bluuebunny/crossref_metadata_2025_split huggingface dataset:
1 Neuropsychiatry mavericks
Authors: David Anthony S 
Published: December 2022

Professor David is among Britain’s preeminent psychiatrists and academics. His research in recent times has focused on schizophrenia, neuropsychiatry, medically unexplained syndromes and neuroimaging. He has particular interest and expertise in the concept and nature of ‘insight’ in schizophrenia, and its relation to treatment compliance and an individual’s decision-making capacity. Professor David is Director of the UCL Institute of Mental Health.Professor David is a widely published author in influential peer-reviewed academic journals. He recently published his latest book, the acclaimed Into the Abyss: A Neuropsychiatrist’s Notes on Troubled Minds. Dr David has co-edited several books, including The Self in Neuroscience and Psychiatry and Insight and Psychosis. He is the co-editor of the journal Cognitive Neuropsychiatry.Professor David is a founding member of both the British Neuropsychological Society and the British Neuropsychiatry Association – he was Chair of the latter organization between 2004 and 2007. In 2018, he delivered the inaugural lecture as part of the Kings Lectures series.AbstractA maverick is an outsider who has rare qualities which may be highly valued in many areas of society. Empirical research has validated ‘maverickism’ as a recognisable personality type. Medicine and psychiatry have always attracted mavericks – neuropsychiatry in particular. Over the last 150 years there have been several notable examples who have a few key characteristics in common, but their contribution has been mostly negative, sometimes disastrously so. Modern mavericks continue to flourish perhaps aided by the loosening of bounds on science communication and governance but also because of the difficulty mainstream neuropsychiatry has in communicating the biopsychosocial approach in a way that satisfies some sufferers. The question is whether they can be a useful stimulus.
10 What can we learn from the nervous sequelae of past pandemics?
Authors: Honigsbaum Mark 
Published: December 2022

Dr Mark Honigsbaum, medical historian and senior lecturer, City University of London. A regular contributor to The Observer & The Lancet, the author of five books including The Pandemic Century: One Hundred Years of Panic, Hysteria, and Hubris (New York and London: Norton; Hurst, 2019), The Fever Trail: In Search of the Cure for Malaria (Farrar Straus Giroux, 2002), and Living With Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918 (Macmillan, 2009), which was longlisted for the Royal Society science book of the year in 2009. A specialist in the history of pandemics and infectious disease, his academic work combines insights from the medical and environmental humanities and the philosophy and sociology of science. His current research focuses on the phenomenon of ‘vaccine hesitancy’. Through case studies of recent vaccine controversies he seeks to understand the role that the media and partial or incomplete scientific knowledge of vaccines plays in suspicion of this valuable medical technology. He is also developing a project interrogating the phenomenon of pandemic remembrance and the tension between narrative framings of Covid-19 as a ‘crisis’ and collective experiences of grief and loss enabled by connective digital technologies.AbstractPandemics of respiratory disease have long been associated with peculiar fatigue states and an array of neurological conditions. However, in the absence of compelling biological evidence, in practice it has proved difficult to differentiate these post-viral syndromes from wider epidemiological signals and medical syndromes.Focussing on the ‘Russian influenza’ pandemic of the 1890s, this talk examines the way in which Victorian nerve doctors sought to make sense of the peculiar nervous sequelae that trailed the pandemic. These sequels included nerve exhaustion, psychosis, insomnia and fatigue and, as with Long Covid, provoked disquisitions and disputes inThe Lancetand other medical journals.Unlike Long Covid, however, men were more likely to fall prey to these syndromes than women. The result was that rather than stigmatizing male sufferers as malingerers, Victorian neurologists provided a functional diagnosis, the ‘psychoses of influenza’. Drawing on notions of ‘overwork’ and ‘overworry’ and theories of entropy, the psychoses closely resembled neurasthenia and, I argue, provided a similarly acceptable label for a spectrum of somatic and psychosomatic disorders.
12 Neuromodulation of intracranial physiological recordings and behaviour
Authors: Voon Valerie 
Published: December 2022

Valerie runs research groups across Cambridge and Shanghai and holds professorships at Cambridge University and Fudan University. She is the current president of the BNPA. She focuses on interventional psychiatry anchored on mechanisms underlying self-control and repetitive behaviours relevant to addictions and compulsivity. Her research group focuses on identifying anatomical and functional biomarkers sensitive to invasive and non-invasive leading towards precision neuromodulation.AbstractDeep brain stimulation is effective for treatment of refractory movement disorders and obsessive compulsive disorder with increasing interest in targeting neuropsychiatric disorders. This talk asks how we might optimize stimulation parameters and targeting to shift behavioural outcomes. I discuss physiological substrates underlying negative emotional processing, anticipation of reward and loss, and risk taking recorded using intracranial electrodes across a network from deep brain stimulation and stereotactic electroencephalography. I address how stimulation at specific frequencies might influence behavioural measures. These studies provide insight underlying the physiological network of these cognitive processes and ultimately leading towards optimizing neuromodulation parameters to treat clinical psychiatric disorders.
15 Attenuated heart-brain integration predicts functional non-epileptic seizures
Authors: Elkommos Samia , Martin-Lopez David , Koreki Akihiro , Jolliffe Claire , Mula Marco , Critchley Hugo , Edwards Mark , Garfinkel Sarah , Richardson Mark P , Yogarajah Mahinda 
Published: December 2022

Objectives/AimsPatients with functional seizures (FS) can experience dissociation (depersonalisation) before their seizures. Depersonalisation encompasses a feeling of disembodiment, putatively caused by reduced afferent visceral mapping, that is, changes in interoceptive processing. The heartbeat-evoked potential (HEP) is an electroencephalographic (EEG) index of synchronised neural responses to individual heartbeats, and a marker interoceptive representation. HEP amplitude is reported to be reduced in patients with depersonalisation-derealisation disorder. The objective of this study was to assess whether alterations in interoceptive processing indexed by the HEP occur prior to FSs, and compare this with epileptic seizures (ES).MethodsHEP amplitudes were calculated from EEG during video-EEG monitoring in 25 patients with FS and 19 patients with ES, and compared between interictal and preictal states. HEP amplitudes were calculated at frontal and central EEG electrodes. HEP amplitude difference was calculated as a composite measure of preictal HEP amplitude minus interictal HEP amplitude. A Receiver Operating Characteristic (ROC) curve analysis was later used to evaluate the diagnostic performance of the HEP amplitude difference measure in discriminating functional cases from epilepsy cases.ResultsThe FS group demonstrated a significant reduction in HEP amplitude between interictal and preictal states at F8 (effect size rB=0.612, p=0.006) and C4 (rB=0.600, p=0.007). No differences in HEP amplitude were found between interictal and preictal states in the ES group. Between diagnostic groups, HEP amplitude difference was significantly different between the FS and ES group at C4 (rB=0.457, p=0.009) and F8 (rB=0.423, p=0.017). These findings were not related to heart rate, mean ECG or QRS amplitudes, which did not differ between interictal/preictal states, or groups. There was no difference in age between FS and ES groups, however there were a greater proportion of females compared to males in the FS group as compared to the ES group. Using HEP amplitude difference at frontal and central electrodes plus sex as variables, the ROC curve demonstrated an area under the curve (AUC) of 0.893, with sensitivity=0.840 and specificity=0.842 (p=0.000).ConclusionsOur data support the notion that aberrant interoception underpins disembodiment prior to dissociative FS. Changes in HEP amplitude may therefore reflect a neurophysiological biomarker of FS. HEP amplitude difference between interictal and preictal states may have diagnostic utility in differentiating FS and ES.
19 Group psychotherapy/guided self help for patients with FNSD awaiting in-patient MDT programme treatment: a pilot study
Authors: Boico Vasile , Humblestone Susan , Moutoussis Michael , Selai Caroline 
Published: December 2022

BackgroundThe 4-week in-patient Multi-Disciplinary Team Service at Queen Square for patients with Functional Neurological Symptom Disorder (FNSD) has input from Neuropsychiatrists, Occupational Therapists, Physiotherapists, Cognitive Behavioural Therapists, and specialist nursing staff.The Queen Square Guided Self-Help (QGSH) was developed as a brief therapeutic intervention, which aims to ensure that, prior to admission, the patient understands (a) the diagnosis of FNSD and how their own diagnosis has been reached; (b) rehabilitation therapy, both physical and psychological, and (c) the use of goal setting in rehabilitation.The QGSH is a course of Internet-based guided self-help. It runs for up to 12 weeks and includes original videos and patient worksheets, as well as signposting to existing published resources. It involves therapists guiding the patient to use a range of psychoeducational resources and facilitating therapy activities, supported by one-to-one contact via email or phone-calls.With the emergence of the covid pandemic and the first lockdown (March 2020) plus the growing patient waiting lists, we decided to offer the QGSH (i) remotely via zoom (ii) to groups of patients instead of individuals. This required a complete review of the QGSH goals, format, aims and objectives which resulted in a number of modifications including extensive revisions to the current materials.Aim of this studyWe present a service evaluation of the first 8 months of running QGSH therapy groups remotely on zoom.Results(1) We present the modifications we made to the existing QGSH materials which were finalised in April 2021.(2) In the period 11-May-2021 to 31-Jan-2022 we ran three groups with a total of 16 participants.(3) We present challenges and advantages from the perspective of the patients and from the perspective of the QGSH therapists.(4) Drawing on the published literature (Rogers, Yalom) plus our experiences as senior therapists, we outline the specialist knowledge, skills and competencies required to run a therapeutic group with patients with FNSD.DiscussionFeedback from the patients who participated in the groups was overwhelmingly positive. From the patients’ comments, the group furnished 8/11 of Yalom’s curative factors. We outline our plans for the future development of the QGSH preparatory therapy and a new initiative: the development of a ‘stand-alone’ group therapy for patients with FNSD.
27 Prevalence of lower urinary tract dysfunction in consecutive patients attending a tertiary referral functional neurological disorders clinic in Edinburgh
Authors: Wittingham Charlotte , Hoeritzauer Ingrid , Barr Megan 
Published: December 2022

Objectives/AimsFunctional neurological disorders are the second most common reason for outpatient review by a neurologist. The frequency of lower urinary tract symptoms in functional neurological disorders has not been described.Our aim was to carry out a deep phenotyping of patients diagnosed with functional motor and/or dissociative symptoms and to record the prevalence of lower urinary tract dysfunction.MethodsA retrospective notes review was undertaken involving consecutive patients attending a specialist functional neurological disorders clinic in Edinburgh between October 2019-February 2020 for non-urological presentation.ResultsIn a one hundred and fifty-eight patient cohort, 78% of patients were female (n=123) and the mean age was 42. When categorising predominant functional symptoms, 52% of patients had a purely motor disorder (n=82), 17% of patients had a dissociative disorder alone (n=27) and 31% a mixed motor and dissociative disorder (n=49). Fifty percent of patients reported urinary symptoms (n=79). In total, 28% reported storage symptoms (n=45), 9% voiding symptoms (n=15), and 9% had mixed storage and voiding symptoms (n=15).15% of patients attended a specialist clinic regarding their urinary symptoms (n= 23).Patients with a motor disorder had the highest prevalence of lower urinary tract dysfunction (56%) and the dissociative group the lowest (26%). Storage symptoms were the most prevalent symptom (35% in motor, 15% in dissociative, 24% in mixed) and patients with storage or mixed LUTS were most likely to have a motor disorder (n=29, 64%; n=12, 80%), whereas those with voiding symptoms were more likely to have mixed functional neurological symptoms (n=10, 67%).20% of patients reported urinary retention and/or voiding dysfunction (n = 32). 100% of these patients had motor or mixed symptoms.11% of patients reported urinary retention (n=17) comprising 14 females and 3 men, with an average age of 36.4. 59% of patients with urinary retention were on opioid medication.Conclusions50% of patients with functional neurological disorders report lower urinary tract dysfunction however just 15% of patients attended a specialist clinic regarding their urinary symptoms.This research has provided an insight into the potential associations between urological symptoms and functional neurology and may impact or change future management.
30 Dissociation and its biological and clinical correlates in functional neurological disorder: a systematic review and meta-analysis
Authors: Campbell Malcolm C , Smakowski Abigail , Rojas-Aguiluz Maya , Goldstein Laura H , Cardeña Etzel , Nicholson Timothy R , Reinders Antje ATS , Pick Susannah 
Published: December 2022

Objectives/AimsDissociation is a potential mechanism in FND. Although scientific studies report elevated rates of dissociative symptoms in FND, a systematic assessment of the biological and clinical correlates of dissociation in FND is lacking. We aimed to systematically review the current evidence describing dissociative symptoms and disorders in functional neurological disorder (FND), and additionally conduct a meta-analysis of dissociative symptom severity in FND. We also aimed to synthesise the existing data on biological and clinical correlates of dissociation in FND.MethodsWe systematically searched Embase, PsycINFO, and Medline, combining terms for FND and dissociation. Studies were eligible for inclusion if reporting on dissociative symptom scale scores or rates of dissociative disorder in FND samples. Studies were appraised for methodological quality using modified Newcastle-Ottawa criteria. Findings pertaining to dissociative symptoms or disorders, as well as biological and clinical correlates of dissociation in FND samples, were synthesised qualitatively. Dissociative symptom scores were included in a meta-analysis using random and mixed effects models.ResultsTwo-thousand and eighty-eight records were screened and seventy-nine studies were included in the final review. Dissociative symptoms were elevated in FND. The meta-analysis demonstrated a significant elevation in dissociation in FND samples relative to neurological and healthy controls, but not psychiatric controls. Dissociative disorders were frequently co-morbid in FND samples. Psychoform (cognitive) dissociation was more prominent in FND-seizures, whereas somatoform (physical) dissociation tended to be more prominent in FND-motor symptom samples. Dissociation was associated with FND symptom severity or frequency, general psychopathology, and reduced quality of life. Biological correlates of elevated dissociation included structural and functional brain alterations in regions that have previously been implicated in FND, such as the anterior cingulate cortex.ConclusionsDissociative symptoms and disorders are common in FND, and different FND subgroups appear to endorse varying degrees of psychoform or somatoform dissociation. Presence of dissociative symptoms in FND is associated with adverse clinical features; there is therefore a clinical need to assess patients with FND for dissociative symptomatology and to address these symptoms during treatment. Future research should examine dissociation further in different FND subgroups, using measures that distinguish between different types of dissociation, alongside measures of underlying pathophysiology.
33 The link between migraine and functional neurological disorder
Authors: Nash Will , Bavington Jasmine , Coeburgh Jan 
Published: December 2022

Objective/AimsTo determine the prevalence of migraine in functional neurological disorder (FND) (data still to collect). Of which patients with concomitant migraine and FND, what proportion ofpatients have adequate migraine treatment and prophylaxis.MethodsPatient data was collected from clinic letters, ‘migraine’ was cross referenced across all electronic clinic letters from a regional functional neurology clinic between 2018–2019.The number of patients with and without holistic migraine treatment, appropriate attack treatment and prophylactic treatment was recorded. The predisposing, precipitating and perpetuating factors for patients’ FND was also recorded.By cross referencing ‘functional neurological disorder’ across the electronic clinic letters over the same period then prevalence data was obtained (data still to collect)Results50 patients with FND over the study period were identified to have a history of migraine, with 48 reporting active migraine and 2 reporting previous migraine.Of these 39 had inadequate attack treatment, and 31 had inadequate migraine prophylaxis.Migraine is a predisposing, precipitating and largely a perpetuating factor in 6, 8 and 24 FND patients respectively.Migraine as a contributing perpetuating factor for FND in 24 patients was more common than other factors: 6 patients had anxiety, 5 patients had a mood disorder, and 3 patients had a traumatic life event.ConclusionsThere is minimal literature on the link between undertreated migraine and functional neurological disorder.These results suggest an overall lack of treatment control of migraine in FND patients.Seeing as migraine can play a role in predisposing, precipitating and perpetuating migraine it shows the importance of treating FND patients holistically.It shows the importance of early detection, asking FND patients about migraine symptoms and ensuring treatment regimens are in place.In the future, larger scale research into the link between migraine and FND will improve patient quality of life and how we treat functional neurological disorders.
34 A systematic review comparing symptomaticity and markers of interoception in patients with functional seizures, and dual diagnosis epilepsy with functional seizures
Authors: Kandasamy Rohan , May Felix , Yogarajah Mahinda 
Published: December 2022

Introduction/ObjectivesComorbid/dual diagnosis (DD) epilepsy (ES) and functional seizures (FS) occur at a significant rate in adult populations but it is not known whether the underlying mechanism or aetiological models are similar to patients with FS alone. We conducted a systematic review of patients with dual diagnosis to understand more about underlying mechanisms and natural history, in comparison to patients with FS only.MethodsThe search strategy used the PRESS (Peer Review of Electronic Search Strategies) 2015 evidence-based checklist. We selected papers from MEDLINE, APA PsychInfo, and Google Scholar with search terms to identify primary research, on comorbid epilepsy and functional seizures confirmed by video EEG/telemetry, excluding people younger than 18 or over 75, and not including studies on populations with learning difficulties. Papers from the last 30 years were examined. Case reports were excluded. Papers were summarised by two authors and results corroborated.Results116 papers (with 1854 participants) were included. Studies indicated patients with DD and FS were similar in the pre-ictal changes to heart-rate variability. Both showed similar degrees of suggestibility and similar semiology. Both had similar levels of, and features of, dissociation during FS. Studies identified differences in the psychiatric profile between these groups, and of symptom burden and comorbidities, especially somatovisceral disorders (e.g. irritable bowel, headache, gastro-oesophageal reflux, or pain) which were more common in patients with FS than patients with DD.Discussion/ConclusionBayesian models of perception have been explored in functional conditions (Edwards, 2012),1suggesting functional symptoms emerge due to a disorder of bodily priors. Recent work on interoception seeks to characterise the contribution of these bodily afferent signals and explore a role of dysregulation in aetiology of FS and functional conditions in general.Our findings suggest that, in the lead up to and during events, patients with DD and FS both experience disordered interoception as indexed by the development of subjective bodily symptoms, and objective changes in autonomic tone (changes in heart-rate variability). Interictally, however, patients with a dual diagnosis are less likely to report other generalised functional symptoms, compared to those with FS alone. Our findings suggest potentially different underlying mechanisms within a Bayesian framework. In patients with FS alone there may be a generalised disorder of hyper-precise bodily priors, while in DD patients the primary problem may be one of excessive attention to bottom-up bodily afferent signals and phenomena linked to their epilepsy.ReferenceMark J Edwards, Rick A Adams, Harriet Brown, Isabel Pareés, Karl J Friston. A Bayesian account of ‘hysteria’,Brain2012;135(11): 3495–3512, https://doi.org/10.1093/brain/aws129