IntroductionFunctional cognitive disorder is seen increasingly in clinics commissioned to assess ... more IntroductionFunctional cognitive disorder is seen increasingly in clinics commissioned to assess cognitive disorders. Patients complain of frequent cognitive, especially memory, failures. The diagnosis can be made clinically, and unnecessary investigations avoided. While there is some evidence that psychological treatments can be helpful, they are not routinely available. Therefore, we have developed a brief psychological intervention using the principles of Acceptance and Commitment Therapy (ACT) that can be delivered in groups and online. We are conducting a feasibility study to assess whether the intervention can be delivered within a randomised controlled trial. We aim to study the feasibility of recruitment, willingness to be randomised to intervention or control condition, adherence to the intervention, completion of outcome measures, and acceptability of treatment.Methods and analysisWe aim to recruit 48 participants randomised 50:50 to either the ACT intervention and Treatme...
Supplemental Material, Appendix_2_Akathisia_Table_of_Included_Studies for The Assessment and Trea... more Supplemental Material, Appendix_2_Akathisia_Table_of_Included_Studies for The Assessment and Treatment of Antipsychotic-Induced Akathisia by Tamara Pringsheim, David Gardner, Donald Addington, Davide Martino, Francesca Morgante, Lucia Ricciardi, Norman Poole, Gary Remington, Mark Edwards, Alan Carson, and Thomas R. E. Barnes in The Canadian Journal of Psychiatry
An increasing proportion of cognitive difficulties are recognized to have a functional cause, the... more An increasing proportion of cognitive difficulties are recognized to have a functional cause, the chief clinical indicator of which is internal inconsistency. When these symptoms are impairing or distressing, and not better explained by other disorders, this can be conceptualized as a cognitive variant of functional neurological disorder, termed functional cognitive disorder (FCD). FCD is likely very common in clinical practice but may be under-diagnosed. Clinicians in many settings make liberal use of the descriptive term mild cognitive impairment (MCI) for those with cognitive difficulties not impairing enough to qualify as dementia. However, MCI is an aetiology-neutral description, which therefore includes patients with a wide range of underlying causes. Consequently, a proportion of MCI cases are due to non-neurodegenerative processes, including FCD. Indeed, significant numbers of patients diagnosed with MCI do not ‘convert’ to dementia. The lack of diagnostic specificity for MC...
... Norman Poole1, Dominic Dougall2, Niruj Agrawal3 ... The Central Executive System (CES) compon... more ... Norman Poole1, Dominic Dougall2, Niruj Agrawal3 ... The Central Executive System (CES) component of working memory appears to be particularly vul-nerable in TBI, and impairment is associated with other symp-toms of the dysexecutive syndrome (McDowell, 1997). ...
Supplemental Material, Appendix_3_III_Submission_Dec_7 for Treatment Recommendations for Tardive ... more Supplemental Material, Appendix_3_III_Submission_Dec_7 for Treatment Recommendations for Tardive Dyskinesia by Lucia Ricciardi, Tamara Pringsheim, Thomas R.E. Barnes, Davide Martino, David Gardner, Gary Remington, Donald Addington, Francesca Morgante, Norman Poole, Alan Carson, and Mark Edwards in The Canadian Journal of Psychiatry
Supplemental Material, Appendix_1_Search_Strategy for The Assessment and Treatment of Antipsychot... more Supplemental Material, Appendix_1_Search_Strategy for The Assessment and Treatment of Antipsychotic-Induced Akathisia by Tamara Pringsheim, David Gardner, Donald Addington, Davide Martino, Francesca Morgante, Lucia Ricciardi, Norman Poole, Gary Remington, Mark Edwards, Alan Carson, and Thomas R. E. Barnes in The Canadian Journal of Psychiatry
Background Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic i... more Background Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited. Objectives To evaluate the clinical effectiveness and cost-effectiveness of dissociative seizure-specific cognitive–behavioural therapy for adults with dissociative seizures. Design This was a pragmatic, multicentre, parallel-arm, mixed-methods randomised controlled trial. Setting This took place in 27 UK-based neurology/epilepsy services, 17 liaison psychiatry/neuropsychiatry services and 18 cognitive–behavioural therapy services. Participants Adults with dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous year and meeting other eligibility criteria were recruited to a screening phase from neurology/epilepsy services between October 2014 and February 2017. After psychiatric assessment around 3 months later, eligible and interested participants were randomised between January 2015 and May 2017. I...
BackgroundBoth stroke and psychosis are independently associated with high levels of disability. ... more BackgroundBoth stroke and psychosis are independently associated with high levels of disability. However, psychosis in the context of stroke has received remarkably little interest from clinicians and researchers. To date there are currently no population studies on their joint prevalence and association.MethodsWe estimated the prevalence of i) probable psychosis in stroke and, ii) stroke in probable psychosis using four nationally representative cross-sectional psychiatric epidemiological studies: two from high-income countries (United Kingdom and United States) and two from middle-income countries (Chile and Colombia) and, subsequently, a combined dataset from all four countries. We also tested the statistical association between stroke and psychosis using single and multi-level regression models to estimate the unadjusted association between stroke and psychosis, and the association adjusted for potential demographic confounders.ResultsAcross the combined countries dataset the pr...
use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you g... more use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this book are included in the book's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the book's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
The climate crisis is a health crisis; it demands the urgent attention and action of healthcare p... more The climate crisis is a health crisis; it demands the urgent attention and action of healthcare professionals and organisations. In this issue of the BJPsych Bulletin, we consider what the destructive effects of the climate and ecological crisis entail for the mental health of populations, and what the response of psychiatrists, both individual and collective, must be. We also highlight the opportunities and benefits a more sustainable and preventative approach could offer individuals, communities and the planet.
There is considerable debate in the literature regarding what to call functional seizures, with t... more There is considerable debate in the literature regarding what to call functional seizures, with terms such as pseudoseizures, nonepileptic attack disorder (NEAD), and dissociative seizures being used. Provision of an accurate diagnosis and coherent explanation is a vital first step in the management of functional seizures and can result in cessation or reduced frequency for some individuals. This study investigated preferences for and offensiveness of terms used to describe functional seizures, and expectations for recovery with psychological treatment. A sample of 87 healthy adults completed an online survey, in which eight different diagnostic terms were ranked in order of preference (1most preferred, 8least preferred): functional nonepileptic attacks (FNEA), dissociative seizures, functional seizures, psychogenic seizures, NEAD, pseudoseizures, conversion disorder, and hysteria. Replicating Stone and colleagues protocol, each term was investigated for five connotations. Offense scores were calculated from the number of participants who selected 'yes' to at least one of the negative connotations ('Putting it on', 'Mad', and 'Imagining Symptoms'). Expectations about the possibility of recovering through medical or psychological treatment were also recorded. Functional nonepileptic attack was ranked the highest preferred term with dissociative seizures and functional seizures closely following. Nonepileptic attack disorder was the least offensive term, with FNEA and functional seizures joint second. Unsurprisingly, the three least preferred terms were also the most offensive: pseudoseizures, conversion disorder, and hysteria. Expectations of nonrecovery from psychological treatment were lowest for terms implicating a psychological cause: pseudoseizures, dissociative seizures, psychogenic seizures, and hysteria. The results suggest that either the terms FNEA or functional seizures should be adopted by healthcare professionals and patients, as they are the most preferred, least offensive, and expectations for nonrecovery with psychological treatment were moderate compared with the other terms. Limitations and areas for future research are discussed.
Journal of Neurology, Neurosurgery & Psychiatry, 2020
Objectives/AimsThe abuse of nitrous oxide (N2O) may be increasing globally and users and clinicia... more Objectives/AimsThe abuse of nitrous oxide (N2O) may be increasing globally and users and clinicians may not be aware of harms. We highlight these potential harms through the case of a woman treated for psychotic disorder for 11 months before developing severe N2O induced myeloneuropathy which should have been preventable. We review the clinical literature regarding N2O abuse to raise the profile of this emerging neuropsychiatric disorder.MethodsA case study was undertaken and a literature review performed of relevant databases for cases of N2O abuse presenting with psychiatric symptoms.ResultsIn our case a 37 year old woman presented with florid polymorphic psychosis and subtle cognitive impairment two weeks after inhaling large amounts of N2O. This was treated with antipsychotics and her symptoms waxed and waned over eleven months by which time she had developed a severe myeloneuropathy, confirmed on MRI cervical spine, and a functional B12 deficiency confirmed by high homocysteine...
IntroductionFunctional cognitive disorder is seen increasingly in clinics commissioned to assess ... more IntroductionFunctional cognitive disorder is seen increasingly in clinics commissioned to assess cognitive disorders. Patients complain of frequent cognitive, especially memory, failures. The diagnosis can be made clinically, and unnecessary investigations avoided. While there is some evidence that psychological treatments can be helpful, they are not routinely available. Therefore, we have developed a brief psychological intervention using the principles of Acceptance and Commitment Therapy (ACT) that can be delivered in groups and online. We are conducting a feasibility study to assess whether the intervention can be delivered within a randomised controlled trial. We aim to study the feasibility of recruitment, willingness to be randomised to intervention or control condition, adherence to the intervention, completion of outcome measures, and acceptability of treatment.Methods and analysisWe aim to recruit 48 participants randomised 50:50 to either the ACT intervention and Treatme...
Supplemental Material, Appendix_2_Akathisia_Table_of_Included_Studies for The Assessment and Trea... more Supplemental Material, Appendix_2_Akathisia_Table_of_Included_Studies for The Assessment and Treatment of Antipsychotic-Induced Akathisia by Tamara Pringsheim, David Gardner, Donald Addington, Davide Martino, Francesca Morgante, Lucia Ricciardi, Norman Poole, Gary Remington, Mark Edwards, Alan Carson, and Thomas R. E. Barnes in The Canadian Journal of Psychiatry
An increasing proportion of cognitive difficulties are recognized to have a functional cause, the... more An increasing proportion of cognitive difficulties are recognized to have a functional cause, the chief clinical indicator of which is internal inconsistency. When these symptoms are impairing or distressing, and not better explained by other disorders, this can be conceptualized as a cognitive variant of functional neurological disorder, termed functional cognitive disorder (FCD). FCD is likely very common in clinical practice but may be under-diagnosed. Clinicians in many settings make liberal use of the descriptive term mild cognitive impairment (MCI) for those with cognitive difficulties not impairing enough to qualify as dementia. However, MCI is an aetiology-neutral description, which therefore includes patients with a wide range of underlying causes. Consequently, a proportion of MCI cases are due to non-neurodegenerative processes, including FCD. Indeed, significant numbers of patients diagnosed with MCI do not ‘convert’ to dementia. The lack of diagnostic specificity for MC...
... Norman Poole1, Dominic Dougall2, Niruj Agrawal3 ... The Central Executive System (CES) compon... more ... Norman Poole1, Dominic Dougall2, Niruj Agrawal3 ... The Central Executive System (CES) component of working memory appears to be particularly vul-nerable in TBI, and impairment is associated with other symp-toms of the dysexecutive syndrome (McDowell, 1997). ...
Supplemental Material, Appendix_3_III_Submission_Dec_7 for Treatment Recommendations for Tardive ... more Supplemental Material, Appendix_3_III_Submission_Dec_7 for Treatment Recommendations for Tardive Dyskinesia by Lucia Ricciardi, Tamara Pringsheim, Thomas R.E. Barnes, Davide Martino, David Gardner, Gary Remington, Donald Addington, Francesca Morgante, Norman Poole, Alan Carson, and Mark Edwards in The Canadian Journal of Psychiatry
Supplemental Material, Appendix_1_Search_Strategy for The Assessment and Treatment of Antipsychot... more Supplemental Material, Appendix_1_Search_Strategy for The Assessment and Treatment of Antipsychotic-Induced Akathisia by Tamara Pringsheim, David Gardner, Donald Addington, Davide Martino, Francesca Morgante, Lucia Ricciardi, Norman Poole, Gary Remington, Mark Edwards, Alan Carson, and Thomas R. E. Barnes in The Canadian Journal of Psychiatry
Background Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic i... more Background Dissociative (non-epileptic) seizures are potentially treatable by psychotherapeutic interventions; however, the evidence for this is limited. Objectives To evaluate the clinical effectiveness and cost-effectiveness of dissociative seizure-specific cognitive–behavioural therapy for adults with dissociative seizures. Design This was a pragmatic, multicentre, parallel-arm, mixed-methods randomised controlled trial. Setting This took place in 27 UK-based neurology/epilepsy services, 17 liaison psychiatry/neuropsychiatry services and 18 cognitive–behavioural therapy services. Participants Adults with dissociative seizures in the previous 8 weeks and no epileptic seizures in the previous year and meeting other eligibility criteria were recruited to a screening phase from neurology/epilepsy services between October 2014 and February 2017. After psychiatric assessment around 3 months later, eligible and interested participants were randomised between January 2015 and May 2017. I...
BackgroundBoth stroke and psychosis are independently associated with high levels of disability. ... more BackgroundBoth stroke and psychosis are independently associated with high levels of disability. However, psychosis in the context of stroke has received remarkably little interest from clinicians and researchers. To date there are currently no population studies on their joint prevalence and association.MethodsWe estimated the prevalence of i) probable psychosis in stroke and, ii) stroke in probable psychosis using four nationally representative cross-sectional psychiatric epidemiological studies: two from high-income countries (United Kingdom and United States) and two from middle-income countries (Chile and Colombia) and, subsequently, a combined dataset from all four countries. We also tested the statistical association between stroke and psychosis using single and multi-level regression models to estimate the unadjusted association between stroke and psychosis, and the association adjusted for potential demographic confounders.ResultsAcross the combined countries dataset the pr...
use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you g... more use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made. The images or other third party material in this book are included in the book's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the book's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.
The climate crisis is a health crisis; it demands the urgent attention and action of healthcare p... more The climate crisis is a health crisis; it demands the urgent attention and action of healthcare professionals and organisations. In this issue of the BJPsych Bulletin, we consider what the destructive effects of the climate and ecological crisis entail for the mental health of populations, and what the response of psychiatrists, both individual and collective, must be. We also highlight the opportunities and benefits a more sustainable and preventative approach could offer individuals, communities and the planet.
There is considerable debate in the literature regarding what to call functional seizures, with t... more There is considerable debate in the literature regarding what to call functional seizures, with terms such as pseudoseizures, nonepileptic attack disorder (NEAD), and dissociative seizures being used. Provision of an accurate diagnosis and coherent explanation is a vital first step in the management of functional seizures and can result in cessation or reduced frequency for some individuals. This study investigated preferences for and offensiveness of terms used to describe functional seizures, and expectations for recovery with psychological treatment. A sample of 87 healthy adults completed an online survey, in which eight different diagnostic terms were ranked in order of preference (1most preferred, 8least preferred): functional nonepileptic attacks (FNEA), dissociative seizures, functional seizures, psychogenic seizures, NEAD, pseudoseizures, conversion disorder, and hysteria. Replicating Stone and colleagues protocol, each term was investigated for five connotations. Offense scores were calculated from the number of participants who selected 'yes' to at least one of the negative connotations ('Putting it on', 'Mad', and 'Imagining Symptoms'). Expectations about the possibility of recovering through medical or psychological treatment were also recorded. Functional nonepileptic attack was ranked the highest preferred term with dissociative seizures and functional seizures closely following. Nonepileptic attack disorder was the least offensive term, with FNEA and functional seizures joint second. Unsurprisingly, the three least preferred terms were also the most offensive: pseudoseizures, conversion disorder, and hysteria. Expectations of nonrecovery from psychological treatment were lowest for terms implicating a psychological cause: pseudoseizures, dissociative seizures, psychogenic seizures, and hysteria. The results suggest that either the terms FNEA or functional seizures should be adopted by healthcare professionals and patients, as they are the most preferred, least offensive, and expectations for nonrecovery with psychological treatment were moderate compared with the other terms. Limitations and areas for future research are discussed.
Journal of Neurology, Neurosurgery & Psychiatry, 2020
Objectives/AimsThe abuse of nitrous oxide (N2O) may be increasing globally and users and clinicia... more Objectives/AimsThe abuse of nitrous oxide (N2O) may be increasing globally and users and clinicians may not be aware of harms. We highlight these potential harms through the case of a woman treated for psychotic disorder for 11 months before developing severe N2O induced myeloneuropathy which should have been preventable. We review the clinical literature regarding N2O abuse to raise the profile of this emerging neuropsychiatric disorder.MethodsA case study was undertaken and a literature review performed of relevant databases for cases of N2O abuse presenting with psychiatric symptoms.ResultsIn our case a 37 year old woman presented with florid polymorphic psychosis and subtle cognitive impairment two weeks after inhaling large amounts of N2O. This was treated with antipsychotics and her symptoms waxed and waned over eleven months by which time she had developed a severe myeloneuropathy, confirmed on MRI cervical spine, and a functional B12 deficiency confirmed by high homocysteine...
This paper presents a debate in which the authors participated at the World Psychiatric Associati... more This paper presents a debate in which the authors participated at the World Psychiatric Association conference in Cape Town, South Africa in November 2016. Professor van Staden acted as chair and here, as at the debate, provides a rationale for debating a topic that many of those involved in mental health believe to be decided. The discussion that ensued demonstrated, however, that while the arguments have moved on they have not ceased. Who won? Well that depends how you look at it. A few in the audience shifted position towards the motion but the majority remained opposed. What do you think?
Uploads
Papers by norman poole