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

OBJECTIVES We aimed to identify existing outcome measures for functional neurological disorder (FND), to inform the development of recommendations and to guide future research on FND outcomes. METHODS A systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previous treatment studies. Searches of Embase, MEDLINE and PsycINFO were conducted between January 1965 and June 2019. The findings were discussed during two international meetings of the FND-Core Outcome Measures group. RESULTS Five FND-specific measures were identified-three clinician-rated and two patient-rated-but their measurement properties have not been rigorously evaluated. No single measure was identified for use across the range of FND symptoms in adults. Across randomised controlled trials (k=40) and observational treatment studies (k=40), outcome measures most often assessed core FND symptom change. Other domains measured commonly were additional physical and psychological symptoms, life impact (ie, quality of life, disability and general functioning) and health economics/cost-utility (eg, healthcare resource use and quality-adjusted life years). CONCLUSIONS There are few well-validated FND-specific outcome measures. Thus, at present, we recommend that existing outcome measures, known to be reliable, valid and responsive in FND or closely related populations, are used to capture key outcome domains. Increased consistency in outcome measurement will facilitate comparison of treatment effects across FND symptom types and treatment modalities. Future work needs to more rigorously validate outcome measures used in this population

Stress and coping in students exposed to crime and violence: a comparative study of students studying at campuses in South Africa, Australia and England

University life has its own stressors but does not take place in a vacuum, especially as universities are no longer homogeneous entities. Stressors exist beyond the control of the student. In South Africa, levels of urban crime and violence experienced beyond that of stable countries is a dominant stressor. The impact of non-war violence on student functioning is poorly understood. The present study investigated the extent and nature of students’ exposure to crime and violence in South Africa, their stress and coping levels and compared the results to students in Australia and England. Students in South Africa were exposed to the most crime and violence but stress and coping levels did not notably differ across campuses. A significant difference was found however between those students exposed to crime and violence and those not exposed. It was concluded that exposure frequency or severity caused psychological sequelae regardless of the place of study