| | - Dario Pistone
- Department of Biomedical Sciences for Health, 9304University of Milan, Milan, Italy
| | - Luigi Pasquale
- Gastroenterology Unit, Avellino Hospital, Avellino, Italy
| | - Giuseppe Milazzo
- Department of Medicine, Vittorio Emanuele III Hospital, Salemi, Italy
| | - Fabio Monica
- Department of Gastroenterology and Digestive Endoscopy, Academic Hospital Cattinara, Trieste, Italy
| | - Salvatore Aragona
- Centre of Regenerative Medicine, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Leonardo Ficano
- Gastroenterology Unit, 18998University of Palermo, Palermo, Italy
| | - Roberto Vassallo
- Department of Gastroenterology and Digestive Endoscopy, Buccheri la Ferla, Fatebenefratelli Hospital, Palermo, Italy
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20
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Widder B, Schneider W; die Leitlinienautoren. [New AWMF guidelines for medicolegal assessment of mental and psychosomatic disorders]. Nervenarzt 2021; 92:36-43. [PMID: 32902655 DOI: 10.1007/s00115-020-00982-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The guidelines, which were first published in 2012, were fundamentally revised by a panel of experts from 9 medical and psychological societies and published on the website of the Association of the Scientific Medical Societies in Germany in December 2019 (AWMF registration number 051-029). The guidelines contribute to interdisciplinary quality assurance when assessing applicants for insurance or other compensation benefits who claim psychological or psychosomatic illnesses with resulting functional disorders. The guidelines are divided into 3 separate parts: part I describes specific aspects of the expert examination, part II describes the criteria for assessing occupational performance capacity in terms of different legal fields and part III deals with questions of causality in cases of claimed posttraumatic mental disorders.
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21
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Schmidt AM, Hirsch K, Schroth M, Stehr M, Schäfer FM. Acute urinary retention in children. J Pediatr Urol 2020; 16:842.e1-842.e6. [PMID: 32900634 DOI: 10.1016/j.jpurol.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/15/2020] [Accepted: 08/15/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Acute urinary retention is a common emergency in adult patients, foremost in older men. In childhood urinary retention is a rare entity with only sparse literature on the etiology. OBJECTIVE To assess the etiology and treatment of acute urinary retention in the pediatric population and assess age and sex distribution. STUDY DESIGN A retrospective analysis of all patients admitted to our emergency department with acute urinary retention between 2005 and 2019 was performed. Exclusion criteria were newborns (because of physiologic postnatal oliguria) and postoperative urinary retention during the same hospital stay. RESULTS 113 children with acute urinary retention (ICD: R33) meeting the above criteria were identified. 16 Patients were excluded because of incomplete medical charts. 97 children were included into the study (age 0.5-18.3 years, mean age 5.3 years). 89 patients had one episode, 8 patients two episodes. A peak around the third year of age was observed. Sex ratio showed a 2:1 male to female distribution. Most common etiology was balanoposthitis (15.5%) and acute constipation/fecal impaction (15.5%). Traumatic urinary retention was found in 11.4% of the cases. Urinary tract infection were found 7.2%. No underlying reason could be found in 12.4% (idiopathic urinary retention). Other causes included febrile non-urinary infection (8.2%), subvesical obstruction (4.1%), vulvovaginitis (3.1%) and urethritis (2.1%). In 50% of the cases of urinary retention under 1 year of age (2 out of 4) an underlying tumor (rhabdomyosarcoma, sacral teratoma) was identified. DISCUSSION Age and sex distribution were similar to previously published series; however, this study shows a marked difference concerning the etiology: e. g. we identified a significantly higher proportion of functional disorders as a reason for acute urinary retention in childhood. It is hypothesized that this is partly because previously published studies originate from areas (USA, Israel, Iran) with different socio-demographic and cultural background. CONCLUSION AUR in children is a rare condition with very heterogeneous causes. Although the majority of cases exhibit mild underlying conditions, serious reasons, such as malignant diseases especially in the first year of life, must be excluded. AUR relief without catheterization is a child-friendly approach in cases of mild inflammatory or functional disorders and can help to minimize traumatization.
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Affiliation(s)
- Ana-Marija Schmidt
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Karin Hirsch
- Department of Urology and Pediatric Urology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054, Erlangen, Germany
| | - Michael Schroth
- Department of Pediatrics and Pediatric Emergency Care, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Maximilian Stehr
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany
| | - Frank-Mattias Schäfer
- Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik, St. Johannis-Mühlgasse 19, 90419, Nürnberg, Germany.
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22
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Guedj E, Million M, Dudouet P, Tissot-Dupont H, Bregeon F, Cammilleri S, Raoult D. 18F-FDG brain PET hypometabolism in post-SARS-CoV-2 infection: substrate for persistent/delayed disorders? Eur J Nucl Med Mol Imaging 2020; 48:592-595. [PMID: 32728799 PMCID: PMC7391029 DOI: 10.1007/s00259-020-04973-x] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Several brain complications of SARS-CoV-2 infection have been reported. It has been moreover speculated that this neurotropism could potentially cause a delayed outbreak of neuropsychiatric and neurodegenerative diseases of neuroinflammatory origin. A propagation mechanism has been proposed across the cribriform plate of the ethmoid bone, from the nose to the olfactory epithelium, and possibly afterward to other limbic structures, and deeper parts of the brain including the brainstem. METHODS Review of clinical examination, and whole-brain voxel-based analysis of 18F-FDG PET metabolism in comparison with healthy subjects (p voxel < 0.001, p-cluster < 0.05, uncorrected), of two patients with confirmed diagnosis of SARS-CoV-2 explored at the post-viral stage of the disease. RESULTS Hypometabolism of the olfactory/rectus gyrus was found on the two patients, especially one with 4-week prolonged anosmia. Additional hypometabolisms were found within amygdala, hippocampus, parahippocampus, cingulate cortex, pre-/post-central gyrus, thalamus/hypothalamus, cerebellum, pons, and medulla in the other patient who complained of delayed onset of a painful syndrome. CONCLUSION These preliminary findings reinforce the hypotheses of SARS-CoV-2 neurotropism through the olfactory bulb and the possible extension of this impairment to other brain structures. 18F-FDG PET hypometabolism could constitute a cerebral quantitative biomarker of this involvement. Post-viral cohort studies are required to specify the exact relationship between such hypometabolisms and the possible persistent disorders, especially involving cognitive or emotion disturbances, residual respiratory symptoms, or painful complaints.
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Affiliation(s)
- E Guedj
- Nuclear Medicine Department, Aix Marseille University, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, 264 rue Saint Pierre, 13005, Marseille, France.
| | - M Million
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, Marseille, France
| | - P Dudouet
- IHU-Méditerranée Infection, Marseille, France.,APHM, Marseille, France
| | | | - F Bregeon
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, Marseille, France.,Service des Explorations Fonctionnelles Respiratoires, Pôle Cardio-Vasculaire et Thoracique, CHU Nord, APHM, Marseille, France
| | - S Cammilleri
- Nuclear Medicine Department, Aix Marseille University, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, 264 rue Saint Pierre, 13005, Marseille, France
| | - D Raoult
- IHU-Méditerranée Infection, Marseille, France.,Aix Marseille University, IRD, APHM, MEPHI, Marseille, France
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23
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Horlings CGC, Kofler M, Hotter A, Reiter E, Wanschitz JV, Löscher WN. The clinical meaning of giant somatosensory evoked potentials of the median nerve. Clin Neurophysiol 2020; 131:1495-1496. [PMID: 32388474 DOI: 10.1016/j.clinph.2020.03.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Markus Kofler
- Department of Neurology, Medical University Innsbruck, Austria; Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Anna Hotter
- Department of Neurology, Medical University Innsbruck, Austria
| | - Eva Reiter
- Department of Neurology, Medical University Innsbruck, Austria
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24
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Burton C, Fink P, Henningsen P, Löwe B, Rief W. Functional somatic disorders: discussion paper for a new common classification for research and clinical use. BMC Med 2020; 18:34. [PMID: 32122350 PMCID: PMC7052963 DOI: 10.1186/s12916-020-1505-4] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/27/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Functional somatic symptoms and disorders are common and complex phenomena involving both bodily and brain processes. They pose major challenges across medical specialties. These disorders are common and have significant impacts on patients' quality of life and healthcare costs. MAIN BODY We outline five problems pointing to the need for a new classification: (1) developments in understanding aetiological mechanisms; (2) the current division of disorders according to the treating specialist; (3) failure of current classifications to cover the variety of disorders and their severity (for example, patients with symptoms from multiple organs systems); (4) the need to find acceptable categories and labels for patients that promote therapeutic partnership; and (5) the need to develop clinical services and research for people with severe disorders. We propose 'functional somatic disorders' (FSD) as an umbrella term for various conditions characterised by persistent and troublesome physical symptoms. FSDs are diagnosed clinically, on the basis of characteristic symptom patterns. As with all diagnoses, a diagnosis of FSD should be made after considering other possible somatic and mental differential diagnoses. We propose that FSD should occupy a neutral space within disease classifications, favouring neither somatic disease aetiology, nor mental disorder. FSD should be subclassified as (a) multisystem, (b) single system, or (c) single symptom. While additional specifiers may be added to take account of psychological features or co-occurring diseases, neither of these is sufficient or necessary to make the diagnosis. We recommend that FSD criteria are written so as to harmonise with existing syndrome diagnoses. Where currently defined syndromes fall within the FSD spectrum - and also within organ system-specific chapters of a classification - they should be afforded dual parentage (for example, irritable bowel syndrome can belong to both gastrointestinal disorders and FSD). CONCLUSION We propose a new classification, 'functional somatic disorder', which is neither purely somatic nor purely mental, but occupies a neutral space between these two historical poles. This classification reflects both emerging aetiological evidence of the complex interactions between brain and body and the need to resolve the historical split between somatic and mental disorders.
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Affiliation(s)
- Christopher Burton
- Academic Unit of Primary Medical Care, University of Sheffield, Northern General Hospital, Samuel Fox House, Sheffield, S5 7AU, UK.
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
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Abstract
BACKGROUND Interactions between brain and gut have been suspected for centuries but our understanding of the neural centers and neurohormonal links that establish bidirectional regulatory communication between these 2 body systems has advanced significantly in the last decades. The label "brain-gut axis" designates a useful but deceivingly simple concept, since the mechanistic complexity of brain-gut interaction is enormous. SUMMARY The significance of the brain-gut axis is perhaps best conceived as "a team" since both systems are physiologically coordinated to ensure a healthy status. However, under pathophysiological conditions, the axis also contributes substantially to distort homeostasis. For instance, normal signals emanating from the gut may be inappropriately received and interpreted by the central nervous system that responds by inadequately recruiting other brain structures and generate both symptoms and commands that disturb normal gut activity. Key Messages: Thus, at each end and in the brain-gut connecting routes, there is the potential for altering perceived and unperceived sensations and further impinging on normal function.
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Affiliation(s)
- Juan R Malagelada
- Consultant Digestive System Research Unit, University Hospital Vall d'Hebron, Barcelona, Spain,
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Hulgaard DR, Rask CU, Risor MB, Dehlholm G. Illness perceptions of youths with functional disorders and their parents: An interpretative phenomenological analysis study. Clin Child Psychol Psychiatry 2020; 25:45-61. [PMID: 31079473 DOI: 10.1177/1359104519846194] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Functional disorders, defined as disorders with no clear medical explanation, are common and impose a significant burden on youths, their families, healthcare services and society as a whole. Currently, the literature describes resistance among patients and their families towards psychological symptom explanations and treatments. More knowledge about the thoughts and understandings of youths with functional disorders and their parents is needed. The aim of this study was to explore the illness perceptions of youths with severe functional disorders and their parents. METHODS A qualitative interview study using interpretative phenomenological analyses. The study included 11 youths aged 11-15 years with functional disorders and their parents, where interviews were performed at the point of referral from a somatic to a psychiatric treatment setting. RESULTS Analyses identified three main themes. Themes 1(Ascribing identity to the disorder) and 2 (Monocausal explanations) explore key elements of the participants' illness perceptions, and theme 3 (Mutable illness perceptions) explores how illness perceptions are influenced by experiences from healthcare encounters. CONCLUSIONS The label 'functional disorder' was poorly integrated in the illness perceptions of the youths and their parents. Participants used a monocausal and typically physical explanation rather than a multicausal biopsychosocial explanation for their symptoms.
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Affiliation(s)
- Ditte Roth Hulgaard
- Child and Adolescent Psychiatry, Department of Clinical Research, University of Southern Denmark, Denmark
| | - Charlotte Ulrikka Rask
- Research Unit, Centre for Child and Adolescent Psychiatry, Central Denmark Region, Aarhus University Hospital, Denmark
| | - Mette Bech Risor
- General Practice Research Unit, Department of Community Medicine, UiT, The Arctic University of Norway, Norway
| | - Gitte Dehlholm
- Child and Adolescent Psychiatry, Department of Clinical Research, University of Southern Denmark, Denmark
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Shah K, Ramos-Garcia M, Bhavsar J, Lehrer P. Mind-body treatments of irritable bowel syndrome symptoms: An updated meta-analysis. Behav Res Ther 2020; 128:103462. [PMID: 32229334 DOI: 10.1016/j.brat.2019.103462] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 07/31/2019] [Accepted: 08/19/2019] [Indexed: 12/18/2022]
Abstract
Irritable bowel syndrome (IBS) is a widespread chronic functional gastrointestinal (GI) disorder having bidirectional comorbidity with psychiatric disorders. This review focuses on psychological treatment of IBS, focusing on symptom severity rather than IBS diagnostic criteria. We chose this dimensional approach in order to assess mind-body effects as an alternative or complement to conventional medical treatment, which focuses on symptom relief. We calculated the effect sizes for various psychosocial-mind-body therapies (MBTs) for IBS symptoms in both children and adults. Therapies included meditation, relaxation, yoga, autogenic training, progressive relaxation, general training in stress coping, hypnotherapy, biofeedback, psycho-education, psychodynamic psychotherapy, and cognitive behavioral therapy. We performed a meta-regression analyses and mixed effects contrasts to find various outcome differences, and we analyzed their relative efficacy in both children and adults. We found 53 studies in 50 reports describing randomized controlled trials. Medium to high effect sizes were found across all methods compared with various controls, with possibly higher effects for children. We found no systematic differences among treatment methods. Meta-regression analyses showed no significant effect for the presence of psychophysiological training, meditation or explicit exposure procedures as treatment components, although most MBTs include exposure as a nonexplicit treatment characteristic, and many relaxation techniques have meditative characteristics. We conclude that there is considerable evidence that an array of mind-body and other psychological therapies can be effective complements to medical treatment for IBS symptom severity, with little evidence for relative superiority of any particular approach. We suggest that the various methods may operate through different mechanisms.
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28
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Dienstag A, Ben-Naim S, Gilad M, Ekstein D, Arzy S, Eitan R. Memory and motor control in patients with psychogenic nonepileptic seizures. Epilepsy Behav 2019; 98:279-84. [PMID: 31419649 DOI: 10.1016/j.yebeh.2019.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/28/2019] [Accepted: 07/05/2019] [Indexed: 11/21/2022]
Abstract
Psychogenic nonepileptic seizures (PNES) are of the most elusive phenomena in epileptology. Patients with PNES present episodes resembling epileptic seizures in their semiology yet lacking the underlying epileptic brain activity. These episodes are assumed to be related to psychological distress from past trauma, yet the underlying mechanism of this manifestation is still unknown. Using resting-state functional magnetic resonance imaging (fMRI), we investigated functional connectivity changes within and between large-scale brain networks in 9 patients with PNES, compared with a group of 13 age- and gender-matched healthy controls. Functional magnetic resonance imaging analyses identified functional connectivity disturbances between the medial temporal lobe (MTL) and the sensorimotor cortex and between the MTL and ventral attention networks in patients with PNES. Within network connectivity reduction was found within the visual network. Our findings suggest that PNES relate to changes in connectivity in between areas that are involved in memory processing and motor activity and attention control. These results may shed new light on the way by which traumatic memories may relate to PNES.
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Abstract
The new regulations of the German Federal Medical Chamber for the specialization in urology have been published in November 2018 and can now be transferred into official regulations by the different Medical Chambers of the German Länder. The new concept consists of different subjects which are each subdivided into different levels of competence. Required numbers for procedures have been kept to a minimum as the emphasis is on everyday procedures of outpatient urology. The scope of urology is well represented and all subspecialities have been incorporated with their basic contents. Higher qualifications in certain subspecialities are available.
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Affiliation(s)
- Oliver W Hakenberg
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland.
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30
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Martellucci J, Sturiale A, Bergamini C, Boni L, Cianchi F, Coratti A, Valeri A. Role of transanal irrigation in the treatment of anterior resection syndrome. Tech Coloproctol 2018; 22:519-527. [PMID: 30083782 DOI: 10.1007/s10151-018-1829-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/23/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Transanal irrigation(TAI) has been reported to be an inexpensive and effective treatment for low anterior resection syndrome(LARS). The aim of the present prospective study was to evaluate the use of TAI in patients with significant LARS symptoms at a single medical center. METHODS Patients who had low anterior resection for rectal cancer between April 2015 and May 2016 at the Careggi University Hospital were assessed for LARS using the LARS and the Memorial Sloan-Kettering Cancer Center Bowel Function Instrument (MSKCC BFI) questionnaires 30-40 days after surgery or ileostomy closure (if this was done). Quality of life was evaluated using a visual analog scale and the Short Form-36 Health Survey. All patients with LARS score of 30 or higher were included (early LARS) as were all patients with a LARS score of 30 or higher referred 6 months or longer after surgery performed elsewhere (chronic LARS) in the same study period. Study participants were trained to perform TAI using the Peristeen™ System for 6 months, followed by 3 months of enema therapy following a similar protocol. RESULTS Thirty-three patients were enrolled in the study. Six patients stopped the treatment. The 27 patients (19 early LARS and 8 chronic LARS) who completed the study had a significant decrease in the number of median daily bowel movements [baseline 7 (range 0-14); 6 months 1 (range 0-4); 9 months 4 (range 0-13)]. The median LARS Score fell from 35.1 (range 30-42) (baseline) to 12.2 (range 0-21) after 6 months (p < 0.0001) and then rose to 27 (range 5-39) after 3 months of enema therapy. There was no difference in LARS score decrease at 6 months between the patients with early and chronic LARS (22.5 and 23.9 respectively; p=0.7) and there were no predictors of score decrease. Four components of the SF-36 significantly improved during the TAI period. The MSKCC BFI score significantly improved in several domains. Twenty-three patients (85%) asked to continue the treatment with TAI after the study ended. CONCLUSIONS TAI appears to be an effective treatment for LARS and results in a marked improvement of continence and quality of life. Patients may be assessed and treated for LARS early after surgery since the treatment benefit is similar to that observed in patients with LARS diagnosed 6 months or longer after surgery. The potential rehabilitative role of TAI for LARS is promising and should be further investigated.
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Affiliation(s)
- J Martellucci
- General Emergency and Minimally Invasive Surgery, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy.
| | - A Sturiale
- General Emergency and Minimally Invasive Surgery, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | - C Bergamini
- General Emergency and Minimally Invasive Surgery, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
| | - L Boni
- Clinical Trial Center, Careggi University Hospital, Florence, Italy
| | - F Cianchi
- General and Endocrine Surgery, Careggi University Hospital, Florence, Italy
| | - A Coratti
- Oncologic and Robotic Surgery, Careggi University Hospital, Florence, Italy
| | - A Valeri
- General Emergency and Minimally Invasive Surgery, Careggi University Hospital, largo Brambilla 3, 50134, Florence, Italy
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Magistro G, Stief CG. The Urinary Tract Microbiome: The Answer to All Our Open Questions? Eur Urol Focus 2018; 5:36-38. [PMID: 30042043 DOI: 10.1016/j.euf.2018.06.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/10/2018] [Accepted: 06/21/2018] [Indexed: 11/27/2022]
Abstract
CONTEXT The dogma of a sterile urinary tract persisted for over a century. With the advances in new high-throughput sequencing technologies and modified culture protocols for microbiome research, we have discovered a variable microbial spectrum in the urinary tract. Its relevance for health and disease is now under investigation. OBJECTIVE To present the latest insights into the role of the urinary tract microbiome in functional disorders. EVIDENCE ACQUISITION Medline, PubMed, the Cochrane database, and Embase were screened for randomised controlled trials, clinical trials, and reviews on the urinary tract microbiome. EVIDENCE SYNTHESIS The urinary tract is not sterile. Every individual harbours a complex microbial network in the urinary tract that is exposed to internal and external factors. Any imbalance in this network is likely to contribute to the development of lower urinary tract symptoms. Functional disorders such as interstitial cystitis, urinary urge incontinence, and chronic prostatitis/chronic pelvic pain syndrome, none of which include a bacterial origin for diagnosis, show features of an altered microbiome with specific dominating urotypes in contrast to urine from asymptomatic healthy individuals. The growing insights into the impact of the urinary microbiome on these entities may help in gaining a deeper understanding of the condition and may provide guidance for optimised management. CONCLUSIONS The urinary tract is not sterile. The discovery of the urinary microbiome suggests that any imbalance may have a relevant role in the development of symptoms in functional disorders. PATIENT SUMMARY The urinary tract is naturally colonised with a specific microbial spectrum for which impairment may cause bothersome symptoms.
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Affiliation(s)
- Giuseppe Magistro
- Department of Urology, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-Universität, Munich, Germany
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Eliasen M, Schröder A, Fink P, Kreiner S, Dantoft TM, Poulsen CH, Petersen MW, Eplov LF, Skovbjerg S, Jørgensen T. A step towards a new delimitation of functional somatic syndromes: A latent class analysis of symptoms in a population-based cohort study. J Psychosom Res 2018; 108:102-117. [PMID: 29602319 DOI: 10.1016/j.jpsychores.2018.03.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 12/21/2017] [Revised: 03/07/2018] [Accepted: 03/07/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The current delimitation of functional somatic syndromes (FSS) is inconsistent. We aimed to investigate somatic symptom profiles in the general adult population to contribute to a new, data-driven delimitation of FSS. METHODS Information on 31 self-reported somatic symptoms used in the delimitation of various FSS and bodily distress syndrome (BDS) was obtained from the DanFunD study-a population-based cohort study on 9656 adults (participation 33.6%) from Greater Copenhagen, Denmark. Latent class analysis was used to identify symptom profiles. The profiles were described by their relation with sex, age, chronic disease, self-perceived health, symptom impact, self-reported FSS, and BDS case-status. RESULTS Eight symptom profiles were identified. The largest profile had no symptoms (49% of the population). Three profiles were characterized by a few, specific symptoms: muscle and joint pain (17%), gastrointestinal symptoms (6%), and general symptoms (13%). Three profiles had multiple symptoms in specific combinations: musculoskeletal and general symptoms (7%); fatigue, musculoskeletal and gastrointestinal symptoms (3%); and cardiopulmonary, gastrointestinal and general symptoms (3%). Lastly, one profile (2%) had high probability of all symptoms. The last four profiles (15%) were strongly associated with BDS case-status, poor self-perceived health and high impact of symptoms. Analyses excluding persons with multi-symptomatic chronic disease showed similar results. CONCLUSIONS We identified eight symptom profiles characterized by specific combinations of symptoms. Four of these had multiple symptoms from several bodily systems showing large overlap with BDS, possibly indicating subtypes of FSS. The profiles contribute to a new delimitation of FSS by illustrating the importance of specific symptom combinations.
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Affiliation(s)
- Marie Eliasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark.
| | - Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Svend Kreiner
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Meinertz Dantoft
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
| | - Chalotte Heinsvig Poulsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark; Mental Health Centre Copenhagen, The Capital Region of Denmark, Hellerup, Denmark
| | - Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Falgaard Eplov
- Mental Health Centre Copenhagen, The Capital Region of Denmark, Hellerup, Denmark
| | - Sine Skovbjerg
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
| | - Torben Jørgensen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Herzog A, Shedden-Mora MC, Jordan P, Löwe B. Duration of untreated illness in patients with somatoform disorders. J Psychosom Res 2018; 107:1-6. [PMID: 29502757 DOI: 10.1016/j.jpsychores.2018.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/20/2017] [Accepted: 01/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE A long duration of untreated mental illness (DUI) has been found to be associated with negative long-term outcomes. Although somatic symptom and related disorders are frequent in the general population and in primary care, data regarding the DUI of these disorders is scarce. The aim of this study was to investigate the DUI in patients with somatoform disorders. METHODS In a cross-sectional study, primary care patients at high risk of having a somatoform disorder were identified using the Patient Health Questionnaire (PHQ). In a second step, life-time somatoform disorder diagnosis was established using the Composite International Diagnostic Interview (CIDI). Additionally, DUI was retrospectively assessed via self-reporting and sociodemographic information was collected. Survival analysis was used to estimate the DUI and to identify patient-related predictors of DUI. RESULTS A total of 139 patients with somatoform disorders were included in the analyses. The mean DUI in these patients was 25.2years (median 23.1years). Higher education significantly predicted shorter DUI, whereas gender and age of onset were unrelated to DUI. CONCLUSIONS The results reveal a substantial delay in adequate treatment of patients with somatoform disorders. The reported DUI emphasizes the importance of improvements in the management of patients with these disorders.
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Dauphinot V, Mouchoux C, Veillard S, Delphin-Combe F, Krolak-Salmon P. Anticholinergic drugs and functional, cognitive impairment and behavioral disturbances in patients from a memory clinic with subjective cognitive decline or neurocognitive disorders. Alzheimers Res Ther 2017; 9:58. [PMID: 28764796 PMCID: PMC5540419 DOI: 10.1186/s13195-017-0284-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/04/2017] [Indexed: 12/14/2022]
Abstract
Background Drugs with anticholinergic properties may be associated with various adverse clinical effects. The relationship between the anticholinergic (AC) burden and functional, global cognitive performance and behavior disturbances was assessed among elderly patients. Methods A cross-sectional study was conducted between January 2012 and June 2014 in a memory clinic among outpatients living at home and with subjective cognitive decline (SCD) or neurocognitive disorders (NCD). The AC burden was measured using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden (ACB), Chew’s score, Han’s score, and the number of drugs with AC activity. Functional, cognitive performance and behavior disturbances were assessed using the Instrumental Activities of Daily Living (IADL) scale (IADL), the Mini Mental State Examination (MMSE), and the Neuropsychiatric Inventory (NPI). Results Among 473 included patients, 46.3% were at major NCD. Patients took on average 5.3 ± 2.6 drugs. MMSE was lower when Han’s score (p = 0.04) and number of AC drugs were higher (p < 0.001). IADL was lower when AC burden was higher, whatever the AC measurement. NPI was higher when ACB, Han’s score, and number of AC drugs were higher. After adjustment, all AC scores remained associated with IADL, while Han’s score and number of drugs with AC remained associated with the MMSE. Conclusions In patients with SCD or NCD, AC burden is associated with lower functional score, whereas the cross-sectional association between AC burden and cognitive performance or behavioral disturbance varies according to AC scores. Particular attention should be paid when prescribing drugs with AC properties, especially among patients with memory complaints.
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Affiliation(s)
- Virginie Dauphinot
- Centre Mémoire de Ressources et de Recherche (CMRR) de Lyon, Hôpital des Charpennes, Hospices Civils de Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France. .,Centre de Recherche Clinique (CRC) - VCF (Vieillissement-Cerveau-Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.
| | - Christelle Mouchoux
- Centre de Recherche Clinique (CRC) - VCF (Vieillissement-Cerveau-Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Hospices Civils de Lyon, Groupement Hospitalier, Service pharmaceutique, Lyon, France.,Université Lyon 1, INSERM, U1028; UMR CNRS 5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France
| | - Sébastien Veillard
- Centre Mémoire de Ressources et de Recherche (CMRR) de Lyon, Hôpital des Charpennes, Hospices Civils de Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France
| | - Floriane Delphin-Combe
- Centre Mémoire de Ressources et de Recherche (CMRR) de Lyon, Hôpital des Charpennes, Hospices Civils de Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France
| | - Pierre Krolak-Salmon
- Centre Mémoire de Ressources et de Recherche (CMRR) de Lyon, Hôpital des Charpennes, Hospices Civils de Lyon, 27 rue Gabriel Péri, 69100, Villeurbanne, France.,Centre de Recherche Clinique (CRC) - VCF (Vieillissement-Cerveau-Fragilité), Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France.,Université Lyon 1, INSERM, U1028; UMR CNRS 5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France
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Ekanayake V, Kranick S, LaFaver K, Naz A, Webb AF, LaFrance WC, Hallett M, Voon V. Personality traits in psychogenic nonepileptic seizures (PNES) and psychogenic movement disorder (PMD): Neuroticism and perfectionism. J Psychosom Res 2017; 97:23-29. [PMID: 28606495 PMCID: PMC5572831 DOI: 10.1016/j.jpsychores.2017.03.018] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/25/2017] [Accepted: 03/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Psychogenic movement disorder (PMD) and psychogenic nonepileptic seizures (PNES) are two subtypes of conversion disorder (CD). In this case-control study, we asked whether these subtypes varied as a function of personality and history of childhood abuse. METHODS Fifty-nine patients with PMD from the Human Motor Control Section Clinic at the National Institutes of Health, 43 patients with PNES from the Rhode Island Hospital Neuropsychiatry and Behavioral Neurology Division, and 26 healthy volunteers (HC) received a battery of neurological, psychiatric and psychological assessments, including the NEO Personality Inventory Revised (NEO PI-R), the Childhood Trauma Questionnaire (CTQ), and the Traumatic Life Events Questionnaire (TLEQ). RESULTS One-way ANOVA between the three groups indicated significant differences in overall domains of Neuroticism (p=0.001) and Conscientiousness (p=0.009): Patients with PNES reported significantly greater levels of Neuroticism (p=0.002) and lower levels of Conscientiousness (p=0.023) than patients with PMD. Levels of Neuroticism remained significantly higher in both PMD and PNES than HC following correction for multiple comparisons. Patients with PNES reported greater levels of depressive and anxiety symptoms, overall psychopathology, greater history of sexual abuse, greater levels of alexithymia, higher levels of dissociative symptoms, and an earlier age at which they experienced their most distressing traumatic event than patients with PMD. CONCLUSIONS These findings suggest that personality traits, type of abuse and age of onset of trauma varies as a function of CD subtype. Patients with PNES rated greater Neuroticism and lower Conscientiousness than patients with PMD. These differing psychological profiles may inform differing treatment approaches such as psychological therapies for PNES and physiotherapy (with/without psychotherapy) for PMD.
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Affiliation(s)
- Vindhya Ekanayake
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
| | - Sarah Kranick
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kathrin LaFaver
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Arshi Naz
- Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence RI, USA
| | - Anne Frank Webb
- Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence RI, USA
| | - W. Curt LaFrance
- Division of Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence RI, USA,Departments of Psychiatry and Neurology, Brown University, Providence RI, USA
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK,Department of Psychiatry, Addenbrookes Hospital, Level E4, Box 189, Cambridge UK, CB2 0QQ
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Karatzias T, Howard R, Power K, Socherel F, Heath C, Livingstone A. Organic vs. functional neurological disorders: The role of childhood psychological trauma. Child Abuse Negl 2017; 63:1-6. [PMID: 27886517 DOI: 10.1016/j.chiabu.2016.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/15/2016] [Accepted: 11/17/2016] [Indexed: 06/06/2023]
Abstract
Although the relationship between psychological trauma and medically unexplained symptoms (MUS) is well established, this relationship is less well understood in people with medically unexplained neurological symptoms. In the present study, we set out to compare people with functional neurological disorders, and organic neurological disorders, in terms of childhood and adulthood traumatic events, traumatic stress, emotional dysregulation and symptoms of depression and anxiety. We have hypothesised that those with functional neurological disorders would be more likely to report childhood and adulthood traumatic life events, traumatic symptomatology, emotional dysregulation and symptoms of anxiety and depression, compared to those with organic neurological disorders. Sample consisted of a consecutive series of people with functional neurological disorders and with organic neurological disorders (n=82) recruited from a hospital in Scotland. Participants completed measures of life events, traumatic stress, emotional regulation, anxiety and depression. The two groups were found to significantly differ in relation to all measures, with the MUS group being more likely to report childhood and adulthood life events, more severe emotional dysregulation, traumatic stress and symptoms of anxiety and stress. Logistic regression analysis revealed that exposure to childhood traumatic life events, specifically childhood sexual abuse, and childhood physical neglect, were the only factors which were significantly associated with membership of the medically unexplained neurological symptoms group. Although further research is required to confirm our findings, our results suggest that identifying and addressing the impact of childhood trauma, may alleviate distress and aid recovery from functional neurological disorders.
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Affiliation(s)
- Thanos Karatzias
- Edinburgh Napier University, School of Health & Social Care, Edinburgh, UK; NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK.
| | - Ruth Howard
- Edinburgh Napier University, School of Health & Social Care, Edinburgh, UK
| | - Kevin Power
- NHS Tayside, Psychological Therapies Service, Dundee, UK; University of Stirling, School Of Natural Sciences, Stirling, UK
| | | | - Craig Heath
- Department of Neurology, Institute of Neurological Sciences, Glasgow, UK
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Wissel BD, Dwivedi AK, Gaston TE, Rodriguez-Porcel FJ, Aljaafari D, Hopp JL, Krumholz A, van der Salm SMA, Andrade DM, Borlot F, Moseley BD, Cavitt JL, Williams S, Stone J, LaFrance WC, Szaflarski JP, Espay AJ. Which patients with epilepsy are at risk for psychogenic nonepileptic seizures (PNES)? A multicenter case-control study. Epilepsy Behav 2016; 61:180-184. [PMID: 27362440 DOI: 10.1016/j.yebeh.2016.05.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/11/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We sought to examine the clinical and electrographic differences between patients with combined epileptic (ES) and psychogenic nonepileptic seizures (PNES) and age- and gender-matched patients with ES-only and PNES-only. METHODS Data from 138 patients (105 women [77%]), including 46 with PNES/ES (39±12years), 46 with PNES-only (39±11years), and 46 with ES-only (39±11years), were compared using logistic regression analysis after adjusting for clustering effect. RESULTS In the cohort with PNES/ES, ES antedated PNES in 28 patients (70%) and occurred simultaneously in 11 (27.5%), while PNES were the initial presentation in only 1 case (2.5%); disease duration was undetermined in 6. Compared with those with ES-only, patients with PNES/ES had higher depression and anxiety scores, shorter-duration electrographic seizures, less ES absence/staring semiology (all p≤0.01), and more ES arising in the right hemisphere, both in isolation and in combination with contralateral brain regions (61% vs. 41%; p=0.024, adjusted for anxiety and depression) and tended to have less ES arising in the left temporal lobe (13% vs. 28%; p=0.054). Compared with those with PNES-only, patients with PNES/ES tended to show fewer right-hemibody PNES events (7% vs. 23%; p=0.054) and more myoclonic semiology (10% vs. 2%; p=0.073). CONCLUSIONS Right-hemispheric electrographic seizures may be more common among patients with ES who develop comorbid PNES, in agreement with prior neurobiological studies on functional neurological disorders.
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Affiliation(s)
- Benjamin D Wissel
- Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Alok K Dwivedi
- Division of Biostatistics & Epidemiology, Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Tyler E Gaston
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Danah Aljaafari
- Division of Neurology, University of Toronto, Toronto, ON, Canada; Department of Neurology, King Fahad Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| | - Jennifer L Hopp
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Allan Krumholz
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sandra M A van der Salm
- Department of Neurology, Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdam, Netherlands
| | | | - Felippe Borlot
- Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Brian D Moseley
- Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer L Cavitt
- Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Stevie Williams
- Department of Clinical Neurosciences, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Jon Stone
- Department of Clinical Neurosciences, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - W Curt LaFrance
- Department of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alberto J Espay
- Department of Neurology and Rehabilitative Medicine, University of Cincinnati, Cincinnati, OH, USA.
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Bhatia V, Deswal S, Seth S, Kapoor A, Sibal A, Gopalan S. Prevalence of functional gastrointestinal disorders among adolescents in Delhi based on Rome III criteria: A school-based survey. Indian J Gastroenterol 2016; 35:294-8. [PMID: 27554498 DOI: 10.1007/s12664-016-0680-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 02/10/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Functional gastrointestinal diseases (FGIDs) are emerging as an important cause of morbidity in adolescents globally. The prevalence of FGIDs among Indian children or adolescents is not clear. METHODS A cross-sectional school-based survey conducted in 1115 children aged 10-17 years attending four semi urban government schools of National capital territory (NCT) of Delhi. Rome III questionnaire was translated into Hindi and was filled by the students under supervision. Prevalence of FGIDs was calculated. RESULTS Ten percent (112) adolescents had FGIDs. Out of 112, 52 % (58) were boys, and 48 % (54) were girls. 2.7 % (30) had functional dyspepsia, 1.3 % (15) had irritable bowel syndrome, 1.4 % (16) had abdominal migraine, 1.5 % (17) had aerophagia, 0.4 % (5) had functional abdominal pain syndrome, and 0.3 % (4) had functional abdominal pain. Prevalence of functional constipation, adolescent rumination syndrome, cyclical vomiting syndrome, and non-retentive fecal incontinence were 0.5 % (6), 0.3 % (4), 0.3 % (3), 0.4 % (5), respectively. Functional abdominal pain-related FGID were present in 6.3 % (70) children (35 boys and 35 girls). Functional constipation (4 vs. 2) and functional abdominal pain syndrome (4 vs. 1, p < 0.05) were significantly more in females. CONCLUSIONS The prevalence of functional gastrointestinal disorders in our study was 10 %. The most frequent FGID noted was functional dyspepsia.
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Affiliation(s)
- Vidyut Bhatia
- Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi, 110 076, India
| | - Shivani Deswal
- Department of Pediatrics, PGIMER and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, 110 001, India.
| | - Swati Seth
- Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi, 110 076, India
| | - Akshay Kapoor
- Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi, 110 076, India
| | - Anupam Sibal
- Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi, 110 076, India
| | - Sarath Gopalan
- Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, Sarita Vihar, Delhi Mathura Road, New Delhi, 110 076, India
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Anagnostou E, Katsika P, Kemanetzoglou E, Vassilopoulou S, Spengos K. The abduction deficit of functional convergence spasm. J Neurol Sci 2016; 363:27-8. [PMID: 27000215 DOI: 10.1016/j.jns.2016.02.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/17/2016] [Accepted: 02/11/2016] [Indexed: 11/30/2022]
Affiliation(s)
- E Anagnostou
- Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece.
| | - P Katsika
- Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
| | - E Kemanetzoglou
- Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
| | - S Vassilopoulou
- Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
| | - K Spengos
- Department of Neurology, University of Athens, Eginition Hospital, Athens, Greece
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Valls-Solé J. The utility of electrodiagnostic tests for the assessment of medically unexplained weakness and sensory deficit. Clin Neurophysiol Pract 2016; 1:2-8. [PMID: 30214953 DOI: 10.1016/j.cnp.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/10/2016] [Indexed: 12/14/2022] Open
Abstract
Medically unexplained symptoms (MUS) are challenge for electrodiagnostic testing. Weakness and sensory deficit can be manifestations of psychogenic disorders. This is a review of electrodiagnostic methods used for the assessment of MUS.
Patients with suspected medically unexplained symptoms or psychogenic disorders are frequently requested to undergo an EMG exam. However, the suspected diagnosis is not always told to the electromyography practitioner, who must be able to recognize such a condition to avoid false positive diagnosis without dismissing the possibility to uncover any true dysfunction. There are many clinical manoeuvers to assess the consistency of the patients’ reported weakness or sensory deficit. The electrodiagnostic practitioner should be aware of those clinical tricks and interpret the electrodiagnostic findings in the clinical context. There are many electrodiagnostic tests that the practitioner can use for the assessment of motor and sensory functions but these tests have also important drawbacks and limitations. Only after a good clinical evaluation would the practitioner be able to give his/her opinion on the clinical relevance of the electrodiagnostic findings. Here we review some of the tests that can help the practitioner to define the electrophysiological characteristics of a suspected functional disorder presenting with weakness or sensory deficit.
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Shedden-Mora MC, Gross B, Lau K, Gumz A, Wegscheider K, Löwe B. Collaborative stepped care for somatoform disorders: A pre-post-intervention study in primary care. J Psychosom Res 2016; 80:23-30. [PMID: 26721544 DOI: 10.1016/j.jpsychores.2015.11.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 10/20/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The successful management of somatoform disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy, and unstructured overuse of health care. This study aimed to investigate the feasibility of establishing a collaborative stepped health care network for somatoform disorders, and its impact on the diagnostic process and treatment recommendations in primary care. METHOD The Network for Somatoform and Functional Disorders (Sofu-Net) was established to connect 41 primary care physicians (PCP), 35 psychotherapists, and 8 mental health clinics. To evaluate Sofu-Net, primary care patients at high risk of having a somatoform disorder were identified using the Patient Health Questionnaire, and were assessed in detail at the patient and PCP level. Discussion of psychosocial distress in the consultations, diagnostic detection rates and treatment recommendations were compared before and 12 months after establishing the network. RESULTS Out of the pre- (n=1645) and 12-months-post Sofu-Net patient samples (n=1756), 267 (16.2%) and 269 (15.3%) high-risk patients were identified. From these, 156 and 123 patients were interviewed and information was assessed from their PCP. Twelve months after Sofu-Net establishment, high-risk patients more frequently discussed psychosocial distress with their PCP (63.3% vs. 79.2%, p<.001). PCPs prescribed more antidepressants (3.8% vs. 25.2%, p<.001) and less benzodiazepines (21.8% vs. 6.5%, p<.001). Sofu-Net did not affect PCP's diagnostic detection rates or recommendation to initiate psychotherapy. CONCLUSION The study results indicate feasibility of an interdisciplinary network for somatoform disorders. Collaborative care networks for somatoform disorders have the potential to improve doctor-patient-communication and prescription behavior.
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Affiliation(s)
- M C Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany.
| | - B Gross
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany
| | - K Lau
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany; Department of Medical Psychology, University of Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany
| | - A Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany
| | - K Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - B Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany
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Abstract
This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome (IBS), discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of IBS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints (fibromyalgia, temporomandibular joint syndrome), heart (non-cardiac chest pain), vascular (post-menopausal syndrome), and brain (anxiety, depression). Most IBS patients do not have psychiatric illness per se, but a range of psychoform (psychological complaints in the absence of psychiatric disorder) symptoms that accompany their somatoform (physical symptoms in the absence of medical disorder) complaints. It is not correct to label IBS patients as psychiatric patients (except those more difficult patients with true somatization disorder). One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS, because the psychoform symptoms that sound similar to those seen in psychiatric disorders may not have the same significance in patients with IBS.
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Abstract
Slow transit constipation has been traditionally considered and classified as a functional disorder. However, clinical and manometric evidence has been accumulating that suggests how most of the motility alterations in STC might be considered of neuropathic type.In addition, further investigations showed that subtle alterations of the enteric nervous system, not evident to conventional histological examination, may be present in these patients. In the present article we will discuss these evidences, and will try to put them in relation with the abnormal motor function of the large bowel documented in this pathological condition.
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