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Computational aspects of concerted [2+2] oxidative‐retrocycloaddition‐cycloreversion reaction through ruthenium alkylidene π‐complexes and ruthenacyclobutane with α,β‐(C—C—C) agostic bonding interactions in olefin metathesis are presented. d6‐Ruthenium carbene complexes, with ruthenium in the oxidation state +2, undergo successive [2+2] cycloaddition and cycloreversion steps, through associative, dissociative, or interchange mechanisms. This process involves coordination of the olefin to 16‐electron Ru complex followed by phosphine dissociation, or first phosphine dissociation then coordination of the olefin to the 14‐electron Ru complex with rearrangement to a ruthenacyclobutane intermediate, followed by symmetrical reverse steps. Donation of σ‐electron density from the two C—C σ‐bonds to the metal center leads to α,β‐(C—C—C) agostic bonds, which stabilized metallacyclobutane as a formally 16‐electron complex, with lower energy than the corresponding π‐complex. In the transformation from π‐complex to ruthenacyclobutane the ruthenium atom is formally oxidized to Ru(IV). The most efficient ligands are those that stabilize the high‐oxidation state metallacyclobutane (IV) intermediate relative to the ruthenium carbene. [ABSTRACT FROM AUTHOR]

AbstractDissociative therapies are being increasingly explored for their psychiatric applications, although questions remain about how they work and how best to use them. In exploring these questions, this review highlights six key areas of clinical relevance: (1) The possible contributions of functional unblinding when interpreting efficacy data; (2) The degree to which the therapeutic effects of dissociative therapies can be distinguished from the transient forms of relief seen with recreational drug use; (3) Understanding the construct of dissociation as it is tasked with describing the function of dissociative drugs; (4) The investigation of subjective drug effects as predictors of therapeutic outcome; (5) Similarities and differences in the effects of dissociative and classic psychedelics; and (6) The anticipated need for judicious prescribing/deprescribing resources as dissociative therapies proliferate. [ABSTRACT FROM AUTHOR]

Despite distinct classes of psychoactive drugs producing putatively unique states of consciousness, there is surprising overlap in terms of their effects on episodic memory and cognition more generally. Episodic memory is supported by multiple subprocesses that have been mostly overlooked in psychopharmacology and could differentiate drug classes. Here, we reanalyzed episodic memory confidence ratings from 10 previously published data sets (28 drug conditions total) using signal detection models to estimate two conscious states involved in episodic memory and one consciously controlled metacognitive process of memory: autonoetic retrieval of specific details (recollection), noetic recognition absent of retrieved details (familiarity), and retrospective introspection of memory decisions (metamemory). Sedatives, dissociatives, psychedelics, stimulants, and cannabinoids had unique patterns of effects on these mnemonic processes dependent on whether they impacted encoding, consolidation, or retrieval (the formation, stabilization, and access to memory traces, respectively). Sedatives at encoding reliably impaired both recollection and familiarity but at consolidation enhanced recollection. Dissociatives and cannabinoids at encoding impaired recollection but less reliably impaired familiarity, and cannabinoids at retrieval increased false recollections. These drug-induced encoding impairments occasionally came with metamemory enhancements, perhaps because of less interstimulus interference. Psychedelics at encoding impaired recollection but tended to enhance familiarity and did not impact metamemory. Stimulants at encoding enhanced metamemory, at consolidation impaired metamemory, and at retrieval enhanced familiarity and metamemory. These findings allude to mechanisms underlying the idiosyncratic phenomena of drugs, such as blackouts from sedatives and presque vu from psychedelics. Finally, these findings converge on a model in which memory quantity and stability influence metamemory. [ABSTRACT FROM AUTHOR]

Spravato and other drugs with consciousness-altering effects show significant promise for treating various mental health disorders. However, the effects of these treatments necessitate a substantial degree of patient monitoring which can be burdensome to healthcare providers and may make these treatments less accessible for prospective patients. Continuous passive monitoring via digital devices may be useful in reducing this burden. This proof-of-concept study tested the MindMed Session Monitoring SystemTM (MSMSTM), a continuous passive monitoring system intended for use during treatment sessions involving pharmaceutical products with consciousness-altering effects. Participants completed 129 Spravato sessions with MSMS at an outpatient psychiatry clinic specializing in Spravato treatment. Results indicated high rates of data quality and self-reported usability among participants and health care providers (HCPs). These findings demonstrate the potential for systems such as MSMS to be used in consciousness-altering treatment sessions to assist with patient monitoring. [ABSTRACT FROM AUTHOR]

Abstract Objective We investigated the associations between FKBP5 single‐nucleotide polymorphisms (SNPs) and functional seizures (FS). Methods Seventy patients with FS, 140 with major depressive disorder (MDD), and 140 healthy controls were studied. Their DNAs were analyzed for the rs1360780 in the 3′ region and rs9470080 in the 5′ region of the FKBP5. Childhood trauma questionnaire and hospital anxiety and depression scale were used. Results Patients with FS and those with MDD had less GG and more AA genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. Similar results were observed for allelic frequencies. There were no significant differences between FS and MDD groups in terms of genotype and allelic frequencies for both SNPs. The results of multinomial logistic regression analysis showed that FKBP5 polymorphisms were not associated with the diagnosis. Significance Patients with FS and those with MDD had significantly different genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. However, it seems that FKBP5 polymorphisms were not associated with FS in the absence of depression. Further genetic investigations of patients with FS may increase our understanding of the neurobiological underpinnings of this condition, but such studies should be large enough and very well designed; they should include a comparison group with depression in addition to a healthy control group.

Abstract Objective We searched for, from the FDA (Food and Drug Administration‐USA)‐approved drugs, inhibitors of FKBP5 with tolerable adverse effect profiles (eg, mild headache, sedation, etc.) and with the ability to cross the blood brain barrier (BBB), using bio‐informatics tools (in‐silico). This may pave the road for designing clinical trials of such drugs in patients with functional seizures (FS) and other stress‐associated disorders. Methods Several databases were used to find all the approved drugs that potentially have interactions with FKBP51 protein [ie, CTD gene‐chemical interaction section of FKBP51 protein of Harmonizome of Mayaanlab, DrugCenteral database, PDID (Protein Drug Interaction Database), DGIdb (the Drug Gene Interaction database)]. Other databases were also searched [eg, clinicaltrials.gov; DRUGBANK (the FASTA format of the FKBP51 protein was imported to the target sequencing section of the database to find the associated drugs), and the STITCH database (to find the related chemical interaction molecules)]. Results After a comprehensive search of the designated databases, 28 unique and approved drugs were identified. Fluticasone propionate and Mifepristone and Ponatinib, Mirtazapine, Clozapine, Enzalutamide, Sertraline, Prednisolone, Fluoxetine, Dexamethasone, Clomipramine, Duloxetine, Citalopram, Chlorpromazine, Nefazodone, and Escitalopram are inhibitors of FKBP5 and have BBB permeability. Significance While the current in‐silico repurposing study could identify potential drugs (that are already approved and are widely available) for designing clinical trials in patients with stress‐associated disorders (eg, FS), any future clinical trial should consider the pharmacological profile of the desired drug and also the characteristics and comorbidities of the patients in order to foster a success.

Background: Dissociative Identity Disorder (DID) is a rare condition that causes alternation of at least two separate personality states and has a prevalence of less than 1% in the general population. This study aims to appraise the social media platforms, YouTube and TikTok, as sources of medical information on DID. Methods: YouTube and TikTok were queried using the following search phrases: “Dissociative Identity Disorder,” “Multiple Personality Disorder,” and “Split Personality Disorder.” The top 60 videos by views for YouTube and likes for TikTok were selected from each search term on each platform. Videos were reviewed by four independent reviewers using a modified DISCERN (mDISCERN) Scale, Global Quality Scale (GQS), and they were further classified as useful, misleading, or neither useful or misleading. Results: Number of videos that met criteria were 60 YouTube videos and 97 TikTok videos. After classification, 51.7% of YouTube videos were useful while only 5.2% of TikTok videos were useful. A significant difference was found between (mDISCERN and GQS) score and the video source, type of content, and classification (α < 0.05). Limitations: This study focused exclusively on English videos. Additionally, it did not evaluate other social media platforms that are used worldwide. Conclusion: This results of this study show the need for healthcare professionals and organizations to not only create content of high quality but increase engagement on social media platforms, particularly TikTok, in order to educate users on DID.

• Forty patients with focal epilepsy, 40 with IGE, and 40 with FS were included. • ADHD screening was positive in 35% of patients with FS. • ADHD screening was positive in 30% of those with focal epilepsy. • ADHD screening was positive in 10% of patients with IGE. • Adult patients with functional seizures are at high risk of ADHD. We investigated the rates of positive screening for attention deficit-hyperactivity disorder (ADHD) in adults with seizures [i.e., focal epilepsy vs. idiopathic generalized epilepsy (IGE) vs. functional seizures (FS)]. We hypothesized that the rates of positive screening for ADHD are different between these three groups of patients. This was a cross sectional study. Patients, 19 to 55 years of age, with a diagnosis of IGE, focal epilepsy or FS were investigated at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from September 2022 until January 2023 and during their follow-up visits. We used the validated Persian version of Adult ADHD Self-Report Scale (ASRS v1.1)15 to investigate and screen for ADHD in these patients. Forty patients with focal epilepsy, 40 with IGE, and 40 with FS were included. Attention deficit-hyperactivity disorder (ADHD) screening was positive in 35% of patients with FS, in 30% of those with focal epilepsy (compared with FS, p = 0.633), and in 10% of patients with IGE (compared with FS, p = 0.007). Adult patients with functional seizures and those with focal epilepsy are at a high risk of self-reporting experiences that could be characteristic of ADHD. Screening tools [e.g., Adult ADHD Self-Report Scale (ASRS v1.1)] are useful to help clinicians address seizure comorbidities such as ADHD. However, a clinical diagnosis of ADHD should be ascertained in a patient with positive screening. [ABSTRACT FROM AUTHOR]

The present study aimed at assessing the effects of combining 20 mg/kg S(+) ketamine with 25 μg/kg dexmedetomidine and 0.4 mg/kg butorphanol on the physiological parameters and anesthetic recovery time and score of eight captive scarlet macaw (Ara macao) specimens. These specimens were captured at the Marabá Zoobotanic Foundation (Fundação Zoobotânica de Marabá), Pará, using butterfly and mist nets, and subsequently subjected to the proposed protocol. The following physiological parameters were evaluated: heart rate (HR), respiratory rate (RR), saturation of peripheral oxygen (SpO2), body temperature (BT), and non-invasive blood pressure 5 min after drug administration (M0) and every 10 min thereafter (M1‒M5), with a total of 55 min of analysis of anesthetic effects. Glycemia was measured 5 min after drug administration and every 30 min thereafter. Anesthetic induction and recovery times were also determined. Among the parameters evaluated in this study, both HR and BT significantly decreased throughout the anesthetic period, with the lowest levels at 55 min after drug administration (M5). In contrast, RR did not significantly differ, and all animals remained stable, maintaining an RR close to a mean of 20 ± 8 cpm. Throughout the anesthetic period, SpO2 was 92 ± 5%, with no significant difference. The birds remained under spontaneous ventilation and without oxygen supplementation. Systolic, diastolic, and mean blood pressures remained stable, with no significant differences in any of these measurements. At M0 and M3, the glycemia decreased slightly, albeit with no significant difference justifying an adverse effect or even hypoglycemia. The anesthetic induction time, from M0 to decubitus, was 2.4 ± 0.7 min. The anesthetic recovery time, from M0 to effortless bipedal position and adequate phalangeal flexion, was 99.3 ± 32.4 min. The sedation was assessed as intense, and the anesthetic recovery was rated excellent in 62.5% and good in 37.5% of the animals.

Background: Evidence on the genetics of functional seizures is scarce, and the purpose of the current scoping systematic review is to examine the existing evidence and propose how to advance the field. Methods: Web of science and MEDLINE were searched, from their initiation until May 2023. The following key words were used: functional neurological disorder(s), psychogenic neurological disorder(s), functional movement disorder(s), psychogenic movement disorder(s), functional seizures(s), psychogenic seizure(s), nonepileptic seizure(s), dissociative seizure(s), or psychogenic nonepileptic seizure(s), AND, gene, genetic(s), polymorphism, genome, epigenetics, copy number variant, copy number variation(s), whole exome sequencing, or next-generation sequencing. Results: We identified three original studies. In one study, the authors observed that six (5.9%) patients with functional seizures carried pathogenic/likely pathogenic variants. In another study, the authors observed that, in functional seizures, there was a significant correlation with genes that are over-represented in adrenergic, serotonergic, oxytocin, opioid, and GABA receptor signaling pathways. In the third study, the authors observed that patients with functional seizures, as well as patients with depression, had significantly different genotypes in FKBP5 single nucleotide polymorphisms compared with controls. Conclusion: Future genetic investigations of patients with functional seizures would increase our understanding of the pathophysiological and neurobiological problems underlying this common neuropsychological stress-associated condition. [ABSTRACT FROM AUTHOR]

Psychogenic nonepileptic seizures (PNES) or functional seizures are universal phenomena. However, data on their epidemiology is limited. The aim of the current study was to review the literature on the epidemiology of PNES and to provide analytical estimates of its incidence and prevalence based on the direct data that are available from previous studies on PNES. The methods of this work had two parts: (1) MEDLINE, PsycINFO, and Scopus from inception to 19 October 2019 were systematically searched. (2) The analytical study of the incidence and prevalence of PNES was performed, based on the following data from previous studies: incidence of PNES, duration of PNES before making a diagnosis, outcome and mortality of PNES. The search strategy yielded five articles; three were on the incidence and two on the prevalence. In the analytical part of the study, the incidence of PNES was calculated to be 3.1 (95% Confidence Interval: 1.1–5.1) per 100,000 population per year. The calculated prevalence rate of PNES in 2019 was 108.5 (95% Confidence Interval: 39.2–177.8) per 100,000 population, in the USA. While, the generalizability of these calculated incidence and prevalence rates to other places in the world is limited, they give us a reasonable hint that PNES is a common condition and the prevalence is much more than that it was thought before. Supplemental data for this article is available online at . [ABSTRACT FROM AUTHOR]

Objective: We searched for, from the FDA (Food and Drug Administration‐USA)‐approved drugs, inhibitors of FKBP5 with tolerable adverse effect profiles (eg, mild headache, sedation, etc.) and with the ability to cross the blood brain barrier (BBB), using bio‐informatics tools (in‐silico). This may pave the road for designing clinical trials of such drugs in patients with functional seizures (FS) and other stress‐associated disorders. Methods: Several databases were used to find all the approved drugs that potentially have interactions with FKBP51 protein [ie, CTD gene‐chemical interaction section of FKBP51 protein of Harmonizome of Mayaanlab, DrugCenteral database, PDID (Protein Drug Interaction Database), DGIdb (the Drug Gene Interaction database)]. Other databases were also searched [eg, clinicaltrials.gov; DRUGBANK (the FASTA format of the FKBP51 protein was imported to the target sequencing section of the database to find the associated drugs), and the STITCH database (to find the related chemical interaction molecules)]. Results: After a comprehensive search of the designated databases, 28 unique and approved drugs were identified. Fluticasone propionate and Mifepristone and Ponatinib, Mirtazapine, Clozapine, Enzalutamide, Sertraline, Prednisolone, Fluoxetine, Dexamethasone, Clomipramine, Duloxetine, Citalopram, Chlorpromazine, Nefazodone, and Escitalopram are inhibitors of FKBP5 and have BBB permeability. Significance: While the current in‐silico repurposing study could identify potential drugs (that are already approved and are widely available) for designing clinical trials in patients with stress‐associated disorders (eg, FS), any future clinical trial should consider the pharmacological profile of the desired drug and also the characteristics and comorbidities of the patients in order to foster a success. [ABSTRACT FROM AUTHOR]

Objective: We investigated the associations between FKBP5 single‐nucleotide polymorphisms (SNPs) and functional seizures (FS). Methods: Seventy patients with FS, 140 with major depressive disorder (MDD), and 140 healthy controls were studied. Their DNAs were analyzed for the rs1360780 in the 3′ region and rs9470080 in the 5′ region of the FKBP5. Childhood trauma questionnaire and hospital anxiety and depression scale were used. Results: Patients with FS and those with MDD had less GG and more AA genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. Similar results were observed for allelic frequencies. There were no significant differences between FS and MDD groups in terms of genotype and allelic frequencies for both SNPs. The results of multinomial logistic regression analysis showed that FKBP5 polymorphisms were not associated with the diagnosis. Significance: Patients with FS and those with MDD had significantly different genotypes in both rs9470080 and rs1360780 SNPs compared with those in healthy controls. However, it seems that FKBP5 polymorphisms were not associated with FS in the absence of depression. Further genetic investigations of patients with FS may increase our understanding of the neurobiological underpinnings of this condition, but such studies should be large enough and very well designed; they should include a comparison group with depression in addition to a healthy control group. [ABSTRACT FROM AUTHOR]

Background: Functional neurological disorders (FND), a subtype of functional disorders (FD), are a frequent motive for neurology referrals. The various presentations and the unknown physiopathology of FD have led to the multiplication of terms describing these disorders over the years. Methods: We examined the FD-related articles published from 1960 to 2020 in PubMed and PsycINFO databases. We searched for: psychogenic, somatization, somatoform, medically unexplained symptoms, hysteria, conversion disorder, dissociative, functional neurological disorder, and functional disorder. Use rates in the title, abstract, keyword, or MeSH fields were collected over successive 5-year periods. After correcting for off-topic results, we examined proportional distribution over time, term associations, and disciplinary fields (neurology and psychiatry). Term impact was estimated via H-index and number of citations. Results: We found that none of the terms is prevailing in the recent medical literature. We observed three trends in the use rates: stability, increase, and decrease of use over time. While most of the terms were present in a stable proportion of the publications, hysteria and psychogenic lost popularity over time. We found a differential preference for terminology between disciplines. Functional neurological disorder showed the highest citation impact, yielding 10% of highly cited publications. Conclusion: We found a dynamic and evolving use of the different terms describing FD in the last 60 years. Despite the tendency to use the term functional in the recent highly cited publications, its low prevalence and coexistence with several other terms suggest that a precise, explanatory and non-offensive term remains yet to be found. [ABSTRACT FROM AUTHOR]

Psychogenic nonepileptic seizures, also called Functional Seizures, are a highly disabling form of Functional Neurological Disorder. The diagnosis of PNES could be missed in clinical scenarios where patients exhibit concurrent musculoskeletal/neurological findings. Characterization of convulsions and judicious use of diagnostics are equally valuable in establishing the diagnosis. [ABSTRACT FROM AUTHOR]

Background: A number of studies have found a possible linkage between obsessive-compulsive symptoms (OCS) and schizotypy. Inferential confusion (IC) can explain the reasoning processes behind both of them. The mechanisms by whichsomepeoplebecome more or less inferentially confused are unknown. Dissociation is one of the variables that may contribute to these mechanisms. Objectives: This study aimed to examine the fitness of the proposed model about the effect of dissociative experiences on the relationship between OCS and schizotypy by considering the mediating role of IC and moderating role of negative affect (NA). Methods: Our study sample consisted of 341 students, selected using cluster sampling method. Data were analyzed using Amos-22 software by structural equation modeling (SEM). Results: The study results showed that the data were fitted with the proposed model. Findings about the negative affect's moderating role indicated that among all paths in the model, only the IC path to OCS was moderated by negative affect. Conclusions: It was concluded that a tendency to experience dissociative states may have increased the vulnerability of individuals to IC. Inferential confusion, in turn, may have developed unusual ways of thinking about reality, which is a common feature of obsessive-compulsive spectrum and schizotypal personality traits. [ABSTRACT FROM AUTHOR]

Abstract Psychogenic nonepileptic seizures, also called Functional Seizures, are a highly disabling form of Functional Neurological Disorder. The diagnosis of PNES could be missed in clinical scenarios where patients exhibit concurrent musculoskeletal/neurological findings. Characterization of convulsions and judicious use of diagnostics are equally valuable in establishing the diagnosis.

[Display omitted] • Comparison of poly(propylene maleate) with poly(propylene fumarate) to produce dissociative CANs using multifunctional furan crosslinkers. • Networks comprising poly(propylene maleate) have higher dissociation temperatures than networks comprising poly(propylene fumarate). • The characteristics of the networks comprising furan-maleate cycloadducts are similar to networks based on furan-maleimide cycloadducts. • The unsaturated polyesters are commercially available in large quantities (currently used for thermosets), and the multifunctional furan crosslinkers are made with high atom efficiency. Unsaturated polyesters (UPEs) are a class of thermosetting resins which are prevalent in the polymer industry, offering excellent durability in many applications. However, their permanent crosslinks prevent re-use or recycling at their end-of-life. This problem is addressed using UPEs to generate dissociative covalent adaptable networks (CANs). Poly(propylene maleate) and poly(propylene fumarate) were copolymerised with furan-functionalised crosslinkers to form networks comprising reversible Diels-Alder cycloadducts. The thermal properties of each material were analysed by differential scanning calorimetry (DSC), showing that the furan-maleate networks dissociated at 130 °C compared to the furan-fumarate networks which dissociated at a significantly lower temperature (100 °C). The network formed from poly(propylene maleate) using a flexible trifunctional furan crosslinker provided the largest increase in T g and T rDA , producing the highest gel fraction (99 %) and a stable plateau modulus of 10 MPa by DMA. The networks reform at ambient temperature, although the rate of formation can be increased significantly by mild heating at 65 °C. Overall, the results indicate that furan-maleate CANs behave like reference furan-maleimide networks. Thermal analysis indicated that the furan-maleate cycloadduct was retained by heating to 150 °C, whereas isomerisation of maleate to fumarate was observed after repeated heating cycles to 180 °C. Mechanical testing showed that a bond strength of almost 10 MPa was achieved using these CANs as adhesives, which could be readily modified through changes in copolymer composition. [ABSTRACT FROM AUTHOR]

Dissociative (conversion) disorders are mental disorders that can impair sensory, motor functions [1]. The term “conversion” describes the transformation of unconsciously suppressed negative emotions resulting from internal conflicts into somatic symptoms [3]. Symptoms can vary in severity, be episodic or persistent [1]. They are not simulated, it is a physical expression of emotional suffering that is consciously not understood [2]. This article describes a clinical case in which a 47-year-old patient complained of anxiety, depressive symptoms in addition to a tremor in the arms, especially the right, wrist drop of the right hand, decreased stength of the right arm and leg, weakness of the right leg and arm movements. The duration of symptoms before the diagnosis of dissociative movement disorders was prolonged: the patient has not seen a doctor for some time after feeling unwell, when referred to neurologists, the cause of the worsening condition was not immediately recognized. The patient’s condition was differentiated with neurological diseases, organic or thyroid pathology. After a detailed examination and prescribed treatment by neurologists, while the diagnostic issues remained, the patient was referred for psychiatric consultation. [ABSTRACT FROM AUTHOR]

The dissociation of H 2 O on γ -U (110) and γ -U (100) surfaces has been studied by using ab initio molecular dynamics simulations at an elevated temperature of 800 K. The simulation results show the dissociation of H 2 O into the OH group and H atom, which are finally adsorbed on the uranium surface. The dissociation results from electronic interactions between surface uranium 6d/5 f states and the s orbitals of H and the 2p orbitals of O. Additionally, the hybridization between the 6d orbital of surface uranium and the 2p orbital of oxygen plays a dominant role in dissociative adsorption. A significant charge transfer from the uranium surface to the O and H atoms is observed, indicating the formation of U-O and U-H chemical bonds. Specifically, for γ -U (110) surface, the most preferred site for OH is the 3-fold hollow site and H occupies the bridge site or the 3-fold hollow site. On the other hand, for γ -U (100) surface, OH prefers to adsorb on the bridge site and H occupies the 3-fold hollow site or the bridge site. Furthermore, when H 2 O is placed on the TOP site, its initial dissociation on the γ -U (110) surface is easier compared to the γ -U (100) surface., (© 2024 IOP Publishing Ltd.)

• Dual diagnosis of epilepsy and DS has rarer achievement of remission than DS only. • Safety of ASM rationalisation in this group has not been assessed. • We assessed outcomes of 139 patients post rationalisation during an inpatient stay. • ASM frequency was lower at follow-up compared to at admission. • Fewer hospital contacts were required in the year following admission. Patients with a dual-diagnosis of epilepsy and dissociative seizures (DS) have received far less attention than those with single pathology. Anti-seizure medication (ASM) prescription patterns and safety of rationalisation have not been reviewed. We undertook a retrospective cohort study of all patients with a dual-diagnosis admitted to the Scottish Epilepsy Centre between 2012–2020. ASM frequencies were compared across admission, discharge and follow-up and emergency hospital attendances compared a year before and after admission. Demographic data, seizure characteristics and mortality data were also reviewed. Across the 139 patients included in our study, ASM frequency at follow-up was significantly lower than on admission (mean 2.51 vs 2.14, Z = −2.11 p = 0.035, r = −0.215). Total hospital attendances in the year following admission were significantly lower than in the year before (mean 1.27 vs 0.77, Z = 2.306, p = 0.021, r = −0.262). Those with inactive epilepsy had their medications reduced to a greater extent that those with active epilepsy. 44 patients had their ASM frequency reduced during admission with a similar trend of reduced hospital attendances (mean 1.29 vs 0.43 Z = −3.162 p = 0.002). There was one epilepsy related death. Clinicians should consider the development of co-morbid DS in patients with epilepsy not responding to an escalation of ASM, especially if presenting with a new seizure type. Patients with a dual-diagnosis of epilepsy and DS, particularly those with well controlled epilepsy, are likely overtreated with ASM. Medication review in a tertiary epilepsy centre allows for safe rationalisation of ASM and likely contributes to the need for fewer hospital attendances. [ABSTRACT FROM AUTHOR]

Introduction: Psychotic dissociative disorder is a mental process where a person disconnects from their own thoughts, feelings, memories or sense of identity. It usually occurs after the person experienced a traumatic event and it can serve as a defense mechanism against overwhelming emotions. Case Report: The purpose of this report is to present a rare case of psychotic dissociative disorder with serious damage of physical health. The 18 year old patient was brought to emergency service of psychiatric clinic due bizarre and chaotic behaviour, incomprehensible speech. This acute psychotic episode debuted four days prior and was characterized by autoand allopsychic disorientation, disjointed and tangential speech, echolalia, marked suggestibility and restlessness, purposeless movements. The patient's drug test came back negative and she doesn't have any history of psychiatric disorders. According to the patient's mother, symptoms debuted following a traumatic event at school and they worsened during those 4 days. Over the initial three weeks of hospitalization, the patient was noncooperative and did not respond to the prescribed treatment regimen. Her condition got gradually worse and she started manifesting muscle spasms, dysphonia, dysphagia and ultimately entering a catatonic state. Consequently, she was transferred to the ICU, where she remained for the next 2 weeks. Upon returning to the psychiatric clinic, her mental state had not improved, she continued to exhibit extreme agitation, aimless laughter, and peculiar behaviour. A revised treatment plan yielded success, leading to the patient's discharge after a month of care. Currently, there have been no recurrences of psychotic episodes, and the patient maintains a stable clinical course. Discussions : Considering the patient's established hysterical personality tendencies, the traumatic event had an even bigger impact on her. Due to the inclination to seek attention and the reduced capacity to tolerate stress and psychological trauma, the patient dissociated as a way of coping. Several examinations were conducted to ascertain the etiology of her physical deterioration, yet all results returned within normal parameters. This underscores the proposition that her catatonic state was solely precipitated by psychological factors. Conclusions: Psychotic dissociative disorder stands as a complex and multifaceted condition that requires a comprehensive and meticulous approach, because clearly this disorder poses significant challenges for both those affected and their caregivers, potentially even endangering the patient's life. [ABSTRACT FROM AUTHOR]

Rationale: N-methyl-D-aspartate receptor-mediated dissociatives and serotonergic hallucinogens are being increasingly used in therapeutic interventions that involve nonordinary states of consciousness and may represent a unique mental health paradigm wherein pharmacologically induced experiences are conducive to psychological well-being., Objective: The aim of this study was to further understand how the phenomenological and health-promoting effects of high-dose dextromethorphan (DXM) compared to psilocybin in the same participants when administered under experimental conditions that are typical of therapeutic psychedelic trials., Methods: Single, acute oral doses of DXM (400 mg/70 kg), psilocybin (10, 20, 30 mg/70 kg), and inactive placebo were administered under double-blind and psychologically supportive conditions to 20 healthy participants with histories of hallucinogen use. Ratings of personal meaning, spiritual significance, psychological challenge, and psychological insight attributed to acute drug experiences were assessed 7 h (at session end) and 1 week after each drug administration. Persisting psychological effects were assessed 1 week after each drug administration., Results: High-dose DXM and psilocybin produced similar increases over placebo in ratings of drug experience that was predictive of psychological benefit at 1 week, even when expectancy effects were minimized. These effects tended to favor psilocybin in a dose-dependent manner and were limited by poor physical tolerability for DXM., Conclusions: This analysis suggests the utility of exploring clinical applications of dissociatives that occur within the supportive contexts that are characteristic of psychedelic research and that prioritize the optimization of psychologically valuable drug experiences. This study was registered with ClinicalTrials.gov (NCT02033707)., Competing Interests: J.C.S. has received research funding from the Canopy Growth Corporation. A.G.-R. serves as a paid scientific advisor to Innerwell and NeonMind Biosciences. R.R.G. is on the board of directors of the Heffter Research Institute. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright 2023, Mary Ann Liebert, Inc., publishers.)

• Those with late-onset FS were more likely to have medical comorbidities. • Those with late-onset FS more likely had a history of head injury. • Duration of illness was significantly longer in patients with childhood-onset FS. We investigated childhood-onset functional seizures (FS) and late-onset FS and hypothesized that there are differences in their characteristics. In this retrospective study, we investigated all patients with confirmed FS with an age at onset of 14 years or younger and those with an age at onset of 50 years or older, who were admitted to the epilepsy monitoring units at one center in Iran (Shiraz Comprehensive Epilepsy Center, from 2008 until 2022) and one center in the USA (Vanderbilt University Medical Center, from 2011 until 2022). One-hundred and forty patients were included. They included 80 patients with childhood-onset FS and 60 with late-onset FS. Those with late-onset FS were more likely to have medical comorbidities compared with the patients with childhood-onset FS (OR = 13.9). Those with late-onset FS more likely had a history of head injury compared with the patients with childhood-onset FS (OR = 5.97). Duration of illness was significantly longer in patients with childhood-onset FS compared with the patients with late-onset FS (6 years vs. 2 years). Our study identified several similarities and differences in the clinical characteristics and predisposing factors of patients with childhood-onset and late-onset FS. In addition, we found that childhood-onset FS is more likely to remain undiagnosed and thus untreated for many years. These findings provide additional evidence that FS is a heterogenous condition and we propose that a proportion of the differences between patients may be accounted for by age-associated factors. [ABSTRACT FROM AUTHOR]