Hypnosis and suggestion as interventions for functional neurological disorder: A systematic review.

OBJECTIVE: Functional neurological disorder (FND) involves the presence of neurological symptoms that cannot be explained by neurological disease. FND has long been linked to hypnosis and suggestion, both of which have been used as treatments. Given ongoing interest, this review examined evidence for the efficacy of hypnosis and suggestion as treatment interventions for FND. METHOD: A systematic search of bibliographic databases was conducted to identify group studies published over the last hundred years. No restrictions were placed on study design, language, or clinical setting. Two reviewers independently assessed papers for inclusion, extracted data, and rated study quality. RESULTS: The search identified 35 studies, including 5 randomised controlled trials, 2 non-randomised trials, and 28 pre-post studies. Of 1584 patients receiving either intervention, 1379 (87%) showed significant improvements, including many who demonstrated resolution of their symptoms in the short-term. Given the heterogeneity of interventions and limitations in study quality overall, more formal quantitative synthesis was not possible. CONCLUSIONS: The findings highlight longstanding and ongoing interest in using hypnosis and suggestion as interventions for FND. While the findings appear promising, limitations in the evidence base, reflecting limitations in FND research more broadly, prevent definitive recommendations. Further research seems warranted given these supportive findings.

Longitudinal outcomes of patients with pseudodementia: a systematic review.

Depression and a number of other psychiatric conditions can impair cognition and give the appearance of neurodegenerative disease. Collectively, this group of disorders is known as 'pseudodementia' and are important to identify given their potential reversibility with treatment. Despite considerable interest historically, the longitudinal outcomes of patients with pseudodementia remain unclear. We conducted a systematic review of longitudinal studies of pseudodementia. Bibliographic databases were searched using a wide range of search terms. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 18 studies with follow-up varying from several weeks to 18 years. Overall, 284 patients were studied, including 238 patients with depression, 18 with conversion disorder, 14 with psychosis, and 11 with bipolar disorder. Irrespective of diagnosis, 33% developed irreversible dementia at follow-up, 53% no longer met criteria for dementia, and 15% were lost to follow-up. Considerable variability was identified, with younger age at baseline, but not follow-up duration, associated with better outcomes. ECT and pharmacological interventions were also reported to be beneficial, though findings were limited by the poor quality of the studies. Overall, the findings suggest that pseudodementia may confer an increased risk of irreversible dementia in older patients. The findings also indicate, however, that a significant proportion improve, while many remain burdened with their psychiatric condition, independent of organic dementia. The findings support the clinical value of the construct and the need for its re-examination in light of developments in neuroimaging, genomics, other investigative tools, and trial methodology.

Effectiveness of corticosteroid compared with non-corticosteroid therapy for the treatment of drug-induced acute interstitial nephritis: a systematic review.

Corticosteroids may hasten recovery in drug-induced acute interstitial nephritis (DI-AIN). However, there is no consensus regarding the effectiveness of corticosteroid compared with non-corticosteroid therapy. We conducted a systematic review of the literature according to Preferred Reporting in Systematic Reviews and Meta-Analysis (PRISMA) guidelines using MEDLINE, EMBASE, CINAHL, Scopus and Web of Science from inception until November 2017 using predefined search terms. Studies that compared the effects of corticosteroid therapy versus non-corticosteroid therapy in the treatment of DI-AIN were included. Outcomes were change in serum creatinine, adverse drug reactions, need for renal replacement therapy (RRT) and death. Due to considerable heterogeneity, a meta-analysis was not performed. There were no randomised controlled trials. Eight retrospective studies met inclusion criteria, with 430 patients (300 received and 130 did not receive corticosteroid therapy) and a median age of 57 (range 29-75) and 58 (22-76) years respectively. When treatment details were reported, prednisone was commenced at 40-60 mg daily in five studies, and two studies commenced intravenous methylprednisolone 1 mg/kg with a treatment duration of 1.5-12 weeks. Non-corticosteroid therapy was poorly defined across all studies. Four studies showed no difference in serum creatinine between corticosteroid and comparator arms, while four studies found a benefit. Adverse drug reactions, need for RRT and deaths were infrequently reported. Risk of bias was high across all domains. The limited evidence does not support the use of corticosteroids in the treatment of DI-AIN. Larger, well-designed trials are needed to help guide clinical management of this condition.

Non-pharmacological interventions for Lewy body dementia: a systematic review.

Lewy body dementia (consisting of dementia with Lewy bodies and Parkinson's disease dementia) is a common neurodegenerative disease characterised by visual hallucinations, fluctuating attention, motor disturbances, falls, and sensitivity to antipsychotics. This combination of features presents challenges for pharmacological management. Given this, we sought to review evidence for non-pharmacological interventions with patients with Lewy body dementia and their carers. Bibliographic databases were searched using a wide range of search terms and no restrictions were placed on study design, language, or clinical setting. Two reviewers independently assessed papers for inclusion, rated study quality, and extracted data. The search identified 21 studies including two randomised controlled trials with available subgroup data, seven case series, and 12 case studies. Most studies reported beneficial effects of the interventions used, though the only sizeable study was on dysphagia, showing a benefit of honey-thickened liquids. Given the heterogeneity of interventions and poor quality of the studies overall, no quantitative synthesis was possible. Overall, identified studies suggested possible benefits of non-pharmacological interventions in Lewy body dementia, but the small sample sizes and low quality of studies mean no definite recommendations can be offered. Our findings underscore the clear and urgent need for future research on this topic.

Meditation and auditory attention: An ERP study of meditators and non-meditators.

The findings of a study by Cahn and Polich (2009) suggests that there is an effect of a meditative state on three event-related potential (ERP) brain markers of "low-level" auditory attention (i.e., acoustic representations in sensory memory) in expert meditators: the N1, the P2, and the P3a. The current study built on these findings by examining trait and state effects of meditation on the passive auditory mismatch negativity (MMN), N1, and P2 ERPs. We found that the MMN was significantly larger in meditators than non-meditators regardless of whether they were meditating or not (a trait effect), and that N1 amplitude was significantly attenuated during meditation in non-meditators but not expert meditators (an interaction between trait and state). These outcomes suggest that low-level attention is superior in long-term meditators in general. In contrast, low-level attention is reduced in non-meditators when they are asked to meditate for the first time, possibly due to auditory fatigue or cognitive overload.

Can we measure surgical resilience?

Surgical resilience describes psychological resilience within a surgical setting. Within a surgical setting, psychologically resilient patients have improved recovery and wound-healing. The search for biological correlates in resilient patients has led to the hypothesis that certain endogenous biomarkers (namely neuropeptide Y (NPY), testosterone, and dehydroepiandrosterone (DHEA)) are altered in resilient patients. The concept of surgical resilience raises the question of whether enhanced recovery following surgery can be demonstrated in patients with high titres of resilience biomarkers as compared to patients with low titres of resilience biomarkers. To determine the prognostic value of resilience biomarkers in surgical recovery, a cohort of patients undergoing major surgery should initially be psychometrically tested for their resilience levels before and after surgery so that biomarker levels of NPY, testosterone and DHEA can be compared to a validated psychometric test of resilience. The primary outcome would be length of hospital stay with and without an enhanced recovery program. Secondary outcome measures such as complications, time in rehabilitation and readmission could also be included. If the hypothesis is upheld, resilience biomarkers could be used to support more individualised perioperative management and lead to more efficient and effective allocation of healthcare resources.

Singing emotionally: a study of pre-production, production, and post-production facial expressions.

Singing involves vocal production accompanied by a dynamic and meaningful use of facial expressions, which may serve as ancillary gestures that complement, disambiguate, or reinforce the acoustic signal. In this investigation, we examined the use of facial movements to communicate emotion, focusing on movements arising in three epochs: before vocalization (pre-production), during vocalization (production), and immediately after vocalization (post-production). The stimuli were recordings of seven vocalists' facial movements as they sang short (14 syllable) melodic phrases with the intention of communicating happiness, sadness, irritation, or no emotion. Facial movements were presented as point-light displays to 16 observers who judged the emotion conveyed. Experiment 1 revealed that the accuracy of emotional judgment varied with singer, emotion, and epoch. Accuracy was highest in the production epoch, however, happiness was well communicated in the pre-production epoch. In Experiment 2, observers judged point-light displays of exaggerated movements. The ratings suggested that the extent of facial and head movements was largely perceived as a gauge of emotional arousal. In Experiment 3, observers rated point-light displays of scrambled movements. Configural information was removed in these stimuli but velocity and acceleration were retained. Exaggerated scrambled movements were likely to be associated with happiness or irritation whereas unexaggerated scrambled movements were more likely to be identified as "neutral." An analysis of singers' facial movements revealed systematic changes as a function of the emotional intentions of singers. The findings confirm the central role of facial expressions in vocal emotional communication, and highlight individual differences between singers in the amount and intelligibility of facial movements made before, during, and after vocalization.

Emotional communication in speech and music: the role of melodic and rhythmic contrasts.

Many acoustic features convey emotion similarly in speech and music. Researchers have established that acoustic features such as pitch height, tempo, and intensity carry important emotional information in both domains. In this investigation, we examined the emotional significance of melodic and rhythmic contrasts between successive syllables or tones in speech and music, referred to as Melodic Interval Variability (MIV) and the normalized Pairwise Variability Index (nPVI). The spoken stimuli were 96 tokens expressing the emotions of irritation, fear, happiness, sadness, tenderness, or no emotion. The music stimuli were 96 phrases, played with or without performance expression and composed with the intention of communicating the same emotions. Results showed that nPVI, but not MIV, operates similarly in music and speech. Spoken stimuli, but not musical stimuli, were characterized by changes in MIV as a function of intended emotion. The results suggest that these measures may signal emotional intentions differently in speech and music.

A comparison of the McGurk effect for spoken and sung syllables.

The importance of visual cues in speech perception is illustrated by the McGurk effect, whereby a speaker's facial movements affect speech perception. The goal of the present study was to evaluate whether the McGurk effect is also observed for sung syllables. Participants heard and saw sung instances of the syllables /ba/ and /ga/ and then judged the syllable they perceived. Audio-visual stimuli were congruent or incongruent (e.g., auditory /ba/ presented with visual /ga/). The stimuli were presented as spoken, sung in an ascending and descending triad (C E G G E C), and sung in an ascending and descending triad that returned to a semitone above the tonic (C E G G E C#). Results revealed no differences in the proportion of fusion responses between spoken and sung conditions confirming that cross-modal phonemic information is integrated similarly in speech and song.