• MeSH
• disociační poruchy MeSH
• konverzní poruchy * MeSH
• lidé MeSH
• neurozobrazování MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Předkládaná studie zkoumá vzorce citové vazby (attachment/ obranné postoje) a míru nevyřešených ztrát/traumat u dětí a dospívajících, kteří se prezentují na specializovaném pracovišti (multidisciplinární genderová služba). Padesát sedm dětí a dospívajících (8,42–15,92 let; 24 nar. jako muži a 33 nar. jako ženy) projevujících se genderovou dysforií se účastnilo strukturovaných příjmových rozhovorů kódovaných pomocí dynamicko-vývojové modelové (DMM) diskurzivní analýzy. Byly porovnány děti s genderovou dysforií věkově a pohlavím odpovídajícím dětem z komunity (neklinická skupina) a skupinou dětí školního věku se smíšenými psychiatrickými poruchami (smíšená psychiatrická skupina). Informace byly o averzivních zkušenostech z dětství (ACE), diagnózách duševního zdraví a byla také shromážděna globální úroveň fungování. Na rozdíl od dětí z neklinické skupiny, které byly primárně zařazeny do normativních vzorců vazby (A1-2, B1-5 a C1-2) a kteří měly nízkou míru nevyřešených ztrát/traumat, děti s pohlavní dysforií byly většinou klasifikovány ve vysoce rizikových vzorcích emoční vazby (attachmentu) (A3-4, A5-6, C3-4, C5-6 a A/C) (2 $ = 52,66; p < 0,001) a měly vysokou míru nevyřešených ztrát/traumat (2 $ = 18,64; p < 0,001). Komorbidní psychiatrické diagnózy (n = 50; 87,7 %) a časté byly také sebepoškozování, sebevražedné myšlenky nebo symptomy úzkosti. Globální úroveň fungování byla narušena (rozsah 25–95/100; průměr = 54,88; SD = 15,40; medián = 55,00). Mezi dětmi s genderovou dysforií nebyly žádné rozdíly v porovnání s dětmi se smíšenými psychiatrickými poruchami podle vzorců vazby (2 $ = 2,43; p = 0,30) a míry nevyřešených ztrát a traumat (2 $ = 0,70; p = 0,40). Post hoc analýzy ukázaly, že nižší SES, rodinná konstelace (netradiční rodinná jednotka), ACE –včetně špatného zacházení (fyzické zneužívání, sexuální zneužívání, emoční zneužívání, zanedbávání a vystavení domácímu násilí) – zvýšilo pravděpodobnost klasifikace dítěte do vysoce rizikového vzoru emoční vazby. Podobnost dětí s jinými formami psychologického distressu, dětem s genderovou dysforií je v existenci kontextu vícečetné interakce rizikových faktorů, mezi které patří riziková vazba, nevyřešená ztráta/trauma, rodinný konflikt a ztráta rodinné soudržnosti a vystavení více ACE.

The current study examines patterns of attachment/self-protective strategies and rates of unresolved loss/trauma in children and adolescents presenting to a multidisciplinary gender service. Fifty-seven children and adolescents (8.42–15.92 years; 24 birthassigned males and 33 birth-assigned females) presenting with gender dysphoria participated in structured attachment interviews coded using dynamic-maturational model (DMM) discourse analysis. The children with gender dysphoria were compared to age- and sex-matched children from the community (non-clinical group) and a group of school-age children with mixed psychiatric disorders (mixed psychiatric group). Information about adverse childhood experiences (ACEs), mental health diagnoses, and global level of functioning was also collected. In contrast to children in the non-clinical group, who were classified primarily into the normative attachment patterns (A1-2, B1-5, and C1-2) and who had low rates of unresolved loss/trauma, children with gender dysphoria were mostly classified into the high-risk attachment patterns (A3-4, A5-6, C3-4, C5-6, and A/C) ($2 = 52.66; p < 0.001) and had a high rate of unresolved loss/trauma ($2 = 18.64; p < 0.001). Comorbid psychiatric diagnoses (n = 50; 87.7%) and a history of self-harm, suicidal ideation, or symptoms of distress were also common. Global level of functioning was impaired (range 25–95/100; mean = 54.88; SD = 15.40; median = 55.00). There were no differences between children with gender dysphoria and children with mixed psychiatric disorders on attachment patterns ($2 = 2.43; p = 0.30) and rates of unresolved loss and trauma ($2 = 0.70; p = 0.40). Post hoc analyses showed that lower SES, family constellation (a non-traditional family unit), ACEs—including maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence)—increased the likelihood of the child being classified into a high risk attachment pattern. Akin to children with other forms of psychological distress, children with gender dysphoria present in the context of multiple interacting risk factors that include at-risk attachment, unresolved loss/trauma, family conflict and loss of family cohesion, and exposure to multiple ACEs.

Functional neurological disorder (FND) was of great interest to early clinical neuroscience leaders. During the 20th century, neurology and psychiatry grew apart - leaving FND a borderland condition. Fortunately, a renaissance has occurred in the last two decades, fostered by increased recognition that FND is prevalent and diagnosed using "rule-in" examination signs. The parallel use of scientific tools to bridge brain structure - function relationships has helped refine an integrated biopsychosocial framework through which to conceptualize FND. In particular, a growing number of quality neuroimaging studies using a variety of methodologies have shed light on the emerging pathophysiology of FND. This renewed scientific interest has occurred in parallel with enhanced interdisciplinary collaborations, as illustrated by new care models combining psychological and physical therapies and the creation of a new multidisciplinary FND society supporting knowledge dissemination in the field. Within this context, this article summarizes the output of the first International FND Neuroimaging Workgroup meeting, held virtually, on June 17th, 2020 to appraise the state of neuroimaging research in the field and to catalyze large-scale collaborations. We first briefly summarize neural circuit models of FND, and then detail the research approaches used to date in FND within core content areas: cohort characterization; control group considerations; task-based functional neuroimaging; resting-state networks; structural neuroimaging; biomarkers of symptom severity and risk of illness; and predictors of treatment response and prognosis. Lastly, we outline a neuroimaging-focused research agenda to elucidate the pathophysiology of FND and aid the development of novel biologically and psychologically-informed treatments.

• MeSH
• konverzní poruchy * MeSH
• lidé MeSH
• nemoci nervového systému * diagnostické zobrazování   MeSH
• neurozobrazování MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Research Support, N.I.H., Extramural MeSH
• Research Support, N.I.H., Intramural MeSH
• Research Support, U.S. Gov't, Non-P.H.S. MeSH

OBJECTIVES: We aimed to identify existing outcome measures for functional neurological disorder (FND), to inform the development of recommendations and to guide future research on FND outcomes. METHODS: A systematic review was conducted to identify existing FND-specific outcome measures and the most common measurement domains and measures in previous treatment studies. Searches of Embase, MEDLINE and PsycINFO were conducted between January 1965 and June 2019. The findings were discussed during two international meetings of the FND-Core Outcome Measures group. RESULTS: Five FND-specific measures were identified-three clinician-rated and two patient-rated-but their measurement properties have not been rigorously evaluated. No single measure was identified for use across the range of FND symptoms in adults. Across randomised controlled trials (k=40) and observational treatment studies (k=40), outcome measures most often assessed core FND symptom change. Other domains measured commonly were additional physical and psychological symptoms, life impact (ie, quality of life, disability and general functioning) and health economics/cost-utility (eg, healthcare resource use and quality-adjusted life years). CONCLUSIONS: There are few well-validated FND-specific outcome measures. Thus, at present, we recommend that existing outcome measures, known to be reliable, valid and responsive in FND or closely related populations, are used to capture key outcome domains. Increased consistency in outcome measurement will facilitate comparison of treatment effects across FND symptom types and treatment modalities. Future work needs to more rigorously validate outcome measures used in this population.

• MeSH
• hodnocení výsledků zdravotní péče * MeSH
• lidé MeSH
• nemoci nervového systému diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH