• La psiquiatría más allá del paradigma actual

      Evans, Chris; Moldavsky, Daniel (2013)
      A series of editorials in this journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially "applied neuroscience". While not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service-user movement. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(journal abstract)
    • Learning and altering behaviours by reinforcement: Neurocognitive differences between children and adults

      Shephard, Elizabeth; Jackson, Georgina M.; Groom, Madeleine J. (2014)
      This study examined neurocognitive differences between children and adults in the ability to learn and adapt simple stimulus-response associations through feedback. Fourteen typically developing children (mean age=10.2) and 15 healthy adults (mean age=25.5) completed a simple task in which they learned to associate visually presented stimuli with manual responses based on performance feedback (acquisition phase), and then reversed and re-learned those associations following an unexpected change in reinforcement contingencies (reversal phase). Electrophysiological activity was recorded throughout task performance. We found no group differences in learning-related changes in performance (reaction time, accuracy) or in the amplitude of event-related potentials (ERPs) associated with stimulus processing (P3 ERP) or feedback processing (feedback-related negativity; FRN) during the acquisition phase. However, children's performance was significantly more disrupted by the reversal than adults and FRN amplitudes were significantly modulated by the reversal phase in children but not adults. These findings indicate that children have specific difficulties with reinforcement learning when acquired behaviours must be altered. This may be caused by the added demands on immature executive functioning, specifically response monitoring, created by the requirement to reverse the associations, or a developmental difference in the way in which children and adults approach reinforcement learning. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.
    • Lithium treatment in cluster headache, review of literature

      Abdel-Maksoud, Mohamed B. (2009)
      Background: The pain, which is involved in Cluster Headache (CH), is excruciating and is probably one of the most painful conditions known to humans. In the early 70es it was found out that lithium could be used in treating this rare condition. Ekbom produced his first report of using lithium successfully to treat five cases of CH and this was followed later by other studies, which showed the effectiveness of lithium in this condition. Objective: In this article we reviewed the evidence for using lithium in CH. We discuss some issues including the duration, the dosage of lithium required and the short and long-term side effects, which are likely to occur. We also included the mechanism of action of lithium in treating this condition. Methodology: We searched the Medline database from 1950 to date. We included all studies done in English, which were related to the use of lithium in cluster headache. We excluded all studies which were not in English and which included other types of headache. Results and conclusions: We concluded that lithium is effective in both chronic and episodic forms of cluster Headache.
    • Machine learning as a diagnostic decision aid for patients with transient loss of consciousness

      Jamnadas-Khoda, Jennifer; Broadhurst, Mark (2020)
      BackgroundTransient loss of consciousness (TLOC) is a common reason for presentation to primary/emergency care; over 90% are because of epilepsy, syncope, or psychogenic non-epileptic seizures (PNES). Misdiagnoses are common, and there are currently no validated decision rules to aid diagnosis and management. We seek to explore the utility of machine-learning techniques to develop a short diagnostic instrument by extracting features with optimal discriminatory values from responses to detailed questionnaires about TLOC manifestations and comorbidities (86 questions to patients, 31 to TLOC witnesses).MethodsMulti-center retrospective self- and witness-report questionnaire study in secondary care settings. Feature selection was performed by an iterative algorithm based on random forest analysis. Data were randomly divided in a 2:1 ratio into training and validation sets (163:86 for all data; 208:92 for analysis excluding witness reports).ResultsThree hundred patients with proven diagnoses (100 each: epilepsy, syncope and PNES) were recruited from epilepsy and syncope services. Two hundred forty-nine completed patient and witness questionnaires: 86 epilepsy (64 female), 84 PNES (61 female), and 79 syncope (59 female). Responses to 36 questions optimally predicted diagnoses. A classifier trained on these features classified 74/86 (86.0% [95% confidence interval 76.9%-92.6%]) of patients correctly in validation (100 [86.7%-100%] syncope, 85.7 [67.3%-96.0%] epilepsy, 75.0 [56.6%-88.5%] PNES). Excluding witness reports, 34 features provided optimal prediction (classifier accuracy of 72/92 [78.3 (68.4%-86.2%)] in validation, 83.8 [68.0%-93.8%] syncope, 81.5 [61.9%-93.7%] epilepsy, 67.9 [47.7%-84.1%] PNES).ConclusionsA tool based on patient symptoms/comorbidities and witness reports separates well between syncope and other common causes of TLOC. It can help to differentiate epilepsy and PNES. Validated decision rules may improve diagnostic processes and reduce misdiagnosis rates.Classification of evidenceThis study provides Class III evidence that for patients with TLOC, patient and witness questionnaires discriminate between syncope, epilepsy and PNES.
    • Managing post-stroke fatigue: A qualitative study to explore multifaceted clinical perspectives

      das Nair, Roshan (2021)
      Introduction: Post-stroke fatigue (PSF) is common and debilitating. However, while its effective management is a priority for clinicians and stroke survivors, there remains little evidence to provide guidance or underpin practice. Our aim, therefore, was to gain insights into the experiences of clinicians who routinely manage patients with fatigue. Method: Qualitative interview study. The target was to recruit a purposeful sample of approximately 20 participants with expertise in managing PSF and fatigue arising from other conditions. Maximum variation sampling was used to ensure a balance of participants across different settings. Data were analysed using a framework approach, iteratively developed and refined by including emergent themes. Results: We recruited 20 participants: nine occupational therapists (OTs), five physiotherapists, three nurses and three psychologists, which included three ‘fatigue experts’ from Europe and Australia. Analysis generated core themes around management and strategies used; these were similar regardless of professional background, clinical or geographical setting or condition treated. OTs felt a particular responsibility for fatigue management, although multidisciplinary teamwork was stressed by all. Conclusion: There are clear similarities in clinicians’ experiences of managing PSF and fatigue across different conditions and also across professional groups. Clinicians rely predominantly on their own clinical knowledge for guidance. © The Author(s) 2021.
    • Mental health of people with multiple sclerosis during the COVID-19 outbreak: A prospective cohort and cross-sectional case-control study of the UK MS Register

      Morriss, Richard K.; das Nair, Roshan
      Background: People with MS (pwMS) have had higher rates of anxiety and depression than the general population before the COVID-19 pandemic, placing them at higher risk of experiencing poor psychological wellbeing during the pandemic. Objective: To assess mental health and its social/lifestyle determinants in pwMS during the first wave of the outbreak in the United Kingdom. Methods: This is a community-based, prospective longitudinal cohort and cross-sectional case–control online questionnaire study. It includes 2010 pwMS from the UK MS Register and 380 people without MS. Results: The Hospital Anxiety and Depression Scale scores of pwMS for anxiety and depression during the outbreak did not change from the previous year. PwMS were more likely to have anxiety (using General Anxiety Disorder-7) and/or depression (using Patient Health Questionnaire-9) than controls during the outbreak (OR: 2.14, 95% CI: 1.58–2.91). PwMS felt lonelier (OR: 1.37, 95% CI: 1.04–1.80) reported worse social support (OR: 1.90, 95% CI: 1.18–3.07) and reported worsened exercise habits (OR: 1.65, 95% CI: 1.18–2.32) during the outbreak than controls. Conclusion: Early in the pandemic, pwMS remained at higher risk of experiencing anxiety and depression than the general population. It is important that multidisciplinary teams improve their support for the wellbeing of pwMS, who are vulnerable to the negative effects of the pandemic on their lifestyle and social support.
    • A meta-synthesis of qualitative studies on patients' views and experiences of Multiple Sclerosis diagnosis

      das Nair, Roshan (2019)
      Background and aims: The process of being diagnosed with multiple sclerosis (MS) can be long and frustrating for individuals, which may affect their perceptions of MS and future relationships with healthcare professionals. This, in turn, may have a negative impact on psychosocial adjustment to MS and treatment outcomes. Providing support at the point of diagnosis could facilitate the adjustment process. However, there is a lack of adequate theoretical frameworks that would allow researchers and clinicians to fully understand the needs and experiences of people at diagnosis, making it difficult to design and implement support services. Therefore, we conducted a meta-synthesis of qualitative studies to improve our conceptual understanding of the needs and experiences of people around MS diagnosis. <br/>Method(s): We systematically searched five electronic databases to identify qualitative papers that focussed on views and experiences of people around MS diagnosis. Identified studies were qualityappraised using a standardised checklist, and data entered onto a bespoke data extraction form. Extracted data were synthesised using meta-ethnographic methods. <br/>Result(s): We identified 28 papers (with 750 people with MS, 38 family members/carers and 19 healthcare professionals) that focused on diagnosis experiences of people with MS. The line of argument synthesis highlighted that people experience several negative emotions (e.g., shock, denial, anger, anxiety) and external stressors (e.g., lengthy diagnostic process) around diagnosis, which may limit their ability to make sense of the diagnosis and adjust to MS. However, helpful coping and support resources (e.g., using re-appraisal, seeking relevant and reliable information, formal/informal support) might facilitate the adjustment process to MS diagnosis. <br/>Discussion(s): Our synthesis highlights the need for providing person- centred support and relevant and adequate information for people at the time of MS diagnosis. We present novel theoretical insights into the needs and experiences of individuals around diagnosis for designing interventions to improve adjustment to MS.
    • Modifiable risk factors for poor health outcomes in multiple sclerosis: The urgent need for research to maximise smoking cessation success

      das Nair, Roshan (2019)
      Tobacco smoking is a well-established risk factor for multiple sclerosis (MS) onset, progression and poor health outcomes in people with MS. Despite smoking being a modifiable risk factor, no research has been undertaken to understand how, or who is best placed, to assess or understand smoking behaviour in people with MS, or how healthcare professionals can best assist people with MS to quit. People with MS may have unique motivators to continue smoking, or unique barriers to smoking cessation, that are not addressed by existing cessation tools. Research is urgently needed in this area if the aim is to maximise health outcomes for all people with MS.
    • Motor disorder in severe mental handicap

      Jones, Jo (1991)
      In response to the D. Rogers et al (see record 1991-21389-001) finding that motor disorder is significantly associated with more severe mental handicap, the present author discusses the appropriateness of using the Dyskinesia Identification System: Condensed User Scale (R. L. Sprague and K. M. Shaw, 1989) with patients with mental handicaps. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Multimodal coding and strategic approach in young and older adults' visual working memory performance

      English, Brad (2019)
      Visual working memory (WM) was investigated in young (18-35 yrs) and older (63-88 yrs) adults by assessing use of visual and verbal processing, and strategic approach. Experiment 1 comprised a visual interference paradigm, to investigate visual rehearsal during an abstract visual WM task. Results suggested both groups used a visual strategy, but older adults struggled more when visual interference was administered first, perhaps due to difficulty developing non-visual strategies. In Experiment 2, a more meaningful task version was additionally administered, offering greater opportunity for multimodal coding. Despite the marked effect of age, both groups benefited from semantic availability to the same extent. Young adults reported a verbal strategy more than older adults, who reported less verbal labeling and more visual refreshing, and a less efficient approach overall. The results highlight age-related limitations in visual WM capacity and strategy use, but show potential for compensation, and a role for task practice.
    • A neural basis for contagious yawning

      Kim, Soyoung; Jackson, Stephen R.; Jackson, Georgina M. (2017)
      Contagious yawning, in which yawning is triggered involuntarily when we observe another person yawn, is a common form of echophenomena-the automatic imitation of another's words (echolalia) or actions (echopraxia) [1]. The neural basis for echophenomena is unknown; however, it has been proposed that it is linked to disinhibition of the human mirror-neuron system [1-4] and hyper-excitability of cortical motor areas [1]. We investigated the neural basis for contagious yawning using transcranial magnetic stimulation (TMS). Thirty-six adults viewed video clips that showed another individual yawning and, in separate blocks, were instructed to either resist yawning or allow themselves to yawn. Participants were videoed throughout and their yawns or stifled yawns were counted. We used TMS to quantify motor cortical excitability and physiological inhibition for each participant, and these measures were then used to predict the propensity for contagious yawning across participants. We demonstrate that instructions to resist yawning increase the urge to yawn and alter how yawns are expressed (i.e., full versus stifled yawns) but do not alter the individual propensity for contagious yawning. By contrast, TMS measures of cortical excitability and physiological inhibition were significant predictors of contagious yawning and accounted for approximately 50% of the variability in contagious yawning. These data demonstrate that individual variability in the propensity for contagious yawning is determined by cortical excitability and physiological inhibition in the primary motor cortex.
    • Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability

      Lee, Claire (2021)
      In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge.Objectives To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus.Setting Virtual nominal group technique (vNGT) across the UK.Participants Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience.Methods Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique’s five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements.Results A combined total of 421 statements achieved positive consensus (&gt;75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required.Conclusion The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.Data are available on reasonable request.
    • Nominal group technique to establish the core components of home-based rehabilitation for survivors of stroke with severe disability

      Lee, Claire (2021)
      In the UK, over 20% of patients leaving hospital after a stroke will be severely disabled. Despite this, limited clinical guidance is available to teams tasked with providing support for this complex population at home. Additionally, many areas across the UK are not commissioned to treat this patient cohort, leaving them with no specialist support on discharge.Objectives To establish core components of home-based rehabilitation for survivors of stroke with severe disability, based on expert panel consensus.Setting Virtual nominal group technique (vNGT) across the UK.Participants Experts in the field of stroke rehabilitation (n=14) including researchers, clinicians and those with lived experience.Methods Two vNGT were completed using a freely available online platform, Microsoft Teams. The technique’s five stages were completed virtually; introduction, silent idea generation, round robin, clarifications and scoring. Statements were analysed for consensus, those achieving consensus underwent content analysis to form rich overarching consensus statements.Results A combined total of 421 statements achieved positive consensus (&gt;75% in agreement), which formed 11 overarching consensus statements. These outline key components of home-based rehabilitation for survivors of stroke with severe disability including the structure and members of the team, as well as the skills and knowledge required.Conclusion The consensus statements highlight the complexity of managing patients with severe stroke disability following discharge from hospital. This study has the potential to support the provision of services for this patient group, providing a benchmark for commissioners and clinicians as well as setting expectations for stroke survivors and their carers. What remains unknown is how many services currently offer this service to patients with severe disability.Data are available on reasonable request.
    • The notion of “invisibility” in people’s experiences of the symptoms of multiple sclerosis: a systematic meta-synthesis

      das Nair, Roshan (2020)
      Purpose: Invisible symptoms have a negative impact on people living with Multiple Sclerosis (MS), related to the very notion that they are “unseen.” It is important to understand the notion of “invisibility” in MS, as invisible symptoms are particularly distressing, and there is a paucity of research focussing on their invisible nature and its specific impact. We aimed to systematically identify, appraise and synthesise qualitative research regarding the notion of “invisibility” in relation to people’s lived experience of symptoms of MS. Methods and materials: Articles meeting inclusion criteria were critically appraised and synthesised using a meta-ethnographic approach. Results: 17 articles were identified from six electronic databases. Three third-order themes were presented as a line of argument. “Invisibility” was conceptualised by people with MS as a discrepancy between the internal experience of symptoms and what is observed externally. “Invisibility” of MS symptoms was found to have numerous impacts, including not feeling understood or validated by others, issues around the perceived legitimacy of the illness, and living with needs which are hidden. We found that “invisibility” by its nature offers people a choice of strategies they use to navigate it. This choice introduces a dilemma: disclose the diagnosis to be “seen,” or remain “invisible.” Conclusions: This review revealed the manner in which people with MS are affected by the invisibility of their symptoms and the various adaptations used to navigate these lived experiences. We highlight the need to improve clinician and public understanding, and to better respond to these experiences. Future research focusing on the exploration of people’s experiences of “invisibility” in MS, including the ways in which “invisibility” is managed on a day-to-day basis could raise clinical and public awareness of the impact of “invisibility” and how to provide support for this, thus easing the dilemmas faced by those with MS.IMPLICATIONS FOR REHABILITATION People with Multiple Sclerosis (MS) experience symptoms that are not overtly visible to others, impacting their emotional and social wellbeing negatively. It is important for healthcare professionals to validate MS patients’ experiences around “invisibility” and provide appropriate support. Healthcare professionals should address with MS patients any issues around disclosure of their diagnosis to those around them and support them to navigate these decisions. Raising awareness about the impact of “invisibility” for people with MS may help to lessen patient burden and promote understanding amongst healthcare professionals and the general public. © 2020, © 2020 Informa UK Limited, trading as Taylor & Francis Group.
    • On the interaction between sad mood and cognitive control: The effect of induced sadness on electrophysiological modulations underlying Stroop conflict processing

      Nixon, Elena; Liddle, Peter F.; Nixon, Neil L. (2013)
      The present study employed high-density ERPs to examine the effect of induced sad mood on the spatiotemporal correlates of conflict monitoring and resolution in a colour-word Stroop interference task. Neuroimaging evidence and dipole modelling implicates the involvement of the anterior cingulate cortex (ACC) and medial prefrontal cortex (mPFC) regions in conflict-laden interference control. On the basis that these structures have been found to mediate emotion-cognition interactions in negative mood states, it was predicted that Stroop-related cognitive control, which relies heavily on anterior neural sources, would be affected by effective sad mood provocation. Healthy participants (N=14) were induced into transient sadness via use of autobiographical sad scripts, a well-validated mood induction technique (Liotti et al., 2000a, 2002). In accord with previous research, interference effects were shown at both baseline and sad states while Stroop conflict was associated with early (N450) and late (Late Positive Component; LPC) electrophysiological modulations at both states. Sad mood induction attenuated the N450 effect in line with our expectation that it would be susceptible to modulation by mood, given its purported anterior limbic source. The LPC effect was displayed at the typical posterior lateral sites but, as predicted, was not affected by sad mood. However, frontocentral LPC activity-presumably generated from an additional anterior limbic source-was affected at sad state, hinting a role in conflict monitoring. Although the neurophysiological underpinnings of interference control are yet to be clarified, this study provided further insight into emotion-cognition interactions as indexed by Stroop conflict-laden processing.Copyright © 2012 Elsevier B.V. All rights reserved.
    • The oscillatory effects of rhythmic median nerve stimulation

      Jackson, Stephen R. (2022)
      Entrainment of brain oscillations can be achieved using rhythmic non-invasive brain stimulation, and stimulation of the motor cortex at a frequency associated with sensorimotor inhibition can impair motor responses. Despite the potential for therapeutic application, these techniques do not lend themselves to use outside of a clinical setting. Here, the aim was to investigate whether rhythmic median nerve stimulation (MNS) could be used to entrain oscillations related to sensorimotor inhibition. MEG data were recorded from 20 participants during 400 trials, where for each trial 10 pulses of MNS were delivered either rhythmically or arrhythmically at 12 or 20 Hz. Our results demonstrate a frequency specific increase in relative amplitude in the contralateral somatosensory cortex during rhythmic but not arrhythmic stimulation. This was coupled with an increase in inter-trial phase coherence at the same frequency, suggesting that the oscillations synchronised with the pulses of MNS. The results show that 12 and 20 Hz rhythmic peripheral nerve stimulation can produce entrainment. Rhythmic MNS resulted in synchronous firing of neuronal populations within the contralateral somatosensory cortex meaning these neurons were engaged in processing of the afferent input. Therefore, MNS could prove therapeutically useful in disorders associated with hyperexcitability within the sensorimotor cortices. © 2022
    • Oxytocin affects the connectivity of the precuneus and the amygdala: A randomized, double-blinded, placebo-controlled neuroimaging trial

      Vollm, Birgit A.; Palaniyappan, Lena (2014)
      Background: Although oxytocin is one of the most widely studied neuropeptides in recent times, the mechanistic process by which it modulates social-affective behavior in the brain is not yet clearly understood. Thus, to understand the neurophysiological basis of oxytocin effects, we used resting-state functional MRI to examine the effects of intranasal oxytocin on brain connectivity in healthy males.; Methods: Using a randomized, double-blinded, placebo-controlled, crossover design, 15 healthy male volunteers received 24 IU intranasal oxytocin or placebo prior to resting-state functional MRI acquisition at 3T.; Results: We found that oxytocin significantly reduced the degree centrality of the right precuneus (P<.05). Oxytocin also reduced connectivity between the bilateral amygdalae and between the right precuneus and the right and left amygdala (P<.05). Although there were no significant changes in regional homogeneity at the whole brain level, posthoc results showed a reduction involving the right precuneus (P<.05).; Conclusions: These results show that oxytocin affects one of the key centers in the brain for social cognition and introspective processing, the precuneus, and enhances our understanding of how oxytocin can modulate brain networks at rest. An improved understanding of the neurophysiological effects of oxytocin can be important in terms of evaluating the mechanisms that are likely to underlie the clinical responses observed upon long-term oxytocin administration.; © The Author 2015. Published by Oxford University Press on behalf of CINP.
    • Oxytocin modulates the effective connectivity between the precuneus and the dorsolateral prefrontal cortex

      Vollm, Birgit A. (2019)
      Our social activity is heavily influenced by the process of introspection, with emerging research suggesting a role for the Default Mode Network (DMN) in social cognition. We hypothesize that oxytocin, a neuropeptide with an important role in social behaviour, can effectively alter the connectivity of the DMN. We test this hypothesis using a randomized, double-blind, crossover, placebo-controlled trial where 15 healthy male participants received 24 IU oxytocin or placebo prior to a resting-state functional MRI scan. We used Granger Causality Analysis for the first time to probe the role of oxytocin on brain networks and found that oxytocin reverses the pattern of effective connectivity between the bilateral precuneus and the left dorsolateral prefrontal cortex (dlPFC), a key central executive network (CEN) region. Under placebo, the bilateral precuneus exerted a significant negative causal influence on the left dlPFC and the left dlPFC exerted a significant positive causal influence on the bilateral precuneus. However, under oxytocin, these patterns were reversed, i.e. positive causal influence from the bilateral precuneus to the left dlPFC and negative causal influence from the left dlPFC to the bilateral precuneus (with statistically significant effects for the right precuneus). We propose that these oxytocin-induced effects could be a mechanistic process by which it modulates social cognition. These results provide a measurable target for the physiological effects of oxytocin in the brain and offer oxytocin as a potential agent to enhance the cooperative role of the predominantly 'task-inactive''default mode' brain regions in both healthy and patient populations.<br/>Copyright &#xa9; 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
    • Patients' and carers' experiences of UK memory services

      Orrell, Martin (2016)
      OBJECTIVE: The objective of this study is to test the validity of an accreditation programme for memory services in the UK by investigating whether different levels of accreditation status (excellent compared with accredited) are reflected in patients' and carers' reported satisfaction.