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4. Investigating psychobiological causes and mechanisms in functional seizures and functional motor symptoms: Study protocol

Author

Pick, Susannah, primary, David, Anthony S., additional, Edwards, Mark J., additional, Goldstein, Laura H., additional, Hodsoll, John, additional, Millman, L. S. Merritt, additional, Nicholson, Timothy R., additional, Reinders, A.A.T.S., additional, Stanton, Biba, additional, Winston, Joel S., additional, Mehta, Mitul A., additional, Chalder, Trudie, additional, and Hotopf, Matthew, additional

Published
2024
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6. Psychological Therapy for Functional Neurological Disorder: Examining Impact on Dissociation, Psychological Distress and General Functioning.

Author

Esteban-Serna, Celia, Loewenberger, Alana, Pick, Susannah, and Cope, Sarah R.

Subjects
ANXIETY prevention, PREVENTION of mental depression, SOMATOFORM disorders, PSYCHOTHERAPY, PSYCHOLOGICAL distress, QUESTIONNAIRES, FUNCTIONAL status, ACCEPTANCE & commitment therapy, MEMORY disorders
Abstract

Functional neurological disorder (FND) represents a broad group of motor and sensory clinical symptoms which cannot be explained by other neurological diagnoses. Dissociation is considered a key mechanism in their development and maintenance. Despite psychological therapy being the recommended choice of treatment for FND, evidence for its effectiveness is in its infancy. This study explored the dissociative profile of forty-seven patients with FND and evaluated whether individual psychological therapy improved dissociative symptoms, psychological distress and general functioning among twenty-five adults with FND. Patients completed the Multiscale Dissociation Inventory, the EuroQol five-dimensional descriptive system, the General Anxiety Disorder-7 scale and the Patient Health Questionnaire-9. Our sample showed high levels of disengagement, depersonalization and memory disturbance at baseline. Treatment was associated with significant improvements in general functioning, and symptoms of dissociation and anxiety. Improvements in dissociative experiences were found to be possibly due to reduction in anxiety. Improvements in depression were the strongest predictor of improvements in general functioning. Limitations and areas for further research are discussed. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Investigating psychobiological causes and mechanisms in functional seizures and functional motor symptoms: Study protocol.

Author

Pick, Susannah, David, Anthony S., Edwards, Mark J., Goldstein, Laura H., Hodsoll, John, Millman, L. S. Merritt, Nicholson, Timothy R., Reinders, A. A. T. S., Stanton, Biba, Winston, Joel S., Mehta, Mitul A., Chalder, Trudie, and Hotopf, Matthew

Subjects
*INTEROCEPTION, *LIFE change events, *PSYCHOBIOLOGY, *ECOLOGICAL momentary assessments (Clinical psychology), *MENTAL illness, *MAGNETIC resonance imaging, *ISOMETRIC exercise
Abstract

Introduction: Advances have been made in understanding the aetiology of functional neurological disorder (FND); however, its pathophysiological mechanisms have not been definitively demonstrated. Evidence suggests interacting roles for altered emotional processing and interoception, elevated autonomic arousal, and dissociation, but there is limited evidence demonstrating their causal influence on specific FND symptoms. Our superordinate aim is to elucidate potentially shared and distinct aetiological factors and mechanisms in two common FND subtypes, functional seizures (FS) and functional motor symptoms (FMS). Methods: This study has a multimodal, mixed between- and within-groups design. The target sample is 50 individuals with FS, 50 with FMS, 50 clinical controls (anxiety/depression), and 50 healthy controls. Potential aetiological factors (e.g., adverse life events, physical/mental health symptoms, dissociative tendencies, interoceptive insight/sensibility) will be assessed with a detailed medical history interview and self-report questionnaires. A laboratory session will include a neurocognitive battery, psychophysiological testing, cardiac interoception and time estimation tasks and an isometric handgrip task. A subsample will undergo magnetic resonance imaging, including structural, resting-state and task-based scans combined with psychophysiological recording. Remote monitoring with ecological momentary assessment and wearables will measure variability in FND symptoms and their potential predictors/correlates for ≥2 weeks in patients' daily lives. Longitudinal follow-ups at 3, 6, and 12-months will monitor longer-term outcomes in the clinical groups. Discussion: This study employs multimodal research methods to rigorously examine several putative mechanisms in FND, at subjective/experiential, behavioural, and physiological levels. The study will test causal hypotheses about the role of altered emotional processing, autonomic arousal, dissociation and interoception in the initiation or exacerbation of FND symptoms, directly comparing these processes in FS and FMS to healthy and clinical controls. This is the first study of its kind, with potential to reveal important targets for prevention and treatment of FND in future. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Unravelling the influence of affective stimulation on functional neurological symptoms: a pilot experiment examining potential mechanisms.

Author

Pick, Susannah, Millman, L. S. Merritt, Ward, Emily, Short, Eleanor, Stanton, Biba, Reinders, A. A. T. Simone, Winston, Joel S., Nicholson, Timothy R., Edwards, Mark J., Goldstein, Laura H., David, Anthony S., Chalder, Trudie, Hotopf, Matthew, and Mehta, Mitul A.

Subjects
INTEROCEPTION, PSYCHOGENIC nonepileptic seizures, EPILEPSY, PILOT projects, AFFECT (Psychology), SOMATOFORM disorders, PATIENTS' attitudes, YOUNG adults
Published
2024
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10. 13 Predisposing, precipitating and perpetuating factors in functional neurological disorder: a pilot study

Author

Merritt Millman, LS, primary, Short, Eleanor, additional, Ward, Emily, additional, Sun, Yiqing, additional, Stanton, Biba, additional, Bradley-Westguard, Abigail, additional, Goldstein, Laura H, additional, Winston, Joel, additional, Mehta, Mitul, additional, Nicholson, Timothy, additional, Reinders, Simone, additional, David, Anthony, additional, Edwards, Mark, additional, Chalder, Trudie, additional, Hotopf, Matthew, additional, and Pick, Susannah, additional

Published
2023
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11. 12 A pilot investigation of interoceptive accuracy, awareness, and sensibility in functional neurological disorder

Author

Merritt Millman, LS, primary, Short, Eleanor, additional, Stanton, Biba, additional, Winston, Joel, additional, Nicholson, Timothy, additional, Mehta, Mitul, additional, Reinders, Simone, additional, Edwards, Mark, additional, Goldstein, Laura, additional, David, Anthony, additional, Hotopf, Matthew, additional, Chalder, Trudie, additional, and Pick, Susannah, additional

Published
2023
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12. Unravelling the influence of affective stimulation on functional neurological symptoms: a pilot experiment examining potential mechanisms

Author

Pick, Susannah, primary, Millman, LS Merritt, additional, Ward, Emily, additional, Short, Eleanor, additional, Stanton, Biba, additional, Reinders, AAT Simone, additional, Winston, Joel S, additional, Nicholson, Timothy R, additional, Edwards, Mark J, additional, Goldstein, Laura H, additional, David, Anthony S, additional, Chalder, Trudie, additional, Hotopf, Matthew, additional, and Mehta, Mitul A, additional

Published
2023
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15. Objective and subjective neurocognitive functioning in functional motor symptoms and functional seizures: preliminary findings

Author

Pick, Susannah, primary, Millman, L.S. Merritt, additional, Sun, Yiqing, additional, Short, Eleanor, additional, Stanton, Biba, additional, Winston, Joel S., additional, Mehta, Mitul A., additional, Nicholson, Timothy R., additional, Reinders, Antje A.T.S., additional, David, Anthony S., additional, Edwards, Mark J., additional, Goldstein, Laura H., additional, Hotopf, Matthew, additional, and Chalder, Trudie, additional

Published
2023
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16. Interoception in functional motor symptoms and functional seizures: Preliminary evidence of intact accuracy alongside reduced insight and altered sensibility

Author

Millman, L.S. Merritt, primary, Short, Eleanor, additional, Stanton, Biba, additional, Winston, Joel S., additional, Nicholson, Timothy R., additional, Mehta, Mitul A., additional, Reinders, Antje A.T.S., additional, Edwards, Mark J., additional, Goldstein, Laura H., additional, David, Anthony S., additional, Hotopf, Matthew, additional, Chalder, Trudie, additional, and Pick, Susannah, additional

Published
2023
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17. Emotional processing and psychosocial factors in individuals diagnosed with dissociative seizures

Author

Pick, Susannah and Goldstein, Laura Hilary

Subjects
150
Abstract

The thesis presents research exploring emotional processing and psychosocial factors in individuals diagnosed with dissociative seizures (DS). Initially, clinical, biological, and psychosocial correlates of DS are discussed, in addition to theoretical perspectives on the disorder. This is followed by a review of previous research investigating dissociation and emotional processing in DS. A novel model of the triggering mechanism underlying DS is proposed, and the rationale, aims, general hypotheses and overall methodology are outlined. Four empirical quantitative studies are then described, in which the DS group were compared to healthy control participants. A study of psychosocial factors, based on self-report questionnaires, generally confirmed/extended findings from previous studies. Patients with DS reported elevated depression, anxiety, post-traumatic symptoms, borderline personality features, and psychological and somatoform dissociation. Higher rates and greater impact of adverse life events were also reported by the DS group. Contrary to expectations, no group differences in childhood family functioning were observed. Another study utilising an emotional Stroop paradigm revealed the presence of a preconscious attentional bias towards emotional facial expressions in DS patients. A related experimental investigation of explicit facial affect processing elicited evidence of a deficit in facial expression recognition in the DS sample, alongside reduced autonomic responding to the stimuli in a subgroup of patients. A further experimental study explored patients’ affective responses to visual images. Whilst there were no group differences in subjective emotional responses on this task, autonomic responding was elevated in a subgroup of patients. Qualitative techniques were used in the final study, which explored emotional experiences in a subsample of patients. The findings provided phenomenological insights into patients’ understanding of these processes. The findings are drawn together and discussed, and the proposed triggering model is presented in a modified form in the final chapter.

Published
2015

19. MODIFI: protocol for randomised feasibility study of eye-movement desensitisation and reprocessing therapy (EMDR) for functional neurological disorder (FND)

Author

Cope, Sarah R, primary, Smith, Jared G, additional, El-Leithy, Sharif, additional, Vanzan, Serena, additional, Pentland, Caitlin, additional, Pick, Susannah, additional, Golder, Dawn, additional, Hogwood, Patricia, additional, Turner, Kati, additional, Billings, Jo, additional, and Edwards, Mark J, additional

Published
2023
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20. Functional neurological disorder is a feminist issue

Author

McLoughlin, Caoimhe, primary, Hoeritzauer, Ingrid, additional, Cabreira, Verónica, additional, Aybek, Selma, additional, Adams, Caitlin, additional, Alty, Jane, additional, Ball, Harriet A, additional, Baker, Janet, additional, Bullock, Kim, additional, Burness, Chrissie, additional, Dworetzky, Barbara A, additional, Finkelstein, Sara, additional, Garcin, Béatrice, additional, Gelauff, Jeannette, additional, Goldstein, Laura H, additional, Jordbru, Anika, additional, Huys, Anne-Catherine ML, additional, Laffan, Aoife, additional, Lidstone, Sarah C, additional, Linden, Stefanie Caroline, additional, Ludwig, Lea, additional, Maggio, Julie, additional, Morgante, Francesca, additional, Mallam, Elizabeth, additional, Nicholson, Clare, additional, O’Neal, Mary, additional, O‘Sullivan, Suzanne, additional, Pareés, Isabel, additional, Petrochilos, Panayiota, additional, Pick, Susannah, additional, Phillips, Wendy, additional, Roelofs, Karin, additional, Newby, Rachel, additional, Stanton, Biba, additional, Gray, Cordelia, additional, Joyce, Eileen M, additional, Tijssen, Marina AJ, additional, Chalder, Trudie, additional, McCormick, Maxanne, additional, Gardiner, Paula, additional, Bègue, Indrit, additional, Tuttle, Margaret C, additional, Williams, Isobel, additional, McRae, Sarah, additional, Voon, Valerie, additional, and McWhirter, Laura, additional

Published
2023
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26. Dissociation and its biological and clinical associations in functional neurological disorder:systematic review and meta-analysis

Author

Campbell, Malcolm, Smakowski, Abigail, Rojas-Aguiluz, Maya, Goldstein, Laura, Cardena, Etzel, Nicholson, Timothy, Reinders, Antje A. T. S., and Pick, Susannah

Subjects
Medically Unexplained Symptoms, functional neurological disorder, somatic symptom disorder, Dissociative seizures, Systematic Review Meta-analysis, Conversion disorder, Dissociation, Psychogenic non-epileptic seizures, Movement disorder, Dissociative
Abstract

Background Studies have reported elevated rates of dissociative symptoms and comorbid dissociative disorders in functional neurological disorder (FND); however, a comprehensive review is lacking. Aims To systematically review the severity of dissociative symptoms and prevalence of comorbid dissociative disorders in FND and summarise their biological and clinical associations. Method We searched Embase, PsycInfo and MEDLINE up to June 2021, combining terms for FND and dissociation. Studies were eligible if reporting dissociative symptom scores or rates of comorbid dissociative disorder in FND samples. Risk of bias was appraised using modified Newcastle-Ottawa criteria. The findings were synthesised qualitatively and dissociative symptom scores were included in a meta-analysis (PROSPERO CRD42020173263). Results Seventy-five studies were eligible (FND n = 3940; control n = 3073), most commonly prospective case-control studies (k = 54). Dissociative disorders were frequently comorbid in FND. Psychoform dissociation was elevated in FND compared with healthy (g = 0.90, 95% CI 0.66-1.14, I 2 = 70%) and neurological controls (g = 0.56, 95% CI 0.19-0.92, I 2 = 67%). Greater psychoform dissociation was observed in FND samples with seizure symptoms versus healthy controls (g = 0.94, 95% CI 0.65-1.22, I 2 = 42%) and FND samples with motor symptoms (g = 0.40, 95% CI −0.18 to 1.00, I 2 = 54%). Somatoform dissociation was elevated in FND versus healthy controls (g = 1.80, 95% CI 1.25-2.34, I 2 = 75%). Dissociation in FND was associated with more severe functional symptoms, worse quality of life and brain alterations. Conclusions Our findings highlight the potential clinical utility of assessing patients with FND for dissociative symptomatology. However, fewer studies investigated FND samples with motor symptoms and heterogeneity between studies and risk of bias were high. Rigorous investigation of the prevalence, features and mechanistic relevance of dissociation in FND is needed.

Published
2023

29. International online survey of 1048 individuals with functional neurological disorder

Author

Butler, Matthew, primary, Shipston‐Sharman, Oliver, additional, Seynaeve, Mathieu, additional, Bao, Jianan, additional, Pick, Susannah, additional, Bradley‐Westguard, Abigail, additional, Ilola, Eveliina, additional, Mildon, Bridget, additional, Golder, Dawn, additional, Rucker, James, additional, Stone, Jon, additional, and Nicholson, Timothy, additional

Published
2021
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32. Trial Of Neurostimulation In Conversion Symptoms (TONICS): a feasibility randomised controlled trial of transcranial magnetic stimulation for functional limb weakness

Author

Pick, Susannah, primary, Hodsoll, John, additional, Stanton, Biba, additional, Eskander, Amy, additional, Stavropoulos, Ioannis, additional, Samra, Kiran, additional, Bottini, Julia, additional, Ahmad, Hena, additional, David, Anthony S, additional, Purves, Alistair, additional, and Nicholson, Timothy R, additional

Published
2020
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37. Driving a motor vehicle and psychogenic nonepileptic seizures: ILAE Report by the Task Force on Psychogenic Nonepileptic Seizures

Author

Asadi‐Pooya, Ali A., primary, Nicholson, Timothy R., additional, Pick, Susannah, additional, Baslet, Gaston, additional, Benbadis, Selim R., additional, Beghi, Massimiliano, additional, Brigo, Francesco, additional, Buchhalter, Jeffrey, additional, D'Alessio, Luciana, additional, Dworetzky, Barbara, additional, Gigineishvili, David, additional, Kanaan, Richard A., additional, Kozlowska, Kasia, additional, LaFrance, W. Curt, additional, Lehn, Alexander, additional, Perez, David L., additional, Popkirov, Stoyan, additional, Pretorius, Chrisma, additional, Szaflarski, Jerzy P., additional, Tolchin, Benjamin, additional, Valente, Kette, additional, Stone, Jon, additional, and Reuber, Markus, additional

Published
2020
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38. Outcome measurement in functional neurological disorder: a systematic review and recommendations

Author

Pick, Susannah, primary, Anderson, David G, additional, Asadi-Pooya, Ali A, additional, Aybek, Selma, additional, Baslet, Gaston, additional, Bloem, Bastiaan R, additional, Bradley-Westguard, Abigail, additional, Brown, Richard J, additional, Carson, Alan J, additional, Chalder, Trudie, additional, Damianova, Maria, additional, David, Anthony S, additional, Edwards, Mark J, additional, Epstein, Steven A, additional, Espay, Alberto J, additional, Garcin, Béatrice, additional, Goldstein, Laura H, additional, Hallett, Mark, additional, Jankovic, Joseph, additional, Joyce, Eileen M, additional, Kanaan, Richard A, additional, Keynejad, Roxanne C, additional, Kozlowska, Kasia, additional, LaFaver, Kathrin, additional, LaFrance, Jr., W Curt, additional, Lang, Anthony E, additional, Lehn, Alex, additional, Lidstone, Sarah, additional, Maurer, Carine W, additional, Mildon, Bridget, additional, Morgante, Francesca, additional, Myers, Lorna, additional, Nicholson, Clare, additional, Nielsen, Glenn, additional, Perez, David L, additional, Popkirov, Stoyan, additional, Reuber, Markus, additional, Rommelfanger, Karen S, additional, Schwingenshuh, Petra, additional, Serranova, Tereza, additional, Shotbolt, Paul, additional, Stebbins, Glenn T, additional, Stone, Jon, additional, Tijssen, Marina AJ, additional, Tinazzi, Michele, additional, and Nicholson, Timothy R, additional

Published
2020
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39. Clinical characteristics of psychogenic nonepileptic seizures across the lifespan: An international retrospective study

Author

Sawchuk, Tyson, primary, Asadi-Pooya, Ali A., additional, Myers, Lorna, additional, Valente, Kette D., additional, Restrepo, Anilu Daza, additional, D' Alessio, Luciana, additional, Homayoun, Maryam, additional, Bahrami, Zahra, additional, Alessi, Rudá, additional, Paytan, Angélica Aroni, additional, Kochen, Silvia, additional, Taha, Firas, additional, Lazar, Lorraine M., additional, Pick, Susannah, additional, Nicholson, Timothy R., additional, and Buchhalter, Jeffrey, additional

Published
2020
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41. Adult-onset psychogenic nonepileptic seizures: A multicenter international study

Author

Asadi-Pooya, Ali A., primary, Valente, Kette, additional, Restrepo, Anilu Daza, additional, D' Alessio, Luciana, additional, Homayoun, Maryam, additional, Bahrami, Zahra, additional, Alessi, Rudá, additional, Paytan, Angélica Aroni, additional, Kochen, Silvia, additional, Myers, Lorna, additional, Sawchuk, Tyson, additional, Buchhalter, Jeffrey, additional, Taha, Firas, additional, Lazar, Lorraine M., additional, Pick, Susannah, additional, and Nicholson, Timothy, additional

Published
2019
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42. Sex differences in demographic and clinical characteristics of psychogenic nonepileptic seizures: A retrospective multicenter international study

Author

Asadi-Pooya, Ali A., primary, Myers, Lorna, additional, Valente, Kette, additional, Restrepo, Anilu Daza, additional, D' Alessio, Luciana, additional, Sawchuk, Tyson, additional, Homayoun, Maryam, additional, Bahrami, Zahra, additional, Alessi, Rudá, additional, Paytan, Angélica Aroni, additional, Kochen, Silvia, additional, Buchhalter, Jeffrey, additional, Taha, Firas, additional, Lazar, Lorraine M., additional, Pick, Susannah, additional, and Nicholson, Timothy, additional

Published
2019
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43. Autonomic and subjective responsivity to emotional images in people with dissociative seizures

Author

Pick, Susannah, Mellers, J.D.C., and Goldstein, L.H.

Subjects
psyc
Abstract

People with dissociative seizures (DS) report a range of difficulties in emotional functioning and exhibit altered responding to emotional facial expressions in experimental tasks. We extended this research by investigating subjective and autonomic reactivity (ratings of emotional valence, arousal and skin conductance responses [SCRs]) to general emotional images in 39 people with DS relative to 42 healthy control participants, whilst controlling for anxiety, depression, cognitive functioning and, where relevant, medication use. It was predicted that greater subjective negativity and arousal and increased SCRs in response to the affective pictures would be observed in the DS group. The DS group as a whole did not differ from controls in their subjective responses of valence and arousal. However, SCR amplitudes were greater in ‘autonomic responders’ with DS relative to ‘autonomic responders’ in the control group. A positive correlation was also observed between SCRs for highly arousing negative pictures and self-reported ictal autonomic arousal, in DS ‘autonomic responders’. In the DS subgroup of autonomic ‘non-responders’, differences in subjective responses were observed for some conditions, compared to control ‘non-responders’. The findings indicate unaffected subjective responses to emotional images in people with DS overall. However, within the group of people with DS, there may be subgroups characterized by differences in emotional responding. One subgroup (i.e., ‘autonomic responders’) exhibit heightened autonomic responses but intact subjective emotional experience, whilst another subgroup (i.e., ‘autonomic non-responders’) seem to experience greater subjective negativity and arousal for some emotional stimuli, despite less frequent autonomic reactions. The current results suggest that therapeutic interventions targeting awareness and regulation of physiological arousal and subjective emotional experience could be of value in some people with this disorder.

Published
2018

48. Emotion and dissociative seizures: a phenomenological analysis of patients' perspectives

Author

Pick, Susannah, Mellers, John, and Goldstein, Laura Hilary

Abstract

Quantitative research has indicated that patients with dissociative seizures (DS) show altered responses to emotional stimuli, in addition to considerable emotional distress and dysregulation. The present study sought to further explore emotional processes in this population, to extend previous findings and provide a phenomenological insight into patients’ perspectives on these issues. Semi-structured interviews were carried out with 15 patients with DS and the principles of interpretative phenomenological analysis (IPA) were adopted in data analysis. Key themes elicited included: i) general emotional functioning; ii) adverse (stressful/traumatic) life experiences; iii) the role of emotions in DS; (iv) relating to others; and v) resilience, protective factors and coping mechanisms. The clinical and theoretical implications of the findings are discussed.

Published
2016

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