Emotional processing and Social Cognition in Amyotrophic Lateral Sclerosis

Building on evidence for cognitive-behavioural change in people with Amyotrophic Lateral Sclerosis (ALS), the current study uses a range of neuropsychological measures to delineate the nature and scope of reported deficits in emotional processing and social cognition in people with ALS. Compared to the healthy control group, the ALS group was impaired on composite scores indexing executive function and performance on the emotional processing and social cognition tasks. Single-case analyses revealed that ALS patients showed heterogeneous performance across the cognitive tasks

Clinical- and cost-effectiveness of a nurse led self-management intervention to reduce emergency visits by people with epilepsy

People with chronic epilepsy (PWE) often make costly, and clinically unnecessary emergency department (ED) visits. Some do it frequently. No studies have examined interventions to reduce them. An intervention delivered by an epilepsy nurse specialist (ENS) might reduce visits. The rationale is it may optimize patients' self-management skills and knowledge of appropriate ED use. We examined such an intervention's clinical- and cost-effectiveness. Eighty-five adults with epilepsy were recruited from three London EDs with similar catchment populations. Forty-one PWE recruited from two EDs received treatment-as-usual (TAU) and formed the comparison group. The remaining 44 PWE were recruited from the ED of a hospital that had implemented a new ENS service for PWE attending ED. These participants formed the intervention group. They were offered 2 one-to-one sessions with an ENS, plus TAU. Participants completed questionnaires on health service use and psychosocial well-being at baseline, 6- and 12-month follow-up. Covariates were identified and adjustments made. Sixty-nine (81%) participants were retained at follow-up. No significant effect of the intervention on ED visits at 12 months or on other outcomes was found. However, due to less time as inpatients, the average service cost for intervention participants over follow-up was less than for TAU participants' (adjusted difference £558, 95% CI, −£2409, £648). Covariates most predictive of subsequent ED visits were patients' baseline feelings of stigmatization due to epilepsy and low confidence in managing epilepsy. The intervention did not lead to a reduction in ED use, but did not cost more, partly because those receiving the intervention had shorter hospital admissions. Our findings on long-term ED predictors clarifies what causes ED use, and suggests that future interventions might focus more on patients' perceptions of stigma and on their confidence in managing epilepsy. If addressed, ED visits might be reduced and efficiency-savings generated

Easily altered minerals and reequilibrated fluidinclusions provide extensive records of fluid andthermal history: gypsum pseudomorphs of the TeraGroup, Tithonian-Berriasian, Cameros Basin

This study reports a complex fluid and thermal history using petrography, electron microprobe, isotopic analysisand fluid inclusions in replacement minerals within gypsum pseudomorphs in Tithonian-Berriasian lacustrine de-posits in Northern Spain. Limestones and dolostones, formed in the alkaline lakes, contain lenticularly shapedgypsum pseudomorphs, considered to form in an evaporative lake. The gypsum was replaced by quartz andnon-ferroan calcite (Ca-2), which partially replaces the quartz. Quartz contains solid inclusions of a preexistingnon-ferroan calcite (Ca-1), anhydrite and celestine.High homogenization temperatures (Th) values and inconsistent thermometric behaviour within secondary fluidinclusion assemblages in quartz (147-351◦C) and calcite (108-352◦C) indicate high temperatures after precipita-tion and entrapment of lower temperature FIAs. Th are in the same range as other reequilibrated fluid inclusionsfrom quartz veins in the same area that are related to Cretaceous hydrothermalism.Gypsum was replaced by anhydrite, likely during early burial. Later, anhydrite was partially replaced by Ca-1associated with intermediate burial temperatures. Afterward, both anhydrite and Ca-1 were partially replacedby quartz and this by Ca-2. All were affected during higher temperature hydrothermalism and a CO2-H2O fluid.Progressive heating and hydrothermal pulses, involving a CO2-H2O fluid, produce the reequilibration of the FIAs,which was followed by uplift and coolin

Headache Diagnosis in Primary Care

Introduction: Doctors in primary care are responsible for diagnosing and managing patients with headache, but frequently lack confidence in doing so. We aimed to compare Family Practitioners’ (FPs) diagnosis of headaches to classification based on a symptom questionnaire, and to describe how classification links to other important clinical features. Methods: This was an observational study of patients attending primary care doctors for headache. Main outcome measures: Patients completed a questionnaire including the Headache Impact Test, the Migraine Disability Assessment Score, the Hospital Anxiety and Depression Scale, the Illness Perceptions Questionnaire, a satisfaction scale, a service use inventory and a symptom questionnaire rated by two Practitioners with Special Interest (PSIs) in Headache. Results: 255 patients completed questionnaires. There was low agreement between FP diagnosis and classification using the symptom questionnaire. FPs frequently did not use the diagnosis migraine, when patient reported symptoms which justified this. FPs did not classify patients with ≥15 days of headache separately as chronic daily headache (CDH), and this could be because the classification system used does not have that code. Patients classified as CDH using the symptom questionnaire reported more disability, more symptoms of anxiety and depression (HADS), more service use, and less satisfaction with FP care. Conclusion: Patients, who present with headache in primary care, tend to receive non-specific diagnoses. Having a system that would allow separate classification of people with headache of ≥ 15 days a month might help FPs to explore and address associated features with patients in terms of disability, psychological co-morbidity and cost, and improve satisfaction with care

How does cognitive behaviour therapy for dissociative seizures work? A mediation analysis of the CODES Trial

Background We compared dissociative seizure specific cognitive behaviour therapy (DS-CBT) plus standardised medical care (SMC) to SMC alone in a randomised controlled trial. DS-CBT resulted in better outcomes on several secondary trial outcome measures at the 12-month follow-up point. The purpose of this paper is to evaluate putative treatment mechanisms. Methods We carried out a secondary mediation analysis of the CODES trial. 368 participants were recruited from the National Health Service in secondary / tertiary care in England, Scotland and Wales. Sixteen mediation hypotheses corresponding to combinations of important trial outcomes and putative mediators were assessed. Twelve-month trial outcomes considered were final-month seizure frequency, Work and Social Adjustment Scale (WSAS), and the SF-12v2, a quality-of-life measure providing physical (PCS) and mental component summary (MCS) scores. Mediators chosen for analysis at six months (broadly corresponding to completion of DS-CBT) included: a) beliefs about emotions, b) a measure of avoidance behaviour, c) anxiety and d) depression. Results All putative mediator variables except beliefs about emotions were found to be improved by DS-CBT. We found evidence for DS-CBT effect mediation for the outcome variables dissociative seizures, WSAS and SF-12v2 MCS scores by improvements in target variables avoidance behaviour, anxiety and depression. The only variable to mediate the DS-CBT effect on the SF-12v2 PCS score was avoidance behaviour. Conclusions Our findings largely confirmed the logic model underlying the development of CBT for patients with dissociative seizures. Interventions could be additionally developed to specifically address beliefs about emotions to assess whether it improves outcomes. <br/

Neurologists’ experiences of participating in the CODES study—A multicentre randomised controlled trial comparing cognitive behavioural therapy vs standardised medical care for dissociative seizures

Purpose We investigated neurologists’ experience of participating in the large CODES trial involving around 900 adults with dissociative seizures which subsequently evaluated the effectiveness of tailored cognitive behavioural therapy (CBT) plus standardised medical care versus standardised medical care alone in 368 patients with dissociative seizures. Method We asked all neurologists referring patients with dissociative seizures to the CODES study to complete a 43-item online survey. This examined neurologists’ (i) demographics, (ii) knowledge of dissociative seizures before and after their involvement in the CODES trial, (iii) clinical practice before, during and since their involvement, and (iv) their experience of the CODES trial. Results Forty-three (51%) neurologists completed the questionnaire. Only about half of neurologists could make referrals to psychological intervention specific for dissociative seizures before and after the trial. One-third of doctors reported having changed their referral practice following their involvement. The majority (>69%) agreed that patient satisfaction with different aspects of the trial was very high, and 83.7% thought that it was easy to recruit patients for the study. Over 90% agreed they would like the treatment pathway to continue. Respondents found different elements of the trial useful, in particular, the patient factsheet booklet (98%), diagnosis communication advice (93%) and the CBT package (93%). Conclusions Neurologists participating in CODES generally found it easy to recruit patients and perceived patient satisfaction as very high. However, 46.5% of neurologists could not offer psychotherapy once the trial had finished, suggesting that problems with lack of access to psychological treatment for dissociative seizures persist