Identifying and evaluating novel treatment targets for the development of evidence-based interventions for functional neurological disorder.
Identifying and evaluating novel treatment targets for the development of evidence-based interventions for functional neurological disorder.
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DOI：
10.1016/j.ebr.2021.100479
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发表时间：
2021
影响因子：
--
通讯作者：
Szaflarski JP
中科院分区：
文献类型：
--
作者：
Fobian AD;Szaflarski JP
最近的证据表明，目标情绪对 FND 的影响可能有限甚至没有影响。未来的研究应该确定和评估新的治疗靶点。已经确定了需要进行额外调查的机制作为目标。研究应该评估症状的变化是否与目标的变化相关。这将使神经科学成果转化为新的 FND 治疗方法。从历史上看，功能性神经障碍（FND）在心理动力学术语中被描述为心理困扰的身体表现。通常向患者和护理人员解释为焦虑、压力、创伤或其他精神合并症的结果。然而，最近的证据表明，针对情绪和压力并不等同于 FND 的治疗，并且可能对 FND 症状的影响有限甚至没有影响。鉴于 FND 治疗的随机对照试验很少，并且情绪和压力作为有效治疗目标的证据有限，新的治疗目标或介质的识别和评估是一个充满机遇的领域，应该成为未来研究的重点。直接识别和针对可改变的疾病机制，而不是仅仅治疗精神合并症，可能会提高治疗 FND 症状的功效，改善患者的治疗效果，并降低医疗成本。已经确定了几种新的机制，需要进行额外的研究作为潜在的治疗目标，包括对受影响区域的异常注意力集中、对疾病的信念和期望、习惯性损害以及对行为的控制感下降。未来的干预研究应采取基于机制的方法，并利用有效可靠的措施或特定的生物标志物来确定 FND 症状的改善是否与治疗目标的变化相关。这种跨诊断方法将使研究人员能够将神经生理学和神经科学研究中出现的新机制结果转化为新的或改进的基于证据的 FND 治疗和预防方法。
Recent evidence indicates targeting mood may have limited to no effect on FND. Future research should identify and evaluate novel treatment targets. Mechanisms have been identified that warrant additional investigation as targets. Studies should assess if change in symptoms are associated with change in targets. This will allow the translation of neuroscience outcomes into new FND treatments. Historically, functional neurological disorder (FND) has been described in psychodynamic terms as the physical manifestation of psychological distress. It is often explained to patients and caregivers as the result of anxiety, stress, trauma or other psychiatric comorbidities. However, recent evidence indicates that targeting mood and stress is not equivalent to the treatment of FND and may have limited to no effect on FND symptoms. Given the few randomized controlled trials for FND treatments and the limited evidence of mood and stress as effective treatment targets, the identification and evaluation of novel treatment targets or mediators is an area of great opportunity and should be the focus of future research. Identifying and targeting modifiable disease mechanisms directly as opposed to only treating psychiatric comorbidities may result in greater efficacy in treating FND symptoms, better patient outcomes and lower healthcare costs. Several novel mechanisms have been identified that warrant additional investigation as potential treatment targets including abnormal attentional focus on the affected area, beliefs and expectations about illness, impairments in habituation, and decreased sense of control over actions. Future intervention studies should take a mechanism-based approach and utilize valid and reliable measures or specific biomarkers to determine whether improvements in FND symptoms are associated with changes in the treatment targets. This transdiagnostic approach will allow researchers to translate the novel mechanistic outcomes emerging from neurophysiological and neuroscience studies into new or improved evidence-based approaches to FND treatment and prevention.
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DOI：
10.1016/b978-0-12-801772-2.00014-x
发表时间：
2016-01-01
期刊：
FUNCTIONAL NEUROLOGIC DISORDERS
影响因子：
--
作者：
Frodl, T.
通讯作者：
Frodl, T.
DOI：
10.1176/appi.neuropsych.19030067
发表时间：
2020-12-01
影响因子：
2.9
作者：
O'Connell, Nicola;Watson, Gillian;David, Anthony S.
通讯作者：
David, Anthony S.
影响因子：
--
作者：
Crimlisk, HL;Bhatia, K;Ron, MA
通讯作者：
Ron, MA
影响因子：
4.8
作者：
Edwards MJ;Fotopoulou A;Pareés I
通讯作者：
Pareés I
影响因子：
5.1
作者：
Butler, Matthew;Shipston-Sharman, Oliver;Nicholson, Timothy
通讯作者：
Nicholson, Timothy