Trauma-focused therapy in early intervention for psychosis settings: Results of a feasibility RCT of 'EMDR for psychosis'

Aims: Trauma is particularly prevalent amongst Early Intervention (EI) patients and is associated with adverse clinical and prognostic outcomes. To determine the feasibility of a large-scale randomized controlled trial (RCT) of an 'EMDR for psychosis' intervention for trauma survivors with active psychotic symptoms supported by EI services, we conducted a single-blind RCT comparing 16 sessions of EMDRp + TAU versus TAU only. Method(s): EMDRp therapy and trial assessments were completed both in-person and remotely during the COVID-19 pandemic, and key feasibility outcomes (recruitment & retention, therapy attendance/ engagement, adherence to EMPRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes) were examined at 6- and 12-month post-randomization assessments. Results and Conclusion(s): 60 participants (100% of the recruitment target) received TAU or EMDR + TAU. The feasibility criteria examined in this trial were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable post-treatment outcomes, including improved psychotic symptoms (PANSS), subjective recovery (QPR), post-traumatic symptoms (PCL-5;ITQ), depression (PHQ-9), anxiety (GAD-7) and general health status (EQ-5D-VAS) at the 6-month assessment. Signals of efficacy at 12-month were less pronounced, but remained robust for trauma symptoms and general health status. The findings will be discussed with relevance to future clinical trials of trauma-focused therapy in clients with early psychosis, and the provision of more tailored trauma therapies for EI service users.

Can eye movement desensitisation and reprocessing improve psychological recovery following COVID-19 related critical illness? the CovEMERALD feasibility trial

Introduction: Over 200,000 patients survive an intensive care admission each year in the United Kingdom (UK). For patients, survival is frequently beset by a range of chronic disabilities. Approximately 50% must navigate an often complex convalescence, while suffering serious and persistent symptoms of post-traumatic stress disorder (PTSD), anxiety and/or depression.1 Eye-movement desensitisation and reprocessing (EMDR) is a trauma-focussed psychological therapy, recommended for treating PTSD by the International Society for Traumatic Stress Studies2 and NICE.3 However, EMDR has never been systematically investigated for patient benefit following intensive care admission. Objective(s): CovEMERALD4 evaluated the feasibility of delivering a randomised controlled trial (RCT), testing the effect of EMDR on the psychological health of intensive care survivors, following COVID-19 related critical illness. We also provide preliminary evidence of the effect on clinically relevant outcomes. Findings will inform the design of a subsequent fully-powered RCT. Method(s): This feasibility RCT was conducted at a single-centre, teaching hospital in the UK (University Hospital Southampton). Patients were eligible if they were admitted to intensive care for over 24-hours with confirmed COVID-19, were above 18 years of age, were recruited within 3-months of hospital discharge, and had no cognitive impairment or pre-existing psychotic diagnosis. Participants were randomised (1:1) to receive either up to 8 sessions of remotely-delivered EMDR (Recent traumatic events protocol) or standard care alone as the control group (CG). Psychometric evaluation was undertaken at Baseline and 6-months after hospital discharge. Result(s): Seventy-five consecutive patients were screened at hospital discharge, from October 2020 to April 2021. 51 eligible patients approached. 26 (51%) provided consent. Reasons for declining participation were;no psychological distress (n=16), no internet access (n=7) and being physically unready (n=2). Demographic variables were balanced between groups. Of the 13 patients randomised to EMDR, one withdrew prior to intervention: the remaining attended all sessions recommended by the psychological therapists (mean of 3-4 sessions per patient), giving an overall adherence of 93%. One patient from each group declined the 6-month follow-up evaluation, so trial completion was possible in 23 of 26 (88%) participants. No reasons for trial withdrawal were given. There were no attributable adverse events. Mean change in PTSD score (PTSD Checklist-Civilian) from Baseline to 6-months, was -8 (SD=10.49) in the EMDR group vs. +0.75 (SD=15.17) in CG (p=0.126). Mean change in anxiety (Hospital Anxiety and Depression Scale-Anxiety) was -0.45 (SD=2.3) following EMDR vs. -0.83 (SD=4.0) in the CG (p=0.787), and median change in depression (HADS-D) was -2(IQR:-3.0,1.0) following EMDR vs. +1(IQR-1.5,2.0) in the CG (p=0.263). Figure 1. Box-plot of change in PTSD symptoms (PCL-C) from baseline to 6-months post-hospital discharge for control group and EMDR intervention group. Conclusion(s): EMDR can improve psychological recovery following an intensive care admission for COVID-19, and appeared feasible and safe. Although not powered to determine clinical effectiveness, this single-centre feasibility study returned a positive signal, in reducing PTSD and depressive symptoms. A full results manuscript will be submitted prior to congress. CovEMERALD has supported a successful NIHR doctoral fellowship application, during which protocol refinements will be tested, within existing, and recommended rehabilitation pathways. Trial activity and progression will be consistent with the Medical Research Council framework for developing and evaluating complex healthcare interventions.5.

Inviting the body, movement, and the creative arts into telehealth: A culturally responsive model for online EMDR preparation

This chapter addresses the emerging need to enhance the cross-cultural applications of Eye Movement Desensitization and Reprocessing (EMDR) over telehealth to effectively respond to the COVID-19 crisis. The chapter aims to provide therapists with skills to expand Phase Two of EMDR treatment to increase safety and readiness for online trauma reprocessing. It presents The COME BACK Tool, a set of eight stabilization practices that integrates movement and creative arts, as a comprehensive framework for Phase Two of EMDR. The chapter discusses the benefits of using body-based practices when working with complex trauma and dissociation as well as its application to intercultural work, and also presents a case example of using yoga to facilitate dual attention during trauma reprocessing in Phase Four of EMDR over telehealth. The chapter then outlines eight COME BACK Tool scripts, one practice for each letter, so that readers can easily and immediately begin offering these practices to clients and even applying them to their own self-care routine. By integrating movement and creative arts therapies, the whole body is engaged for a present-moment experience and provides a concrete, external focus so mindfully connecting to thoughts, feelings, and sensations is more tolerable and titrated. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Gen Z in crisis: Blending EMDR and art therapy for a more robust therapeutic experience

This chapter presents a model for combining Eye Movement Desensitization and Reprocessing (EMDR) and art therapy for the Gen Z population (young people born in the United States between 1997 and 2007). Adolescents and young adults have increased rates of depression, anxiety, addiction, reports of loneliness, and suicide attempts compared to previous generations. The COVID-19 pandemic has exacerbated these worrisome trends. The chapter offers techniques for enhancing eight phases of EMDR through a variety of art therapy directives identified in multiple case studies. Art prompts, scripts, and case studies for art directives offer readers a comprehensive understanding for creative case conceptualization using EMDR with adolescents and young adults. When EMDR and art therapy are combined, these two disciplines can be incredibly effective and transformative, serving as a new avenue to meet specific needs of young people. Newer research revealing the unique stage of brain development during adolescence reinforces the need to enhance EMDR protocols for adolescents and young adults with the creative interventions of art therapy. This comprehensive model includes a conceptual framework to understand this generation and to provide ideas and directives. Each creative intervention is designed to be replicated by clinicians to help young people. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

A Case of Ocular Myasthenia Gravis Seen by Rheumatology as Suspected Mononeuritis Multiplex in an Adult Male Shortly after Pfizerbiontech Sars-Cov-2 Vaccination

Background/Aims Myasthenia gravis (MG) is an antibody-mediated autoimmune disease targeting proteins at the postsynaptic membrane of the neuromuscular junction. MG is thought to occur in genetically susceptible individuals following an environmental trigger. SARS-CoV-2 infection has been associated with new-onset autoimmune disease, new-onset MG, and exacerbations of pre-existing MG, with molecular mimicry between SARS-CoV-2 epitopes and autoantigen-induced autoreactivity thought to be part of the underlying mechanism. We report a case of newonset ocular MG following first dose Pfizer-BioNTech BNT162b2 SARS-COV2 vaccination which was referred to rheumatology as suspected mononeuritis multiplex. Methods A 53-year-old man of East Asian ethnicity presented to the emergency department (ED) with sudden onset diplopia and left lateral gaze restriction 7 days after receiving his first dose of the Pfizer-BioNTech BNT162b2 SARS-COV2 vaccination. He had longstanding myopia and dry eyes but no other medical history, no regular medications or significant family history. He was a current smoker, with a 50-pack year history. He did not drink alcohol or use any recreational drugs. He was found to have an isolated left VI cranial nerve (CN) palsy with an otherwise normal ocular and physical examination. Blood tests were unremarkable apart from raised cholesterol, and he was discharged with a suspected self-limiting microvascular CN lesion. Three weeks later he presented to ED with worsening diplopia, increasingly restricted eye movements, headache, nausea, vomiting and blurred vision. Ophthalmology assessment noted new right sided CN III and VI palsy, persistent left CN VI palsy, and vertical diplopia in all fields of gaze. Neurological and physical examination were normal. Bloods including an autoimmune screen were unremarkable. SARS-CoV-2 Spike antibodies were positive consistent with SARS-CoV-2 vaccination but not infection. Intracranial and thoracic imaging were unremarkable. He was referred to and seen by both rheumatology and neurology as a case of suspected mononeuritis multiplex. Results A diagnosis of ocular MG was confirmed with positive serum acetylcholine receptor antibodies, and he was started on prednisolone, and pyridostigmine to good effect. Daily forced vital capacity (FVC) showed no respiratory muscle involvement, and nerve conduction studies and electromyography were normal, excluding secondary generalisation. Conclusion A review of the literature found 14 reported cases of new-onset MG all within 4 weeks following SARS-CoV-2 vaccine. Whilst these cases provide interesting insights into the pathogenesis of autoimmune conditions such as MG, they are not epidemiological studies to inform vaccine safety. Ultimately, current evidence suggests that the risks of SARS-COV-2 infection outweigh the risk of vaccine-related adverse events, therefore we suggest clinicians should be aware of potential new-onset autoimmune conditions, but support the safety of SARSCOV2 vaccination. Further, research into possible immunological mechanisms behind this phenomenon, including identifying potential epitopes inducing molecular mimicry, could help establish the likelihood of a causative link.

Thyroid Eye Disease Following COVID-19 Infection in a Patient with a History of Graves' Disease

Introduction: Autoimmune and inflammatory thyroid diseases have been reported following SARS-CoV-2 infection or vaccination, but thyroid eye disease (TED) post-COVID-19 infection is less common. We describe a case of TED following SAR-CoV-2 infection in a patient with a history of Graves' disease. Case Description: A 59-year-old female with history of Graves' disease status post radioiodine ablation therapy in 2002. She developed post-ablative hypothyroidism which has been stable on levothyroxine 88 mcg daily. In January 2021, the patient's husband and daughter were diagnosed with COVID-19 infection. A few days later, the patient developed an upper respiratory tract infection associated with loss of sense of smell and taste consistent with COVID-19 infection. Three days later, she developed bilateral watery eyes which progressed to eye redness, eyelid fullness, retraction, and pain with eye movement over 1-month duration. Her eye examination was significant for severe periocular soft tissue swelling, lagophthalmos and bilateral exophthalmos. The laboratory workup was consistent with normal TSH 0.388 mIU/L (0.358-3.740 mIU/L) and positive TSI 1.01 (0.0-0.55). The patient was referred to an Ophthalmologist for evaluation of TED. He noted bilateral exophthalmos, no restrictive ocular dysmotility or compressive optic neuropathy (clinical activity score 4/7 points). CT scan of orbit showed findings compatible with thyroid orbitopathy. Based on clinical activity score of 4, treatment with Teprotumumab was recommended pending insurance approval. Discussion(s): Many cases of new-onset Graves' hyperthyroidism have been reported after COVID-19, with only a few associated with TED. Our patient has been in remission for 20 years before she developed COVID-19 infection with occurence of TED.This suggests that COVID-19 infection may have played a role. SARS-CoV-2 may act through several mechanisms, including breakdown of central and peripheral tolerance, molecular mimicry between viral and self-antigens, stimulation of inflammasome with release of type I interferon. In our patient, treatment with Teprotumumab was indicated due to Graves' orbitopathy clinical activity score greater than or equal to 3. In conclusion, it is very uncommon for TED to present after COVID-19 infection. Our case reinforces the speculative hypothesis that SARS-CoV-2 virus could have triggered an autoimmune response against eye antigens. There is a need for increased awareness about the link between COVID-19 and autoimmunity to help better define the management of patients.Copyright © 2023

The Future for Psychedelic Agents in the Treatment of Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) treatment options, including the potential use of psychedelic-assisted therapy, are reviewed. Traditional PTSD treatment remains ineffective for many, and includes, trauma focused cognitive behavioral therapy, eye movement desensitization and remodeling, and selective serotonin reuptake inhibitors. Evidence has shown that with further supportive research, psychedelic-assisted therapy may offer an alternative treatment option.

Hyperkinetic movement disorder following Covid-19 Temporal correlation or Coincidental

Objective: Hypokinetic movement disorder and parkinsonian picture has been well described in literature following covid-19 but hyperkinetic MDS are very in global literatures. To investigate the epidemiology,clinical picture,the diagnostic and therapeutic challenges in patients hyperkinetic MDS in this context and to know the time schedule of the onset of the MDS with exploring the possible pathogenesis Background: Infections are up to 20% of movement disorders.The most frequent agents are beta-hemolytic streptococcus,and flavivirus causing Japanese encephalitisThe role of the viral stimulation of microglial activation in neuroinflammation has regained attention in the context of covid19 Methods: Patients of MDS attended the clinic from 31st march 2020 to March 2022,with recent onset of hyperkinetic movements were screened. Subjects had medical history either prior to the study or medical history reviewed by physicians suggestive of covid.PCR +VE or Presence of covid antibody in blood or csf in patients with recent onset hyperkinetic MDS within 6-12 weeks of onset of symptoms except.Ventilatory cases Other markers were used to rule out other viral infections causing MDS.MRI brain and EEG as a routine in all Immune markers in very selected cases in suspected immuomediated MDSThe attempted treatment were symptomatic and immunotherapy Results: In last 2 years 50 cases of new onset Hyperkinetic MDS are recorded, out of which only 9 cases were directly or indirectly linked to Covid,Nystagmus, orofacial dyskinesia and segmental or generalized myoclonus and ataxic gait associated delirium,tremors and ocular movement disorders along with epileptic seizures are also seen.Positive EEG findings are in the form of diffused bihemispheric slowing or periodic complexes with polyspikes at irregular interval and delta brush in few cases .MRI findings varied between non-specific changes to bitemporoparietal hyperintensities in flair and T2 both cortical and subcortical or bilateral basal ganglia. Treatment response in all the cases are statisfactory Conclusion(s): observational study revealed MDS in covid do happen Myoclonus is the most Frequent movement disorder associated with COVID-19 followed by dystonia and tremors .pathophysiology included neuro inflammation, autoimmune mechanisms and small vessels thrombosis hence not be co-incidental , response to steroid also s/o immune mediated.

Post-COVID simultaneous onset of Graves' disease and ocular myasthenia gravis in a patient with a complex ocular motility impairment.

A 74-years-old man experienced severe diplopia one month after recovery from an uncomplicated SARS-CoV-2 infection. Neurological examination was normal whereas ophthalmological examination showed bilateral exophthalmos with a complex ocular motility disorder characterized by a pseudo-internuclear ophthalmoplegia after fatigue associated to impairment of elevation and infraduction. Antibodies against TSH and acetylcholine receptors were positive; subsequent hormonal tests, ultrasonography of thyroid gland, single fiber electromyography and orbit MRI confirmed the diagnosis of concomitant Graves Disease (GD) and Myasthenia Gravis (MG). The coexistence between MG and GD is not rare but simultaneous onset after viral infection is very unsual. The complex ocular disorder simulated a deficit of the oculomotor nerve nuclei, and on clinical examination it posed some problems in the diagnosis. We suggest that recent SARS-COV-2 infection may have triggered a complex autoimmune response.

The flexibility of the intermediate vs. wholistic/analytic styles-an eye tracking study

In the aftermath of the COVID-19 pandemic, the educational system is increasingly incorporating twenty-first-century skills, such as online learning, that require learners to demonstrate cognitive flexibility. Cognitive flexibility is the ability to quickly reconfigure our minds to meet the task demands. This study investigates the degree of cognitive flexibility of the wholistic-intermediate-analytic dimensions, by classifying patterns of Eye Movements (EM) and behavioural data. Using the E-CSA-W/A test, 113 participants were classified based on their tendency towards a particular style (wholistic/intermediate/analytic). Results indicate that wholistics and intermediates demonstrated greater cognitive flexibility in adapting to the task requirements than the analytics. Analytics were slower at completing the test and made more transitions between Areas of Interest than the other groups. Finally, while the behavioural data demonstrate quantitative differences between the groups, EM provides qualitative information regarding the cognitive process that leads to the response. Theoretical, methodological, and practical contributions are discussed.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

A new case of myasthenia gravis following COVID-19 Vaccination

Background: Myasthenia gravis (MG) is an autoimmune disease of unknown etiology. Infections are known as a major cause of MG exacerbations. A few studies have shown an association between new onset MG and SARS-CoV-2 infection. Case presentation: We have reported a case of new onset myasthenia gravis in a 68-year-old man presented with bulbar symptoms a few days after receiving COVID-19 vaccine (Sinopharm vaccine). The disease was confirmed by high titer of antibody against acetylcholine receptor and electrophysiological examinations. Conclusion(s): Among the adverse effects reported with the COVID-19 vaccine, new onset myasthenia gravis is very rare. The underlying mechanism is unknown but the immune response after vaccination and molecular mimicry theory has been proposed.Copyright © 2022

Clinicians' Reflections of the Therapeutic Relationship in Videoconferencing: A Qualitative Study

Introduction: In recent years the use of distance psychotherapy has been gaining in popularity (Hollis et al., 2015), especially due to the Covid-19 pandemic, which has forced many clinicians to use online interventions to comply with social distancing rules, enabling them to experience the resources and the limitations of online tools and consultations (Van Daele et al., 2020). Among the different ways of providing online psychotherapy, videoconferencing psychotherapy has many advantages (e.g., reaching people who have conditions that hinder the carrying out of a face-to-face treatment, the possibility of improving the integration network between the different territorial services, facilitating access to them) and its effectiveness was demonstrated in the literature (Thomas et a., 2021;Backhaus et al., 2012). Despite these advantages, for clinicians, one of the biggest concerns about videoconferencing psychotherapy is its potential negative influence on the therapeutic relationship with clients in terms of strategies, quality and emotion detection by the online communication modality, especially because of the lack or reduction of conventional, non-verbal signs and clues typical of a traditional clinical setting (Cipolletta & Mocellin, 2018). Many clinicians report feeling insecure about their ability to communicate their empathy and build a therapeutic alliance online as well as to feel more tired, less competent and confident, less authentic or genuine, and less connected with clients during online video sessions (Bekes & Aafjes-van Doorn, 2020). Moreover, recent studies seem to suggest that different relational aspects may intervene in the video-mediated relationship than in the presence, such as the necessity of an extensive use of ostensive cues (Fisher et al., 2020), a greater disinhibition and openness in videoconferencing or an increased flexibility;these elements could have a different role in online than face-to-face interventions (Simpson et al., 2020;Cipolletta et al., 2017). According to these considerations, the aim of this work is to further explore which are the peculiar aspects involved in the video-mediated clinical relationship and its differences from face-to-face interventions. Method(s): We involved in the study 32 psychotherapists (85.2% female;Mage=35.07) affiliated to an Italian agency that provides online psychotherapy, which were divided into three groups based on their levels of clinical experience. Each group attended an online 2-session focus group conducted by two psychotherapists who administered an ad hoc semi-structured interview to the participants based on the core issues of this study and the evidence presented in the literature about the characteristics of video-mediated relationship. In the focus groups the experiences of the therapists were investigated through 4 areas: (1) therapeutic relationship;(2) personal and professional background;(3) non-verbal communication and (4) management of therapeutic boundaries. All sessions were video-recorded and transcribed. Transcripts were coded using the inductive thematic analysis method (Braun & Clarke, 2012) by three coders supervised at regular intervals by two experts. Each of the coder independently coded the transcripts and each discrepancy was discussed in group until obtaining agreement among coders. Result(s): Preliminary results show that clinicians refer how the relationship in videoconferencing has distinctive characteristics that differed from face-to-face setting. These characteristics are related to four main areas, which emerged from the analysis: (1) emotional and relational aspects of psychotherapy;(2) motivation and beliefs;(3) corporeity and movement and (4) management of therapeutic boundaries. Regarding emotional and relational as- pects, clinicians reported the presence of some elements that differ from face-to-face therapy, such as the establishing of the therapeutic alliance, the level of intimacy and safety of the therapeutic relationship and the drop-out rates. About the second area, principal themes pointed out by clinicians regarding the presence of differences in levels of motivation and urgency in the request of psychological intervention expressed by patients who choose online psychotherapy;furthermore, both clinicians and patients (as referred by their therapist) initially have some prejudices about the effectiveness of videoconferencing psychotherapy. There is a general agreement among therapists about the lack of non-verbal signals and corporeity in videoconferencing that forced clinicians to focus on facial movements, eye contact and tone of voice;furthermore, also the use of silence is different in online psychotherapy. Lastly, concerning the management of therapeutic boundaries, therapists affirmed that technical problems (internet connection, device use.), the possibility of maintaining privacy, the increased responsibility of the patient in the setting construction and the consequent need to educate the patient on how to be in therapy are the principal characteristics of the videoconferencing therapy. Further and more detailed results will be presented. Conclusion(s): The preliminary results of this study suggest that in the therapist's perception the therapeutic relationship in videoconferencing has peculiar characteristics and is different from the face-to-face context, but there is no agreement on what. Perception is highly variable from therapist to therapist and the critical aspects identified vary from prejudice to technical problems, from the setting to the quality of the relationship.

EMDR in the time of the COVID-19 pandemic in India: A short report

During the period of the COVID-19 pandemic from the start of 2020 till late 2021, mental health services- seeking and providing-have gone through various changes and adaptations. In this article, we report on eye movement desensitization and reprocessing (EMDR) psychotherapy service providers in India, and how they adapted to the changing circumstances during this time, using a narrative enquiry approach. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Post-traumatic stress disorder in doctors: Origins, approach and Eye Movement Desensitisation and Reprocessing therapy.

OBJECTIVES: Navigating a high-stakes clinical environment, medical doctors tend to consider trauma and adverse workplace events as 'part of their job'. This often leads to delays in help-seeking in doctors who develop acute traumatic stress symptoms (ATSS), post-traumatic stress disorder (PTSD) and their comorbidities. This article outlines the prevalence of acute traumatic stress and PTSD in this population and summarises the emerging evidence base for Eye Movement Desensitisation and Reprocessing (EMDR) early-intervention protocols of this population. CONCLUSION: Doctors have higher prevalence rates of ATSS and PTSD than the general public. Eye Movement Desensitisation and Reprocessing therapy's early-intervention protocols for recent, prolonged and ongoing traumatic stress have the potential to be a widely acceptable, timely and cost-effective intervention for doctors and other healthcare workers (HCWs), as highlighted in the emerging evidence base, which has grown considerably in response to the impact of the COVID pandemic on HCWs' mental health. These evidence-based interventions could potentially be routinely offered to doctors and other HCWs within 1 month of an adverse workplace experience to reduce ATSS, PTSD and other comorbidities.

[Covid-19 caregivers, psychotraumatized superheroes]. / Soignants de la Covid-19, de super-héros à psychotraumatisés.

The Covid-19 pandemic has taken its toll on health care teams faced with deaths and hospital overcrowding. Some caregivers suffered from vicarious trauma. Analyzing the impact of this trauma, its inclusion in a context of tension, fatigue and increased lassitude, is imperative in order to propose adjusted care. Eye Movement Desensitization and Reprocessing therapy seems to have a relevant place in this context.

Some observations on remote delivery of eye-movement desensitisation and reprocessing to people with intellectual disabilities

It is increasingly recognised that many people with intellectual disabilities suffer from post-traumatic stress disorder (PTSD). Eye-movement desensitisation and reprocessing (EMDR) has been proposed as a potentially helpful intervention that is less reliant on verbal skills than other effective treatments for PTSD and therefore could be more effective than verbal interventions for people with intellectual disabilities. The Trauma-AID project is a randomised clinical trial (RCT) evaluating the effectiveness of a bespoke EMDR protocol for adults with intellectual disability and PTSD, which incorporates a prolonged phase of Psycho-Education and Stabilisation (PES) prior to the trauma confrontation phase of EMDR. The COVID-19 pandemic struck during the feasibility phase of the Trauma-AID project, necessitating a second feasibility study to evaluate the acceptability and feasibility of remote or hybrid delivery of the PES + EMDR protocol. To this end, we conducted two online surveys of therapists followed by interviews with clients, carers and senior therapists. The surveys were analysed descriptively. Content analysis was used for client and carer interviews, and framework analysis for therapist interviews. All stakeholders reported positive experiences of EMDR;however, some challenges were identified. The majority of clients, carers and therapists interviewed reported that the intervention, whether PES alone or the full PES-EMDR package, had improved symptoms of PTSD and psychological well-being, and carers also reported decreases in challenging behaviour. A full account of the data is provided in four Supplementary Digital files. PES-EMDR therapy appears both feasible and acceptable for clients with intellectual disabilities and therapists, whether delivered face-to-face or in a remote or hybrid mode, though remote working appears easier for the PES phase than the EMDR phase of the intervention. © 2023 The Authors. Journal of Policy and Practice in Intellectual Disabilities published by International Association for the Scientific Study of Intellectual and Developmental Disabilities and Wiley Periodicals LLC.

Incorporation of a smart sock with the virtual immersive test for postural stability

Purpose of Study: Assessment of an individual's postural stability serves as an indirect measure for both physiological and biomechanical stresses placed on an individual. More recently, some individuals after COVID-19 (SARS-CoV-2) infection have been identified with neurological complaints (Post-Acute Sequelae of Covid - PASC). These individuals can also be predisposed to decreased postural stability and an increased risk for falls. The purpose of the project was to incorporate two different wearable technology (virtual reality (VR) based virtual immersive sensorimotor test - VIST and pressure senor-based smart sock) to assess postural stability among healthy and individuals with PASC to quantify the overall status of the postural control system. Methods Used: All methods were conducted based on the University's Institutional Review Board (IRB# 21-296) with informed consent. A total of 12 males and females (six healthy and six with self-reported complaints of PASC) have completed the study so far. All participants were tested using the VIST, while standing on a force platform and wearing the smart sock simultaneously. The (VIST uses a VR headset and proprietary software to test an individual's integrated sensory, motor, and cognitive processes through eight unique tests (smooth pursuits, saccades, convergence, peripheral vision, object discrimination, gaze stability, head-eye coordination, cervical neuromotor control). Center of pressure (COP) data from force platform and pressure sensor data from the smart socks were used to calculate anterior-posterior and medial-lateral postural sway variables. These postural sway variables were analyzed using an independent samples t-test between the healthy and PASC groups at an alpha set at 0.05. Summary of Results: Significant differences (p < 0.05) between healthy and individuals with PASC with anteriorposterior and medial-lateral postural sway variables derived from COP measures, with individuals with PASC exhibiting significantly greater postural sway compared to healthy individuals in all eight tests of the VIST. The measures from the smart sock, while not statistically significant, exhibited the same findings of increased postural sway in individuals with PASC compared to healthy individuals. Conclusion(s): Findings from the current analysis revealed that individuals with PASC demonstrated significantly worse postural control compared to the healthy, when challenged with various sensorimotor tests in VIST, suggesting that postural control is compromised due to PASC. While not statistically significant due to a lower sample size, the measures from smart sock also indicated the same findings of the COP measures, suggesting a promising use of wearable technology in postural control assessments. In addition to other neurological signs and symptoms of PASC, assessment of postural stability using the VIST can provide more detailed clinical measures for diagnosis, treatment, and prognosis assessments. Copyright © 2023 Southern Society for Clinical Investigation.

Autoimmune syndrome induced by adjuvants (asia) in a 71-year- old filipino female after an inactivated virus vaccine: A case report

Background: Autoimmune Syndrome Induced by Adjuvants, or ASIA, suggests certain environmental exposures, including vaccination can cause hyperstimulation of the innate and adaptive immune system leading to production of autoantibodies in a genetically predisposed individual. A diagnosis of exclusion, proposed diagnostic criteria suggested ASIA if specified major and minor criteria are fulfilled. Suspicion for ASIA was raised in our patient due to identified exposure accompanied by typical manifestations not explained by another cause. Case: A 71-year- old Filipino female with controlled hypertension and diabetes, came in due to progressive right eye pain, supraorbital headache, ptosis and limitation of extra-ocular movements for 3 weeks. No blurring of vision, color vision changes, or visual field cuts. She didn't have other systemic features but received 2 doses of inactivated COVID-19 vaccine 1 month (1st) and 1 day (2nd) prior to the symptom onset. The left eye was unremarkable. ESR was elevated (109) with normal CRP. ANA was 1:80 with a speckled pattern. The complements were normal and lupus confirmatory panel was negative. CSF studies showed slightly elevated protein and glucose with no pleiocytosis, IgG level was normal with negative oligoclonal panel and cultures. EMG-NCV showed acute partial incomplete bilateral facial neuropathy. Cranial MRI/MRA showed chronic lacunar infarct in the right corona radiata. The MRI of the orbits showed right optic nerve enhancement with hyperintense nerve sheath compatible with optic neuritis. She underwent pulse IV steroid therapy (Methylprednisolone 1 g) for 3 days and was maintained on oral steroid 1 mg/kg/day. There was minimal improvement of symptoms for which she received intravenous immunoglobulin for 5 days. Her symptoms gradually improved upon discharge. Conclusion(s): Identification of the possible autoimmunity from adjuvants is not to discourage vaccination but rather raise awareness of the need for further studies to screen who might be at risk and to prepare or even develop alternatives, such as vaccines with a different type of adjuvant.

Dream-enactment behaviours during the COVID-19 pandemic: an international COVID-19 sleep study.

There has been increasing concern about the long-term impact of coronavirus disease 2019 (COVID-19) as evidenced by anecdotal case reports of acute-onset parkinsonism and the polysomnographic feature of increased rapid eye movement sleep electromyographic activity. This study aimed to determine the prevalence and correlates of dream-enactment behaviours, a hallmark of rapid eye movement sleep behaviour disorder, which is a prodrome of α-synucleinopathy. This online survey was conducted between May and August 2020 in 15 countries/regions targeting adult participants (aged ≥18 years) from the general population with a harmonised structured questionnaire on sleep patterns and disorders, COVID-19 diagnosis and symptoms. We assessed dream-enactment behaviours using the Rapid Eye Movement Sleep Behaviour Disorder Single-Question Screen with an additional question on their frequency. Among 26,539 respondents, 21,870 (82.2%) answered all items that were analysed in this study (mean [SD] age 41.6 [15.8] years; female sex 65.5%). The weighted prevalence of lifetime and weekly dream-enactment behaviours was 19.4% and 3.1% and were found to be 1.8- and 2.9-times higher in COVID-19-positive cases, respectively. Both lifetime and weekly dream-enactment behaviours were associated with young age, male sex, smoking, alcohol consumption, higher physical activity level, nightmares, COVID-19 diagnosis, olfactory impairment, obstructive sleep apnea symptoms, mood, and post-traumatic stress disorder features. Among COVID-19-positive cases, weekly dream-enactment behaviours were positively associated with the severity of COVID-19. Dream-enactment behaviours are common among the general population during the COVID-19 pandemic and further increase among patients with COVID-19. Further studies are needed to investigate the potential neurodegenerative effect of COVID-19.

Utility of F-18 FDG PET/CT in a Rare Case of Tolosa-Hunt Syndrome secondary to COVID 19 nasopharyngeal swab trauma, when MRI is inconclusive

Aim/Introduction: Tolosa-Hunt Syndrome (THS) is a rare disease with incidence rate of about 1/106 per year worldwide. Etiology include idiopathic granulomatous, nonspecific unilateral inflammation of the superior orbital fissure- cavernous sinus, causing severe headaches, eye pain, and ophthalmoplegia- paresis of the cavernous sinus nerves, sometimes Horner syndrome. THS is a diagnosis of exclusion that requires careful ruling out of alternative diagnoses. Material(s) and Method(s): We report an interesting case of 45 years old lady, who presented with complains of left sided headache, left eye retro-orbital pain with diplopia (double vision), ptosis and gradual difficulty in eye movements since last 2 months. She had history of nasopharyngeal mucosal swab collection for COVID 19 RT-PCR test after which she started complaints of pain along nasopharynx and later along ipsilateral eye orbit. MRI of brain and bilateral orbit suggested mild relative prominence of peri-optic CSF space along left side, without any abnormality along cavernous sinus or rest of the brain parenchyma. FDG PET/CT (PET/ CT) scan was performed to rule out other cause of THS showed impaired tracer uptake along left eye rectus muscles, suggesting paresis of CN III, IV and VI without any abnormal metabolically active lesion in brain parenchyma or rest of the body. Result(s): Based on clinical, radiological and PET/CT findings presumptive diagnosis of resolving left sided THS secondary to trauma induced inflammation was made. The patient shows clinical improvement after treatment with high dose steroid on follow up. Conclusion(s): PET/CT is helpful in detection of inflammatory tissue is a recognized fact. When MRI is unable to shows any tissue abnormality in cavernous sinus or superior orbital fissure;PET CT can play a role in its ability to demonstrate the paresis of cranial nerves supplying ipsilateral eye extrinsic muscles. Thus reaching the diagnosis of post traumatic inflammatory THS by exclusion. This case of THS with unique PET/ CT findings imply the useful indication of PET/CT in detecting and monitoring of treatment response in THS when MRI is inconclusive.