Publications by authors named "Timothy R Nicholson"

Migraine and functional neurological disorder (FND) are two of the most common conditions in neurological practice. It is assumed that the two conditions have distinct underlying mechanisms. However, it can be clinically challenging to disentangle their relative contributions to a patient's symptoms.

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Aims And Method: Neuropsychiatry training in the UK currently lacks a formal scheme or qualification, and its demand and availability have not been systematically explored. We conducted the largest UK-wide survey of psychiatry trainees to examine their experiences in neuropsychiatry training.

Results: In total, 185 trainees from all UK training regions completed the survey.

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Background: In this qualitative study, we aimed to obtain and synthesise the views of patients with functional neurological disorder (FND), their caregivers, and relevant healthcare professionals (HCPs) on outcome measurement in FND.

Methods: Semi-structured interviews were conducted with 22 FND patients, 18 caregivers and 21 HCPs, sampled purposively in the United Kingdom. Transcripts were analysed through inductive thematic analysis.

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It is established that patients hospitalised with COVID-19 often have ongoing morbidity affecting activity of daily living (ADL), employment, and mental health. However, little is known about the relative outcomes in patients with COVID-19 neurological or psychiatric complications. We conducted a UK multicentre case-control study of patients hospitalised with COVID-19 (controls) and those who developed COVID-19 associated acute neurological or psychiatric complications (cases).

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Introduction: Functional neurological disorder (FND) and autism spectrum disorder (ASD) are two complex neuropsychiatric conditions that have been historically classified within psychiatric domains, resulting in a lack of extensive research, insufficient clinical recognition, and persistent societal stigma. In recent years, there has been an increasing recognition among professionals and affected individuals of their possible overlap. This review explores the potential clinical and mechanistic overlap between FND and ASD, with particular attention to shared symptoms across sensory, motor, and psychiatric domains.

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Article Synopsis
  • - Functional Neurological Symptom Disorder (FNSD) involves neurological-like symptoms without a clear neurological cause, and the mechanisms behind it are complex and not fully understood.
  • - A study tested the use of remote monitoring technologies (RMT) on 17 individuals with FNS and 17 healthy controls to track symptoms, daily events, and physiological data, finding that those with FNS reported higher levels of negative emotions, pain, and sleep issues.
  • - Results indicate that daily stressors and negative feelings significantly impact FNS severity, suggesting that addressing emotional responses could help those with FNS, and calls for larger studies to explore these findings further.
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  • Mental health issues are prevalent among individuals with epilepsy, affecting their medication adherence, quality of life, and even lifespan, highlighting the need for regular screening and intervention despite challenges like lack of standardized procedures and time constraints.* -
  • This study aimed to assess the practicality and effectiveness of a digital tool leveraging electronic Patient-Reported Outcome Measures (ePROMs) to identify mental health symptoms in both adult and pediatric epilepsy patients before their outpatient consultations.* -
  • Findings showed that a significant portion of patients experienced mental health symptoms, with many not receiving support; specifically, 37.4% of adults reported anxiety, 29.2% showed depression symptoms, and a notable number of pediatric patients exhibited behavioral issues, emphasizing the importance of digital screening
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  • Functional neurological disorder (FND) causes symptoms like paralysis and seizures and can be very serious, leading to high healthcare costs.
  • Researchers plan to study the effects of psilocybin (a psychedelic) on people with FND to understand how it might help their condition.
  • The study will look at brain activity and other factors related to FND both before and after people take psilocybin, tracking their experiences for three months.
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The spectrum, pathophysiology and recovery trajectory of persistent post-COVID-19 cognitive deficits are unknown, limiting our ability to develop prevention and treatment strategies. We report the 1-year cognitive, serum biomarker and neuroimaging findings from a prospective, national study of cognition in 351 COVID-19 patients who required hospitalization, compared with 2,927 normative matched controls. Cognitive deficits were global, associated with elevated brain injury markers and reduced anterior cingulate cortex volume 1 year after COVID-19.

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Functional neurological disorder (FND) is a common and disabling condition at the intersection of neurology and psychiatry. Despite remarkable progress over recent decades, the mechanisms of FND are still poorly understood and there are limited diagnostic tools and effective treatments. One potentially promising treatment modality for FND is virtual reality (VR), which has been increasingly applied to a broad range of conditions, including neuropsychiatric disorders.

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Introduction: Advances have been made in understanding the aetiology of functional neurological disorder (FND); however, its pathophysiological mechanisms have not been definitively demonstrated. Evidence suggests interacting roles for altered emotional processing and interoception, elevated autonomic arousal, and dissociation, but there is limited evidence demonstrating their causal influence on specific FND symptoms. Our superordinate aim is to elucidate potentially shared and distinct aetiological factors and mechanisms in two common FND subtypes, functional seizures (FS) and functional motor symptoms (FMS).

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Background: A critical first step in managing functional neurological disorder (FND) is a positive diagnosis and clear explanation using an understandable illness model. Multidisciplinary group education sessions are one way to achieve this, with some evidence they improve understanding, confidence in diagnosis and outcomes with further treatment. In many conditions, illness perceptions and stigma affect distress, functioning, quality of life and engagement.

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Objective: This study examined etiological factors and symptom triggers of functional motor symptoms (FMS) or functional seizures (FS) and assessed potential relationships with relevant clinical features (i.e., functional symptoms, quality of life, and general functioning).

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Background And Purpose: This review aims to characterize the pattern of post-COVID-19 cognitive impairment, allowing better prediction of impact on daily function to inform clinical management and rehabilitation.

Methods: A systematic review and meta-analysis of neurocognitive sequelae following COVID-19 was conducted, following PRISMA-S guidelines. Studies were included if they reported domain-specific cognitive assessment in patients with COVID-19 at >4 weeks post-infection.

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Children and young people with epilepsy are at higher risk of mental health disorders and atypical neurodevelopmental outcomes compared to the general population. It is essential to detect such comorbidities early in children with epilepsy and provide appropriate interventions, to improve clinical outcomes. We aimed to identify and evaluate the measurement properties of Patient-Reported Outcome Measures (PROMs) that have been validated specifically to measure mental health and neurodevelopmental outcomes in children and/or young people with epilepsy.

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The coronavirus disease 2019 (COVID-19) pandemic substantially impacted different age groups, with children and young people not exempted. Many have experienced enduring health consequences. Presently, there is no consensus on the health outcomes to assess in children and young people with post-COVID-19 condition.

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Article Synopsis
  • The study investigated how highly arousing emotional stimuli affect functional neurological symptoms (FNS) in individuals with functional neurological disorder (FND) compared to healthy controls, focusing on the relationship between emotional response and autonomic reactivity.
  • Results showed that FND participants reported higher FNS after viewing negative images, particularly when viewing them passively, and physiological measures, such as skin conductance and heart rate, correlated with those symptom ratings.
  • The findings suggest that emotional events may influence FNS through autonomic responses rather than changes in subjective feelings, with cognitive detachment potentially playing a moderating role; more research is needed to explore the neural mechanisms involved.
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Post-COVID-19 condition (also known as long COVID) is a new, complex, and poorly understood disorder. A core outcome set (COS) for post-COVID-19 condition in adults has been developed and agreement is now required on the most appropriate measurement instruments for these core outcomes. We conducted an international consensus study involving multidisciplinary experts and people with lived experience of long COVID.

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  • Breastfeeding has benefits for both mothers and babies, and this study looks at how it might affect mental health for both.
  • The researchers gathered and examined 21 studies about breastfeeding and mental health, focusing mainly on kids but also considering moms.
  • They found mixed results—some studies suggested breastfeeding could help with depression and anxiety, but overall, the evidence isn't very strong or clear.
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Background And Purpose: Acute encephalitis is associated with psychiatric symptoms. Despite this, the extent of mental health problems following encephalitis has not been systematically reported.

Methods: We recruited adults who had been diagnosed with encephalitis of any aetiology to complete a web-based questionnaire.

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Introduction: The prevalence of mental health symptoms in people with epilepsy (PWE) is elevated compared with that of the general population. These symptoms can negatively impact epilepsy management and patient outcomes but can be treated once recognised. It is, therefore, important to screen for these symptoms to identify needs and put in place appropriate support.

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  • The study evaluated neurocognitive functioning in individuals with functional motor symptoms (FMS) and functional seizures (FS) compared to healthy controls, focusing on attention, executive function, social cognition, and metacognitive accuracy.
  • Results indicated no significant differences in objective cognitive tests between the two groups, but the FMS/FS group showed faster reaction times on an emotional task and reported more cognitive complaints in daily life.
  • The findings highlight a disconnect between subjective self-reports of cognitive issues and actual performance on cognitive assessments in the FMS/FS group, potentially influenced by associated factors like depression and psychological symptoms.
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  • The study investigated interoception (awareness of internal body states) in individuals with functional motor symptoms (FMS) and seizures (FS) compared to healthy controls (HC), focusing on measures of accuracy and insight.* -
  • Results showed no significant differences in interoceptive accuracy or confidence between the two groups, but those with FMS/FS scored lower on certain awareness subscales related to not being distracted and trusting bodily signals.* -
  • Impaired interoceptive accuracy might not be central to FMS/FS; instead, a lack of insight and altered body awareness could play a role in the severity and impact of symptoms, suggesting that reduced self-evaluation certainty contributes to the disorder's development
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Encephalitis describes inflammation of the brain parenchyma, typically caused by either an infectious agent or through an autoimmune process which may be postinfectious, paraneoplastic or idiopathic. Patients can present with a combination of fever, alterations in behaviour, personality, cognition and consciousness. They may also exhibit focal neurological deficits, seizures, movement disorders and/or autonomic instability.

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