bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in the prevalence and treatment of depressive symptoms in Peru: a population-based study
Authors: Villarreal-Zegarra David , Cabrera-Alva Milagros , Carrillo-Larco Rodrigo M , Bernabe-Ortiz Antonio
Published: July 2020

Objectives

This study aimed to estimate the trends in the prevalence and treatment of depressive symptoms using nationally representative surveys in Peru from 2014 to 2018.

Design

A secondary analysis was conducted using five nationally representative surveys carried out consecutively in the years between 2014 and 2018.

Setting

The study was conducted in Peru.

Participants

Individuals, men and women, aged ≥15 years who participated in the selected surveys. Sampling was probabilistic using a two-stage approach.

Main outcome measures

Two versions of the Patient Health Questionnaire (PHQ-9) that focused on the presence of depressive symptoms were administered (one in the last 2 weeks and other in the last year). Scores ≥15 were used as the cut-off point in both versions of the PHQ-9 to define the presence of depressive symptoms. Also, the treatment rate was based on the proportion of individuals who had experienced depressive symptoms in the last year and who had self-reported having received specific treatment for these symptoms. The age-standardised prevalence was estimated.

Results

A total of 161 061 participants were included. There was no evidence of a change in age-standardised prevalence rates of depressive symptoms at the 2 weeks prior to the point of data collection (2.6% in 2014 to 2.3% in 2018), or in the last year (6.3% in 2014 to 6.2% in 2018). Furthermore, no change was found in the proportion of depressive cases treated in the last year (14.6% in 2014 to 14.4% in 2018). Rural areas and individuals with low-level of wealth had lower proportion of depressive cases treated.

Conclusions

No changes in trends of rates of depressive symptoms or in the proportion of depressive cases treated were observed. This suggests the need to reduce the treatment gap considering social determinants associated with inequality in access to adequate therapy.
Survey of physician attitudes to using multisource feedback for competence assessment in Alberta
Authors: Ashworth Nigel , Kain Nicole Allison , Jess Ed , Mazurek Karen
Published: July 2020

Background

The use of multisource feedback (MSF) for assessing physician performance is widespread and rapidly growing. Findings from early very small research studies using highly selected participants suggest high levels of satisfaction and support. However, after nearly two decades of experience using MSF to evaluate all physicians in Alberta, we are sceptical of this.

Objectives

To determine physicians’ actual opinions of MSF using the entire physician population of Alberta, Canada

Design

Online survey.

Setting

Alberta, Canada.

Participants

All physicians with a full licence to practice in Alberta in 2015.

Interventions

All participants were asked to grade how well they thought MSF was at assessing various aspects of physician performance using a 10-point Likert-type scale. There was also a text response field for written comments.

Outcomes

Mean responses to quantitative questions. Qualitative content and thematic analysis of open-ended text responses.

We analysed the data using SPSS V.23 and NVivo V.11 and built a multivariate model highlighting the predictors of high and low opinions of MSF.

Results

Survey response rate was high for physicians with 2215 responses (25%). The mean rating for how successful MSF was at assessing a variety of dimensions, varied from a low of 5.03/10 for medical knowledge to a high of 6.38/10 for professionalism and communication. Canadian-trained MDs rated MSF significantly lower on every dimension by approximately 20% compared with non-Canadian-trained MDs.

Conclusions

Alberta physicians have much lower opinions about the ability of MSF to measure any dimension of their performance than what has been suggested in the literature. Canadian-trained MDs have a particularly low opinion of MSF for reasons that remain unclear. The results of this survey offer a serious challenge to the effectiveness of a programme that is designed to promote self-reflection and performance improvement.
Prospective long-term follow-up analysis of the cardiovascular system in marathon runners: study design of the Pro-MagIC study
Authors: Schoenfeld Julia , Schindler Michael Johannes , Haller Bernhard , Holdenrieder Stefan , Nieman David Christopher , Halle Martin , La Gerche André , Scherr Johannes
Published: July 2020

Introduction

Prolonged strenuous exercise training may result in structural, functional and electrical cardiac remodelling, as well as vascular and myocardial injuries. However, the extent to which high-volume, intense exercise is associated with arrhythmias, myocardial fibrosis, coronary heart disease and pathological alterations of the vasculature remains unknown. In addition, there is no clear consensus on the clinical significance of these exercise-induced changes. Previous studies typically used cross-sectional designs and examined exercise-induced cardiovascular changes in small cohorts of athletes for up to 3–7 days of recovery. Long-term longitudinal studies investigating cardiovascular changes induced by prolonged strenuous exercise in large cohorts of athletes are needed to improve scientific understanding in this area.

Methods and analysis

In this prospective observational monocenter study, 277 participants of the Beer, Marathon, Genetics, Inflammation and the Cardiovascular System (Be-MaGIC) study (ClinicalTrials.gov:NCT00933218) will be invited to participate in this 10-year follow-up study. A minimum target sample size of 130 participants will be included in the study. Participating athletes will be examined via the following: anthropometry, resting electrocardiography and echocardiography, blood sampling, retinal vessel diameters, carotid sonography and cardiopulmonary exercise testing, including exercise electrocardiography.

Discussion

This longitudinal study will provide comprehensive data on physiological changes in the cardiovascular system and the development of pathologies after a 10-year period of prolonged and strenuous endurance exercise. Since the participants will have engaged in a wide range of training loads and competitive race events, this study will provide useful risk factor determinants and training load cut-off values. The primary endpoint is the association between the exercise-induced increase in cardiac troponin during the Munich marathon 2009 and the decline in right ventricular ejection fraction over the next 10 years.

Trial registration number

NCT04166903.
Monocyte-derived APCs are central to the response of PD1 checkpoint blockade and provide a therapeutic target for combination therapy
Authors: Schetters Sjoerd T T , Rodriguez Ernesto , Kruijssen Laura J W , Crommentuijn Matheus H W , Boon Louis , Van den Bossche Jan , Den Haan Joke M M , Van Kooyk Yvette
Published: July 2020

Background

PD1 immune checkpoint blockade (αPD1 ICB) has shown unparalleled success in treating many types of cancer. However, response to treatment does not always lead to tumor rejection. While αPD1 ICB relies on cytotoxic CD8+T cells, antigen-presenting cells (APCs) at the tumor site are also needed for costimulation of tumor-infiltrating lymphocytes (TILs). It is still unclear how these APCs develop and function before and during αPD1 ICB or how they are associated with tumor rejection.

Methods

Here, we used B16 mouse melanoma and MC38 colorectal carcinoma tumor models, which show differential responses to αPD1 ICB. The immune composition of ICB insensitive B16 and sensitive MC38 were extensively investigated using multi-parameter flow cytometry and unsupervised clustering and trajectory analyses. We additionally analyzed existing single cell RNA sequencing data of the myeloid compartment of patients with melanoma undergoing αPD1 ICB. Lastly, we investigated the effect of CD40 agonistic antibody on the tumor-infiltrating monocyte-derived cells during αPD1 ICB.

Results

We show that monocyte-derived dendritic cells (moDCs) express high levels of costimulatory molecules and are correlated with effector TILs in the tumor microenvironment (TME) after αPD1 ICB only in responding mouse tumor models. Tumor-resident moDCs showed distinct differentiation from monocytes in both mouse and human tumors. We further confirmed significant enrichment of tumor-resident differentiated moDCs in patients with melanoma responding to αPD1 ICB therapy compared with non-responding patients. Moreover, moDCs could be targeted by agonistic anti-CD40 antibody, supporting moDC differentiation, effector T-cell expansion and anti-tumor immunity.

Conclusion

The combined analysis of myeloid and lymphoid populations in the TME during successful and non-successful PD1 ICB led to the discovery of monocyte-to-DC differentiation linked to expanding T-cell populations. This differentiation was found in patients during ICB, which was significantly higher during successful ICB. The finding of tumor-infiltrating monocytes and differentiating moDCs as druggable target for rational combination therapy opens new avenues of anti-tumor therapy design.
10 State dissociation and interoception in functional neurological disorder
Authors: Pick Susannah , Butler Morgan , Rojas-Aguiluz Maya , Nicholson Timothy , Laura H
Published: July 2020

Objective/aims

Interoceptive differences have been proposed as an aetiological factor in functional neurological disorder (FND) but there is limited supportive evidence. Previous studies are few, have mixed findings and assessed only (objective) interoceptive accuracy, but not (metacognitive) interoceptive awareness. The aim of this study was to explore interoception in FND in greater detail, by assessing interoceptive accuracy and awareness in individuals with a range of FND presentations. As dissociative symptoms (e.g., depersonalisation, derealisation) are common in FND and could influence interoception, we sought to examine the effects of induced acute dissociation on interoception. We hypothesised that interoceptive accuracy/awareness would be impaired at baseline in FND relative to healthy controls, but that the differences would be exacerbated following dissociation induction.

Methods

Twenty adults with FND were recruited from online FND support groups. Diagnosis was confirmed by medical documentation from a relevant healthcare professional. The FND group was compared to a group of 20 healthy controls recruited from online community groups. A modified heart-beat tracking task measured interoceptive accuracy (correct detection of heart beats) and awareness (confidence judgements). A control task involved counting visually presented geometric shapes. Both tasks were completed before and after a validated dissociation induction procedure (mirror-gazing).

Results

The FND group reported elevated dissociation at baseline relative to controls (p<0.01) but this difference was larger following mirror-gazing (p<0.001). Interoceptive accuracy did not differ significantly between groups at baseline; however, the FND group had significantly lower accuracy scores following mirror-gazing (p<0.05). There was no effect of group on shape counting accuracy at either timepoint. Confidence ratings on the interoception and shape counting tasks were significantly lower at both timepoints in the FND group relative to controls (all p-values <0.05 or <0.01).

Conclusions

Individuals with FND reported elevated dissociation both before and after a dissociation induction procedure, although this was exacerbated post-dissociation induction. In contrast, interoceptive accuracy was unimpaired at baseline, but impaired following dissociation induction, relative to controls. The FND group showed reduced metacognitive awareness for detection of bodily states and external (visual) stimuli. Future research should better determine the nature of interoceptive deficits in FND and assess the impact of dissociation on a range of cognitive and affective processes relevant to the disorder.
11 Development of psychopathology: how can neurocognitive and genetically informative research improve our understanding of environmental risk?
Authors: Viding Essi
Published: July 2020

Essi Viding is Professor of Developmental Psychopathology at the Division of Psychology and Language Sciences, University College London where she co-directs the Developmental Risk and Resilience Unit. She is also adjunct faculty at Yale University Medical School Child Study Centre. Her research combines a variety of methodologies in an effort to chart different developmental pathways to persistent antisocial behaviour. Professor Viding has received several prizes for her work, including the British Academy Wiley Prize in Psychology, the British Psychological Society Spearman Medal, and the Royal Society Rosalind Franklin Award.

To progress our understanding of how psychopathology develops, we need to combine different analytical approaches within a longitudinal, developmental, genetically informative framework. In this talk I will provide a brief overview of neurocognitive and genetically informative research into developmental risk for conduct disorder. I will use this overview as a framework for considering how atypical neurocognitive functioning may serve to generate and maintain maladaptive social interactions. I will argue that neurocognitive studies can inform our understanding of individuals as active agents in the generation of particular social ecologies and that unlocking the mechanisms of gene-environment and environment- environment correlation will be of key importance. Advances in this area of research have scope to inform theoretical understanding, as well as interventions designed to help children at risk of developing a disorder and their families.
12 Neuroscience of pleasure and eudaimonia
Authors: Kringelbach Morten L
Published: July 2020

Professor Morten L Kringelbach leads the Hedonia Research Group based at the Universities of Oxford and Aarhus. His prizewinning research uses neuroimaging and whole-brain computational models of, for example, food, infants, sex, drugs and music to find ways to increase eudaimonia (the life well-lived). He has published fourteen books, and over 300 scientific papers, chapters and other articles and his research features regularly in newspapers, magazines, radio and television. He is a fellow of The Queen’s College, Oxford, of the Association for Psychological Science, on the advisory board of Scientific American and a board member of the world’s first Empathy Museum.

Anhedonia, the lack of pleasure, has been shown to be a critical feature of a range of neuropsychiatric disorders. Yet, it is currently measured primarily through subjective self- reports and as such has been difficult to submit to rigorous scientific analysis. New insights from affective neuroscience hold considerable promise in improving our understanding of anhedonia and for providing useful objective behavioral measures to complement traditional self-report measures, potentially leading to better diagnoses and novel treatments.

Reviewing the state-of-the-art of hedonia research and specifically the established mechanisms of wanting, liking, and learning, I propose to conceptualize anhedonia as impairments in some or all of these processes; thereby departing from the longstanding view of anhedonia as solely reduced subjective experience of pleasure. I show how advances in whole-brain computational modelling can help stratify the heterogeneity of anhedonia across neuropsychiatric disorders, depending on which parts of the pleasure networks are most affected. These advances may also help us finally get a handle on eudaimonia and well-being which are difficult to study empirically. I will show how diverse routes such as caregiving of infants, drugs or music could potentially offer new insights. The evidence suggests that eudaimonia could be linked to optimal metastability in the pleasure system, which in turn has implications for diagnosis and treatment of anhedonia.
1 Large-scale tractography of the anterior limb of the internal capsule: predictors of capsulotomy outcomes in obsessive compulsive disorder
Authors: Zhang Chencheng , Kim Seung-Goo , Li Jun , Zhang Yingying , Lv Qiming , Zeljic Kristina , Gong Hengfen , Zhan Shikun , Lin Guozhen , Sun Bomin , Wang Zheng , Voon Valerie
Published: July 2020

Objectives/Aims

Surgical procedures targeting the anterior limb of the internal capsule (aLIC) can be effective in medically refractory obsessive-compulsive disorder (OCD). The aLIC consists of white-matter tracts connecting cortical and subcortical structures. Here we assess how specific aLIC tracts are affected in OCD and which tracts predicts improvement post-capsulotomy.

Methods

Large-scale diffusion imaging was used to compare detailed white- matter connectivity via aLIC between OCD patients (n=100) and healthy controls (n=88). For each individual, the fractional anisotropy and tract counts were calculated for each white-matterfiber bundle connecting a functionally defined prefrontal and subcortical region. Correlations between tractography measures and pre- and post- capsulotomy clinical outcomes (in obsessive-compulsive, anxiety and depression scores 6 months after surgery) were assessed in 41 OCD patients. We focused on the dorsolateral prefrontal cortex and dorsal cingulate, regions implicated in prediction of capsulotomy and stimulation outcomes.

Results

Hierarchical clustering dendograms show an aLIC organization clustering lateral and dissociating ventral and dorsal prefrontal-thalamic tracts highly relevant to targeting. OCD patients had lower aLIC fractional anisotropy across prefrontal cortical-subcortical regions compared to healthy controls (p=0.023, FDR-adjusted). Greater fractional anisotropy and tract counts of the dorsolateral prefrontal-thalamic and -subthalamic tracts in OCD patients predicted greater post-capsulotomy obsessive-compulsive improvements. In contrast, greater counts of the dorsal cingulate-thalamic tracts predicted surgical outcome mediated by depressive and anxiety improvements.

Conclusions

These findings shed light on the critical role of the aLIC in OCD and potentially leads towards precision targeting to optimize outcomes as a function of symptom dimension in OCD.
2 The history of psychedelics in psychiatry
Authors: Jay Mike
Published: July 2020

Mike Jay has written widely on the history of science and medicine, and particularly on the discovery of psychoactive drugs during the 18th and 19th centuries. His books on the subject include Emperors of Dreams: drugs in the nineteenth century (2000, revised edition 2011) and most recently High Society: mind-altering drugs in history and culture (2010), which accompanied the exhibition he curated at Wellcome Collection in London. The Atmosphere of Heaven is also the third book in his series of biographical narratives of political reformers in 1790s Britain. It follows The Air Loom Gang (2003, revised edition forthcoming 2012) and The Unfortunate Colonel Despard (2004).

The history of psychedelics in psychiatry is longer than usually recognised. The potential of psychedelic drugs to effect mental cures, and the difficulty of managing their powerful effects, were both recognised over a century ago. Since 1962 the research protocols for demonstrating drug efficacy have posed particular problems for psychedelic-assisted therapy.
5 Differentiating transient epileptic amnesia from epilepsy in dementia and mild cognitive impairment
Authors: Baker John , Savage Sharon , Zeman Adam
Published: July 2020

Objectives/Aims

Patients with TEA experience epileptic seizures characterised primarily by a transient impairment of memory. These seizures sometimes include brief periods of unresponsiveness and other ictal features, including olfactory hallucinations and motor automatisms. TEA patients also report interictal memory difficulties: autobiographical amnesia, accelerated long-term forgetting, and topographical amnesia. Epileptic seizures in dementia can lead to behavioural arrest and altered responsiveness, as well as periods of increased confusion and amnesia.

We aimed to compare and contrast these conditions with the objective of developing a decision aid to distinguish them efficiently in typical clinical settings.

Methods

This retrospective study examined the case notes of two groups of patients enrolled in two separate studies. The Impairment of Memory in Epilepsy (TIME) study has established a cohort of 115 patients with TEA. The Presentation of Epileptic Seizures in Dementia (PrESIDe) study assessed 144 patients with MCI or dementia and identified a clinical suspicion of epilepsy in 37 (25.7%). The Addenbrooke’s Cognitive Examination - Version III (ACE-III) scores were compared as a measure of cognitive function. The prevalence of several key seizures features in both the TEA and epilepsy in dementia populations were identified.

Results

The average age of seizure onset in the dementia group was 76.91 years, 15 years older than in the TEA group. A range of seizure features were seen in both groups. PrESIDe patients were more likely to have seizures where loss of awareness was a feature. Automatisms occurred in a similar prevalence across both groups, although olfactory hallucinations were significantly more common in the TEA group, as were seizures where amnesia was the sole manifestation. More than 50% of participants in both groups experienced amnestic episodes on waking. Patients with epilepsy in dementia scored significantly lower than patients with TEA on all domains of the ACE-III. However, despite typically normal results on the ACE-III, patients with TEA demonstrate impairments when recall is tested over longer delays (>24 hrs), or on measures of autobiographical memory.

Conclusions

In patients with TEA, the onset of seizures occurs at a younger age than in patients who experience seizures as a feature of their dementia, there are also key differences in the types of seizure reported by these two groups of patients. In contrast to patients with dementia, those with TEA commonly perform normally on standard cognitive tests.
6 Drug treatment of older patients presenting to a tic disorder clinic, a descriptive study
Authors: Raymond Sophia G , Stern Jeremy S , Simmons Helen
Published: July 2020

Aims

Drugs such as neuroleptics are known to have varying efficacy in the management of Tourette’s syndrome, and there is a particular lack of research about their efficacy when used for older patients presenting for treatment for the first time. Therefore, in this study, we aim to describe the outcomes of drug treatment in patients aged 40 years and older who presented to a Tic Disorder clinic.

Method

The Tic Disorder clinic letter database was used to search for patients who presented to the clinic aged 40+. Clinical information gleaned from the letters including age of onset, severity of symptoms, comorbidities and treatments offered was recorded in an Excel spreadsheet. Those patients with incomplete data were removed from the sample. The spreadsheet data was then used to describe the severity of tics in this cohort and the effectiveness of drugs for all patients who used them.

Results

There were a total of 33 patients aged 40+ who presented to the Tic Disorder Clinic, that we could find a set of clinical notes on. Male: female ratio = 26:7 Tic severity was calculated from either clinical comment, or in most cases, the Yale Global Tic Severity Score (YGTSS). YGTSS of 1–19 is mild, 20–39: moderate and 40–50: severe. Patients with tics since childhood: 75.8%, late onset tics >40 yrs: 15.2%, unknown: 9%. 63.6% have had obsessionality, a common comorbidity of GTS, and 42.4% suffer with two or more psychiatric comorbidities. 25/33 patients tried drugs for tics, whether before or at presentation to this clinic. 40% of them found drugs beneficial; 60% did not, or experienced adverse reactions or were lost to follow up (see bar chart).

Conclusions

Overall, even though this study shows that medications for tics is more likely to be unsuccessful or cause adverse effects, it was still effective in a substantial proportion of patients and thus may be a good intervention for some. The study also suggests that this may be more difficult cohort to monitor due to the frequency of absences to follow up.
7 Converging evidence from local field potentials and acute stimulation for subthalamic nucleus theta involvement in internally generated decisions to initiate or withhold actions
Authors: Manssuer Luis , Voon Valerie , Zhang Chen Cheng , Wang Linbin
Published: July 2020

Objectives/Aims

To examine the causal role of the subthalamic nucleus (STN) in externally cued or internally generated decisions to execute or withhold an action by recording and stimulating neural activity in this region using deep brain stimulation (DBS) electrodes implanted for the treatment of Parkinson’s disease (PD).

Methods

20 PD patients completed an intentional inhibition task in which they were instructed by visual cues to go, stop or choose to go or stop. Each cue was on the screen until the patient pressed a button with their left thumb or for a maximum of 1500 ms and was preceded by a fixation cross for 1000–1500 ms. Local field potentials (LFP) were simultaneously recorded from the left STN and stimulated in the right STN at the clinical frequency of 130Hz or theta frequency 7Hz for 500 ms prior to the onset of the cue on half of the choice trials.

Results

On non-stimulation choice trials, analysis of the LFP’s showed a significant decrease in theta activity when patients chose to stop compared to go. This difference began prior to the onset of the response. Behaviourally, patients chose to respond less when the STN was stimulated at a frequency of 7 hz for 500 ms prior to the onset of the cue but not at 130 Hz.On non-stimulation choice trials, analysis of the LFP’s also showed that there was a significant decrease in theta activity when patients chose to stop compared to go. This difference began prior to the onset of the response.

Conclusions

The findings suggest that pre-existing theta activity in the STN may bias one’s pre-disposition to choose to initiate an action and that stimulation of this activity may interfere with this process.
3 The emerging role of cannabis therapeutics in psychiatry
Authors: Valerie Curran H
Published: July 2020

Val Curran is Director and Founder of the UCL Clinical Psychopharmacology Unit at UCL, Professor of Psychopharmacology, a founding member of the charity DrugScience, Research Lead at a London NHS Drug Service and an advisor to the UK All Party Parliamentary Group on Drug Policy Reform. Her research focuses on the short- and long-term effects of drugs on our mood, thought processes, memory and the brain. Her research is funded mainly by the Medical Research Council. Val’s work spans drugs used in medical treatments, drugs used recreationally and some drugs (e.g. cannabinoids, ketamine, opiates) used in both contexts. Currently she is running several projects on cannabinoids including their differential effects on adolescents compared with adults; the use of cannabidiol (CBD) as a treatment for cannabis addiction and other potential medical uses of cannabinoids. Val’s cannabis research formed the basis of the Channel 4 documentary: Drugs Live: Cannabis on Trial.

Cannabis contains over 140 unique ‘cannabinoids’ and levels of these vary in different types of cannabis. Research to date has focussed on just two of these cannabinoids:

Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD). We have shown that this variation can influence the effects of cannabis and people’s vulnerability to experiencing mental health problems such as addiction and psychosis. On the opposite side of the coin, THC and CBD and their combination are emerging as potential treatments for some mental health problems. Cannabis based medicines can now be prescribed in the UK, although hardly any patients have yet received these treatments on the NHS. This talk will summarise relevant background research in experimental medicine before presenting new data from a recent RCT of the effects of different doses of CBD for treating cannabis use disorder. I will argue that research on cannabinoids is not only about the ‘cause or cure’ of mental health problems; critically, we should emphasise prevention as a key approach which will require politicians to take evidence-based decisions on UK drug policy.
12 tDCS modulation of pavlovian bias under intermittent loss of control
Authors: Sedlinská Terezie Lekscha , Bolte Lara , Melsæter Eirik , Csifcsák Gábor , Mittner Matthias
Published: July 2020

Objectives/Aims

Learning from experience and making decisions based on integrated environmental feedback is crucial for human functioning and wellbeing. Difficulties in learning and decision-making have been found in several psychiatric conditions. Pavlovian bias, a tendency to approach reward and remain passive in the face of punishment, can be advantageous in some situations, while in others, it can lead to maladaptive decisions and needs to be overcome by cognitive control. It has been suggested that healthy humans rely more heavily on Pavlovian bias when instrumental control over environmental reinforcers is compromised. In our study, we were focusing on the influence of transcranial direct current stimulation (tDCS) on Pavlovian bias during and after an intermittent loss of control over rewards and losses.

Methods

In our pilot study, 19 adults underwent three blocks of an orthogonalized go-nogo reinforcement learning task. Blocks 1 and 3 had a response-feedback contingency of 70–30%, enabling learning via trial-and-error. In the second block, the outcome was independent of the participants’ responses (50%-50% contingency level). Cortical responses of all participants were recorded via EEG. Multi-electrode tDCS targeting the medial prefrontal cortex was administered in a randomised, double-blind placebo-controlled manner.

Results

We conducted a repeated-measures ANOVA with ‘session’ (PRE x tDCS x POST), ‘valence’ (Win x Avoid) and ‘PB-congruency’ (Pavlovian bias congruent x incongruent) as within-factors, ‘group’ (Active stimulation x Sham) as the between- factor and ‘accuracy’ as the dependent variable. The interaction of ‘session’ and ‘PB- congruency’ with F(2,16)=2.62, p=0.09 were marginally significant, pointing towards slightly enhanced Pavlovian bias in the second block. However, the interaction of ‘session’, ‘PB-congruency’ and ‘group’ was not significant (F(2,16)=0.46, p=0.63). The evaluation of the feedback-related negativity (FRN) in the EEG revealed gradually increasing amplitudes in reward trials in the sham group, whereas we found a trend towards reduced FRN amplitude in the active group with F(2,13)=2.83, p=0.08.

Conclusions

Our preliminary data show that a loss of control over feedbacks might increase the effect of Pavlovian bias on the choices of all participants. Although active tDCS seems to attenuate cortical responses during feedback evaluation, this effect is not accompanied by alterations in choice behaviour. Our data collection is still ongoing. The results from the full sample of 50 participants will be analysed by February 2020.
15 The neurological patient experience survey (England)
Authors: Dilley Michael , McIntosh Katharine , Vibert Sarah ,   on behalf of The Neurological Alliance
Published: July 2020

Objectives/aims

The Neurological Alliance’s patient experience survey 2018/19 aimed to gather relevant data of the experiences of 10,000 neurology patients across England, in order to reveal how patients are faring, and to provide insight about the impact service provision (or lack thereof) is having in people’s lives. It is the only pan- neurological national survey of neurology patients. Mental wellbeing questions were included to build our understanding of service provision and whether people’s needs are being met.

Methods

An online and in-clinic survey was conducted during the course of 2018–2019. The online survey was promoted by The Neurological Alliance’s member organisations (predominantly charities), and via social media. The in-clinic data was collected from patients attending neurology outpatient appointments at 39 clinics across England. The data underwent a rigorous cleaning process. Data regarding patient’s home postcodes was collected in order to be able to attribute responses to STPs. Results were subsequently anonymised prior to analysis.

Results

Of those to whom these questions were relevant:

40% of respondents (n=2879) felt their mental wellbeing needs were not being met at all, and an additional 22% (n=1613) said their needs were only being met to a small extent 30% (n=2821) had not been referred or signposted to support for their mental wellbeing by a health professional, but would have liked this 58% (n=5593) said they were not asked about their mental wellbeing by a health or social care professional.

Of those referred/signposted for mental health support, 26% (n=616) were referred to a neuropsychologist/neuropsychiatrist, 60% (n=1452) to a counsellor/therapist, 7% (n=167) to a buddying/befriending support group 62% (n=1249) said this support helped them feel better/more positive; 24% (n=481) said that this support did not make them feel better/more positive; 14% (n=270) said it was not suitable for them.

The older respondents were, the less likely they were to have been signposted to support for managing their mental health: 18–24s scored 36%, 55–64s scored 26%, 65–74s scored 17%, and 75+ scored 12%. People aged 75+ were most likely (67%) to report they did not need/want signposting.

Conclusions

The data gathered enhances our understanding of the mental wellbeing of people with neurological conditions, and provides a baseline for monitoring improvement/future interventions, such as the forthcoming neuropsychiatry service specification.
16 Outcomes of a novel 5-week individualized multidisciplinary outpatient (day-patient) treatment programme for functional (psychogenic) neurological symptoms
Authors: Petrochilos P , Elmalem M , Selai C , Patel D , Hayward K , Ranu J , Louissaint H
Published: July 2020

Aim

We report the results of a novel 5-week treatment programme, delivered by a multi-disciplinary team, with individualised sessions to treat functional neurological symptoms in a neuropsychiatric outpatient setting. The primary aims of this MDT programme were to (a) reduce symptoms (b) improve health and social functioning (c) improve functional performance (d) improve health status.

Method

Treatment involved individual sessions of neuropsychiatry, cognitive behavioural therapy, physiotherapy, occupational therapy, education and family meetings. Outcome measures were collected at the beginning and end of treatment and at a 6 month face to face follow-up. These were both patient and clinician reported. The aims were assessed by the following measures: symptom reduction (PHQ15, PHQ9, GAD7, SPIN, Rosenberg, CGI); health and social functioning (HONOS, WSAS); functional performance (COPM); and improvements in health status (EQ5DL). Results: Analyses were conducted on 78 patients who started and completed the programme and attended a 6 month face to face review. There were high baseline levels of disability compared to EQ5DL population norms and high rates of disability and psychopathology as indicated by the WSAS and mental health indices (PHQ9, GAD7, SPIN, Rosenberg’s self-esteem). At baseline, 92.3% met the IAPT caseness threshold for depression (PHQ9 >10) and 71% met the IAPT caseness threshold for anxiety (GAD7 >8). A repeated measures Freidman’s ANOVA over 3 timepoints (admission, discharge and 6 month follow-up) followed by Dunn-Bonferroni post hoc tests indicated statistically significant improvements from admission to discharge and admission to 6 months follow up. These improvements were seen in in somatic symptoms (PHQ15), depression (PHQ9) and anxiety (GAD7) symptoms, health and social functioning (HONOS), functional performance (COPM), health status (EQ5D-5L and EQ5D-EL VAS) and patient ratings of clinical global improvement (CGI). There was a high acceptance of this neuropsychiatry led MDT programme indicated by the patient reported visual analogue scale for benefit of programme averaging at 90%.

Conclusion

An MDT can effectively deliver an outpatient programme for FNS which can serve as an alternative to an inpatient programme for patients with fewer or no nursing needs, for those whose preference is an outpatient setting or for those seeking to minimise disruption to work or family life. There may be potential cost reductions for institutions compared to inpatient treatment depending on local calculations. In the future, earlier identification and treatment of co-morbidities may modify some predisposing and perpetuating factors.
17 Presentation of Capras syndrome in anti-NMDA receptor encephalitis: a neuro-rehabilitation approach
Authors: Francis Richard , Ching Hui , Tyagi Himanshu , Swayne Orlando , Ajina Sara , Monaghan Bernadette
Published: July 2020

Objectives/Aims

Capgras syndrome is not often seen in neuro-rehabilitation and few case-reports of Capgras syndrome after anti-NMDA receptor encephalitis exist in literature. This case is relevant in light of how the Capgras sydrome and delusional beliefs affected this patient’s discharge planning, engagement with the multi- disciplinary team during rehabilitation and side-effects of pharmacological management. The challenging aspects of the case revolve around the patient’s persecutory beliefs, his delusional misidentifation disorder and its subsequent management.

Methods

The patient is a middle-aged gentleman with a background of relapsing- remitting multiple sclerosis who presented with seizures, headache, rash and intermittent fevers. He was initially treated as infectious meningoencephalitis and his condition deteriorated due to combination of behavioural change and seizures. A MRI-head suggested viral encephalitis but lumbar puncture and serum showed strongly positive for anti-NMDA receptor antibodies, thought potentially secondary to the patient’s disease-modifying drugs for his multiple sclerosis. After step-down from Intensive Care, the patient was noted to have fixed persecutory delusions regarding his wife and children. He believed that his wife and children were imposters and that the hospital and doctors within it were conspiring against him. He was managed initially with risperidone however the dose could not be increased due to the sedating side-effects resulting in an inability to engage with rehabilitation. He was subsequently changed to aripiprazole and escitalopram with the intention to decrease his delusional misidentification disorder. His delusions partially resolved with the patient accepting his children as his own, but not accepting his wife as truly ‘his wife’. The discharge destination represented a difficulty due to concerns that he may become aggressive (physically/verbally) to his wife if he continued to deem her an ‘imposter’. The patient was managed by sidestepping the conflict; he was more accepting of his wife if introduced as a ‘friend who loves him’. The patient was also allowed to drive the narrative rather than forced to deal with his Capgras syndrome. Results: A discharge home with support (including his wife) became feasible as his delusion thawed.

Conclusions

Managing complicated patients like this involves not only pharmacological options but also psychological/psychiatric intervention and employment of non-confrontational techniques to help better engagement with rehabilitation.
18 Impulse control disorder secondary to dopaminergic therapies in parkinson’s – evaluating risk
Authors: Thomas Jane , Kobyleki Chris , Perera Nilika
Published: July 2020

Method

Literature review and original work for Parkinson’s Academy Masterclass.

Aim

To enhance the depth and breadth of evaluation of risk in the management of ICD secondary to dopaminergic therapies in PD.

Summary Impulse control disorder (ICDs) can result in serious consequences for patients, their carers and families. They are characterized by a failure to resist a temptation, urge or impulse that may cause harm to oneself or others. They occur secondary to dopaminergic therapies in Parkinson’s, especially Dopamine agonists (DA). There is a dose and duration of treatment association. They may be accompanied by a degree of compulsion to act which increases risk. Risk factors associated their development have been identified including younger age at onset, being male, living alone, genetic and family history and preceding history of impulse control traits. A variety of screening tools exist but do not replace the detailed clinical interview. They may lead to criminal acts and consequent judicial proceedings, and whilst sentences may be commuted due to impaired capacity, the impact is frequently devastating. Class action law suits have been sought against the drug companies and prescribers have a clear medico-ethical responsibility for monitoring the drugs they prescribe. Management is often difficult and limited, necessitating slow withdrawal of the agent, and risk needs to be evaluated and managed throughout this period. An outline structure for evaluating risk is delineated focusing on areas of pre-disposing factors; detailed history of ICDs; degree of control and elucidation of risks.

Results

Abstract 18 Figure 1

Risk analysis – complete – individual and collateral histories

Conclusion

Whilst screening tools are helpful in identifying and assessing certain ICDs, they do not replace the clinical interview. There is an issue regarding self- reporting. Insight by the patient or reluctance to share the nature or degree of the ICD may lead to low identification of ICDs. Collateral information from carers or other involved professionals is essential in a comprehensive evaluation of risk. Whilst a structured risk assessment is likely to be less targeted to the specific risks dependant on the nature of the ICD, a framework for evaluating and thinking about risk with patient, carers and other professionals involved could enhance practice and more accurately meet the guidance established for monitoring and managing risk outlined in GMC and NICE guidance.
20 International online survey of 1162 individuals with functional neurological disorder: demographics, symptom comorbidities, self- management strategies, and illness beliefs
Authors: Butler Matthew , Seynaeve Mathieu , Pick Susannah , Rucker James , Nicholson Timothy
Published: July 2020

Aims

Functional neurological disorder (FND) is common and often severe. It is poorly understood, and there have been no international large-scale studies of self- management and illness beliefs in FND. We created a patient questionnaire to assess FND demographics, symptom comorbidity, self-management strategies (particularly in relation to prohibited substances), views on novel treatments, and illness beliefs.

Methods

The questionnaire was shared open access over a three-week period.

Participants were recruited internationally through social media and patient groups. RESULTS: In total, 1162 respondents from 16 countries took the survey. Of these, 98% reported a formal diagnosis of FND from a consultant neurologist or other suitably trained clinician. Females constituted 86% of respondents, with an average age of 41.7 years (SD=12.50). Mean symptom duration was 7.69 years (SD=9.37) and average time from diagnosis was 2.24 years (SD=3.35), indicating a diagnostic lag of over 5 years. Symptom comorbidity was very high, with respondents reporting current: seizures (50%), gait disturbance (76%), loss of balance (77%), tremors (61%), muscle jerks/spasms (65%), altered sensations (79%), speech difficulties (65%), memory problems (80%), fatigue (93%), and headache (70%). Current psychiatric comorbidities – depression (43%), anxiety (51%), panic (20%), and PTSD (22%) - were also common. Illness beliefs varied, with respondents agreeing most strongly that FND is a combination of physical and stress/trauma-related factors. Respondents rated FND as having a severe effect on their life, with little control felt over their symptoms. Respondents had received a wide range of medical interventions, and many had tried alternative treatments. Prohibited substances such as cannabis, ketamine, and psychedelics had been used by 15% of respondents, with the majority experiencing no or minimal physical (90%) and psychological (95%) sequelae. Many respondents reported that they would be willing to try medically supervised psychedelic therapy if it was found to be safe and effective.

Conclusions

This large international online survey of FND patients indicated a striking co-occurrence of multiple symptoms. As expected, respondents reported that FND severely impacted on their lives, and many had lived with symptoms, which are not well managed by current medical therapies, for years. There was interest in novel putative treatments, such as medically supervised psychedelic therapies, which indicates a strong need to investigate alternative treatments for this poorly served patient group.
22 Whole-brain functional connectivity based on the graph theory analysiisn Psychogenic Non-Epileptic Seizures (PNES)
Authors: Arbabi M , Amiri S , Badragheh F , Mirbagheri MM , Asadi-Pooya AA
Published: July 2020

Objective

Despite being the subject of many studies over the past two decades, mechanisms underlying psychogenic non-epileptic seizures (PNES) are still poorly understood. We tried to address this issue by utilizing brain functional connectivity analysis to identify brain regions with abnormal activities in patients with PNES. In a case-control study, we performed graph based network analysis, a robust technique that determines the organization of brain connectivity and characterizes topological properties of the brain networks.

Methods

Twelve individuals with PNES and twenty-one healthy control subjects were examined. Resting state functional magnetic resonance imaging (rsfMRI) was acquired. All subjects were asked to keep their eyes open during the scanning process. The rsfMRI analysis consisted of pre-processing, extracting the functional connectivity matrix (FCM) based on the AAL atlas, threshold for binary FCM, constructing a graph network from FCM and extracting graph features, and finally statistical analysis. For all cortical and subcortical regions of the AAL atlas, we calculated measures of ‘degree,’ which is one of the features of the graph theory. Results: Our results revealed that, as compared to the healthy control subjects, patients with PNES had a significantly lower degree in some brain regions including their left and right insula (INS), right Putamen (PUT), left and right Supramarginal gyrus (SMG), right Middle occipital gyrus (MOG), and left and right Rolandic operculum (ROL). In contrast, degree was significantly greater in two regions [i.e., right Caudate (CAU) and left Inferior frontal gyrus orbital part (ORBinf)] in patients with PNES compared to that in controls.

Conclusion

Our findings suggest that functional connectivity of several major brain regions are different in patients with PNES compared with that in healthy individuals. While there is hypoactivity in regions important in perception, motor control, self- awareness, and cognitive functioning (e.g., insula) and also movement regulation (e.g., putamen), there is hyperactivity in areas involved in feedback processing (i.e., using information from past experiences to influence future actions and decisions) (e.g., caudate) in patients with PNES. The observation that individuals with PNES suffer from a wide range of abnormal activities in functional connectivity of their brain networks is consistent with the fact that PNES occur in a heterogeneous patient population; no single mechanism or contributing factor could explain PNES in all patients.