Brain Matters 3: Values at the Crossroads of Neurology, Psychiatry, and Psycholog

Brain Matters 3：神经学、精神病学和心理学十字路口的价值观

• 批准号: 8400217
• 负责人: Paul Jason Ford
• 金额: $ 2.5万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8400217
• 关键词: Address; Adult; Antiepileptic Agents; Area; Automobile Driving; Benchmarking; Bioethics; Biological; Brain; Childhood; Clinical; Collaborations; Communication; Conversion disorder; Diagnosis; Discipline; Disclosure; Documentation; Empirical Research; Epilepsy; Ethicists; Ethics; Etiology; Exhibits; Exposure to; Family; Fibromyalgia; Fostering; Futile Treatments; Head; Health Personnel; Healthcare Systems; Individual; International; Medical; Medical Education; Movement Disorders; National Institute of Neurological Disorders and Stroke; Neurologic; Neurology; Ohio; Oral; Orphan; Pain; Pain Disorder; Patient Care; Patients; Pharmaceutical Preparations; Physicians; Placebos; Post-Traumatic Stress Disorders; Psychiatry; Psychology; Publications; Research; Research Personnel; Role; Seizures; Services; Stigmata; Symptoms; Syndrome; United States National Institutes of Health; Update; Work; abstracting; chronic pain; disability; disability burden; experience; interest; medical specialties; multidisciplinary; neuroethics; posters; psychologic; research study; social stigma; symposium; working group

DESCRIPTION (provided by applicant): Brain Matters 3: Values at the crossroads of Neurology, Psychiatry, and Psychology October 24-25, 2012; Cleveland, Ohio Overview: This conference addresses ethical dilemmas in the treatment and research for conditions with neurological symptomatology but that are without identifiable biological correlates/causes. The conditions of interest are often framed as medically unexplained symptoms (MUS), non-specific etiologies (NOS), or purely psychological. These diagnoses include, but are not limited to, chronic pain disorders, psychogenic movement disorders, conversion disorders, post traumatic stress disorder, and fibromyalgia. The complexities of suffering and disability experienced by individuals with these conditions are significant; including exposure to dangerous and futile treatments. Among clinicians, disagreement continues over which aspects of these conditions are "all in one's head," either literally or figuratively. Hidden value assumptions about causation permeate research studies and clinical decisions, and effect underlying treatment and care of patients. These assumptions have significant influence on the obligations, roles, and entitlements for patients and health care providers. Patients who suffer from these conditions are "orphaned" by specialties and largely ignored in bioethics discussions. The plenary speakers of this conference will address ethical challenges from a variety of academic disciplines and medical subspecialties. Presentations will be given by patients, physicians, neuroscientists, and ethicists. Research abstracts will be solicited both for oral presentations as well as poster presentations. Special Non-Epileptic Seizure Track: Psychogenic non-epileptic seizures (PNES) constitute a major unaddressed challenge to our healthcare system. PNES was identified in the 2007 NINDS Epilepsy Benchmarks as an important area in need of significant further study and as of the April 2011 progress update, only modest gains have been made in this area. On average, these patients carry an epilepsy misdiagnosis for seven years prior to being identified as PNES and are exposed to high levels of anti-epileptic medications during this period. "Workups and treatments for what is mistakenly thought to be epilepsy are estimated to incur $100 to $900 million per year in medical services" (LaFrance and Benbadis. 2006). Even with a proper diagnosis, PNES leaves significant disability and burden on patients and their families, as there is no definitive treatment (Brown et al., 2011). Given that Brain Matters 3 will overlap with the 21st International Epilepsy Symposium and will occur in the same building, a dedicated PNES ethics sub-theme will occur on Day 1 of Brain Matters 3 to take advantage of the crossover audience. This will include working group sessions on both Adult and Pediatric ethics issues in PNES. These working groups will analyze the current needs in ethics of PNES and will outline the theoretical and empirical research necessary to provide guidance for the best ethical practices around PNES. Ethical challenges facing clinicians and researchers include communication of disclosure, documentation and purposeful mislabeling, return to work requests, driving restrictions, placebo use in diagnosis and treatment, and stigma in medical education. The hope is to create neuroethics collaborations on conditions with neurological symptomatology, but that have medically unexplained symptoms or are believed to have psychogenic components. To this end, conference support is being sought from NIH that would allow a rich dissemination of results through publication and video access, remove barriers to participation by emerging researchers, and integrate working groups into this conference that will occur in 2012. PUBLIC HEALTH RELEVANCE: The current multidisciplinary conference examines the ethical challenges inherent in researching and treating patients with conditions that exhibit neurological symptomatology, but with unclear biological correlates/causes. In particular there is a focus on Psychogenic Non-epileptic Seizures, but a generalization to broader conditions such as post-traumatic stress disorder, pain syndromes, and psychogenic movement disorders.

2012年10月24-25日，《大脑问题3：神经病学、精神病学和心理学交叉路口的价值》；概述：本次会议讨论了在治疗和研究具有神经症状但没有可识别的生物学相关性/原因的疾病中的伦理困境。感兴趣的情况通常被定义为医学上无法解释的症状（MUS），非特异性病因（NOS）或纯粹的心理。这些诊断包括但不限于慢性疼痛障碍、心因性运动障碍、转换障碍、创伤后应激障碍和纤维肌痛。患有这些疾病的个人所经历的痛苦和残疾的复杂性是显著的；包括接受危险而无效的治疗。在临床医生中，对于这些疾病的哪些方面是“完全在一个人的头脑中”，无论是字面上还是比喻上，分歧仍然存在。关于因果关系的隐藏价值假设