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Functional stroke symptoms: A prospective observational case series

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Functional stroke symptoms : A prospective observational case series. / Jones, Abbeygail; Smakowski, Abigail; O'Connell, Nicola; Chalder, Trudie; David, Anthony S.

In: Journal of Psychosomatic Research, Vol. 132, 109972, 05.2020.

Research output: Contribution to journalArticle

Harvard

Jones, A, Smakowski, A, O'Connell, N, Chalder, T & David, AS 2020, 'Functional stroke symptoms: A prospective observational case series', Journal of Psychosomatic Research, vol. 132, 109972. https://doi.org/10.1016/j.jpsychores.2020.109972

APA

Jones, A., Smakowski, A., O'Connell, N., Chalder, T., & David, A. S. (2020). Functional stroke symptoms: A prospective observational case series. Journal of Psychosomatic Research, 132, [109972]. https://doi.org/10.1016/j.jpsychores.2020.109972

Vancouver

Jones A, Smakowski A, O'Connell N, Chalder T, David AS. Functional stroke symptoms: A prospective observational case series. Journal of Psychosomatic Research. 2020 May;132. 109972. https://doi.org/10.1016/j.jpsychores.2020.109972

Author

Jones, Abbeygail ; Smakowski, Abigail ; O'Connell, Nicola ; Chalder, Trudie ; David, Anthony S. / Functional stroke symptoms : A prospective observational case series. In: Journal of Psychosomatic Research. 2020 ; Vol. 132.

Bibtex Download

@article{edb606160c534cffb8e846613b3c6f1a,
title = "Functional stroke symptoms: A prospective observational case series",
abstract = "Objective: Functional symptoms are a common mimic of stroke in acute stroke settings, but there are no guidelines on how to manage such patients and scant research on their clinical profile. We explore the presentation of patients with functional stroke symptoms at admission and 2-month follow-up. Methods: We conducted a prospective observational study across four SE London acute stroke units, with two-month follow-up. Demographic information, clinical data and GP attendances were recorded. Patients completed self-report measures: Cognitive Behavioural Responses Questionnaire short version, Brief Illness Perception Questionnaire, Hospital Anxiety and Depression Scale, Work and Social Adjustment Scale and Short Form Health Survey. Results: Fifty-six patients (mean age: 50.9 years) were recruited at baseline; 40 with isolated functional symptoms, the remaining functional symptoms in addition to stroke. Thirty-one completed self-report follow-up measures. Of 56 participants, 63{\%} were female. Patients presented symptoms across modalities, with unilateral and limb weakness the most frequent. There was inconsistent and ambiguous recording of symptoms on medical records. Approximately 40{\%} of patients reported levels of anxiety and depression above the threshold indicating a probable diagnosis. Higher anxiety was associated with greater resting or all-or-nothing behaviours, embarrassment avoidance and symptom focussing on the CBRQ. Only SF-36 physical functioning improved at follow-up. Less than 50{\%} who responded at follow-up were accessing a treatment, though 82{\%} had ongoing symptoms. Conclusion: Patients with functional symptoms in stroke settings report substantial distress, associated with cognitive-behavioural responses to symptoms. Follow-up data suggest recovery can be slow, indicating access to supportive interventions should be improved.",
keywords = "Case series, Functional neurological symptoms, Observational, Prospective, Stroke",
author = "Abbeygail Jones and Abigail Smakowski and Nicola O'Connell and Trudie Chalder and David, {Anthony S.}",
year = "2020",
month = "5",
doi = "10.1016/j.jpsychores.2020.109972",
language = "English",
volume = "132",
journal = "Journal of Psychosomatic Research",
issn = "0022-3999",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Functional stroke symptoms

T2 - A prospective observational case series

AU - Jones, Abbeygail

AU - Smakowski, Abigail

AU - O'Connell, Nicola

AU - Chalder, Trudie

AU - David, Anthony S.

PY - 2020/5

Y1 - 2020/5

N2 - Objective: Functional symptoms are a common mimic of stroke in acute stroke settings, but there are no guidelines on how to manage such patients and scant research on their clinical profile. We explore the presentation of patients with functional stroke symptoms at admission and 2-month follow-up. Methods: We conducted a prospective observational study across four SE London acute stroke units, with two-month follow-up. Demographic information, clinical data and GP attendances were recorded. Patients completed self-report measures: Cognitive Behavioural Responses Questionnaire short version, Brief Illness Perception Questionnaire, Hospital Anxiety and Depression Scale, Work and Social Adjustment Scale and Short Form Health Survey. Results: Fifty-six patients (mean age: 50.9 years) were recruited at baseline; 40 with isolated functional symptoms, the remaining functional symptoms in addition to stroke. Thirty-one completed self-report follow-up measures. Of 56 participants, 63% were female. Patients presented symptoms across modalities, with unilateral and limb weakness the most frequent. There was inconsistent and ambiguous recording of symptoms on medical records. Approximately 40% of patients reported levels of anxiety and depression above the threshold indicating a probable diagnosis. Higher anxiety was associated with greater resting or all-or-nothing behaviours, embarrassment avoidance and symptom focussing on the CBRQ. Only SF-36 physical functioning improved at follow-up. Less than 50% who responded at follow-up were accessing a treatment, though 82% had ongoing symptoms. Conclusion: Patients with functional symptoms in stroke settings report substantial distress, associated with cognitive-behavioural responses to symptoms. Follow-up data suggest recovery can be slow, indicating access to supportive interventions should be improved.

AB - Objective: Functional symptoms are a common mimic of stroke in acute stroke settings, but there are no guidelines on how to manage such patients and scant research on their clinical profile. We explore the presentation of patients with functional stroke symptoms at admission and 2-month follow-up. Methods: We conducted a prospective observational study across four SE London acute stroke units, with two-month follow-up. Demographic information, clinical data and GP attendances were recorded. Patients completed self-report measures: Cognitive Behavioural Responses Questionnaire short version, Brief Illness Perception Questionnaire, Hospital Anxiety and Depression Scale, Work and Social Adjustment Scale and Short Form Health Survey. Results: Fifty-six patients (mean age: 50.9 years) were recruited at baseline; 40 with isolated functional symptoms, the remaining functional symptoms in addition to stroke. Thirty-one completed self-report follow-up measures. Of 56 participants, 63% were female. Patients presented symptoms across modalities, with unilateral and limb weakness the most frequent. There was inconsistent and ambiguous recording of symptoms on medical records. Approximately 40% of patients reported levels of anxiety and depression above the threshold indicating a probable diagnosis. Higher anxiety was associated with greater resting or all-or-nothing behaviours, embarrassment avoidance and symptom focussing on the CBRQ. Only SF-36 physical functioning improved at follow-up. Less than 50% who responded at follow-up were accessing a treatment, though 82% had ongoing symptoms. Conclusion: Patients with functional symptoms in stroke settings report substantial distress, associated with cognitive-behavioural responses to symptoms. Follow-up data suggest recovery can be slow, indicating access to supportive interventions should be improved.

KW - Case series

KW - Functional neurological symptoms

KW - Observational

KW - Prospective

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=85080078818&partnerID=8YFLogxK

U2 - 10.1016/j.jpsychores.2020.109972

DO - 10.1016/j.jpsychores.2020.109972

M3 - Article

AN - SCOPUS:85080078818

VL - 132

JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

SN - 0022-3999

M1 - 109972

ER -

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