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Health consequences that persist beyond the acute infection phase of COVID-19, termed post-COVID-19 condition (also commonly known as long COVID), vary widely and represent a growing global health challenge. Research on post-COVID-19 condition is expanding but, at present, no agreement exists on the health outcomes that should be measured in people living with the condition. To address this gap, we conducted an international consensus study, which included a comprehensive literature review and classification of outcomes for post-COVID-19 condition that informed a two-round online modified Delphi process followed by an online consensus meeting to finalise the core outcome set (COS). 1535 participants from 71 countries were involved, with 1148 individuals participating in both Delphi rounds. Eleven outcomes achieved consensus for inclusion in the final COS: fatigue; pain; post-exertion symptoms; work or occupational and study changes; survival; and functioning, symptoms, and conditions for each of cardiovascular, respiratory, nervous system, cognitive, mental health, and physical outcomes. Recovery was included a priori because it was a relevant outcome that was part of a previously published COS on COVID-19. The next step in this COS development exercise will be to establish the instruments that are most appropriate to measure these core outcomes. This international consensus-based COS should provide a framework for standardised assessment of adults with post-COVID-19 condition, aimed at facilitating clinical care and research worldwide.

Functional neurological disorder (FND) causes a high burden of disability and distress. Although it is a common disorder, there is a pressing need for improved access to evidence-based treatments. With difficulties in finding effective treatment, some people with FND may seek alternative means of symptom relief, such as legal and illicit psychoactive substances, although the prevalence and nature of such self-management strategies are currently unclear. Additionally, psychoactive substances may represent novel treatment research opportunities, particularly for those with suboptimal improvement. The investigators examined the use of self-management techniques, as well as perspectives on novel therapies, in this patient population.An online survey was created to assess self-management strategies and views on novel treatments for FND, including psychedelic therapy. The survey was accessible for 1 month, and respondents were recruited internationally through social media and patient groups. A total of 1,048 respondents from 16 countries completed the survey.Almost half (46%) of 980 respondents reported having tried legal psychoactive substances for the management of their FND symptoms and, on average, nicotine, alcohol, and cannabidiol were reported as modestly effective. Additionally, 15% of respondents reported having used illicit substances, mostly cannabis, to manage FND, with the majority reporting moderate effectiveness and experiencing no or minimal physical (90%) and psychological (95%) sequelae. Many respondents (46%) reported that they would be willing to try medically supervised psychedelic therapy (with 19% of respondents ambivalent) if it were found to be safe and effective.Many people with FND seek alternative means of symptom management outside usual medical care, including legal and illicit psychoactive substances. Further research exploring novel treatment options, such as psychedelics, in FND may be warranted.

Objectives/AimsChildren with epilepsy (cwE) are at a higher risk of mental health disorders such as depression, anxiety, and attention deficit hyperactivity disorder (ADHD) compared to the general population. Psychiatric comorbidities can negatively impact cwE as they can be associated with reduced response to treatment, reduced quality of life, as well as increased mortality. Despite the high prevalence and negative impact on cwE, psychiatric comorbidities often go undetected and as a result are not treated. Therefore, it is essential to detect psychiatric comorbidities early in cwE, to facilitate provision of appropriate interventions and improve long-term neuropsychological outcomes. We sought to identify and evaluate child mental health Patient-Reported Outcome Measures (PROMs) that have been validated specifically in children and/or young people with epilepsy, to inform selection of high quality mental health PROMs in paediatric epilepsy settings.MethodsWe systematically searched MEDLINE, EMBASE and Psych Info for studies that validated mental health PROMs in paediatric epilepsy samples and assessed methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. Data on PROM development, structural validity, internal consistency, test-retest reliability, convergent validity and responsiveness were extracted and used to assess the measurement properties with reference to standardised criteria.ResultsA total of nine papers were identified that validated 10 mental health PROMs (two epilepsy-specific, eight generic). The overall appraisal of each questionnaire was limited by the availability of only one or two published articles for each PROM. Internal consistency and convergent validity were the more commonly assessed properties across studies, whereas there were very few evaluations of PROM development, structural validity, test-retest reliability, and criterion validity. The strongest performing tool demonstrating the most evidence was The Neurological Disorders Depression Inventory-Epilepsy for Youth (NDDI-Y-E). The ADHD Rating Scale-IV (ADHD-RS-IV) and The Paediatric Symptom Checklist -17 (PSC-17) demonstrated good evidence in favour of at least two measurement properties.ConclusionsThis systematic review identified only a small number of validated mental health PROMs for paediatric epilepsy, highlighting the need for further development, validation and evaluation of mental health PROMs in this population.

Background: Increasingly neurological complications of COVID-19 are identified, mostly in small series. Larger studies have been limited by both geography and specialty.Consequently, the breadth of complications is not represented. Comprehensive characterization of clinical syndromes is critical to rationally select and evaluate potential therapies.Methods: During the exponential pandemic phase, we developed coordinated online portals for rapid notification across the spectrum of major UK neuroscience bodies, representing neurology, stroke, psychiatry, and intensive care. Evidence of infection and clinical case definitions were applied prospectively. Cases were compared to overall Government Public Health COVID-19 reporting.Findings: Within three weeks, 153 cases were notified, both geographically and temporally representative of overall COVID-19 Public Health reports. Median (range) age was 71 (23-94) years. 77 (62%) had a cerebrovascular event: 57 (74%) ischemic strokes, nine (12%) intracerebral hemorrhages, and one CNS vasculitis.The second most common group were 39 (31%) who had altered mental status, including 16 (41%) with encephalopathy of whom seven (44%) had encephalitis. The remaining 23 (59%) had a psychiatric diagnosis of whom 21 (92%) were new diagnoses; including ten (43%) with psychosis, six (26%) neurocognitive (dementia-like) syndrome, and 4 (17%) an affective disorder. Cerebrovascular events predominated in older patients. Conversely, altered mental status, whilst present in all ages, had disproportionate representation in the young.Interpretation: This is the first nationwide, cross-specialty surveillance study of acute complications of COVID-19 in the nervous system. Alteration in mental status was common, reflecting encephalopathy/encephalitis and primary psychiatric diagnoses, often in young patients.These data provide valuable and timely information urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy throughout the areas of neurology and neuropsychiatry.

Objectives This study aims i) to describe the patterns of prescription medication in functional motor disorder (mFND) treated in a Mental Health Trust, using a control group comprised of a random sample of contemporaneous patients treated in the same trust; and ii) explore the sociodemographic variables and symptoms linked to higher medication usage. Methods This is a retrospective case-control study using an electronic psychiatric case register in South London and Maudsley NHS Foundation Trust (SLaM). SLaM provides psychiatric inpatient and community services and receives national referrals for functional neurological disorder (FND) patients. Data were obtained from 322 mFND patients and 644 controls between 1stJanuary 2006 and 31st December 2016 using the ‘Clinical Records Interactive Search’ (CRIS) database. Results 247 (76.7%) mFND patients were prescribed medication, lower than 83.4% in the control group (OR: 0.59, 95% CI: 0.39–0.89, p Conclusions mFND patients are prescribed an extensive range of medications for psychiatric and somatic symptoms, most commonly anti-depressants, anti-epileptics and analgesics. The diversity in medications may be partially explained by higher rates of physical co- morbidities but may also reflect ‘somatisation’ or excessive symptom reporting combined with a lack of therapeutic options for clinicians managing patients with complex functional and ‘organic’ conditions and chronic pain. Non-essential medication prescribing may reinforce somatic illness beliefs and cause iatrogenic harm, particularly high rates of opioid pain medication, with important implications for clinical management in primary and secondary care.

Objective Studies on motor functional neurological disorder (mFND) often originate in neurology settings and are characterised by low sample sizes, and lack control groups. There are few prescription guidelines and no gold standard treatments. This study aims to establish mFND patients’ socio-demographic and clinical characteristics, medication prescription patterns and patients’ responses to outpatient cognitive behavioural therapy (CBT). Methods This is a retrospective case-control study of mFND patients in contact with secondary mental health services in South London and Maudsley (SLaM) NHS Foundation Trust between 2006 and 2016. Data were obtained from anonymous electronic health records using the ‘Clinical Records Interactive Search’ (CRIS) database. Data were extracted on socio-demographic, clinical and medication variables. Control patients were a random sample of contemporaneous psychiatric patients treated within the same Trust and were matched at a ratio of 1:2. In a separate study, we employed these methods to identify mFND patients who attended an outpatient neuropsychiatry CBT clinic in SLaM, comparing therapeutic outcomes in mFND to patients with organic neuropsychiatric disorders (ONP) treated in the same clinic. Results Our search returned 322 mFND and 644 control patients. Weakness was the most common functional symptom. mFND patients were more likely to be female, British, married, employed pre-morbidly, to have a carer and a physical health condition, but less likely to have had an inpatient psychiatric admission or to receive benefits. There was no difference in rates of childhood sexual and physical abuse between groups. A lower proportion of mFND patients received medication compared to controls (76.6% v. 83.4%, p Conclusions mFND patients have a distinct socio-demographic profile and are prescribed a heterogeneous array of psychotropic and somatic medications. mFND patients treated in a specialist CBT clinic show similar improvements in psychological functioning to patients with organic neuropsychiatric disorders. This study establishes the socio-demographic profile of this under-studied patient group and could help guide the development of future therapeutic interventions and inform the design of a pilot RCT.

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In April 2012, staff at the British National Archives made headlines worldwide when they released part of the formerly secret cornucopia of files associated with the end of the colonial empire in Kenya. These files revealed British concern that Barack Obama, eponymous father of the American president, and other Kenyan students studying in the United States, might ‘fall into the wrong hands’ and associate with anti-colonial organizations (from the late 1950s and early 1960s).1 Although it was the group studying in the United States that received the most attention at the time, East African students of the late colonial and early independence periods travelled to three continents in search of university education. With some assistance from family, friends and teachers, they worked to take advantage of newly available resources such as scholarships, travel assistance and educational opportunities made available by long-standing British connections in the region and rising Cold War competition. Focusing on students from Kenya and Tanzania,2 this chapter highlights the life experiences of these students as they studied abroad in the English-speaking world.

Objectives Bacillus Calmette-Guerin (BCG) and interferon alpha-2b (IFN α 2b) have been used individually for the treatment of bladder cancer. We used a low dose of BCG combined with IFN α 2b to determine the safety and to assess the efficacy of this combination therapy. Methods A study of 12 patients with superficial bladder cancer evaluated the safety and efficacy of a combination of low-dose BCG and IFN α 2b, given weekly for 6 weeks. Three patients were assigned to each of four groups in which 60 mg of BCG was combined with 10, 30, 60, or 100 × 10 6 ILJ of IFN α 2b. Results The combination BCG/IFN α 2b therapy was well tolerated, with adverse effects being mild to moderate and resolved at the end of treatment. At 12 months post-treatment there has been no tumor progression. Two patients with previous multifocal transitional cell carcinoma have had solitary recurrences. One patient has had recurrent carcinoma in situ. Conclusions This preliminary study found combination BCG/IFN α 2b induction therapy to be safe and well tolerated. These early results show a high response rate, but efficacy can only be determined with Phase II and III studies.