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Background Background: Functional motor disorders (FMDs) are abnormal movements that are significantly altered by distractive maneuvers and are incongruent with movement disorders seen in typical neurological diseases. Objective Objective: The objectives of this article are to (1) describe the clinical manifestations of FMDs, including nonmotor symptoms and occurrence of other functional neurological disorders (FND); and (2) to report the frequency of isolated and combined FMDs and their relationship with demographic and clinical variables. Methods Methods: For this multicenter, observational study, we enrolled consecutive outpatients with a definite diagnosis of FMDs attending 25 tertiary movement disorders centers in Italy. Each patient underwent a detailed clinical evaluation with a definition of the phenotype and number of FMDs (isolated, combined) and an assessment of associated neurological and psychiatric symptoms. Results Results: Of 410 FMDs (71% females; mean age, 47 AE 16.1 years) the most common phenotypes were weakness and tremor. People with FMDs had higher educational levels than the general population and frequent nonmotor symptoms, especially anxiety, fatigue, and pain. Almost half of the patients with FMDs had other FNDs, such as sensory symptoms, nonepileptic seizures, and visual symptoms. Patients with combined FMDs showed a higher burden of nonmotor symptoms and more frequent FNDs. Multivariate regression analysis showed that a diagnosis of combined FMDs was more likely to be delivered by a movement disorders
Objective: To verify whether features of CNS involvement can be detected in SLE patients without overt neuropsychiatric manifestations. Methods: 114 SLE patients who had never received a diagnosis of neuropsychiatric lupus (never-NPSLE) were studied and compared to 65 SLE patients with known neuropsychiatric involvement (NPSLE). The study relied on evaluation of neurocognitive functions by means of a battery of neuropsychological tests, on psychiatric and neuropsychological assessments and on neuroimaging studies (computed tomography, magnetic resonance, single photon emission computed tomography (SPECT)). Results: Clinical features, including disease durationaactivity and pharmacological therapy, of never-NPSLE and NPSLE patients were similar. Short-term and long-term memory, visuo-spatial and verbal information processing were similarly compromised in never-NPSLE and in NPSLE patients; only attention was signi®cantly more compromised in NPSLE patients. Psychiatric morbidity was higher than expected in never-NPSLE patients, although less than in the control neuropsychiatric group. Ischemic lesions, multiple small high intensity lesions and cortical atrophy, detected by CT and MR scans, as well as abnormal SPECT were also frequently detected in never-NPSLE patients. Interestingly, left parietal and occipital area hypoperfusion by SPECT was signi®cantly more frequent in the patients with impaired visuo-spatial intelligence and short-term memory.Conclusions: Most abnormalities detected by available diagnostic tools and characteristics of neuropsychiatric SLE are also present in non-symptomatic patients. They may derive from an unexpected widespread involvement of the CNS and are not per se suf®cient, in the absence of clinical manifestations, for a diagnosis of neuropsychiatric SLE.
This study does not seem to confirm the described association of anti-P with SLE neuropsychiatric manifestations. However, it supports the anti-P association with different skin manifestations as well as the presence of anticardiolipin in a subset of patients with SLE characterized by early disease onset.
Introduction: Since February 2020, the outbreak of COVID-19 spread to several countries worldwide, including Italy. In this study, we aimed to assess the psychopathological impact of the pandemic across the general population of Lombardy, the most affected Italian region, and to compare the prevalence of psychiatric symptoms between the general public and healthcare workers.Methods: Four hundred and thirty-two participants completed an online survey including: the Depression, Anxiety and Stress Scale−21 items (DASS-21), the Impact of Event Scale—Revised (IES-R) and the Pittsburgh Sleep Quality Index (PQSI). Healthcare workers were also asked to complete the Maslach Burnout Inventory (MBI).Results: At the DASS-21, 33.3% of the responders presented pathological levels of stress, 25.5% of anxiety, and 35.9% of depression. At the IES-R, 13.9% appeared at risk of developing Post-Traumatic Stress Disorder (PTSD). At the PSQI, 57.6% presented sleep disturbances. Female gender and younger age predicted higher scores of distress. Healthcare workers presented higher levels of psychiatric symptoms than the general public. Moreover, working in contact with COVID-19 patients predicted higher scores at the IES-R subscale Intrusion.Conclusion: Our results showed that about a third of our sample presented symptoms of stress, anxiety, and depression during the first month of the COVID-19 pandemic outbreak in Lombardy; more than half of the responders presented sleep disturbances, and 13% appeared at risk of PTSD. Italian authorities should develop specific strategies to guarantee psychological support to the population of Lombardy, with particular attention to women, young people, and healthcare workers exposed to COVID-19 patients.
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