A Web-Based Educational Module Using Clinical Neuroscience to Deliver the Diagnosis of Functional Neurological Disorder.

Neuroscience-based patient education has become an evidence-based strategy for enhancing chronic pain treatment. Advances in understanding the neuroscience of functional neurological disorder (FND) may allow similar approaches to be developed and disseminated to clinicians, given the public health need for greater provider awareness and expertise around the condition. Accordingly, the authors developed an online video module for clinicians that delivers neuroscience-based psychoeducation for FND and assessed whether the intervention would be associated with changes in clinicians' perception of FND patients and knowledge about the condition. The online intervention consisted of a 20-minute video module, including an 8-minute scripted role-play that modeled neuroscience-informed diagnosis delivery. Pre- and postintervention questionnaires were embedded into the online module and included a self-assessment of FND-related perceptions and knowledge and a multiple-choice assessment of retention of the neuroscience-based content. Wilcoxon signed-rank tests and McNemar's tests were used for statistical analyses. Of the 103 individuals who submitted surveys, 40 participants provided a complete data set from before and after the intervention. Following the intervention, self-assessment items showed respondents had significantly greater comfort with diagnosis delivery and treatment options and decreased negative perception of FND patients. The percentage of correct responses on a multiple-choice assessment regarding the functional neuroanatomy of FND was significantly increased. In summary, the online neuroscience-based educational intervention was effective for increasing clinician knowledge about FND and comfort with diagnosis delivery and treatment options. Implementing web-based formats may be a viable and cost-effective approach to disseminating knowledge and basic clinical skills in the care of patients with FND.

Using Patient-Centered Clinical Neuroscience to Deliver the Diagnosis of Functional Neurological Disorder (FND): Results from an Innovative Educational Workshop.

OBJECTIVES: Psychiatry training is lacking examples of neuroscience education that translates neuroscience literature into accessible clinically oriented concepts. The authors created a teaching activity using patient-centered neuroscience education that focused on delivering the diagnosis of functional neurological disorder (FND). This study aimed to (i) develop a workshop modeling a clinician-patient interaction, (ii) provide a modern neuroscience perspective of FND, and (iii) evaluate the change in clinicians' perceptions of FND. METHODS: A total of six workshops (each 1 h long and consisting of a video, PowerPoint slides, and pre and post questionnaires) were conducted. Paired t tests were used to measure the change. RESULTS: Forty-seven clinicians participated. After completing the workshop, nearly all endorsed that functional symptoms are "real" (95%) and that treatment is helpful (100%). Participants also reported a greater comfort level with discussing FND diagnosis (46% vs 85%, p < 0.001), an overall increase in understanding the disorder (33% vs 82%, p < 0.001), assessing need for tests (33% vs 66%, p < 0.001), understanding treatment options (26% vs 89%, p < 0.001), and recognition that treatment can help control these symptoms (81% vs 100%, p < 0.01). In addition, learners were more likely to report that patients with FND are truthful (75% vs 95%, p < 0.001) and less likely to be manipulative (48% vs 80%, p < 0.001). CONCLUSIONS: A brief, educational intervention using neuroscience-based content was found to significantly improve clinicians' perception and confidence when delivering the diagnosis of FND.

Physical Examination Skills Among Chief Residents in Psychiatry: Practices, Attitudes, and Self-Perceived Knowledge.

OBJECTIVES: The authors investigated the attitudes, self-perceived competence, and the need for a dedicated curriculum on physical examination skills among chief residents in psychiatry. METHODS: A voluntary 28-item web-based questionnaire was distributed to psychiatry chief residents in the USA between January 2019 and February 2019. RESULTS: Of 181 chief residents, 79 (response rate, 44%) completed the online survey. The majority of chief residents want to improve their physical exam skills (64%) and believe that there should be a targeted curriculum aimed at incorporating these skills into everyday psychiatric practice (63%). However, most (57%) chief residents reported that they only conduct physical exams on a few selected patients (< 25% of the time) and almost half (48%) last used a stethoscope a year ago, if not longer. Self-perceived competence and comfort level with neurology-related exam findings was especially low: only 35% could identify discrepant neurological findings and 33% elicit Hoover's sign of leg paresis. A significant majority (86%) believed that performing a physical exam would not interfere with the therapeutic relationship. CONCLUSIONS: Although chief residents in psychiatry believe that developing competence in physical examinations is important to their education, the current educational landscape does not support the development of these skills. Future educational strategies should focus on addressing this need.

Neuroimaging Education in Psychiatry Residency Training: Needs Assessment.

OBJECTIVE: The authors investigated the attitudes, self-perceived knowledge, and the need for a dedicated neuroimaging curriculum among psychiatrists-in-training. METHODS: An anonymous voluntary 20-item Web-based survey was distributed to psychiatry residents at seven university-based USA programs between December 2017 and February 2019. RESULTS: Of 302 psychiatry residents, 183 (response rate, 60.5%) completed the survey. Although a large majority of residents (83%) believed that neuroradiology education is important to psychiatric training, only 7% reported that they are receiving adequate training in this discipline. The majority (80%) believed that there should be a formal neuroimaging curriculum during their training. Self-perceived competence and comfort level was found to be low with several psychiatrically relevant neuroimaging modalities. In particular, regarding CT head/brain MRI, there was a marked difference in self-perceived competence at interpreting the actual brain images (8%) versus the radiological reports/impression summaries (48%). Comfort level with functional neuroimaging was especially low (7%). Clinically, only 26% reported confidence at being able to explain neuroimaging topics to patients. Compared to junior residents, senior residents rated higher confidence at interpreting the radiological reports/impression summaries of CT head/brain MRI (p = 0.008) and PET/SPECT (p = 0.014), but no difference was found with the actual brain images. Further, senior residents were less likely to identify with "neurophobia" (p = 0.028) and more likely to believe that a neuroimaging curriculum should be included in psychiatric residency training (p = 0.027) when compared to junior residents. CONCLUSIONS: Psychiatrists-in-training have a very strong interest in neuroimaging education. Future educational interventions should address this need.

Catatonia Associated With Systemic Lupus Erythematosus (SLE): A Report of Two Cases and a Review of the Literature.

BACKGROUND: Systemic lupus erythematosus (SLE) is known to cause neuropsychiatric symptoms (NPSLE). While not formally recognized as a syndrome associated with NPSLE, catatonia has frequently been reported. OBJECTIVE: It is important for clinicians to recognize and treat catatonia as a potential manifestation of NPSLE. We present 2 cases of SLE with catatonia and review the cases reported in the literature. METHODS: We performed a PubMed search for reported cases of catatonia in SLE. Case reports that met Diagnostic and Statistical Manual of Mental Disorders-5th ed. diagnostic criteria for catatonia were summarized to assess common diagnostic tests and treatments. RESULTS: Twenty-six articles describing a total of 35 patients (all female), in addition to our 2 patients, were included in the report. All but one of the patients received immunosuppressive therapy for treatment of SLE. To treat catatonia symptoms, 81% of the patients received benzodiazepines, and 38% received electroconvulsive therapy. CONCLUSIONS: Catatonia can be a manifestation of NPSLE, particularly in the presence of serologies and symptoms indicative of an active lupus flare. Management of catatonia involves management of the underlying condition, in this case immunomodulatory treatments for NPSLE; avoidance of treatments, such as antipsychotics, which can worsen catatonia; and symptomatic treatments for catatonia, for which benzodiazepines are a first-line treatment, and electroconvulsive therapy when catatonia is refractory to benzodiazepines.

Catatonia Under-Diagnosis in the General Hospital.

Catatonia is under-diagnosed in psychiatric settings. No studies have explored the under-diagnosis of catatonia in general hospitals. The authors conducted a retrospective chart review using DSM-5 criteria to diagnose catatonia in medical inpatients between 2011 and 2013. Of 133 case subjects meeting DSM-5 criteria for catatonia retrospectively, 79 had never been diagnosed and 54 had a documented diagnosis. Multiple logistic regression revealed that psychiatry consultation significantly decreased the odds of under-diagnosis of catatonia, whereas presence of agitation, grimacing, or echolalia increased the likelihood of under-diagnosis. Under-diagnosed case subjects received significantly lower doses of lorazepam, and increased mortality during admission and increased length of hospital stay both fell short of statistical significance in this group. Catatonia appears to be frequently under-diagnosed in the general hospital, and psychiatry consultation services play a crucial role in its detection and treatment. Strategies to improve recognition and treatment of catatonia should be implemented.