Psychological Profiles and Clinical Clusters of Patients Diagnosed With Functional Neurological Disorder.

Our understanding about underlying mechanisms leading to Functional Neurological Disorders (FND) has changed in recent years. While in the past these disorders were presumed to be solely due to psychological issues we know now that their development is dependent on complex interactions between biological, psychological and social factors. We present an analysis of clinical presentations and psychological profiles of patients who were seen in our FND outpatient clinic over 3 years. We aim to review the prevalence of common symptoms in the patients seen within our clinic, and to identify any common psychological or psychiatric profiles that differentiated these symptom groups. This may help to elucidate underlying mechanisms leading to the development of functional symptoms and identify the predisposing, triggering and perpetuation factors.

Adaptive ability, behavior and quality of life pre and posttraumatic brain injury in childhood.

CONTEXT: Traumatic brain injury (TBI) is a common, acquired childhood disability, which has been shown to have a significant impact on children's cognitive and educational function. While behavioral problems are also noted, there is ongoing debate about the contribution of preinjury factors in this domain. Few studies have attempted to measure the impact of these preinjury functions on postinjury behavior. OBJECTIVE: To compare pre and postinjury adaptive ability, behavior, executive function and quality of life (QOL) and to identify factors that contribute to outcomes in these domains including injury severity, socio-demographic and preinjury characteristics. DESIGN: Consecutive recruitments to a prospective, longitudinal study, utilizing a between factor design, with injury severity as the independent variable. PARTICIPANTS AND METHODS: Children admitted to hospital with a diagnosis of TBI aged between 6 and 14 years (n = 205) were divided according to injury severity (mild, moderate and severe). Adaptive behavior (Vineland Adaptive Behavior Scales), child behavior (Child Behavior Checklist), everyday executive functions (Behavior Rating Inventory of Executive Function) and QOL (Child Health Questionnaire) assessed at 6 months post-TBI. RESULTS AND CONCLUSIONS: Severity by time interactions were identified across a range of outcome domains demonstrating that more severe injury is associated with a decrease in functional ability at 6 months post-TBI. This effect was most pronounced for everyday executive skills, social function and internalizing aspects of child behavior. Preinjury function was a consistent predictor of postinjury status. Injury severity contributed little to the prediction of functional outcomes once preinjury functioning was accounted for in the model. Age at injury and family cohesion were relevant to specific outcome domains only. Socio-economic status did not contribute significantly to outcome at 6 months. Preinjury functioning as reported by parents in the acute phase may be a useful predictive tool for identifying children who may be at risk of functioning difficulties 6 months post-TBI.

Early attention impairment and recovery profiles after childhood traumatic brain injury.

OBJECTIVES: To examine recovery of attention from 3 to 6 months postinjury; to identify effects of injury severity and time since injury on performance; to explore whether complex attention skills (eg, shifting, divided attention, attentional control) are more vulnerable to traumatic brain injury (TBI), and slower to recover than simple attention skills (eg, attentional capacity, selective attention, sustained attention). DESIGN: Prospective longitudinal investigation. PARTICIPANTS: A total of 205 school-aged children with TBI were divided into groups according to injury severity (mild = 63%, moderate = 27%, severe = 10%). SETTING: Emergency departments of 3 metropolitan children's hospitals across Australia. MAIN MEASURES: Standardized clinical measures of both simple and complex attention were administered at 3 months and 6 months postinjury. RESULTS: Attention skills were vulnerable to the impact of TBI. More severe injury affected attention skills most negatively. Significant recovery was observed over time. There were few interaction effects, with severity groups exhibiting similar levels of recovery over the 6 months post-TBI. No differences in recovery trajectories were detected for simple and complex attention. CONCLUSIONS: These findings have important clinical and educational implications, suggesting that children with TBI, and particularly those with more serious injuries, are most vulnerable to attention deficits in the acute stages postinjury. It is important that schools and families are aware of these limitations and structure expectations accordingly. For example, gradual return to school should be considered, and in the early stages of recovery, children should be provided with sufficient rest time, with reduced expectations for tasks such as homework.

Dissociation in children's trauma narratives: an exploratory investigation.

This research examined the nature of children's trauma narrative themes and the relationship between these themes and concurrent and future trauma symptoms. Eighty-seven children aged 7-15 years, and their parents, participated following child exposure to a traumatic event requiring hospitalization. At 4-7 weeks post-trauma, a diagnostic interview was conducted with parents and a trauma narrative was obtained from the child. At 6 months post-trauma the diagnostic interview was re-conducted. Results provided only weak evidence of an association between dissociative trauma narrative themes and PTSD symptoms. Specifically, children who showed temporal disorganization, but not absence of emotion or dissociative amnesia, in narrative themes were more likely to report concurrent subsyndromal PTSD symptoms at 4-7 weeks post-trauma. Children who showed absence of emotion (or at least one dissociative theme) in the trauma narrative were more likely to show symptoms of hyperarousal, but not other symptoms of PTSD, at 6 months post-trauma. These findings have implications for understanding the role of dissociation and the development of PTSD in children.

Cognitive behaviour therapy for panic disorder: long-term follow-up.

This paper describes a long-term follow-up of patients with panic disorder who received cognitive behaviour therapy within a randomized controlled trial. Of 89 patients eligible for follow-up, 28 (31.5%) were reassessed 6-8 years after commencement of treatment in the trial. No differences were found between those who were followed up and those lost to follow-up on most baseline measures including measures of panic-related psychopathology, or depression. Outcomes at long-term follow-up were significantly better than baseline measures of panic, avoidance and depression. In this sub-sample the effect of cognitive behaviour therapy for panic disorder appears to maintain over the long-term.