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BACKGROUND: Rehabilitation has proven effective in improving motor symptoms (i.e., weakness, tremor, gait and balance disorders) in patients with Functional Motor Disorders (FMDs). Its effects on non-motor symptoms (NMSs) such as fatigue, pain, depression, anxiety and alexithymia, have not been explored yet. OBJECTIVE: To explore the effects of a validated inpatient 5-day rehabilitation program, followed by a home-based self-management plan on functional motor symptoms, NMSs, self-rated perception of change, and quality of life (QoL). METHODS: 33 FMD patients were enrolled. Measures for motor symptoms and NMSs were primary outcomes. Secondary outcomes included measures of self-perception of change and QoL. Patients were evaluated pre-treatment (T0), post-treatment (T1), and 3-month follow-up (T2). RESULTS: There was an overall significant decrease in functional motor symptoms, general, physical, and reduced-activity fatigue (for all, p

Background Pain is a subjective experience characterized by sensory (intensity) and emotional (unpleasantness) aspects. Although literature reports behavioural effects on pain due to smell and taste influence, to our knowledge the relationship between tonic pain induced by a capsaicin cream and these chemosensory systems has never been explored before. The aim of this study was to investigate the modulation of olfactory and gustatory substances having different valence on tonic pain perception mediated by a capsaicin cream application. Methods Sixty healthy volunteers were included in two separated experiments (N = 30 smell; N = 30 taste) and underwent different valence smell and taste stimulations, while receiving painful stimuli. Perception of pain intensity (the sensory component) and unpleasantness (the affective component) was measured with a numerical rating scale, both during the two aforementioned experiments. Results Pain unpleasantness rating showed differences only in the smell experiment between the two odourous conditions. In particular, pleasant odour induced lower ratings of pain unpleasantness, while no significant results were found for intensity. Regarding taste, we could not observe significant effects nor for pain unpleasantness or intensity. Conclusions These findings highlight the potential role of pleasant odours in influencing the affective aspects of pain perception induced by this kind of tonic pain. Such evidence might provide new insight for using chemosensory substances as analgesics for modulating the cognitive aspects of neuropathic pain. Significance This work shows the effect of smell on the emotional component of tonic pain, experimentally induced by capsaicin cream application. Previous literature investigated tonic pain in interaction with smell and/or taste stimuli, but mainly with physical methods such as temperature. Our findings add new information in this field, contributing to a deeper insight on the role of olfaction on this particular kind of tonic pain perception. This approach could open to new investigations aimed to consider odours for pain management.

This article describes a randomized controlled trial to evaluate the effectiveness of a supervised online delivery of self-help plus (SH+), during the second wave of COVID-19 contagions in Northern Italy. The SH+ is a psychological intervention developed by the World Health Organization to increase a person's ability to deal with stress. In this trial, it was tested primarily as a tool to reduce anxiety and post-traumatic symptomatology in workers of residential nursing and care homes. In order to partial out non-specific effects of the intervention, the SH+ was compared to an equally supervised and structured alternative activity. Secondarily, in view of future emergencies, the potential of SH+ as a tool to reduce perceived stress, increase subjective well-being and foster individual resilience was explored. At post-intervention, the preregistered analysis revealed no difference in self-reported anxiety and/or post-traumatic symptomatology between the group receiving the SH+ and the group engaged in an alternative activity. Some specific and positive effects of the SH+ intervention were only found on self-reported intervention effectiveness and engagement in exploratory analyses. These findings raise the question whether the previously documented effectiveness of the SH+ on self-reported symptomatology and on the prevention of psychiatric conditions could be attributed mostly to non-specific rather than specific factors connected with participant enrolment in a psychological intervention. Indeed, the effects of the SH+ had been previously compared only to the effects of not being engaged in any alternative activity (often described in the literature as ‘treatment as usual’—or ‘enhanced treatment as usual’, when some relevant information is given to the control group as a one-off). Given the negative findings of this study, before the SH+ is implemented in clinical practice, further studies should be conducted to examine its short- and long-term beneficial effects, by means of randomized studies that employ alternative but similarly structured interventions as control conditions, aiming to minimize the confounding effect of non-specific factors.

Introduction We tested the hypothesis that functional limb weakness is associated with possible dysfunction of the central processing of proprioceptive information, by evaluating the amount of tonic vibration reflex (TVR) and the perception of the TVR movement. Methods The study sample was 20 patients with functional weakness of the lower and/or the upper limbs and 25 healthy controls; delivery of 92-Hz transcutaneous vibration of the biceps brachii tendon of the unrestrained arm stimulated predominantly the muscle spindle afferent and elicited elbow flexion (tonic vibration reflex, TVR). Blindfolded participants had to match the final position of the vibrated arm with their contralateral tracking arm. The TVR and perception of the TVR movement were measured as angle movements of the vibrated arm and the tracking arm, respectively. Results The magnitude of the TVR of the vibrated arm and movement perception of the TVR of the tracking arm were significantly reduced in the patients compared to the controls. No correlation was found between magnitude of the TVR and perception of the TVR movement, suggesting that the abnormalities were independent of each other. Moreover, the abnormalities did not differ between the patients with/without bilateral upper limb involvement or between the affected and the unaffected side in patients with unilateral impairment, suggesting that the observed deficits are independent of motor impairment. Conclusions Proprioceptive dysfunction may underlie alterations in body movement and in sense of agency in such patients and may play a role in the pathophysiology of functional limb weakness.

The current COVID-19 pandemic has been officially linked to the deaths of hundreds of thousands of people across the globe in just a few months. It is particularly lethal for the elderly in general, as well as for populations residing in long-term stay facilities. By this time, those working and caring for high-risk populations have been exposed to very intense and sudden levels of physical and psychological strain. The situation has taken a particularly tragic turn in residential nursing and care homes (NCH), which were hit hard by the pandemic. In residential NCH, neither residents nor workers tend to have immediate access to the same expertise, medication and equipment as in hospitals, which exacerbates an already tense situation. Among the mental health conditions related to exposure to potentially traumatic events, post-traumatic stress disorder and anxiety are the most prevalent and scientifically recognized. In this survey-based epidemiological study, we test the prevalence of anxiety and post-traumatic symptomatology in residential nursing and care home workers—a group of individuals that has been largely neglected but who nonetheless plays a very important and sensitive role in our society. We do this by focusing on the North of Italy, the most affected region during the first COVID-19 outbreak in Italy. Using a single-stage cluster design, our study returns an estimate for the prevalence of moderate-to-severe anxiety and/or post-traumatic symptomatology of 43% (s.e. = 3.09; 95% CI [37–49]), with an 18% (s.e. = 1.83; 95% CI [14–22]) prevalence of comorbidity among workers of Northern Italian NCH between 15 June and 25 July 2020 (i.e. 12–52 days after the end of national lockdown). Women and workers who had recently been in contact with COVID-19-positive patients/colleagues are more likely to report moderate-to-severe symptoms, with odds ratios of 2.2 and 1.7, respectively.

Background Pain perception is a multimodal experience composed of sensory, emotional and cognitive dimensions. Accumulating evidence suggests that the chemical senses can influence pain perception, but their relation with phasic pain is still unknown. The aim of this study was to investigate the influence of smell and taste having different valence on phasic pain. Methods Twenty-eight healthy volunteers received sweet, bitter and neutral odours or gustatory substances while receiving painful stimuli consisting of electrical shocks. Tactile threshold, pain threshold and pain tolerance were collected using the psychophysical method of limits at baseline and in association with smell and taste. Perception of pain intensity and unpleasantness was measured with a numerical rating scale. Results Sweet smell induced lower ratings of pain intensity than bitter smell when stimuli were delivered at pain threshold. Sweet smell also induced lower ratings of pain unpleasantness than neutral smell when stimuli were delivered at pain tolerance. Sweet taste induced lower ratings of pain unpleasantness than bitter taste when stimuli were delivered at pain threshold. Conversely, pain threshold and pain tolerance per se were not affected by smell and taste. Conclusions These findings highlight an effect of sweet substances in reducing the subjective perception of pain intensity and unpleasantness associated to phasic pain. Significance By demonstrating the link between smell, taste and phasic pain this study may have a translational impact in clinical conditions characterized by so-called shock-like pain, such as neuropathic pain.

Neurosyphilis is rather an unusual cause of dementia characterized by a rapidly progressive course and psychiatric symptoms. Diagnosis of neurosyphilis should be suspected in the presence of a global cognitive impairment consisting in disorientation, amnesia and severe impairment of speech and judgement and psychiatric symptoms such as depression, mania and psychosis, with a subacute onset. More commonly, clinical manifestations of neurosyphilis include general PARESIS (involvement of Personality, Affect, Reflexes, Eye, Sensorium, Intellect and Speech). Upon clinical suspicion, diagnosis of neurosyphilis is confirmed by a reactive cerebrospinal fluid (CSF)-Venereal Disease Research Laboratory. Here we report three Human Immunodeficiency Virus (HIV)-negative male patients presenting with psychiatric symptoms and a rapidly evolving dementia. Although magnetic resonance imaging did not address to diagnosis, CSF examination was mandatory in neurosyphilis diagnosis. Other diagnostic tools such as neuropsychology and single-photon emission computed tomography resulted supportive in the diagnosis. We showed that a prompt antibiotic treatment might stop disease progression. Therefore, neurosyphilis should be always considered even in HIV-negative patients in the presence of unexpected psychiatric symptoms accompanied by a rapidly evolving cognitive decline.

A structural representation of the hand embedding information about the identity and relative position of fingers is necessary to counting routines. It may also support associations between numbers and allocentric spatial codes that predictably interact with other known numerical spatial representations, such as the mental number line (MNL). In this study, 48 Western participants whose typical counting routine proceeded from thumb-to-little on both hands performed magnitude and parity binary judgments. Response keys were pressed either with the right index and middle fingers or with the left index and middle fingers in separate blocks. 24 participants responded with either hands in prone posture (i.e., palm down) and 24 participants responded with either hands in supine (i.e., palm up) posture. When hands were in prone posture, the counting direction of the left hand conflicted with the direction of the left–right MNL, whereas the counting direction of the right hand was consistent with it. When hands were in supine posture, the opposite was true. If systematic associations existed between relative number magnitude and an allocentric spatial representation of the finger series within each hand, as predicted on the basis of counting habits, interactions would be expected between hand posture and a unimanual version of the spatial–numerical association of response codes (SNARC) effect. Data revealed that with hands in prone posture a unimanual SNARC effect was present for the right hand, and with hands in supine posture a unimanual SNARC effect was present for the left hand. We propose that a posture-invariant body structural representation of the finger series provides a relevant frame of reference, a within-hand directional vector, that is associated to simple number processing. Such frame of reference can significantly interact with stimulus–response correspondence effects, like the SNARC, that have been typically attributed to the mapping of numbers on a left-to-right mental line.