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There is a lack of clarity about the most useful intervention for functional non-epileptic attacks (FNEA). Outcomes for this condition remain often poor, with considerable personal, social and economic impact. In order to guide clinical practice and future research in this area, we have performed a systematic review of the published literature on the psychological treatment of FNEA.
A comprehensive literature search was carried out using key words: non-epileptic seizures; psychogenic seizures; psychogenic non-epileptic seizures; pseudoseizures; funny turns; non-epileptic attack; hysterical seizures; and pseudoepileptic. Studies specifically looking at psychological treatment of FNEA were identified. Studies of patients also having comorbid organic seizure disorders were excluded.
17 studies that met the inclusion criteria were identified. A broad variety of psychological interventions for FNEA has been investigated. Only one randomised controlled trial has been completed to date. Existing evidence appears to suggest that various psychological treatments, including presenting the diagnosis, psychoeducation, behavioural therapies and mixed modality treatments, may be effective.
While a range of psychological treatments may be beneficial for this patient group, we do not have clear evidence to suggest which treatment is most efficacious. Specific elements of presenting the diagnosis and psychoeducation may be required in addition to traditional cognitive behavioural therapeutic approaches. Large, methodologically robust studies are urgently required to establish the most effective form of treatment.
This study used a prospective design and the technique of structural modelling to examine the complex interrelations between psychological factors, immune status and complications after major surgery.
Twenty-nine women scheduled for elective cholecystectomy were studied prospectively. Information regarding medical history, health practices, life stressors, and coping strategies was obtained two weeks prior to admission. At this initial meeting, as well as three days after surgery, and at one month follow-up immunological tests were performed and the level of psychological distress was assessed. The study additionally included measures of post-operative complications, and infections and negative effect during follow-up.
Pre-operative immune status emerged as a key variable exerting strong effects on subsequent immune function and, thereby producing significant, indirect effects on every recovery variable. Pre-operative distress was directly linked to increased mood disturbance at follow-up. Moreover, distress significantly influenced immune function both before and after surgery, which mediated a significant impact on most recovery variables. Active coping behaviour directly increased the risk of a complicated recovery.
The study demonstrated that distress-induced changes in immune functioning have clinical relevance. Overall, the present findings suggest that recovery from surgery is facilitated in patients with a well-functioning immune system, a low-level of pre-operative distress and a passive coping disposition.
The present study investigated the attentional bias induced by drug-related stimuli in active abusers; abstinent abusers on opioid substitution therapy; and abstinent drug-dependent patients in recovery on a community-based non-pharmacological therapy programme. Drug-dependent groups included both cocaine and heroin abusers.
Classical and emotional Stroop tasks were used to test all drug-dependent patients and controls with no history of addiction. Response times were recorded. An interference effect was obtained by comparing the congruent and incongruent conditions in the classical Stroop version. An attentional bias towards drug cues was derived by comparing latencies in the neutral and emotional conditions of the emotional Stroop.
No between-group differences were found in the classical Stroop. In the emotional Stroop, active drug-dependent patients showed higher attentional bias (i.e. longer response times to drug-related words) than any of the other three groups.
The attentional bias induced by drug cues in patients with addiction disorder might change depending on the patients' clinical status. All treated patients, whether on opioid substitution therapy or on community therapy, showed less attentional bias towards drug-related stimuli than active drug users, although the observed smaller bias was most likely induced by therapy acting through different mechanisms. Although drug-cues response is influenced by other multiple variables, e.g. motivation, craving, classical conditioning and substance availability, these data lend support to the hypothesis that treatment might contribute to decrease the attentional bias towards drug cues, which seems to play a critical role in achieving a positive outcome in the treatment of addiction.
Val66Met polymorphism in the brain-derived neurotrophic factor (BDNF) gene has been suggested to be associated with major depressive disorder (MDD). There were a few reports of the relationship between the variant and late-onset depression (LOD) in Chinese Han population.
To investigate the relationship among BDNF Val66Met gene variants, BDNF plasma level and LOD.
Chinese Han patients with LOD (n = 99) and control subjects (n = 110) were assessed for BDNF Val66Met gene polymorphism. BDNF plasma level was tested only in LOD.
There were no significant differences in genotypes and allele frequencies between cases and controls (p = 0.744 and p = 0.845, respectively). Plasma BDNF level also did not show significant differences in three genotypes in LOD (p = 0.860).
The Val66Met polymorphism in BDNF gene may not confer susceptibility to LOD in Chinese Han population.
Recent studies have proposed the existence of three distinct subgroups of bipolar 1 disorder based on age at onset (AAO). The present study aims to investigate potential clinical and functional differences between these subgroups in an Australian sample.
Participants (n = 239) were enrolled in the Bipolar Comprehensive Outcomes Study (BCOS), a 2-year longitudinal, observational, cross-sectional study. Assessment measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAMD21), Clinical Global Impressions Scale (CGI-BP), SF-36, SLICE/Life Scale, and the EuroQol (EQ-5D). Participants were also asked about their age at the first major affective episode.
Three AAO groups were compared: early (AAO < 20, mean = 15.5 ± 2.72; 44.4% of the participants); intermediate (AAO 20–39, mean = 26.1 ± 4.8; 48.14% of the participants) and late (AAO > 40, mean = 50.6 ± 9.04; 7.4% of the participants). Higher rates of depression, suicidal ideation and binge drinking were reported by the early AAO group. This group also reported poorer quality of life in a number of areas. The early AAO group had a predominant depressive initial polarity and the intermediate group had a manic predominance.