Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.15
N. O'Connell, T. Nicholson, S. Wessely, A. David
Objective Studies on motor functional neurological disorder (mFND) often originate in neurology settings and are characterised by low sample sizes, and lack control groups. There are few prescription guidelines and no gold standard treatments. This study aims to establish mFND patients’ socio-demographic and clinical characteristics, medication prescription patterns and patients’ responses to outpatient cognitive behavioural therapy (CBT). Methods This is a retrospective case-control study of mFND patients in contact with secondary mental health services in South London and Maudsley (SLaM) NHS Foundation Trust between 2006 and 2016. Data were obtained from anonymous electronic health records using the ‘Clinical Records Interactive Search’ (CRIS) database. Data were extracted on socio-demographic, clinical and medication variables. Control patients were a random sample of contemporaneous psychiatric patients treated within the same Trust and were matched at a ratio of 1:2. In a separate study, we employed these methods to identify mFND patients who attended an outpatient neuropsychiatry CBT clinic in SLaM, comparing therapeutic outcomes in mFND to patients with organic neuropsychiatric disorders (ONP) treated in the same clinic. Results Our search returned 322 mFND and 644 control patients. Weakness was the most common functional symptom. mFND patients were more likely to be female, British, married, employed pre-morbidly, to have a carer and a physical health condition, but less likely to have had an inpatient psychiatric admission or to receive benefits. There was no difference in rates of childhood sexual and physical abuse between groups. A lower proportion of mFND patients received medication compared to controls (76.6% v. 83.4%, p Conclusions mFND patients have a distinct socio-demographic profile and are prescribed a heterogeneous array of psychotropic and somatic medications. mFND patients treated in a specialist CBT clinic show similar improvements in psychological functioning to patients with organic neuropsychiatric disorders. This study establishes the socio-demographic profile of this under-studied patient group and could help guide the development of future therapeutic interventions and inform the design of a pilot RCT.
{"title":"15 Motor Functional Neurological Disorder (MFND) in a large UK mental health service: clinical characteristics, medication prescription and response to outpatient cognitive behavioural therapy","authors":"N. O'Connell, T. Nicholson, S. Wessely, A. David","doi":"10.1136/JNNP-2019-BNPA.15","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.15","url":null,"abstract":"Objective Studies on motor functional neurological disorder (mFND) often originate in neurology settings and are characterised by low sample sizes, and lack control groups. There are few prescription guidelines and no gold standard treatments. This study aims to establish mFND patients’ socio-demographic and clinical characteristics, medication prescription patterns and patients’ responses to outpatient cognitive behavioural therapy (CBT). Methods This is a retrospective case-control study of mFND patients in contact with secondary mental health services in South London and Maudsley (SLaM) NHS Foundation Trust between 2006 and 2016. Data were obtained from anonymous electronic health records using the ‘Clinical Records Interactive Search’ (CRIS) database. Data were extracted on socio-demographic, clinical and medication variables. Control patients were a random sample of contemporaneous psychiatric patients treated within the same Trust and were matched at a ratio of 1:2. In a separate study, we employed these methods to identify mFND patients who attended an outpatient neuropsychiatry CBT clinic in SLaM, comparing therapeutic outcomes in mFND to patients with organic neuropsychiatric disorders (ONP) treated in the same clinic. Results Our search returned 322 mFND and 644 control patients. Weakness was the most common functional symptom. mFND patients were more likely to be female, British, married, employed pre-morbidly, to have a carer and a physical health condition, but less likely to have had an inpatient psychiatric admission or to receive benefits. There was no difference in rates of childhood sexual and physical abuse between groups. A lower proportion of mFND patients received medication compared to controls (76.6% v. 83.4%, p Conclusions mFND patients have a distinct socio-demographic profile and are prescribed a heterogeneous array of psychotropic and somatic medications. mFND patients treated in a specialist CBT clinic show similar improvements in psychological functioning to patients with organic neuropsychiatric disorders. This study establishes the socio-demographic profile of this under-studied patient group and could help guide the development of future therapeutic interventions and inform the design of a pilot RCT.","PeriodicalId":347713,"journal":{"name":"Members’ Platform Presentations","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127247482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.17
M. Yogarajah, A. Koreki, N. Agrawal, Sarah R. Cope, T. Eilon, C. G. Praag, S. Garfkinel, H. Critchley, M. Mula, M. Edwards
Objectives The continuity and integrity of a conscious sense of self, is proposed to be dependent upon the control of internal physiological state and its predictive representation through interoception, that is, the sensing of internal bodily changes. We investigated dissociation, interoception and their relationship, in patients with functional seizures (FS), before and after a stressor intervention. Methods 41 participants with functional seizures (FS) and 30 age/gender matched healthy controls (HC) were assessed with the somatoform dissociation questionnaire (SDQ20), multi-scale dissociation inventory (MDI), and the state and trait anxiety inventory (STAI). Standardized measures of interoceptive sensibility, accuracy, and awareness were acquired with the Porges Body Perception Questionnaire (PBPQ), and heartbeat discrimination (HDT), tracking (HTT) and time-tracking tasks (TTT), before and after a cold pressor test. Continuous non-invasive blood pressure monitoring was carried out before, during and after the cold pressor test. Interoceptive trait (ITPE) and state (ISPE) prediction errors, that is, the discrepancy between interoceptive accuracy and the PBPQ (trait), and trial-by-trial confidence estimates (state), were calculated before and after the cold pressor test respectively, for HTT and HDT. An autonomic prediction error (APE), or the discrepancy between the reported increase in pain and the change in blood pressure after the cold pressor, was also calculated. Results Patients with FS differ significantly from HC for HTT, ITPE and ISPE suggesting that they are overall less interoceptively accurate and aware than HC. This is confirmed by a correlation between APE and the ISPE derived from the HDT task (r=0.359, p=0.033) in FS subjects only, after correcting for state anxiety and duration of cold pressor. Furthermore, in FS patients only, ITPE scores, adjusted for trait anxiety, correlated with SDQ-20 and MDI-depersonalization scores for both HTT (r=0.378, p=0.008; r=0.408, p=0.005) and HDT (r=0.364, p=0.011; r=0.281, p=0.044). All results survived FDR correction at a 0.05 threshold. Conclusions These findings demonstrate that state and trait interoception are disrupted in patients with FS. The severity of the disruption in trait interoception correlates with measures of dissociation, such that the bigger the ITPE, the more severe are the dissociative traits. Similarly, the greater the ISPE, the larger the discrepancy between subjective symptoms and objective physiological changes, after a stressor intervention. Our findings suggest that the selective disruption of interoceptive processing is both a potential predisposing and precipitating factor in FS.
{"title":"17 State and trait interoception is disrupted in functional seizures","authors":"M. Yogarajah, A. Koreki, N. Agrawal, Sarah R. Cope, T. Eilon, C. G. Praag, S. Garfkinel, H. Critchley, M. Mula, M. Edwards","doi":"10.1136/JNNP-2019-BNPA.17","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.17","url":null,"abstract":"Objectives The continuity and integrity of a conscious sense of self, is proposed to be dependent upon the control of internal physiological state and its predictive representation through interoception, that is, the sensing of internal bodily changes. We investigated dissociation, interoception and their relationship, in patients with functional seizures (FS), before and after a stressor intervention. Methods 41 participants with functional seizures (FS) and 30 age/gender matched healthy controls (HC) were assessed with the somatoform dissociation questionnaire (SDQ20), multi-scale dissociation inventory (MDI), and the state and trait anxiety inventory (STAI). Standardized measures of interoceptive sensibility, accuracy, and awareness were acquired with the Porges Body Perception Questionnaire (PBPQ), and heartbeat discrimination (HDT), tracking (HTT) and time-tracking tasks (TTT), before and after a cold pressor test. Continuous non-invasive blood pressure monitoring was carried out before, during and after the cold pressor test. Interoceptive trait (ITPE) and state (ISPE) prediction errors, that is, the discrepancy between interoceptive accuracy and the PBPQ (trait), and trial-by-trial confidence estimates (state), were calculated before and after the cold pressor test respectively, for HTT and HDT. An autonomic prediction error (APE), or the discrepancy between the reported increase in pain and the change in blood pressure after the cold pressor, was also calculated. Results Patients with FS differ significantly from HC for HTT, ITPE and ISPE suggesting that they are overall less interoceptively accurate and aware than HC. This is confirmed by a correlation between APE and the ISPE derived from the HDT task (r=0.359, p=0.033) in FS subjects only, after correcting for state anxiety and duration of cold pressor. Furthermore, in FS patients only, ITPE scores, adjusted for trait anxiety, correlated with SDQ-20 and MDI-depersonalization scores for both HTT (r=0.378, p=0.008; r=0.408, p=0.005) and HDT (r=0.364, p=0.011; r=0.281, p=0.044). All results survived FDR correction at a 0.05 threshold. Conclusions These findings demonstrate that state and trait interoception are disrupted in patients with FS. The severity of the disruption in trait interoception correlates with measures of dissociation, such that the bigger the ITPE, the more severe are the dissociative traits. Similarly, the greater the ISPE, the larger the discrepancy between subjective symptoms and objective physiological changes, after a stressor intervention. Our findings suggest that the selective disruption of interoceptive processing is both a potential predisposing and precipitating factor in FS.","PeriodicalId":347713,"journal":{"name":"Members’ Platform Presentations","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116090758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.16
A. Mandali, Arjun Sethi, N. Harrison, V. Voon
Introduction Methylphenidate (MPH) is one of most commonly prescribed drug to patients with Attention Deficit Hyperactivity Disorder (ADHD). While MPH has been known to improve executive functions, its effect on impulsivity, one of the cardinal symptoms in ADHD has mixed findings in part depending on baseline. Data driven computational models such as drift diffusion model utilize behavioural measures to explain subtle changes that are not sensitive to traditional analysis. Here, we aim to analyse risk preference in ADHD and healthy controls and the effects of MPH. Methods Twenty-four healthy volunteers and 25 ADHD patients were tested on the 2 step sequential learning task in both MPH-ON and MPH-OFF conditions. We calculated the risk associated with each choice (variance of reward probability) and defined the choice with maximum variance as the risky one, for all 134 trials. With behavioural measures (selected choice- risky vs non-risky and response time) as inputs and risk as an independent factor, we extracted threshold (a), drift rate (v) and response bias (z) parameters using a hierarchical drift diffusion model (HDDM) for both groups during ON and OFF drug condition. Statistical analysis on the parameters was analysed using Bayesian factors. Results Bayesian repeated measures ANOVA showed evidence for changes in response bias (z) but not in threshold and drift rate. A strong evidence for main effect of drug(BF10=6.03×1011), group(BF10=86344) and group by drug interaction(BF10=3.65×106) was observed. Post-hoc Bayesian independent sample t-tests showed strong evidence that the patient group had a higher preference towards the risky choice during both the ON (BF10=8.94×1014) and OFF (BF10=20.9) conditions. Post-hoc Bayesian paired sample t-tests showed strong evidence for the drug to induce a preference towards the risky choice in both the HV(BF10=397.1) and ADHD(BF10=1.16×1010) population. Behavioural results show a drug by group interaction (F(1,0.01)=11.80, p=0.001) on number of risky choices. Post-hoc analysis using paired sample t-test showed a significant increase in risky behaviour due to drug in the ADHD(t(24)= −3.5, p Conclusions Using a novel analysis, we showed that ADHD subjects had a greater bias towards risk preference and further that MPH increases risk preference in both ADHD and HV with a comparatively greater effect on the patient population. Critically we observe an effect on response bias highlighting the role of apriori information in influencing risky decision making.
{"title":"16 Effect of methylphenidate on risk preference in attention deficit hyperactivity disorder","authors":"A. Mandali, Arjun Sethi, N. Harrison, V. Voon","doi":"10.1136/JNNP-2019-BNPA.16","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.16","url":null,"abstract":"Introduction Methylphenidate (MPH) is one of most commonly prescribed drug to patients with Attention Deficit Hyperactivity Disorder (ADHD). While MPH has been known to improve executive functions, its effect on impulsivity, one of the cardinal symptoms in ADHD has mixed findings in part depending on baseline. Data driven computational models such as drift diffusion model utilize behavioural measures to explain subtle changes that are not sensitive to traditional analysis. Here, we aim to analyse risk preference in ADHD and healthy controls and the effects of MPH. Methods Twenty-four healthy volunteers and 25 ADHD patients were tested on the 2 step sequential learning task in both MPH-ON and MPH-OFF conditions. We calculated the risk associated with each choice (variance of reward probability) and defined the choice with maximum variance as the risky one, for all 134 trials. With behavioural measures (selected choice- risky vs non-risky and response time) as inputs and risk as an independent factor, we extracted threshold (a), drift rate (v) and response bias (z) parameters using a hierarchical drift diffusion model (HDDM) for both groups during ON and OFF drug condition. Statistical analysis on the parameters was analysed using Bayesian factors. Results Bayesian repeated measures ANOVA showed evidence for changes in response bias (z) but not in threshold and drift rate. A strong evidence for main effect of drug(BF10=6.03×1011), group(BF10=86344) and group by drug interaction(BF10=3.65×106) was observed. Post-hoc Bayesian independent sample t-tests showed strong evidence that the patient group had a higher preference towards the risky choice during both the ON (BF10=8.94×1014) and OFF (BF10=20.9) conditions. Post-hoc Bayesian paired sample t-tests showed strong evidence for the drug to induce a preference towards the risky choice in both the HV(BF10=397.1) and ADHD(BF10=1.16×1010) population. Behavioural results show a drug by group interaction (F(1,0.01)=11.80, p=0.001) on number of risky choices. Post-hoc analysis using paired sample t-test showed a significant increase in risky behaviour due to drug in the ADHD(t(24)= −3.5, p Conclusions Using a novel analysis, we showed that ADHD subjects had a greater bias towards risk preference and further that MPH increases risk preference in both ADHD and HV with a comparatively greater effect on the patient population. Critically we observe an effect on response bias highlighting the role of apriori information in influencing risky decision making.","PeriodicalId":347713,"journal":{"name":"Members’ Platform Presentations","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129295197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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