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Patients with persistent postural-perceptual dizziness (PPPD) perceive postural instability larger than the observed sway. It is unknown whether the concept of postural misperception prevails during vestibular stimulation and whether it may account for the unsteadiness patients complain during body movements. We tested the hypothesis of an abnormal sensory-perceptual scaling mechanism in PPPD by recording objective, perceived, and the reproduced postural sway under various standing conditions, modulating visual and proprioceptive input, by binaural galvanic vestibular stimulation (GVS). We related postural sway speed to individual vestibular motion perceptional thresholds and disease-related PPPD questionnaires in 32 patients and 28 age-matched healthy control subjects (HC). All participants showed normal vestibular function tests on quantitative testing at the time of enrollment. The perception threshold of GVS was lower in patients. Compared to HC, patients showed and perceived larger sway on the firm platform. With GVS, posturo-perceptual ratios did not show group differences. The ratio of reproduced to real postural sway showed no group differences indicating normal postural sway perception during vestibular stimulation. Noticeably, only in patients, reproduced postural instability became larger with lower individual thresholds of vestibular motion detection. We conclude that posturo-perceptual (metacognitive) scaling of postural control seems to be largely preserved in PPPD during GVS. Vestibular stimulation does not destabilize patients more than HC, even in challenging postural conditions. Low individual thresholds of vestibular motion perception seem to facilitate instability and postural misperception on solid grounds. This conclusion is important for an effective physical therapy with vestibular exercises in PPPD. [ABSTRACT FROM AUTHOR]

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Copyright of Manuelle Medizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Persistent postural-perceptual dizziness (PPPD) is a chronic disorder of perceived unsteadiness. Symptoms can be exacerbated in visually complex stationary or moving environment. Visual dependence and increased motion sensitivity are predictors for PPPD but its pathophysiology remains unknown. We hypothesized an abnormal sensory–perceptual scaling mechanism in PPPD and tested visual- and vestibular perceptional thresholds in 32 patients and 28 age-matched healthy control subjects (HC). All participants showed normal vestibular function tests on quantitative testing. Visual motion coherence thresholds were assessed by random dot kinetomatograms. Vestibular perceptional thresholds of egomotion were assessed by binaural galvanic vestibular stimulation (GVS) and passive chair rotation around an earth-vertical axis. Chair rotation trials were contrasted with no-motion (sham) stimulus trials. Mean thresholds of visual motion perception were higher in patients compared to HC. The perception threshold of GVS was lower in patients but the threshold of correctly perceived egomotion during chair rotation did not differ. Interestingly, the number of trials with correct perception in the no-motion condition increased with the threshold of correct responses for rotatory egomotion in patients. Unlike expected, PPPD patients required more coherently moving random dots than HC to perceive visual motion. A poorer complex visual motion recognition, e.g., traffic visual stimuli, may increase anxiety and levels of uncertainty as visuomotor reactions might occur delayed. The vestibular rotatory perception threshold predicted the probability of making false assignments in the sham condition in PPPD, i.e., patients who readily recognize the correct egomotion direction are prone to perceive egomotion in the no-motion condition. As this relation was not found in healthy subjects, it may reflect an abnormal sensory–perceptual scaling feature of PPPD. [ABSTRACT FROM AUTHOR]

Background: A significant proportion of individuals with suspicious onset of multiple sclerosis (MS) does not fulfill the diagnostic criteria. Although some receive other diagnoses, many remain undiagnosed and lack healthcare follow‐up. This study aimed to characterize persons with undetermined diagnosis (PwUD) through a questionnaire. Methods: Incident cases with suspected MS were consecutively admitted to a tertiary neurological healthcare center in a prospective cohort study. Those who remained undiagnosed after 40 months (mean, range 31–52) were considered PwUD. They completed a modified questionnaire, previously used in a population‐based case‐control study of incident MS cases. Their responses were compared with two control cohorts, persons with MS (PwMS) and healthy controls, randomly selected from national registries, matched by age, gender, and area of residence. Results: Out of 271 patients with suspected MS onset, 72 (20.3%) were PwUD with a female majority (79%). The response rate was 83% and 39% reported persisting MS‐like symptoms. Compared to controls (n = 548) and PwMS (n = 277), fewer PwUD were currently smoking (p =.4 and p =.03), consumed less alcohol (p =.04 and p =.01), and had children (p =.02 and p =.002). PwUD reported occurrence of other autoimmune disease in 29%, higher compared to PwMS and controls (p <.001 and p <.001). Conclusions: UD is common among persons investigated for suspected MS, in particular among female parents. Our data suggest that PwUD can be characterized as nonsmokers with low alcohol consumption and a higher prevalence of autoimmune disease, in particular thyroid disease. [ABSTRACT FROM AUTHOR]

Introduction: Functional disorders are prevalent in all medical fields and pose a tremendous public health problem, with pain being one of the most common functional symptoms. Understanding the underlying, potentially unifying mechanism in functional (pain) disorders is instrumental in facilitating timely diagnosis, stigma reduction, and adequate treatment options. Neuroscientific models of perception suggest that functional symptoms arise due to dysregulated sensorimotor processing in the central nervous system, with brain-based predictions dominating the eventual percept. Experimental evidence for this transdiagnostic mechanism has been established in various functional symptoms. The goal of the current study was to investigate whether erroneous sensorimotor processing is an underlying transdiagnostic mechanism in chronic (functional) pain. Method: A total of 13 patients with chronic (functional) pain [three patients with chronic (functional) pain disorder, F45.40, ICD-10; 10 patients with chronic pain disorder with somatic and psychological factors, F45.41, ICD-10]; and 15 healthy controls performed large combined eye-head gaze shifts toward visual targets, naturally and with increased headmoment of inertia.We simultaneouslymeasured participants' eye and headmovements to assess head oscillations at the end of the gaze shift, which are an established indicator of (transdiagnostic) sensorimotor processing deficits of head control. Results: Using a Bayesian analysis protocol, we found that patients with chronic (functional) pain and control participants stabilized their heads equally well (Bayes Factor 01 = 3.7, Bayes Factor exclusion = 5.23; corresponding to substantial evidence) during all sessions of the experiment. Conclusion: Our results suggest that patients with chronic (functional) pain do not show measurable symptom-unspecific sensorimotor processing deficits. We discuss outcome parameter choice, organ system specificity, and selection of patient diagnoses as possible reasons for this result and recommend future avenues for research. [ABSTRACT FROM AUTHOR]

With the emergence of such videos addressing Tourette syndrome on YouTube, in which affected persons present themselves, Tourette experts observe an increasing number of patients showing Tourette-like symptoms. Interviews show that they are not only familiar with these videos but have also dealt with them in different ways. Medical analyses combined with the evaluations of the interviews give reason to believe that the videos can be interpreted as triggers for certain groups of people. The evaluation of the data on the media use of the patients traces their subjective use of social media as well as their opinions on central content to get insight on how the use of the videos in question is integrated into their media activities. It becomes apparent that the trigger function of the videos cannot be explained by a consistent mode of reception. Further contextual variables must be taken into account to understand the phenomenon. [ABSTRACT FROM AUTHOR]

Introduction: Patients with functional disorders (FD) often experience cognitive problems such as forgetfulness and distractibility alongside physical symptoms that cannot be attributed to a known somatic disease. Method: Test scores of cognitive tests and psychiatric rating scales of 100 outpatients diagnosed with a functional disorder were compared to a control group (n = 300) of patients with other diagnoses and to test norms for the general population. Results: Out of the 100 patients with functional disorders, 59 reported significant subjective cognitive symptoms. A moderate difference (d = 0.5-0.7) was found between the FD group mean and the population mean in processing speed tests, as well as in four psychiatric rating scales (depression, anxiety, phobias, somatisation) but there were no statistically significant differences in verbal and nonverbal reasoning or in logical memory. Somatisation and logical verbal memory scores were higher in the FD group compared to the control group. Conclusion: The findings of the study suggest that a decline in processing speed is a central feature in the cognitive profile of patients with functional disorders. [ABSTRACT FROM AUTHOR]

Abstract Background A significant proportion of individuals with suspicious onset of multiple sclerosis (MS) does not fulfill the diagnostic criteria. Although some receive other diagnoses, many remain undiagnosed and lack healthcare follow‐up. This study aimed to characterize persons with undetermined diagnosis (PwUD) through a questionnaire. Methods Incident cases with suspected MS were consecutively admitted to a tertiary neurological healthcare center in a prospective cohort study. Those who remained undiagnosed after 40 months (mean, range 31–52) were considered PwUD. They completed a modified questionnaire, previously used in a population‐based case‐control study of incident MS cases. Their responses were compared with two control cohorts, persons with MS (PwMS) and healthy controls, randomly selected from national registries, matched by age, gender, and area of residence. Results Out of 271 patients with suspected MS onset, 72 (20.3%) were PwUD with a female majority (79%). The response rate was 83% and 39% reported persisting MS‐like symptoms. Compared to controls (n = 548) and PwMS (n = 277), fewer PwUD were currently smoking (p = .4 and p = .03), consumed less alcohol (p = .04 and p = .01), and had children (p = .02 and p = .002). PwUD reported occurrence of other autoimmune disease in 29%, higher compared to PwMS and controls (p

IntroductionFunctional disorders are prevalent in all medical fields and pose a tremendous public health problem, with pain being one of the most common functional symptoms. Understanding the underlying, potentially unifying mechanism in functional (pain) disorders is instrumental in facilitating timely diagnosis, stigma reduction, and adequate treatment options. Neuroscientific models of perception suggest that functional symptoms arise due to dysregulated sensorimotor processing in the central nervous system, with brain-based predictions dominating the eventual percept. Experimental evidence for this transdiagnostic mechanism has been established in various functional symptoms. The goal of the current study was to investigate whether erroneous sensorimotor processing is an underlying transdiagnostic mechanism in chronic (functional) pain.MethodA total of 13 patients with chronic (functional) pain [three patients with chronic (functional) pain disorder, F45.40, ICD-10; 10 patients with chronic pain disorder with somatic and psychological factors, F45.41, ICD-10]; and 15 healthy controls performed large combined eye-head gaze shifts toward visual targets, naturally and with increased head moment of inertia. We simultaneously measured participants' eye and head movements to assess head oscillations at the end of the gaze shift, which are an established indicator of (transdiagnostic) sensorimotor processing deficits of head control.ResultsUsing a Bayesian analysis protocol, we found that patients with chronic (functional) pain and control participants stabilized their heads equally well (Bayes Factor 01 = 3.7, Bayes Factor exclusion = 5.23; corresponding to substantial evidence) during all sessions of the experiment.ConclusionOur results suggest that patients with chronic (functional) pain do not show measurable symptom-unspecific sensorimotor processing deficits. We discuss outcome parameter choice, organ system specificity, and selection of patient diagnoses as possible reasons for this result and recommend future avenues for research.

Irritable bowel syndrome with predominant diarrhea (IBS-D) and functional diarrhea (FD) are disorders of gut–brain interaction characterized by recurring symptoms which have a serious impact on the patient's quality of life. Their pathophysiology is far from being completely understood. In IBS-D growing evidence suggests that bile acid malabsorption (BAM) could be present in up to 30% of patients. Microscopic colitis (MC) is a well-known cause of watery diarrhea and some patients, at first, can be diagnosed as IBS-D or FD. Both BAM and MC are often responsible for the lack of response to conventional treatments in patients labelled as "refractory". Moreover, because BAM and MC are not mutually exclusive, and can be found in the same patient, they should always be considered in the diagnostic workout when a specific treatment for BAM or MC is unsatisfactory. In the present review the possible shared pathogenetic mechanisms between BAM and MC are discussed highlighting how MC can induce a secondary BAM. Moreover, a brief overview of the current literature regarding the prevalence of their association is provided. [ABSTRACT FROM AUTHOR]

Background: Eating disorders and functional disorders are severe conditions. Nonverbal treatment approaches, including the use of art, have emerged as promising supplements for the treatment of these patients. Purpose: This qualitative interview study aims to explore how youths with eating and functional disorders experience participation in an art project in a Child and Adolescent Psychiatric setting. Methodology: The participants were three youths who had actively participated in the art project “Painting oneself out of a corner”. Semi-structured interviews were conducted and subsequently analyzed using interpretative phenomenological analysis. Findings: Three main themes were identified in the analysis: Enhancing self-discovery describes how the youths unfold personal themes using art. To be seen illustrates how the art project makes the youths feel seen as more than a patient. Finally, A land we can all set foot on describes how art can facilitate different aspects of communication. Value: This study provides new perspectives to support the use of art as a supplement to traditional treatment approaches for youths with an eating or functional disorder in psychiatric settings and encourages further research in this field.

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Abstract Background Irritable bowel syndrome (IBS) represents the most common functional disorder of the gastrointestinal tract. Many patients with IBS display complex gastrointestinal (GI) symptoms leading to overlapping diagnosis of IBS and other GI diseases in many patients. Methods Using the Disease Analyzer database (IQVIA) featuring patients treated within 2010 and 2019 within 1240 general practices in Germany, we analyzed the prevalence of common GI diseases within 12 months prior to and after the first diagnosis of IBS. Results 65,569 patients with an initial diagnosis of IBS were included into the analysis. Out of these, 29,553 patients had an observation time of at least 12 months prior to the first IBS diagnosis and at least 12 months after the first IBS diagnosis. Mean age was 48.8 (SD: 18.4) years, 65.0% were female. Notably, 16,164 (55%) of these patients had at least one preexisting diagnosis of another GI diseases within 12 months prior to the first IBS diagnosis. Most common overlapping diagnoses were intestinal infectious diseases (26%), gastritis/ duodenitis (21%), diseases of the esophagus (15%), non-infectious enteritis or colitis (7.4%), functional dyspepsia (6%) and ulcers (1.0%). Additionally, 12,048 (41%) received one of these diagnosis within 12 months after the first IBS diagnosis. Conclusion Our data provide evidence for a high overlap between IBS and other GI diagnoses. Moreover, we show that IBS is frequently diagnosed in patients with preexisting GI diseases, potentially putting into question the validity of IBS diagnosis at least in some cases.

Introduction: bruxism is a parafunction characterized by excessive activity of the masticatory muscles, consisting in grinding, or clenching of the teeth. The etiology of bruxism is multifactorial. Carefully collected history and additional tests enable correct diagnosis. There is no single method that is completely effective in treating bruxism. It is important to make the patient aware of the disorder, it’s possible consequences, and the need for treatment. Aim of the study: approximation of the bruxism profile, drawing attention to the prevalence of the disorder and the need for early diagnosis, as well as discussing the current therapeutic options Material and methods: the authors reviewed the literature on bruxism in terms of its causes, epidemiology, symptoms, diagnosis, and treatment Conclusions: Correct, short-term diagnosis and application of appropriate treatment may inhibit the development of functional disorders of the masticatory system.

Current diagnostic concepts of somatic symptom disorder (SSD) in DSM-5 and bodily distress disorder (BDD) in ICD-11 require certain psychological criteria, but researchers have called for further specification. Therefore, in a first step, this systematic review and meta-analysis aimed to summarize the current evidence on psychological factors associated with SSD/BDD and/or disorder-relevant clinical outcomes such as symptom severity and impairment. Psychological factors were systematically searched using Pubmed, Cochrane Library and Psycinfo via EBSCO. Studies providing original data in English or German, after 2009 were included. Cross-sectional, cohort and case-control studies investigating at least one psychological factor in individuals with SSD/BDD in the context of disorder-relevant outcomes were included. Forty-three eligible studies (n = 3760 patients) in SSD (none in BDD) provided data on at least one psychological factor, 37 in case-control format, 10 cross-sectional and 5 longitudinal. Meta-analyses of the case-control studies found patients with SSD to be more impaired by depression (SMD = 1.80), anxiety (SMD = 1.55), health anxiety (SMD = 1.31) and alexithymia (SMD = 1.39), compared to healthy controls. Longitudinal results are scarce, mixed, and require refining, individual studies suggest self-concept of bodily weakness, anxiety and depression to be predictive for persistent SSD and physical functioning. This review provides a detailed overview of the current evidence of psychological factors in relation to SSD/BDD. Future studies on SSD and BDD should include under-studied psychological factors, such as negative affect, fear avoidance, or emotion regulation. More longitudinal studies are needed to assess the predictive value of these factors. • Psychological factors related to Somatic Symptom Disorder need clarification. • Depression, anxiety, illness anxiety and alexithymia importance could be confirmed. • Other factors, such as, emotion regulation and avoidance behaviour are understudied. • Longitudinal data is lacking. [ABSTRACT FROM AUTHOR]

Introduction: Persistent postural–perceptual dizziness (PPPD) is a chronic functional vestibular disorder that can be precipitated by acquired brain injuries. Poststroke depression (PSD) is the most common psychiatric sequela of stroke, affecting 33% of stroke survivors. Pathophysiologic mechanisms of PPPD and PSD are not fully understood. Case Report: A 40-year-old woman developed new, debilitating chronic dizziness exacerbated by her own motion and exposure to visual motion stimuli plus prolonged depressive symptoms, both beginning within days after a localized right insular stroke. A collaborative evaluation by specialists in neurology, otorhinolaryngology, optometry, and psychiatry concluded that the insular stroke caused simultaneous onset of PPPD and PSD. Discussion: Prior case reports described short-lived vertigo following insular strokes, but no long-term vestibular symptoms without ongoing nystagmus or gait ataxia. In this case, chronic dizziness and motion sensitivity continued in the absence of focal neurologic deficits, invoking the possibility that changes in functioning of brain networks subserving spatial orientation persisted despite otherwise adequate recovery from the stroke, a mechanism previously proposed for PPPD. This case also reinforced prior work implicating pathways through the insula in PSD. Co-occurrence of PPPD and PSD offers insights into simultaneous functions of the insula in multiple networks in human brain. [ABSTRACT FROM AUTHOR]

The concept of somatic stress disorders published in 2013 in the DSM-V allows a paradigm shift in the treatment of patients with chronic physical symptoms. The earlier dualistic classification into purely psychogenic or purely physical causes gives way to an overarching bio-psycho-social understanding with the inclusion of modern scientific findings. This promotes an open attitude towards the subjective feelings, values and ideas of the patient, patient-oriented communication and the trusting doctor-patient relationship that is essential for the course of the disease. Integrative medicine offers a suitable framework for this. [ABSTRACT FROM AUTHOR]

Background: Irritable bowel syndrome (IBS) represents the most common functional disorder of the gastrointestinal tract. Many patients with IBS display complex gastrointestinal (GI) symptoms leading to overlapping diagnosis of IBS and other GI diseases in many patients.Methods: Using the Disease Analyzer database (IQVIA) featuring patients treated within 2010 and 2019 within 1240 general practices in Germany, we analyzed the prevalence of common GI diseases within 12 months prior to and after the first diagnosis of IBS.Results: 65,569 patients with an initial diagnosis of IBS were included into the analysis. Out of these, 29,553 patients had an observation time of at least 12 months prior to the first IBS diagnosis and at least 12 months after the first IBS diagnosis. Mean age was 48.8 (SD: 18.4) years, 65.0% were female. Notably, 16,164 (55%) of these patients had at least one preexisting diagnosis of another GI diseases within 12 months prior to the first IBS diagnosis. Most common overlapping diagnoses were intestinal infectious diseases (26%), gastritis/ duodenitis (21%), diseases of the esophagus (15%), non-infectious enteritis or colitis (7.4%), functional dyspepsia (6%) and ulcers (1.0%). Additionally, 12,048 (41%) received one of these diagnosis within 12 months after the first IBS diagnosis.Conclusion: Our data provide evidence for a high overlap between IBS and other GI diagnoses. Moreover, we show that IBS is frequently diagnosed in patients with preexisting GI diseases, potentially putting into question the validity of IBS diagnosis at least in some cases. [ABSTRACT FROM AUTHOR]

IntroductionPersistent postural–perceptual dizziness (PPPD) is a chronic functional vestibular disorder that can be precipitated by acquired brain injuries. Poststroke depression (PSD) is the most common psychiatric sequela of stroke, affecting 33% of stroke survivors. Pathophysiologic mechanisms of PPPD and PSD are not fully understood.Case ReportA 40-year-old woman developed new, debilitating chronic dizziness exacerbated by her own motion and exposure to visual motion stimuli plus prolonged depressive symptoms, both beginning within days after a localized right insular stroke. A collaborative evaluation by specialists in neurology, otorhinolaryngology, optometry, and psychiatry concluded that the insular stroke caused simultaneous onset of PPPD and PSD.DiscussionPrior case reports described short-lived vertigo following insular strokes, but no long-term vestibular symptoms without ongoing nystagmus or gait ataxia. In this case, chronic dizziness and motion sensitivity continued in the absence of focal neurologic deficits, invoking the possibility that changes in functioning of brain networks subserving spatial orientation persisted despite otherwise adequate recovery from the stroke, a mechanism previously proposed for PPPD. This case also reinforced prior work implicating pathways through the insula in PSD. Co-occurrence of PPPD and PSD offers insights into simultaneous functions of the insula in multiple networks in human brain.

Objectives: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder which is also the most common cause of chronic dizziness. Effective treatment is dependent on the awareness of the provider's knowledge of PPPD and correct provision of treatment. This study was aimed to assess the awareness of PPPD and practice patterns among a diverse group of providers who care for patients with chronic dizziness in the outpatient clinics. Materials and Methods: A 12-question web-based survey was distributed to a cross-sectional convenience sample of medical providers from primary care including general practitioners, otorhinolaryngology (ORL) and internal medicine all over Malaysia. We analyzed the responses using multivariate logistic regression. Results: Of the 186 included responses, only 46.7% (85 respondents) replied they have heard of PPPD and 158 (84.9%) have actually encountered patients with symptoms describing PPPD. Those in primary care had less odds of having heard of PPPD (adjusted odds ratio [aOR] 0.37 confidence interval [CI] 0.18–0.76) nor treated patients with PPPD symptoms (aOR 0.18 CI 0.07–0.49) when compared to the General Medical and ORL providers. In terms of treatment of PPPD, gender, level of training, and practice setting predicted the provision of therapy. Conclusion: PPPD awareness is still lacking among our providers and the current practices reflect that the management of chronic dizziness is focused on ruling out systemic causes. Now is the time to invest in health communication strategies to improve the awareness and knowledge of managing chronic dizziness especially PPPD. [ABSTRACT FROM AUTHOR]

Chest pain is a common presenting complaint with a broad differential diagnosis. Even after the full array of special investigations, a cause cannot be found in some patients. Psychological factors can play a significant role in the perception of chest pain. Patients with such a psychological disturbance may not meet the full criteria for a diagnosable psychiatric illness, and thus cannot be assigned a specific diagnosis. Not knowing how to manage this situation can lead to poor rapport between doctor and patient. Through their clinical acumen, judicious use of special investigations and by forming a therapeutic alliance, clinicians can identify and help these patients. [ABSTRACT FROM AUTHOR]

Abstract Background Asthma is a disease of the lung and a systemic disease. Functional disorders are associated with multiple systemic abnormalities that have been explained by complexity models. The aim was to test the similarity in type and aetiology between the extra‐pulmonary symptoms of severe asthma and the symptoms of fibromyalgia. Methods One Hundred patients recruited from a specialist severe asthma clinic and 1751 people reporting different functional disorder diagnoses recruited via the internet completed the same 60‐item questionnaire. Symptom patterns were compared between groups using a new measure, the symptom pattern similarity index where 0 = no relationship, 1 = identical patterns between groups. Results Severe asthma patients report numerous extra‐pulmonary symptoms. The similarity index between the symptom pattern of the asthma patients with other groups was irritable bowel syndrome = 0.54, chronic fatigue syndrome = 0.69, and fibromyalgia = 0.75. The index between fibromyalgia and asthma patients with the most and least frequent extra‐pulmonary symptoms was 0.81 and 0.55 respectively. Conclusions Patients with severe asthma have numerous extra‐pulmonary symptoms similar in type and pattern to the symptoms of fibromyalgia. The similarity of the symptom pattern between asthma and fibromyalgia increases as the number of extra‐pulmonary symptoms increases as predicted by network theory and previously shown to be the case with other functional disorders. These findings support the hypothesis that functional disorders and extra‐pulmonary asthma symptoms have a common complexity or network aetiology. Evidence based behavioural interventions for fibromyalgia may be helpful for patients with severe asthma reporting extra‐pulmonary symptoms.

Balance assessments could render useful objective performance measures to evaluate the efficacy of low back surgeries, yet these assessments have not been collectively examined to determine longitudinal sensitivity across surgical interventions. The purpose of this review was to determine sensitivity of balance measurements for disparate spinal disorders after surgical intervention. We searched PubMed, Embase, Scopus, the Cochrane Library, Web of Science, and CINAHL. Articles were selected based on: (1) sample consisted of low back disorder individuals and (2) balance measurements were obtained both pre- and postsurgery. Most of the articles addressed 2 specific low back disorders: (1) adolescent idiopathic scoliosis/spinal fusion and (2) disc herniation/decompression surgery. For scoliosis patients, body sway increased (14-97%) immediately following surgery but gradually reduced (1-33%) approaching the 1-year post spinal fusion assessment. For patients with disc herniation, sway range, sway velocity, sway area, and sway variability all decreased (19-42%) immediately postsurgery. Balance assessments for adolescents with idiopathic scoliosis who underwent surgical intervention should be performed with visual occlusion, focus on time domain parameters, and evaluated with longer follow-up times. Patients with disc herniation who underwent decompression surgery should have balance assessments with visual deprivation, test conditions specifically addressing hip strategy, and correlation with pain. [ABSTRACT FROM AUTHOR]

Background: Gastrointestinal muscular sampling is useful in the histological assessment of functional gastrointestinal disorders. We devised a new sampling method to obtain a large volume of muscle tissues and then investigated the feasibility and safety of endoscopic muscular resection with a ligation device in an in vivo porcine model. Methods: After establishing a submucosal tunnel, a rubber band was placed on the muscle tissue by sucking the exposed muscle layer. Thereafter, the established pseudopolyp was removed using an electrocautery snare, and the entry site of the submucosal tunnel was closed endoscopically. This procedure was performed at three sites in the esophagus and stomach of two pigs. The technical success, histology, and survival rate on postoperative day 7 were examined postoperatively. Results: We successfully completed the mentioned procedure in 11 of the 12 sites (92%), without the occurrence of severe adverse events. The median diameters of obtained tissues from the esophagus and stomach, respectively, were 5 mm and 10 mm. Histologically, both the inner and outer muscle layers were included in all specimens. The postprocedural course was found uneventful in both pigs during the observatory period. Conclusions: Endoscopic muscular resection using a ligation device enabled us to obtain large and thick muscle tissue samples. This approach may facilitate more precise histological assessments of functional gastrointestinal disorders. [ABSTRACT FROM AUTHOR]

Copyright of Der Schmerz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The expert group under the auspices of the German statutory accident insurance (DGUV) comprehensively, systematically and scientifically analyzed reduction in earning capacity (MdE) values for limb loss in an interdisciplinary methodological approach to review their relevance. The basis for the proposals of new MdE values is the International Classification of Functioning, Disability and Health (ICF) related health and functional disorders that resulted in a grouping of comparable handicaps. The study examined which limitations on the labor market can be assumed today for insured patients with specific accident-related functional restrictions. For this purpose, a scientific literature search and a survey of the relevant occupational science institutes of the Federal Republic of Germany were carried out. As a result, however, it was not possible to generate valid labor market data on employment opportunities related to specific physical disorders. In order to fulfill the mandate and the requirements of § 56 (2) sentence 1 of the Social Security Statutes VII (SGB VII) under the given circumstances, the multiprofessional group of experts applied its interdisciplinary knowledge on dysfunctions and effects on working world and developed new MdE benchmarks, which were each derived, differentiated and justified. The proposals of the expert group should lead to a socially, legally and politically acceptable consensus and thus guarantee that the accident benefits based on the MdE will continue to fulfill their important role as a factor for social satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the incidence and factors associated with long-term functional outcomes of sacrococcygeal teratoma (SCT) after resection in neonates and infants.Methods: Twenty-nine patients with a minimum of 3 years of follow-up who underwent resection and were histologically diagnosed with SCTs between 1982 and 2017 at our institution were included.Results: The median age at the time of the study was 10.0 years. Functional disorders occurred after surgery in 6 (20.7%) patients. Anorectal dysfunction, urologic dysfunction, and lower-extremity motor disorders occurred in 6 (20.7%), 4 (13.8%), and 3 (10.3%) patients, respectively. One patient with all three types of functional disorders developed intestinal perforation due to ileus and died of sepsis at 13 years of age. The overall mortality rate after tumor resection was 3.4%. The patients who developed functional disorders presented a low 1-min Apgar score, larger tumors requiring abdominosacral resection, surgical injury to the pelvic organs, and immature or malignant histological findings.Conclusion: Although the mortality rate was low, the long-term rate of functional disorders after SCT resection was approximately 20%. SCT patients with large tumors, surgical injury to the pelvic organs, and immature or malignant histological findings require thorough follow-up. [ABSTRACT FROM AUTHOR]

Aim: The frequent occurrence of psoriasis with gastrointestinal system diseases indicates that psoriasis may also be associated with IBS. We aimed to evaluate the frequency of irritable bowel syndrome in patients with psoriasis and psoriatic arthritis. Material and Methods: Study included 111 patients with psoriasis, and 214 healthy volunteers. The presence of IBS in the psoriasis and control groups was evaluated according to the Rome III diagnostic criteria (Recurrent abdominal pain or discomfort at least 3 days/month in the last 3 months associated with two or more of the following: Improvement with defecation, onset associated with a change in frequency of stool, onset associated with a change in form (appearance) of stool). The participants were also asked about the presence of findings supporting the diagnosis of IBS. The participants were asked about the frequency of defecation, and the stool type was evaluated according to the Bristol stool form scale Results: 41 (36.9%) patients in the psoriasis group and 27 (12.6%) controls were detected to have IBS( p< 0.001). Passage of mucus, abdominal distension, and straining were found more frequently in the psoriasis group than in the control group (p = 0.023, 0.001, and 0.001, respectively). The mean defecation frequency per week was significantly higher in the psoriasis group than in the control group (p = 0.000). The mean value for the Bristol stool scale was 4.12 ± 1.13 for the psoriasis group and 3.72 ± 1.16 for the control group (p = 0.003). Conclusion: The increased frequency of IBS and the findings supporting the diagnosis of IBS in these patients suggest that they have a tendency to develop IBS. The indication of a higher frequency of IBS in patients with psoriatic arthritis is another important outcome of the present study. [ABSTRACT FROM AUTHOR]

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) has gained increasing acceptance for the treatment of irritable bowel syndrome but safety concerns have been raised regarding nutritional adequacy. Changes in nutrient intake during the elimination phase of the low-FODMAP diet remain predominantly unknown. To determine changes in the mean reported daily nutrient content before and after 4 weeks of a low-FODMAP diet vs modified National Institute for Health and Clinical Excellence (mNICE) dietary intervention and to identify nutritional inadequacies based on comparison to the Dietary Reference Intakes in patients with irritable bowel syndrome-diarrhea subtype. Post hoc analysis of a randomized controlled trial entailing a 4-week trial period comparing the low-FODMAP and mNICE diets. A total of 78 patients (41 low FODMAP and 37 mNICE) meeting the Rome III criteria for irritable bowel syndrome-diarrhea subtype were consecutively recruited from gastroenterology and primary care clinics at the University of Michigan Medical Center between October 2012 and November 2015. Participants randomized to the low-FODMAP arm were instructed to decrease their dietary intake of FODMAPs, whereas participants randomized to the mNICE intervention arm were instructed to eat small frequent meals, avoid trigger foods, and avoid excess alcohol and caffeine. Post hoc evaluation for presence of micronutrient deficiencies per Dietary Reference Intakes when implementing low-FODMAP vs mNICE dietary interventions. Dietary intake was analyzed via 3-day food diaries at baseline and during the final week of the assigned diet. A post hoc analysis utilizing either a t test or χ2 analysis was conducted between before and after data. Both diets resulted in fewer daily kilocalories consumed, fewer number of daily meals consumed, and less daily carbohydrate intake. Among the patients following the low-FODMAP diet, there was a statistically significant decrease from baseline in several micronutrients, which was not observed in the mNICE cohort. However, these differences in the low-FODMAP group remained significant only for riboflavin after correcting for calorie-adjusted nutrient intake. Comparing Dietary Reference Intakes of participants pre- and postintervention, fewer patients met the Dietary Reference Intakes for thiamin and iron in the low FODMAP group, and for calcium and copper in the mNICE group. During a 4-week dietary intervention, the mean daily intake of most micronutrients remained stable and within the Recommended Dietary Allowances for both diets. Although decrease in several micronutrients was observed with implementation of the low-FODMAP diet relative to the mNICE diet, most of these disappeared after adjusting for energy intake. [ABSTRACT FROM AUTHOR]

Stroke mimics form a significant proportion of cases in acute stroke services and some present with functional neurological disorder. Little is known about the prevalence or clinical characteristics of functional stroke mimics (FSMs). A systematic literature search and meta‐analysis were carried out on published studies reporting suspected stroke and stroke mimic rates; 114 papers met the inclusion criteria of which 70 provided an FSM rate. Random‐effects models estimated prevalence rates across settings and moderators of FSM rate. Pooled proportions indicated that 25% [95% confidence intervals (CI), 22–27%] of suspected stroke cases were stroke mimics. Within the 67 studies providing positive FSM rates, FSMs represented 15% (95% CI, 13–18%) of stroke mimics and 2% (95% CI, 2–3%) of suspected strokes. FSMs were younger and more likely to be female, and presented more with weakness/numbness but less with reduced consciousness or language problems. Stratified analyses suggested higher stroke mimic rates in primary care versus acute settings (38% vs. 12%) but higher FSM rates in stroke units compared with primary care (24% vs. 12%). Functional rates were higher in studies that were descriptive, retrospective and in patients receiving thrombolysis. Several studies reported the proportion of functional stroke patients presenting to stroke services. FSMs have discernible demographic and clinical characteristics, but there is a conspicuous lack of evidence on their presentation or guidance for treatment. The social and psychological mechanisms underlying FSM presentations need more accurate quantification to help inform stroke pathways and improve care for these patients. [ABSTRACT FROM AUTHOR]

Background: Asthma is a disease of the lung and a systemic disease. Functional disorders are associated with multiple systemic abnormalities that have been explained by complexity models. The aim was to test the similarity in type and aetiology between the extra‐pulmonary symptoms of severe asthma and the symptoms of fibromyalgia. Methods: One Hundred patients recruited from a specialist severe asthma clinic and 1751 people reporting different functional disorder diagnoses recruited via the internet completed the same 60‐item questionnaire. Symptom patterns were compared between groups using a new measure, the symptom pattern similarity index where 0 = no relationship, 1 = identical patterns between groups. Results: Severe asthma patients report numerous extra‐pulmonary symptoms. The similarity index between the symptom pattern of the asthma patients with other groups was irritable bowel syndrome = 0.54, chronic fatigue syndrome = 0.69, and fibromyalgia = 0.75. The index between fibromyalgia and asthma patients with the most and least frequent extra‐pulmonary symptoms was 0.81 and 0.55 respectively. Conclusions: Patients with severe asthma have numerous extra‐pulmonary symptoms similar in type and pattern to the symptoms of fibromyalgia. The similarity of the symptom pattern between asthma and fibromyalgia increases as the number of extra‐pulmonary symptoms increases as predicted by network theory and previously shown to be the case with other functional disorders. These findings support the hypothesis that functional disorders and extra‐pulmonary asthma symptoms have a common complexity or network aetiology. Evidence based behavioural interventions for fibromyalgia may be helpful for patients with severe asthma reporting extra‐pulmonary symptoms. [ABSTRACT FROM AUTHOR]

Background Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder often seen in outpatient clinics. Diagnosing IBS is often challenging, as it frequently presents with other complicated rheumatological and psychiatric conditions. Asthma has often been associated with gastrointestinal conditions such as gastroesophageal reflux disease and eosinophilic esophagitis. This review and meta-analysis aimed at a better understanding of the association between the conditions. Methods A comprehensive literature review was completed using MEDLINE and EMBASE databases through January 2019. Case-control, cross-sectional and cohort studies that evaluated the association between asthma and IBS were divided into 2 groups: the first included studies that identified patients with asthma first and then looked for the presence of IBS. The second group included studies that identified IBS patients first and then looked for the presence of asthma. Random effects meta-analysis was conducted using STATA 15. Results The search strategy generated a total of 634 studies and 10 eligible studies (8 case-control and 2 cross-sectional) were selected for meta-analysis. Analysis showed that asthmatics have twice the risk of having IBS (pooled odds ratio [OR] 2.0, 95% confidence interval [CI] 1.5-2.8), and patients with IBS have twice the risk of having asthma (pooled OR 2.2, 95%CI 1.3-3.9). Conclusions This study highlights that the risk of asthma is considerably higher in IBS patients and vice versa. Physicians should look out for pulmonary symptoms in IBS patients and consider evaluation with spirometry when necessary. Likewise, asthmatics presenting with gastrointestinal symptoms may need consultation and evaluation for IBS. [ABSTRACT FROM AUTHOR]

Introduction: Functional disorders are prevalent in all medical fields and pose a tremendous public health problem, with pain being one of the most common functional symptoms. Understanding the underlying, potentially unifying mechanism in functional (pain) disorders is instrumental in facilitating timely diagnosis, stigma reduction, and adequate treatment options. Neuroscientific models of perception suggest that functional symptoms arise due to dysregulated sensorimotor processing in the central nervous system, with brain-based predictions dominating the eventual percept. Experimental evidence for this transdiagnostic mechanism has been established in various functional symptoms. The goal of the current study was to investigate whether erroneous sensorimotor processing is an underlying transdiagnostic mechanism in chronic (functional) pain., Method: A total of 13 patients with chronic (functional) pain [three patients with chronic (functional) pain disorder, F45.40, ICD-10; 10 patients with chronic pain disorder with somatic and psychological factors, F45.41, ICD-10]; and 15 healthy controls performed large combined eye-head gaze shifts toward visual targets, naturally and with increased head moment of inertia. We simultaneously measured participants' eye and head movements to assess head oscillations at the end of the gaze shift, which are an established indicator of (transdiagnostic) sensorimotor processing deficits of head control., Results: Using a Bayesian analysis protocol, we found that patients with chronic (functional) pain and control participants stabilized their heads equally well (Bayes Factor 01 = 3.7, Bayes Factor exclusion = 5.23; corresponding to substantial evidence) during all sessions of the experiment., Conclusion: Our results suggest that patients with chronic (functional) pain do not show measurable symptom-unspecific sensorimotor processing deficits. We discuss outcome parameter choice, organ system specificity, and selection of patient diagnoses as possible reasons for this result and recommend future avenues for research., Competing Interests: NL is a shareholder and was a paid consultant to EyeSeeTec GmbH. SG is a shareholder of EyeSeeTec GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Regnath, Biersack, Jäger, Glasauer and Lehnen.)

Nonspecific, functional, and somatoform (NFS) syndromes is an umbrella term for various diagnoses with medically unexplained symptoms. These syndromes are more prevalent among women than among men, and associated with negative preconceptions that can impede rehabilitation. In two studies, we quantitatively assess how patients' gender affects the diagnostic assessment of NFS syndromes, as well as the healthcare experiences of individuals diagnosed with NFS syndromes. In the first study, our vignette‐based experiment showed that Swedish general practitioners (N = 90) were gender biased in their diagnostic assessment of NFS syndromes, such that a female patient with back pain was more likely to be assigned a NFS syndrome compared to an otherwise identical male patient. In the second study, a large community sample of Swedish individuals with medically explained (n = 432) and unexplained pain (n = 521) evaluated their treating physician's relational conduct. Even after accounting for a variety of sociodemographic variables and other pain characteristics, women with at least one NFS syndrome percieved their physician's relational conduct as significantly poorer than other women as well as men with and without NFS syndromes. When women's pain is more likely than men's to be assessed as NFS, their rehabilitation could be prolonged as pertient alternative diagnoses and treatments are omittied and their negative healthcare experiences lower their volition to partake and persevere in treatment. [ABSTRACT FROM AUTHOR]

• Pediatric PNES is associated with a high frequency of psychiatric conditions and psychosocial stressors. • In our cohort, the most common PNES semiology was rhythmic motor (27.3%) and healthcare utilization, including diagnostic testing, was frequent prior to diagnosis. • High clinical suspicion and early recognition of PNES are crucial to decrease healthcare utilization. Psychogenic non-epileptic seizures (PNES) represent a common functional disorder in the pediatric population. We aimed to characterize pediatric PNES by describing their clinical characteristics, PNES semiologies, and healthcare pathway towards and after diagnosis. This was a retrospective, observational chart review of pediatric patients aged 6 to 18 years admitted between December 2020 and December 2021 for spell classification or suspected PNES. Psychogenic non-epileptic seizure diagnosis was made by the capture of a typical event on video electroencephalogram (vEEG). We used descriptive statistics to summarize demographic and clinical characteristics. We included 26 patients (18 females, 69.2%) with a mean age (SD) of 13.9 (2.5) years. Pre-morbid neurologic and psychiatric conditions included: epilepsy (23.1%), migraine (46.2%), mild traumatic brain injury (26.9%), anxiety (57.7%), ADHD (34.6%), and depression (30.8%). Six patients (23.1%) had a prior diagnosis of PNES. 14 patients (53.8%) presented with convulsive, and 6 (23.1%) each with non-convulsive and mixed PNES. Patients were seen by a range of providers prior to diagnosis including ED providers (50%), neurologists (53.8%), pediatricians (34.6%), and psychology/psychiatry (11.5%). Emergency department evaluation occurred for 13 patients (50%) on 15 occasions, and six (23.1%) were admitted to the hospital. The median (p25-p75) time from PNES onset to presentation and diagnosis at our institution was 3.5 (1.5–6.2) and 4.1 (3–7) months, respectively. A total of 33 events from the 26 patients were captured on vEEG. The most frequent semiologies in our cohort were rhythmic motor (27.3%) followed by equal frequency (18.2%) of complex motor and dialeptic. Eighteen patients (69.2%) were followed after the PNES diagnosis, for a median (p25-p75) of 17.3 months (6.3–21) with variable outcome. Pediatric PNES has female predominance and often presents with comorbid psychosocial stressors and psychiatric conditions. High clinical suspicion and early recognition are crucial to decrease healthcare utilization and establish timely diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: Functional motor conversion disorders are characterized by neurological symptoms unrelated to brain structural lesions. The present study was conducted on a woman presenting motor symptoms causing motor dysfunction, using advanced multimodal neuroimaging techniques, electrophysiological and neuropsychological assessment. Methods. The patient underwent fluorodeoxyglucose-positron emission tomography-computed tomography (FDG-PET-CT) and functional magnetic resonance imaging (fMRI) with both task and resting-state paradigms and was compared with 11 healthy matched controls. To test differences in structural parameters, Bayesian comparison was performed. To test differences in functional parameters, a first- and second-level analysis was performed in task fMRI, while a seed-to-seed analysis to evaluate the connections between brain regions and identify intersubject variations was performed in resting-state fMRI. Results. FDG-PET showed two patterns of brain metabolism, involving the cortical and subcortical structures. Regarding the diffusion data, microstructural parameters were altered for U-shape fibers for the hand and feet regions. Resting-state analysis showed hypoconnectivity between the parahippocampal and superior temporal gyrus. Neurophysiological assessment showed no alterations. Finally, an initial cognitive impairment was observed, paralleled by an anxiety and mild depressive state. Conclusions. While we confirmed no structural alterations sustaining this functional motor disorder, we report microstructural changes in sensory–motor integration for both the hand and feet regions that could functionally support clinical manifestations.