Pub Date : 2019-05-01DOI: 10.1136/JNNP-2019-BNPA.29
Berry Aj, D. Kelsey, R. Mitchell, R. Taylor
Objectives/Aims Traumatic brain injury (TBI) is highly prevalent in prison populations, but little is known about TBI prevalence amongst mentally disordered offenders in secure settings. The North London Forensic Service (NLFS) is a tertiary forensic secure psychiatric service, serving a catchment population of over 1.4 million. We aimed to estimate the point-prevalence of head injury amongst inpatients at NLFS, and audit the quality of documentation of head injury. Method We performed a retrospective case note review of the NLFS electronic records system to identify all documented head injuries in all NLFS inpatients on a selected day. To increase detection, we reviewed neuroradiology reports, and medical records were electronically screened for the following text-strings: ‘brain injury’, ‘TBI’, ‘head injury’, ‘road traffic accident’, ‘loss of consciousness’, ‘LOC’, ‘concussion’, ‘MRI’, ‘GCS’ and ‘boxing’. For each injury identified, we assessed whether amnesia and altered consciousness at the time of the injury were documented, in line with established criteria for assessing severity of TBI (Department of Veterans Affairs/Department of Defence criteria). Injury mechanism and date, patient age, and admission length were recorded. Authors AJB and RM co-rated the findings, and disagreements were resolved by consulting a third party. Results 100% of inpatient records were screened (n=194, 6% female, 94% male, mean age 40.2 years). 58 documented head injuries were identified, involving 50 patients (25.8%). 43 head injuries occurred prior to admission to NLFS. 16 patients (8.2%) had head injuries associated with clearly documented impairment of consciousness and/or amnesia, suggestive of TBI. 13.7% of all recorded head injuries included explicit documentation of both consciousness level and amnesia (33% when limited to head injuries occurring during admission to NLFS). The most common identified mechanism was assault (n=30). Mean admission length was 1306 days, and was not significantly different in patients with a history of head injury (p=0.825, Mann-Whitney U ). 34% of inpatients had undergone neuroimaging. Abnormalities were identified in 32% of reports, with leukoaraiosis and generalised cerebral involutional changes being most frequently reported. Conclusion These findings highlight a local need to improve quality of documentation in assessment of patients with head injuries, and provide an estimate of point-prevalence of head injury and TBI at NLFS. The high frequency of assault observed in our sample is comparable to previously published findings in prison populations.
{"title":"29 Assessing point-prevalence and documentation of head injury in the north London forensic service","authors":"Berry Aj, D. Kelsey, R. Mitchell, R. Taylor","doi":"10.1136/JNNP-2019-BNPA.29","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.29","url":null,"abstract":"Objectives/Aims Traumatic brain injury (TBI) is highly prevalent in prison populations, but little is known about TBI prevalence amongst mentally disordered offenders in secure settings. The North London Forensic Service (NLFS) is a tertiary forensic secure psychiatric service, serving a catchment population of over 1.4 million. We aimed to estimate the point-prevalence of head injury amongst inpatients at NLFS, and audit the quality of documentation of head injury. Method We performed a retrospective case note review of the NLFS electronic records system to identify all documented head injuries in all NLFS inpatients on a selected day. To increase detection, we reviewed neuroradiology reports, and medical records were electronically screened for the following text-strings: ‘brain injury’, ‘TBI’, ‘head injury’, ‘road traffic accident’, ‘loss of consciousness’, ‘LOC’, ‘concussion’, ‘MRI’, ‘GCS’ and ‘boxing’. For each injury identified, we assessed whether amnesia and altered consciousness at the time of the injury were documented, in line with established criteria for assessing severity of TBI (Department of Veterans Affairs/Department of Defence criteria). Injury mechanism and date, patient age, and admission length were recorded. Authors AJB and RM co-rated the findings, and disagreements were resolved by consulting a third party. Results 100% of inpatient records were screened (n=194, 6% female, 94% male, mean age 40.2 years). 58 documented head injuries were identified, involving 50 patients (25.8%). 43 head injuries occurred prior to admission to NLFS. 16 patients (8.2%) had head injuries associated with clearly documented impairment of consciousness and/or amnesia, suggestive of TBI. 13.7% of all recorded head injuries included explicit documentation of both consciousness level and amnesia (33% when limited to head injuries occurring during admission to NLFS). The most common identified mechanism was assault (n=30). Mean admission length was 1306 days, and was not significantly different in patients with a history of head injury (p=0.825, Mann-Whitney U ). 34% of inpatients had undergone neuroimaging. Abnormalities were identified in 32% of reports, with leukoaraiosis and generalised cerebral involutional changes being most frequently reported. Conclusion These findings highlight a local need to improve quality of documentation in assessment of patients with head injuries, and provide an estimate of point-prevalence of head injury and TBI at NLFS. The high frequency of assault observed in our sample is comparable to previously published findings in prison populations.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"14 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":"130082299","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.37
N. O'Connell, G. Watson, Clare Grey, Rosa Pastena, K. McKeown, A. David
Objectives There is no gold standard treatment for functional neurological disorder, motor type (mFND). Cognitive behavioural therapy (CBT) is effective in the treatment of certain somatoform disorders. This study aims to evaluate the characteristics and outcomes of mFND patients receiving CBT in a neuropsychiatry outpatient clinic. Method We utilise a large psychiatric register to assess all mFND patients receiving outpatient CBT in a neuropsychiatric clinic between 2006 and 2011. We assess socio-demographic characteristics, changes in physical and psychological outcomes using standardised rating scales, and rates of CBT uptake and dropout. We compare mFND patients to patients with psychiatric and behavioural manifestations of organic neuropsychiatric diseases treated in the same clinic (ONP patients). Results The most common reasons for patients not accepting a CBT referral were referral to the Trust’s inpatient neuropsychiatry ward, or non-attendance at assessment or treatment sessions. We identified a total of 98 patients with mFND and 76 ONP patients treated with CBT. 56.1% of mFND and 56.6% of ONP patients attended all sessions offered. There were no socio-demographic characteristics associated with mFND patients who completed all therapy sessions versus those who dropped out early. Compared to controls, mFND patients were more likely to be female (72.4% v. 44.7%, χ2: 13.6, 95% CI: 12.2–41.9, p=0.001), unemployed (52.6% versus 35.5%, χ2: 5, 95% CI: 2.2–30.8, p=0.03), to have a carer (27.6% versus 14.3%, χ2: 4.4, 95% CI: 0.9–24.7, p=0.04) and to have experienced child sexual abuse (23.8% v 8.2%, χ2: 7.3, p=0.01). The most common mFND symptom was weakness (26.9%), most frequently in the leg or entire body. Both mFND and ONP patients showed significant improvements in measures of psychological functioning (measured with the CORE-OM, HoNOS-ABI, and PHQ-9), with physical symptoms improving in 49.4% of mFND patients. A logistic regression showed acceptance of psychological formulations prior to CBT (p Conclusions mFND patients treated in a specialist CBT clinic show similar improvements in physical and psychological functioning to ONP patients with positive effects on motor symptoms, distress, depression, general health and social functioning. With little evidence on the effectiveness of CBT in treating motor variants of FND, this study could help inform the design of a pilot RCT.
{"title":"37 Outpatient cognitive behavioural therapy for ‘functional’ and ‘organic’ neuropsychiatric disorders: a retrospective case control comparison","authors":"N. O'Connell, G. Watson, Clare Grey, Rosa Pastena, K. McKeown, A. David","doi":"10.1136/JNNP-2019-BNPA.37","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.37","url":null,"abstract":"Objectives There is no gold standard treatment for functional neurological disorder, motor type (mFND). Cognitive behavioural therapy (CBT) is effective in the treatment of certain somatoform disorders. This study aims to evaluate the characteristics and outcomes of mFND patients receiving CBT in a neuropsychiatry outpatient clinic. Method We utilise a large psychiatric register to assess all mFND patients receiving outpatient CBT in a neuropsychiatric clinic between 2006 and 2011. We assess socio-demographic characteristics, changes in physical and psychological outcomes using standardised rating scales, and rates of CBT uptake and dropout. We compare mFND patients to patients with psychiatric and behavioural manifestations of organic neuropsychiatric diseases treated in the same clinic (ONP patients). Results The most common reasons for patients not accepting a CBT referral were referral to the Trust’s inpatient neuropsychiatry ward, or non-attendance at assessment or treatment sessions. We identified a total of 98 patients with mFND and 76 ONP patients treated with CBT. 56.1% of mFND and 56.6% of ONP patients attended all sessions offered. There were no socio-demographic characteristics associated with mFND patients who completed all therapy sessions versus those who dropped out early. Compared to controls, mFND patients were more likely to be female (72.4% v. 44.7%, χ2: 13.6, 95% CI: 12.2–41.9, p=0.001), unemployed (52.6% versus 35.5%, χ2: 5, 95% CI: 2.2–30.8, p=0.03), to have a carer (27.6% versus 14.3%, χ2: 4.4, 95% CI: 0.9–24.7, p=0.04) and to have experienced child sexual abuse (23.8% v 8.2%, χ2: 7.3, p=0.01). The most common mFND symptom was weakness (26.9%), most frequently in the leg or entire body. Both mFND and ONP patients showed significant improvements in measures of psychological functioning (measured with the CORE-OM, HoNOS-ABI, and PHQ-9), with physical symptoms improving in 49.4% of mFND patients. A logistic regression showed acceptance of psychological formulations prior to CBT (p Conclusions mFND patients treated in a specialist CBT clinic show similar improvements in physical and psychological functioning to ONP patients with positive effects on motor symptoms, distress, depression, general health and social functioning. With little evidence on the effectiveness of CBT in treating motor variants of FND, this study could help inform the design of a pilot RCT.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"9 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":"127426765","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.43
A. Mandali, R. Chaudhuri, A. Rizos, V. Voon
Introduction Dopaminergic medication being the standard therapeutic treatment improves motor symptoms in Parkinson’s disease (PD) but also implicated in the occurrence of impulse control disorders. 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 PD subjects in OFF and ON medication and the effect of dopamine on risk. Methods Sixteen patients PD patients during OFF medication and 14 during ON were tested on the 2 step sequential learning task. 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 Independent sample t-test between the 2 groups (ON vs OFF) showed a strong evidence for differences in drift rate (BF10=34.28) and response bias (BF10=1.5×1013). We did not observe any evidence for correlation between RL parameters and z for both ON and OFF condition. Behaviourally, with respect to response time, independent sample t-test showed no significance difference between time taken to make risky (t (28)=−1.28, p=ns) and non-risky choices (t (28)=−1.06, p=ns). Similarly, no difference was found for change in risky choice selection in presence of the drug (t (28)=−1.41, p=ns). No differences were found in the traditional reinforcement learning parameters between the groups. Conclusions Using a novel computational analysis, we showed that dopaminergic medication increased the preference to select a risky choice by modulating drift rate and response bias which was not captured by the behavioural measures. Critically we observe an effect on response bias highlighting the role of apriori information in influencing risky decision making.
{"title":"43 Effect of dopaminergic medication on risk preference in parkinson’s disease","authors":"A. Mandali, R. Chaudhuri, A. Rizos, V. Voon","doi":"10.1136/JNNP-2019-BNPA.43","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.43","url":null,"abstract":"Introduction Dopaminergic medication being the standard therapeutic treatment improves motor symptoms in Parkinson’s disease (PD) but also implicated in the occurrence of impulse control disorders. 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 PD subjects in OFF and ON medication and the effect of dopamine on risk. Methods Sixteen patients PD patients during OFF medication and 14 during ON were tested on the 2 step sequential learning task. 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 Independent sample t-test between the 2 groups (ON vs OFF) showed a strong evidence for differences in drift rate (BF10=34.28) and response bias (BF10=1.5×1013). We did not observe any evidence for correlation between RL parameters and z for both ON and OFF condition. Behaviourally, with respect to response time, independent sample t-test showed no significance difference between time taken to make risky (t (28)=−1.28, p=ns) and non-risky choices (t (28)=−1.06, p=ns). Similarly, no difference was found for change in risky choice selection in presence of the drug (t (28)=−1.41, p=ns). No differences were found in the traditional reinforcement learning parameters between the groups. Conclusions Using a novel computational analysis, we showed that dopaminergic medication increased the preference to select a risky choice by modulating drift rate and response bias which was not captured by the behavioural measures. Critically we observe an effect on response bias highlighting the role of apriori information in influencing risky decision making.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"31 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":"123303403","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.19
R. McCarron
Objectives/aims This research aims to: Understand the journeys and processes that parents follow in seeking help and support for post-brain injury symptoms and changes in their children. Identify the barriers and challenges that parents face in obtaining help and support for their children and family following paediatric Acquired Brain Injury (ABI). Propose ways in which services can be more responsive to the evolving needs of children and adolescents with ABI and their families. Method Five mothers were interviewed using semi-structured interviews about their experiences of seeking help and support for post-brain injury symptoms and changes in their children. The participants’ children were 60% male, 10–16 years old and were 2–6 years post injury. Four had suffered strokes and one had a Traumatic Brain Injury. The age at injury was 4–14 years old. The interviews were audio-recorded and transcribed into 2698 units of data. The data was analysed using a Glaserian grounded theory constant comparative approach. Results After a child suffers an ABI parents feel that it is down to them to ensure that their child gets the help and support that they need. Identifying and accessing support requires a high level of research and persistence that parents experience as a ‘battle’. Obtaining support for mental-health problems is especially challenging. Common barriers include communication issues, time and funding delays, a lack of consistent professionals, not meeting the criteria for services, and a lack of local or age-appropriate services. The challenges of trying to seek help and support impact upon the whole family in terms of time, finances, socially and emotionally. However, through this process parents do become expert parents/carers. They gain new knowledge and language and they look to share this to support other parents going through similar experiences. Conclusions Providing parents with accessible psychoeducation around post-brain injury symptoms and changes in the acute period following a paediatric ABI could be a helpful intervention to make parents feel more prepared and supported in the medium to long term. More specialist paediatric ABI services that can provide integrated, holistic and developmental care are needed. Current services may need a more flexible and longer-term approach to be responsive to the needs of young people with ABI.
{"title":"19 ‘nobody prepared me for this!’ parents’ experiences of seeking help and support with post-brain injury symptoms and changes in children and adolescents with acquired brain injury","authors":"R. McCarron","doi":"10.1136/JNNP-2019-BNPA.19","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.19","url":null,"abstract":"Objectives/aims This research aims to: Understand the journeys and processes that parents follow in seeking help and support for post-brain injury symptoms and changes in their children. Identify the barriers and challenges that parents face in obtaining help and support for their children and family following paediatric Acquired Brain Injury (ABI). Propose ways in which services can be more responsive to the evolving needs of children and adolescents with ABI and their families. Method Five mothers were interviewed using semi-structured interviews about their experiences of seeking help and support for post-brain injury symptoms and changes in their children. The participants’ children were 60% male, 10–16 years old and were 2–6 years post injury. Four had suffered strokes and one had a Traumatic Brain Injury. The age at injury was 4–14 years old. The interviews were audio-recorded and transcribed into 2698 units of data. The data was analysed using a Glaserian grounded theory constant comparative approach. Results After a child suffers an ABI parents feel that it is down to them to ensure that their child gets the help and support that they need. Identifying and accessing support requires a high level of research and persistence that parents experience as a ‘battle’. Obtaining support for mental-health problems is especially challenging. Common barriers include communication issues, time and funding delays, a lack of consistent professionals, not meeting the criteria for services, and a lack of local or age-appropriate services. The challenges of trying to seek help and support impact upon the whole family in terms of time, finances, socially and emotionally. However, through this process parents do become expert parents/carers. They gain new knowledge and language and they look to share this to support other parents going through similar experiences. Conclusions Providing parents with accessible psychoeducation around post-brain injury symptoms and changes in the acute period following a paediatric ABI could be a helpful intervention to make parents feel more prepared and supported in the medium to long term. More specialist paediatric ABI services that can provide integrated, holistic and developmental care are needed. Current services may need a more flexible and longer-term approach to be responsive to the needs of young people with ABI.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"107 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":"115086887","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.23
J. Rogers, T. Pollak, N. Begum, Anna Griffin, R. Patel, M. Pritchard, M. Broadbent, Graham Blackman, A. Kolliakou, R. Stewart, T. Nicholson, A. David
Objectives/Aims Catatonia is an important neuropsychiatric disorder with a high morbidity and mortality. However, due to a perception that it is very infrequent and because of the acuity of the patients, it has remained poorly studied and research has often been confined to small groups. We aimed to establish the demographic, disease-related variables and blood-based biomarkers for catatonia in a large dataset. Methods We used the Clinical Records Interactive Search (CRIS) system hosted at the NIHR Maudsley Biomedical Research Centre to search the clinical records for patients with catatonia. An initial free-text search was refined by use of a natural language processing app. The results of the app were validated by three of the authors, who included patients in the analysis only if a clinician had made a diagnosis of catatonia and two or more items of the Bush-Francis Catatonia Screening Instrument were in evidence. Demographics, disease-related variables and blood-based biomarkers could then be extracted for these patients and compared, where relevant, to non-catatonic psychiatric patients. Results The natural language processing app extracted the records of 2766 patients with at least one mention of catatonia in their records. The majority of cases identified by the app could be validated by the researchers. A high proportion of patients had more than one episode of catatonia. Full results will be available in time for the presentation. Conclusions This study demonstrates that catatonia is not very rare, even relying on clinician identification. The frequency of recurrence is interesting, as it suggests that catatonia might indicate an underlying trait, rather than merely a transient state.
{"title":"23 Epidemiology of catatonia in a large dataset","authors":"J. Rogers, T. Pollak, N. Begum, Anna Griffin, R. Patel, M. Pritchard, M. Broadbent, Graham Blackman, A. Kolliakou, R. Stewart, T. Nicholson, A. David","doi":"10.1136/JNNP-2019-BNPA.23","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.23","url":null,"abstract":"Objectives/Aims Catatonia is an important neuropsychiatric disorder with a high morbidity and mortality. However, due to a perception that it is very infrequent and because of the acuity of the patients, it has remained poorly studied and research has often been confined to small groups. We aimed to establish the demographic, disease-related variables and blood-based biomarkers for catatonia in a large dataset. Methods We used the Clinical Records Interactive Search (CRIS) system hosted at the NIHR Maudsley Biomedical Research Centre to search the clinical records for patients with catatonia. An initial free-text search was refined by use of a natural language processing app. The results of the app were validated by three of the authors, who included patients in the analysis only if a clinician had made a diagnosis of catatonia and two or more items of the Bush-Francis Catatonia Screening Instrument were in evidence. Demographics, disease-related variables and blood-based biomarkers could then be extracted for these patients and compared, where relevant, to non-catatonic psychiatric patients. Results The natural language processing app extracted the records of 2766 patients with at least one mention of catatonia in their records. The majority of cases identified by the app could be validated by the researchers. A high proportion of patients had more than one episode of catatonia. Full results will be available in time for the presentation. Conclusions This study demonstrates that catatonia is not very rare, even relying on clinician identification. The frequency of recurrence is interesting, as it suggests that catatonia might indicate an underlying trait, rather than merely a transient state.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"9 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":"125202744","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.34
R. Zahn, Tanja Jaeckle, Williams Scr., G. Barker, A. H. Young, R. Basilio, J. Moll
Objectives/Aims FMRI-neurofeedback for major depressive disorder (MDD) is of great interest to clinicians and neuroscientists. Here, the aim was to review the current clinical trials evidence. Methods We undertook a systematic literature search of fMRI-neurofeedback trials in MDD, including our unpublished results. Results fMRI-neurofeedback was effective in current MDD when reinforcing brain responses to positive pictures,1 but was not superior to a control neurofeedback intervention in a recent randomised controlled trial2 (RCT). Another RCT showed that reinforcing amygdala responses to positive autobiographical memories3 was superior versus a control neurofeedback intervention4. We have developed neurofeedback of self-blame-selective functional connectivity between right superior anterior temporal (AT) and subgenual frontal regions. In remitted MDD, we demonstrated that self-esteem can be increased using this approach in a double-blind RCT. In a recently completed RCT in early treatment-resistant MDD, the majority of patients responded to guilt-related AT-subgenual connectivity neurofeedback. Surprisingly, a self-guided matched psychological intervention tackling self-blame without neurofeedback showed comparable levels of response. Secondary analyses, however, showed that neurofeedback was superior for those patients without anxious distress features. Conclusions This calls for longer-term studies to reproduce previous results and stratified trials to combine psychological and neurofeedback interventions. As a research tool, neurofeedback uncovers causal relationships between functions and anatomical subdivisions. References D. E. Linden, et al., PloS one 2012;7:e38115. D. M. A. Mehler, et al., Neuropsychopharmacology, (2018). K. D. Young, et al., PloS one 2014;9:e88785. K. D. Young, et al., Am. J. Psychiatry 2017;174:748–755.
fmri神经反馈治疗重度抑郁症(MDD)是临床医生和神经科学家非常感兴趣的问题。本文的目的是回顾当前的临床试验证据。方法:我们进行了系统的fmri神经反馈试验的文献检索，包括我们未发表的结果。结果在最近的一项随机对照试验2 (RCT)中，fmri神经反馈在增强大脑对积极图像的反应时对当前的重度抑郁症有效，但并不优于对照神经反馈干预。另一项随机对照试验显示，强化杏仁核对积极自传体记忆的反应优于对照神经反馈干预。我们已经开发了自责-选择功能连接的神经反馈右前颞上区(AT)和亚属额叶区。在缓解的重度抑郁症中，我们在一项双盲随机对照试验中证明了使用这种方法可以提高自尊。在最近完成的一项早期治疗抵抗性重度抑郁症的随机对照试验中，大多数患者对内疚相关的at -亚属连通性神经反馈有反应。令人惊讶的是，在没有神经反馈的情况下，自我引导的匹配心理干预处理自责表现出类似的反应水平。然而，二次分析表明，对于那些没有焦虑困扰特征的患者，神经反馈是优越的。这需要更长期的研究来重现以前的结果和分层试验，以结合心理和神经反馈干预。作为一种研究工具，神经反馈揭示了功能和解剖细分之间的因果关系。引用文献D. E. Linden等，科学通报，2012;7:e38115。D. M. A. Mehler等，神经精神药理学，(2018)。杨凯德，等，科学通报，2014;9:e88785。K. D. Young等人。中华精神病学杂志;2017;34(4):748 - 755。
{"title":"34 The future role of fmri neurofeedback in depression treatment and research","authors":"R. Zahn, Tanja Jaeckle, Williams Scr., G. Barker, A. H. Young, R. Basilio, J. Moll","doi":"10.1136/JNNP-2019-BNPA.34","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.34","url":null,"abstract":"Objectives/Aims FMRI-neurofeedback for major depressive disorder (MDD) is of great interest to clinicians and neuroscientists. Here, the aim was to review the current clinical trials evidence. Methods We undertook a systematic literature search of fMRI-neurofeedback trials in MDD, including our unpublished results. Results fMRI-neurofeedback was effective in current MDD when reinforcing brain responses to positive pictures,1 but was not superior to a control neurofeedback intervention in a recent randomised controlled trial2 (RCT). Another RCT showed that reinforcing amygdala responses to positive autobiographical memories3 was superior versus a control neurofeedback intervention4. We have developed neurofeedback of self-blame-selective functional connectivity between right superior anterior temporal (AT) and subgenual frontal regions. In remitted MDD, we demonstrated that self-esteem can be increased using this approach in a double-blind RCT. In a recently completed RCT in early treatment-resistant MDD, the majority of patients responded to guilt-related AT-subgenual connectivity neurofeedback. Surprisingly, a self-guided matched psychological intervention tackling self-blame without neurofeedback showed comparable levels of response. Secondary analyses, however, showed that neurofeedback was superior for those patients without anxious distress features. Conclusions This calls for longer-term studies to reproduce previous results and stratified trials to combine psychological and neurofeedback interventions. As a research tool, neurofeedback uncovers causal relationships between functions and anatomical subdivisions. References D. E. Linden, et al., PloS one 2012;7:e38115. D. M. A. Mehler, et al., Neuropsychopharmacology, (2018). K. D. Young, et al., PloS one 2014;9:e88785. K. D. Young, et al., Am. J. Psychiatry 2017;174:748–755.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"31 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":"126758394","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.36
N. O'Connell, T. Nicholson, Graham Blackman, Jenni Tavener, A. David
{"title":"36 Medication prescriptions in 322 functional motor disorder patients in a large UK mental health service: a case control study","authors":"N. O'Connell, T. Nicholson, Graham Blackman, Jenni Tavener, A. David","doi":"10.1136/jnnp-2019-bnpa.36","DOIUrl":"https://doi.org/10.1136/jnnp-2019-bnpa.36","url":null,"abstract":"","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"54 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":"115733162","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.21
L. Mcwhirter, N. Miller, Catriona Campbell, I. Hoeritzauer, Andrew Lawton, Alan J. Carson, J. Stone
{"title":"21 Understanding foreign accent syndrome","authors":"L. Mcwhirter, N. Miller, Catriona Campbell, I. Hoeritzauer, Andrew Lawton, Alan J. Carson, J. Stone","doi":"10.1136/jnnp-2019-bnpa.21","DOIUrl":"https://doi.org/10.1136/jnnp-2019-bnpa.21","url":null,"abstract":"","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"57 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":"121488976","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.46
M. Arbabi, E. Ziaee, S. Eybpoosh
Background/Aims Delirium is associated with numerous complications such as physical problems, cognitive impairment, prolonged hospital stay and increased mortality rates. Therefore, the diagnosis and prevention of delirium is an essential issue in admitted patients care. The purpose of this study was to investigate the prevalence and risk factors of delirium in a general hospital. Materials and methods This study has a descriptive method done on 220 samples between 2017 to 2018. Subjects were recruited among all adult patients admitted to the general hospital who had a Richmond Agitation Sedation Scale (RASS scale) of more than 3. Patients with decrease in the level of consciousness who were unable to answer questions and patients who were admitted to the Intensive care unit were excluded. After primary assessment, demographic data were obtained and secondly the rate of delirium was evaluated by using CAM (Confusion Assessment Method). Results The prevalence of delirium was 10% in hospital admissions. The rate of delirium was in emergency ward (31.3%), hematology (22.2%), internal medicine (11.6%) and surgery (2.4%). The prevalence of delirium increased with age, visual deficits, sleep disorders, dementia, and neurological diseases, diabetes and malignancies. The use of antibiotics, analgesics and sedative agents was associated with an increase in delirium, but only there was a significant relation with the use of anticoagulants. Conclusions Delirium almost has been detected in all general hospital wards and its prevalence was related to age, visual problems, sleep disturbances, existence of dementia and neurological diseases and the usage of anticoagulant agents.
{"title":"46 Predictors of delirium in patients admitted in a general hospital","authors":"M. Arbabi, E. Ziaee, S. Eybpoosh","doi":"10.1136/JNNP-2019-BNPA.46","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.46","url":null,"abstract":"Background/Aims Delirium is associated with numerous complications such as physical problems, cognitive impairment, prolonged hospital stay and increased mortality rates. Therefore, the diagnosis and prevention of delirium is an essential issue in admitted patients care. The purpose of this study was to investigate the prevalence and risk factors of delirium in a general hospital. Materials and methods This study has a descriptive method done on 220 samples between 2017 to 2018. Subjects were recruited among all adult patients admitted to the general hospital who had a Richmond Agitation Sedation Scale (RASS scale) of more than 3. Patients with decrease in the level of consciousness who were unable to answer questions and patients who were admitted to the Intensive care unit were excluded. After primary assessment, demographic data were obtained and secondly the rate of delirium was evaluated by using CAM (Confusion Assessment Method). Results The prevalence of delirium was 10% in hospital admissions. The rate of delirium was in emergency ward (31.3%), hematology (22.2%), internal medicine (11.6%) and surgery (2.4%). The prevalence of delirium increased with age, visual deficits, sleep disorders, dementia, and neurological diseases, diabetes and malignancies. The use of antibiotics, analgesics and sedative agents was associated with an increase in delirium, but only there was a significant relation with the use of anticoagulants. Conclusions Delirium almost has been detected in all general hospital wards and its prevalence was related to age, visual problems, sleep disturbances, existence of dementia and neurological diseases and the usage of anticoagulant agents.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","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":"129865812","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.35
A. Jones, N. O'Connell, A. David
Aims Reconfiguration of stroke services in England has emphasised fast diagnosis and treatment and subsequently, the proportion of stroke mimic patients entering stroke pathways has been highlighted. Stroke mimic patients may be ‘medical mimics’, with medical explanations for symptoms, e.g. syncope, seizure, but a proportion of presenting patients have a functional aetiology. Functional stroke mimics accounted for 8% of admissions to an acute stroke service in London (Gargalas et al., 2015) and the prevalence and burden of functional stroke is well recognised by clinicians. We present a systematic review and meta-analysis aiming to: 1) estimate the prevalence of stroke mimics and functional stroke mimics across medical settings; and 2) describe the demographic and symptom profiles of functional stroke patients. Methods Three literature searches took place between 2015–2018 utilising OvidSP, PubMed, CINAHL and Google Scholar. A total of 13 974 abstracts were reviewed and 114 papers met inclusion criteria. Age and sex proportions were compared between stroke, stroke mimic and functional mimic groups. Prevalence rates across settings and moderators of functional mimic rates were calculated using random-effects models. Results Stroke, stroke mimic and functional mimic definitions varied between studies. Across settings, 25% of suspected stroke patients were stroke mimics and 15% of stroke mimics had a functional aetiology. Stroke mimics were younger than stroke patients and more likely to be female. Similarly, functional patients were younger and more often female than medical mimics. 10 papers gave symptom information for functional patients; compared to medical mimics, functional patients were more likely to display weakness/numbness and less likely to present with reduced consciousness, visual symptoms or speech/language symptoms. Meta-analyses show a higher rate of stroke mimics in primary care (38%) vs more acute settings (12%) but the inverse for functional mimics (24% in stroke units vs only 12% in primary care). Functional rates were highest in studies that were descriptive, retrospective, from high income countries and in studies where all patients received thrombolysis. Conclusions Functional diagnoses are an important differential of suspected stroke. Definitions of functional stroke mimics vary widely in stroke literature. Our findings suggest functional stroke patients are most commonly seen in tertiary settings. There are no guidelines on the management of these patients within acute stroke settings. In the context of these findings, a feasibility study is underway investigating the presentation of functional stroke patients and their views on possible interventions and this research may help improve current care pathways.
英国中风服务的重新配置强调了快速诊断和治疗，随后，中风模拟患者进入中风途径的比例得到了强调。中风模拟患者可能是“医学模拟”，对症状有医学解释，如晕厥、癫痫发作，但有一部分患者有功能性病因。在伦敦，功能性卒中模拟患者占急性卒中就诊人数的8% (Gargalas et al.， 2015)，临床医生已经充分认识到功能性卒中的患病率和负担。我们提出了一项系统回顾和荟萃分析，旨在:1)估计卒中模拟和功能性卒中模拟在医疗环境中的患病率;2)描述功能性脑卒中患者的人口学特征和症状特征。方法利用OvidSP、PubMed、CINAHL和Google Scholar检索2015-2018年的3篇文献。共审查了13 974篇摘要，其中114篇符合纳入标准。比较中风组、中风模拟组和功能模拟组的年龄和性别比例。使用随机效应模型计算不同环境的患病率和功能模拟率的调节因子。结果中风、中风模拟和功能模拟的定义在不同的研究中有所不同。在不同的情况下，25%的疑似中风患者是中风模拟患者，15%的中风模拟患者有功能性病因。模仿中风的人比中风患者更年轻，而且更有可能是女性。同样，与模仿医学的患者相比，功能正常的患者更年轻，而且往往是女性。10篇为功能患者提供症状信息;与医学模拟相比，功能性患者更有可能表现出虚弱/麻木，而不太可能出现意识下降、视觉症状或言语/语言症状。荟萃分析显示，初级保健的卒中模拟率(38%)高于更急性的环境(12%)，但功能模拟率相反(卒中单位24%，初级保健只有12%)。在高收入国家的描述性、回顾性研究和所有患者接受溶栓治疗的研究中，功能率最高。结论功能诊断是鉴别疑似脑卒中的重要依据。在卒中文献中，功能性卒中模拟的定义差异很大。我们的研究结果表明，功能性卒中患者最常见于三级医院。目前还没有关于这些患者在急性脑卒中情况下的管理指南。在这些发现的背景下，一项可行性研究正在调查功能性卒中患者的表现和他们对可能干预措施的看法，这项研究可能有助于改善当前的护理途径。
{"title":"35 The epidemiology and symptomology of functional stroke mimics: a systematic review and meta-analysis","authors":"A. Jones, N. O'Connell, A. David","doi":"10.1136/JNNP-2019-BNPA.35","DOIUrl":"https://doi.org/10.1136/JNNP-2019-BNPA.35","url":null,"abstract":"Aims Reconfiguration of stroke services in England has emphasised fast diagnosis and treatment and subsequently, the proportion of stroke mimic patients entering stroke pathways has been highlighted. Stroke mimic patients may be ‘medical mimics’, with medical explanations for symptoms, e.g. syncope, seizure, but a proportion of presenting patients have a functional aetiology. Functional stroke mimics accounted for 8% of admissions to an acute stroke service in London (Gargalas et al., 2015) and the prevalence and burden of functional stroke is well recognised by clinicians. We present a systematic review and meta-analysis aiming to: 1) estimate the prevalence of stroke mimics and functional stroke mimics across medical settings; and 2) describe the demographic and symptom profiles of functional stroke patients. Methods Three literature searches took place between 2015–2018 utilising OvidSP, PubMed, CINAHL and Google Scholar. A total of 13 974 abstracts were reviewed and 114 papers met inclusion criteria. Age and sex proportions were compared between stroke, stroke mimic and functional mimic groups. Prevalence rates across settings and moderators of functional mimic rates were calculated using random-effects models. Results Stroke, stroke mimic and functional mimic definitions varied between studies. Across settings, 25% of suspected stroke patients were stroke mimics and 15% of stroke mimics had a functional aetiology. Stroke mimics were younger than stroke patients and more likely to be female. Similarly, functional patients were younger and more often female than medical mimics. 10 papers gave symptom information for functional patients; compared to medical mimics, functional patients were more likely to display weakness/numbness and less likely to present with reduced consciousness, visual symptoms or speech/language symptoms. Meta-analyses show a higher rate of stroke mimics in primary care (38%) vs more acute settings (12%) but the inverse for functional mimics (24% in stroke units vs only 12% in primary care). Functional rates were highest in studies that were descriptive, retrospective, from high income countries and in studies where all patients received thrombolysis. Conclusions Functional diagnoses are an important differential of suspected stroke. Definitions of functional stroke mimics vary widely in stroke literature. Our findings suggest functional stroke patients are most commonly seen in tertiary settings. There are no guidelines on the management of these patients within acute stroke settings. In the context of these findings, a feasibility study is underway investigating the presentation of functional stroke patients and their views on possible interventions and this research may help improve current care pathways.","PeriodicalId":438758,"journal":{"name":"Members’ POSTER Abstracts","volume":"104 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120918464","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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