Perceptual Disturbances Research Articles

Intact tactile anisotropy despite altered hand perception in complex regional pain syndrome: rethinking the role of the primary sensory cortex in tactile and perceptual dysfunction.

Complex Regional Pain Syndrome (CRPS) is characterised by pain, autonomic, sensory and motor abnormalities. It is associated with changes in the primary somatosensory cortex (S1 representation), reductions in tactile sensitivity (tested by two-point discrimination), and alterations in perceived hand size or shape (hand perception). The frequent co-occurrence of these three phenomena has led to the assumption that S1 changes underlie tactile sensitivity and perceptual disturbances. However, studies underpinning such a presumed relationship use tactile sensitivity paradigms that involve the processing of both non-spatial and spatial cues. Here, we used a task that evaluates anisotropy (i.e., orientation-dependency; a feature of peripheral and S1 representation) to interrogate spatial processing of tactile input in CRPS and its relation to hand perception. People with upper limb CRPS (n = 14) and controls with (n = 15) or without pain (n = 19) judged tactile distances between stimuli-pairs applied across and along the back of either hand to provide measures of tactile anisotropy. Hand perception was evaluated using a visual scaling task and questionnaires. Data were analysed with generalised estimating equations. Contrary to our hypotheses, tactile anisotropy was bilaterally preserved in CRPS, and the magnitude of anisotropic perception bias was comparable between groups. Hand perception was distorted in CRPS but not related to the magnitude of anisotropy or bias. Our results suggest against impairments in spatial processing of tactile input, and by implication S1 representation, as the cause of distorted hand perception in CRPS. Further work is warranted to elucidate the mechanisms of somatosensory dysfunction and distorted hand perception in CRPS.

Another Case Of Physical Abuse In Childhood Between Age 7-11 And Alice In Wonderland-Like Seizures Retrospectively Described By A 45 Years-Old Man In Detail

The phenomenon of Alice in Wonderland Syndrome is not considered a disease in its own right but usually occurs as an accompanying symptom of a migraine attack or as a precursor of an epileptic seizure in the form of an aura with pronounced visual perceptual disturbances [1]. However, an Alice in Wonderland syndrome can also be caused by the Epstein-Barr virus, influenza virus [18], drugs [3] or encephalitis [2]. The term "Alice in Wonderland syndrome" was named after the children's book Alice in Wonderland by Lewis Carroll and coined by John Todd as a possible, but not essential, concomitant of migraine and epilepsy [1]. Carroll suffered from migraines himself; it is believed that his experiences with the condition served as inspiration for the hallucination-like effects described in his work [1]. In addition, Carroll's narrative has been discussed as a description of a trip following consumption of mind-altering drugs. In one of the most famous sequences in the book, Alice changes size by biting off pieces from different sides of a mushroom. However, there is no evidence of drug use by Lewis Carroll. Alice in Wonderland syndrome results in changes in the perception of one's surroundings [6,7]. These changes include both micropsia and macropsia (everything appears reduced or enlarged), as well as altered auditory perception, altered tactile perception, an altered sense of time. The syndrome is particularly common in children. Attacks are often shorter and may also be completely painless, although accompanying symptoms such as nausea, vomiting, and sensitivity to light and sound is more pronounced. Neurological deficits may occur so that the affected child begins to hallucinate. He or she perceives his or her body as larger or smaller and/or begins to see "fantastic images“. The changes in perception can severely affect affected individuals, causing them to become disoriented and "unable to find their way around." In extreme cases, falls and other accidents may occur. The perceptual disturbances can lead to Alice in Wonderland syndrome being confused with other mental disorders or misinterpreted as "craziness". The primary focus is the treatment of the underlying condition, such as symptomatic treatment of migraine. Recent publications shed light on sexual abuse in childhood as the origin of AIWS-like visual disturbances [4,5].

Schizotypy 17 years on: Psychotic symptoms in midlife.

Determining the long-term psychosis-related outcomes of late-teen individuals characterized initially by a nonpsychotic, schizotypic feature (elevated perceptual aberrations) can further our understanding of the developmental pathways leading to schizophrenia, nonaffective psychotic conditions, and psychotic symptoms later in adulthood. Using the well-known laboratory/psychometric high-risk approach, the present study investigated the associations between nonpsychotic perceptual aberrations measured at age 18, in individuals with no prior history of psychosis, and clinical psychotic symptom outcomes 17 years later in midlife (middle 30s). Clinical assessments for hallucinations and delusions were completed for 191 adults (95% of the original sample) in the follow-up study. Elevated perceptual aberrations at age 18 predicted increased levels of hallucinations, delusions, and total psychotic symptoms in midlife as well as psychotic illness. The associations between baseline perceptual aberrations and later psychotic symptoms were not accounted for by general nonspecific psychopathology factors such as anxiety or depression present at age 18. Early detection of subtle, nonpsychotic forms of perceptual disturbance may aid in identifying individuals at increased risk for nonaffective psychosis outcomes in adulthood. Perceptual aberrations may constitute a useful endophenotype for genetic, neurobiological, and cognitive neuroscience investigations of schizophrenia liability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Judgmental perception of co-speech gestures in MDD

Cognitive bias in depression may increase sensitivity to judgmental appraisal of communicative cues. Nonverbal communication encompassing co-speech gestures is crucial for social functioning and is perceived differentially by men and women, however, little is known about the effect of depression on the perception of appraisal. We investigate if a cognitive bias influences the perception of appraisal and judgement of nonverbal communication in major depressive disorder (MDD).During watching videos of speakers retelling a story and gesticulating, 22 patients with MDD and 22 matched healthy controls pressed a button when they perceived the speaker as appraising in a positive or negative way. The speakers were presented in four different conditions (with and without speech and with natural speaker or as stick-figures) to evaluate context effects. Inter-subject covariance (ISC) of the button-press time series measured consistency across the groups of the response pattern depending on the factors diagnosis and gender.Significant effects emerged for the factors diagnosis (p = .002), gender (p = .007), and their interaction (p < .001). The female healthy controls perceived the gestures more consistently appraising than male controls, the female patients, and male patients whereas the latter three groups did not differ. Further, the ISC measure for consistency correlated negatively with depression severity. The natural speaker video without audio speech yielded the highest responses consistency. Indeed co-speech gestures may drive these ISC effects because number of gestures but not facial shrugs correlated with ISC amplitude.During co-speech gestures, a cognitive bias led to disturbed perception of appraisal in MDD for females. Social communication is critical for functional outcomes in mental disorders; thus perception of gestural communication is important in rehabilitation.

Beaming in the Charcot foot: A case series with 12-month minimum follow-up

BackgroundCharcot neuropathic arthropathy is a progressive degeneration of the weightbearing joints of the foot induced by denervation and disturbance of sensorial perception. This entity clinically behaves as a destructive fast-progressive arthropathy, resulting in loss of independent walking and often requiring amputation of the leg. This study analyzes our experience with midfoot realignment arthrodesis and stabilization by intramedullary beaming in patients with Charcot diabetic foot as a limb-sparing procedure. MethodsPatients with Charcot foot treated in our Foot and Ankle unit between January 2018 and December 2019 were analyzed. In all of the patients beaming technique was performed: open reduction and stabilization by a midfoot medial fusion beam and a lateral fusion bolt. Demographical, clinical and radiological pre and post-surgery data were assessed. The primary outcome measure was defined as an autonomous ambulation through an ulcer-free plantigrade foot. A minimum follow-up of 12 months was performed. ResultsA total of 5 patients were treated. Median age 64 years, mean follow-up 25 months (12–31). An ulcer-free plantigrade foot was obtained in 80% of the patients. Complications were observed in 80% of patients: 1 deep infection, 2 hardware failure, 3 Charcot foot progression. Rate of reoperation 40%, including 1 amputation. Significant improvement in all radiographic angles was observed. ConclusionBeaming the medial and lateral columns of the foot in patients with Charcot foot enabled the restoration of a functional plantigrade foot and an ulcer-free autonomous ambulation, despite a relatively high complication rate. Level of evidenceIV, prospective case series.

Visual illusions modulate body perception disturbance and pain in Complex Regional Pain Syndrome: A randomized trial.

Effective treatment of longstanding Complex Regional Pain Syndrome (CRPS) is a challenge, as causal mechanisms remain elusive. People with CRPS frequently report distorted subjective perceptions of their affected limb. Evidence of pain reduction when the affected limb is visually altered in size suggests that visual illusions used to target central processing could restore coherence of this disrupted limb representation. We hypothesized that using virtual reality that alters hand image to match the patient's desired hand appearance would improve body perception disturbance and pain. Also, repeated exposure would maintain any therapeutic effect. A blinded randomized controlled trial of 45 participants with refractory upper-limb CRPS and body perception disturbance (BPD) viewed a digital image of their affected hand for 1min. The image was digitally altered according to the patient's description of how they desired their hand to look in the experimental group and unaltered in the control group. BPD and pain were measured pre- and post-intervention. A subgroup was followed up 2weeks after a course of repeated interventions. BPD (mean-6, ±SD 7.9, p=0.036, effect size [ES]=0.6) and pain intensity (mean-0.43, ±SD 1.3, p=0.047, ES=0.5) reduced in 23 participants after single exposure compared to controls (n=22). At follow-up, the subgroup (experimental n=21; control n=18) showed sustained pain reduction only (p=0.037, ±SD 1.9, ES=0.7), with an overall 1.2 decrease on an 11-point scale. Visually changing the CRPS hand to a desired appearance modulates BPD and pain suggesting therapeutic potential for those with refractory CRPS. Further research to optimize this therapeutic effect is required. Visual bodily illusions that change the shape and appearance of the painful CRPS hand to that desired by the patient result in a rapid amelioration of pain and body perception disturbance in people with longstanding CRPS. These findings highlight the future potential of this drug-free approach in the treatment of refractory CRPS.

Repetitive Transcranial Magnetic Stimulation as a Therapeutic and Probe in Schizophrenia: Examining the Role of Neuroimaging and Future Directions.

Schizophrenia is a complex condition associated with perceptual disturbances, decreased motivation and affect, and disrupted cognition. Individuals living with schizophrenia may experience myriad poor outcomes, including impairment in independent living and function as well as decreased life expectancy. Though existing treatments may offer benefit, many individuals still experience treatment resistant and disabling symptoms. In light of the negative outcomes associated with schizophrenia and the limitations in currently available treatments, there is a significant need for novel therapeutic interventions. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique that can modulate the activity of discrete cortical regions, allowing direct manipulation of local brain activation and indirect manipulation of the target's associated neural networks. rTMS has been studied in schizophrenia for the treatment of auditory hallucinations, negative symptoms, and cognitive deficits, with mixed results. The field's inability to arrive at a consensus on the use rTMS in schizophrenia has stemmed from a variety of issues, perhaps most notably the significant heterogeneity amongst existing trials. In addition, it is likely that factors specific to schizophrenia, rather than the rTMS itself, have presented barriers to the interpretation of existing results. However, advances in approaches to rTMS as a biologic probe and therapeutic, many of which include the integration of neuroimaging with rTMS, offer hope that this technology may still play a role in improving the understanding and treatment of schizophrenia.

Premenstrual syndrome and cortisol

Premenstrual syndrome (PMS), including the severe subtype premenstrual dysphoric disorder (PMDD), DSM-5 category, represents a challenging combination of hormonal, environmental and neuroendocrine dysfunctions with menstrual cycle-related pattern. Controversies around the role of daily stress and associated anomalies of hypothalamic-pituitary-adrenal axis are related to the fact that stress is all the time, not just a fluctuating element. This is a narrative review on PMS/PMDD and cortisol profile. 46 articles are cited (between 2009 and 2020). PMD/PMDD underlines multiple imbalances and anomalies of the cortisol levels or its secretory pattern may be a few of them, despite the fact that multiple controversies are still present and most of studies are of limited statistical power. Women with PMS may have higher levels of cortisol in relationship to stress independently of the cycle phase, also a delay of CAR (cortisol awakening response) peak and a delayed cortisol slope during day time. It does not seem that CAR pattern is related to the phases of menstrual cycle. CAR anomalies may be associated with pain perception disturbances in PMS females. The most modern area of interest is related to allopregnanolone, a progesterone metabolite with neuroactive profile. The diurnal serum baseline cortisol and the values of cortisol after dexamethasone suppression test may be similar between patients with PMS and without, but the females with PMS that have higher allopregnanolone associate blunted values of cortisol during the night versus control (without PMS) and versus women with low allopregnanolone levels, thus proving a suboptimal response to stress. Allopregnanolone modules GABA receptors on a paradoxical manner inducing anxiety and irritability during luteal phase on women with a specific predisposal configuration of GABA receptor as those confirmed with PMDD. Overall, PMS/PMDD impairs the quality of life, thus the more we understand about its pathogeny, the easier it gets to control it.

Ocular defect in children with cerebral palsy and its correlation with the types of cerebral palsy

Background: Cerebral palsy (CP) describes a group of permanent disorder of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbance that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication and behavior, by epilepsy, and secondary musculoskeletal problem. However, no known study has been found on this aspect. Objective of this study was to evaluate the ocular defect in children with cerebral palsy and to correlate with the types of CP.Methods: Study was done in the Paediatric Neurology unit of BSMMU from January 2012 to July 2012. One hundred thirty children with cerebral palsy were studied. The patients were randomly selected who full filled the inclusion criteria and ophthalmological examination was done.Results: Sixty four (64%) of CP patients had pathological finding and 36% percent had normal finding. Most of the abnormalities were squint (strabismus) (40%) and refractive error (36.9%). Most of the ocular defects were found in spastic cerebral palsy, mainly in spastic quadriplegia (34.6%) and spastic diplegia (29.2%).Conclusions: Ocular defect like squint and refractive error common associations of cerebral palsy. Spastic quadriplegic and diplegic children had more ocular defects.

Body perception disturbances in women with pregnancy-related lumbopelvic pain and their role in the persistence of pain postpartum

BackgroundLumbopelvic pain (LPP) is common during pregnancy and can have long-lasting negative consequences in terms of disability and reduced quality of life. Therefore, it is crucial to identify women at risk of having pregnancy-related LPP after childbirth. This study aimed to investigate the association between body perception, pain intensity, and disability in women with pregnancy-related LPP during late pregnancy and postpartum, and to study whether a disturbed body perception during late pregnancy predicted having postpartum LPP.MethodsA prospective cohort study in 130 primiparous women (median age = 30 years) was performed. Pain intensity, disability, and lumbopelvic body perception during the last month of pregnancy and 6 weeks postpartum were assessed with the Numerical Pain Rating Scale (NPRS), Oswestry Disability Index, and Fremantle Back Awareness Questionnaire, respectively. Having pregnancy-related LPP was defined as an NPRS score ≥ 1/10. At both timepoints, women were categorized into three groups; pain-free, LPP with low disability, and LPP with high disability (based on Oswestry Disability Index scores). At each timepoint, body perception was compared between groups, and correlations between body perception, pain intensity, and disability were evaluated in women with LPP by using non-parametric tests. Logistic regression analysis was used to determine whether body perception during the last month of pregnancy predicted the presence of LPP 6 weeks postpartum.ResultsWomen with LPP at the end of pregnancy, and 6 weeks postpartum reported a more disturbed body perception compared to pain-free women (p ≤ 0.005). Greater body perception disturbance correlated with higher pain intensity (σ = 0.266, p = 0.008) and disability (σ = 0.472, p < 0.001) during late pregnancy, and with pain intensity 6 weeks postpartum (σ = 0.403, p = 0.015). A disturbed body perception during late pregnancy nearly significantly predicted having postpartum LPP (Odds Ratio = 1.231, p = 0.052).ConclusionsBody perception disturbance was greater in women experiencing LPP during late pregnancy and postpartum compared to pain-free women, and correlated with pain intensity and disability. Though non-significant (p = 0.052), the results of the regression analysis suggest that greater body perception disturbance during late pregnancy might predict having LPP postpartum. However, future studies should follow up on this.

Clinical and biochemical footprints of inherited metabolic disease. V. Cerebral palsy phenotypes.

Cerebral palsy is the most common physical disability of childhood describing a heterogeneous group of neurodevelopmental disorders that cause activity limitation, but often are accompanied by disturbances of sensation, perception, cognition, communication and behavior, or by epilepsy. Inborn errors of metabolism have been reported in the literature as presenting with features of cerebral palsy. We reviewed and updated the list of metabolic disorders known to be associated with symptoms suggestive of cerebral palsy and found more than 150 relevant IEMs. This represents the fifth of a series of articles attempting to create and maintain a comprehensive list of clinical and metabolic differential diagnosis according to system involvement.

Nursing Knowledge and Practices Regarding Delirium as an Under-Recognized Syndrome in Intensive Care Units (ICU psychosis)

Background: Delirium is an acute and fluctuating change in mental status that characterized by marked disturbance of attention, with associated deficits in memory and orientation, disorganized thinking, perceptual disturbance, anxiety, sleep problems, agitation and motor unrest. The aim of this study was to assess the nurses' knowledge and practices regarding to delirium of critically ill patients in ICU. Design: A descriptive design was used. Subjects: A sample of convenience 64 critical care nurses who were currently available at morning shifts working was recruited for this study. Tool: Delirium awareness and practice in ICUs Questionnaire to measure healthcare professionals’ awareness and practice related to delirium in the ICU. Results: The results revealed that lower significant knowledge score was observed for nurses who were not mentioned the definition of delirium and only one nurse attended training course/lecture about delirium within last year (1.6%), while 98.4% did not attend any training courses/ lecture about delirium last year. Conclusion: Based on this result, it was concluded that delirium was a problem that requires active interventions from the health care providers and it is under-diagnosed syndrome. Recommendations: Condensed training required to optimally manage the condition of delirium is needed for earlier intervention and greater interdisciplinary collaboration and more involvement of psychiatric services are needed.

Microsaccades and attention in a high-acuity visual alignment task

While aiming and shooting, we make tiny eye movements called microsaccades that shift gaze between task-relevant objects within a small region of the visual field. However, in the brief period before pressing the trigger, microsaccades are suppressed. This might be due to the lack of a requirement to shift gaze as the retinal images of the two objects begin to overlap on the fovea. Alternatively, we might actively suppress microsaccades to prevent any disturbances in visual perception caused by microsaccades around the time of their occurrence and their subsequent effect on shooting performance. In this study we looked at microsaccade rates while participants performed a simulated shooting task under two conditions: a normal condition in which they moved their eyes freely, and an eccentric condition in which they maintained gaze on a fixed target while performing the shooting task at 5° eccentricity. As expected, microsaccade rate dropped near the end of the task in the normal viewing condition. However, we also found the same decrease for the eccentric condition in which microsaccades did not shift gaze between the task objects. Microsaccades are also produced in response to shifts in covert attention. To test whether disengagement of covert attention from the eccentric shooting location caused the drop in microsaccade rate, we monitored the location of participants’ spatial attention by using a Rapid Serial Visual Presentation (RSVP) task simultaneously at a location opposite to the shooting task. Target letter detection at the RSVP location did not improve during the drop in microsaccade rate, suggesting that covert attention was maintained at the shooting task location. We conclude that in addition to their usual gaze-shifting function, microsaccades during fine-acuity tasks might be modulated by cognitive processes other than spatial attention.

Local versus long-range connectivity patterns of auditory disturbance in schizophrenia

Auditory hallucinations are a debilitating symptom of schizophrenia. Effective treatment is limited because the underlying neural mechanisms remain unknown. Our study investigates how local and long-range functional connectivity is associated with auditory perceptual disturbances (APD) in schizophrenia. APD was assessed using the Auditory Perceptual Trait and State Scale. Resting state fMRI data were collected for N=99 patients with schizophrenia. Local functional connectivity was estimated using regional homogeneity (ReHo) analysis; long-range connectivity was estimated using resting state functional connectivity (rsFC) analysis. Mediation analyses tested whether local (ReHo) connectivity significantly mediated associations between long-distance rsFC and APD. Severity of APD was significantly associated with reduced ReHo in left and right putamen, left temporoparietal junction (TPJ), and right hippocampus-pallidum. Higher APD was also associated with reduced rsFC between the right putamen and the contralateral putamen and auditory cortex. Local and long-distance connectivity measures together explained 40.3% of variance in APD (P < 0.001), with the strongest predictor being the left TPJ ReHo (P < 0.001). Additionally, TPJ ReHo significantly mediated the relationship between right putamen – left putamen rsFC and APD (Sobel test, P = 0.001). Our findings suggest that both local and long-range functional connectivity deficits contribute to APD, emphasizing the role of striatum and auditory cortex. Considering the translational impact of these circuit-based findings within the context of prior clinical trials to treat auditory hallucinations, we propose a model in which correction of both local and long-distance functional connectivity deficits may be necessary to treat auditory hallucinations.

Development and validation of a shoulder-specific body-perception questionnaire in people with persistent shoulder pain

BackgroundThere is evidence that people with persistent shoulder pain exhibit findings consistent with the presence of sensorimotor dysfunction. Sensorimotor impairments can manifest in a variety of ways, and further developing our understanding of sensorimotor dysfunction in shoulder pain may improve current models of care. The Fremantle Back Awareness Questionnaire (FreBAQ) has been developed to assess disturbed body perception specific to the back. The purpose of the present study was to develop a shoulder-specific self-perception questionnaire and evaluate the questionnaire in people with persistent shoulder pain.MethodsThe Fremantle Shoulder Awareness Questionnaire (FreSHAQ-J) was developed by modifying the FreBAQ. One hundred and twelve consecutive people with persistent shoulder pain completed the FreSHAQ-J. Thirty participants completed the FreSHAQ-J again two-weeks later to assess test-retest reliability. Rasch analysis was used to assess the psychometric properties of the FreSHAQ-J. Associations between FreSHAQ-J total score and clinical status was explored using correlational analysis.ResultsThe FreSHAQ-J has acceptable category order, unidimensionality, no misfitting items, and excellent test-retest reliability. The FreSHAQ-J was moderately correlated with disability and pain catastrophization.ConclusionsThe FreSHAQ-J fits the Rasch measurement model well and is suitable for use with people with shoulder pain. Given the relationship between the FreSHAQ-J score and clinical status, change in body perception may be worth assessing when managing patients with shoulder pain.

Common Factors Underlying Diverse Responses in Alcohol Use Disorder.

ObjectiveInterindividual variation in responses to alcohol is substantial, posing challenges for medical management and for understanding the biological underpinnings of alcohol use disorders (AUD). It is important to understand whether diverse alcohol responses such as sedation, which is predictive of risk and partly heritable, occur concurrently or independently from responses such as blackouts and withdrawal. We hypothesized that latent factors accounting for sources of variance in diverse alcohol response phenotypes could be identified in a large, deeply phenotyped sample of patients with AUD.MethodsWe factor analyzed 17 alcohol response related items from the Alcohol Dependence Scale (ADS) in 938 individuals diagnosed with AUD via structured clinical interviews. Demographic, genetic, and clinical characteristics were tested as predictors of the latent factors by multiple indicators, multiple causes analysis.ResultsThe final factor solution included three alcohol response factors: Physical Symptoms, Perceptual Disturbances, and Neurobiological Effects. Both gender and genetic ancestry were identified as variables influencing alcohol response. Major depressive disorder positively predicted physical symptoms and aggression negatively predicted physical symptoms. Barratt's Impulsivity Scale total score predicted the Physical and Perceptual domains. Family history, average drinks per drinking day, and negative urgency (an impulsivity measure) predicted all three domains.ConclusionsDiverse items from the ADS concurrently load onto three correlated alcohol response factors rather than loading independently. Genetic ancestry and clinical characteristics predicted the severity of items that define the alcohol response factors even after accounting for degree of alcohol consumption. Co‐occurring phenotypes point towards an underlying shared physiology of diverse alcohol responses.

Effectiveness of Video Assisted Teaching Programme on Knowledge and Expressed Practices Regarding the First Aid Management of Epilepsy among Patient’s Family Members in Selected Hospitals of Ambala, Haryana

The epilepsy is a symptom complex of several disorders of brain function characterized by recurring seizures.Practically epilepsy is not a disease but a symptom that may lead to further mental diseases. It includes lossof consciousness, excess movement or loss of muscle tone or movement, disturbances of behaviour, mood,sensation, and perception. Only the patient experiences the Epileptic fits or seizures causing a “sensation”within him/her. Most important thing in the epilepsy first aid management we have to stay calm; mostseizures last less than a few minutes. Help the person having the seizure from getting hurt by movingany nearby objects out of the way, as necessary.The research includes Quantitative approach and quasiexperimental non-equivalent control group pretest-posttest design. Total 60 patient’s family members (30 inexperimental group and 30 in comparison group) were recruited. Conveniently 1 hospital were selected andthen the sample was chosen by convenience sampling technique. Tools in the study were selected variables,structured knowledge questionnaire and structured expressed practices scale. The mean post-test knowledgescore of experimental group was higher (14.67) than the mean post test score of comparison group (9.77)which was found to be statistically significant (‘t’ = 2.21, p = 0.00**) at the 0.05 level of significance. Themean post-test expressed practices score of the experimental group was higher (91.87) than the mean posttest expressed practices score of comparison group (74.50), which was found to be statistically significant (‘t’= 14.46, p =0.00**) at the 0.05 level of significance. No significant association was found among knowledgescores and expressed practices scores regarding first aid management of epilepsy among patient’s familymembers with selected variable. Video assisted teaching was effective to improve the knowledge andexpressed practices regarding First aid management Epilepsy among patient’s family members as there wasa significant difference between experimental and comparison group.

Barriers to managing sleep disturbance in people with malignant brain tumours and their caregivers: a qualitative analysis of healthcare professionals’ perception

This study explores healthcare professionals (HCPs)' perception and current management of sleep disturbance (SD) in people with malignant brain tumours and their caregivers. We aimed to identify barriers to effective management of SD in neuro-oncology care. We conducted semi-structured interviews with 11 HCPs involved in neuro-oncology care. The study was underpinned by the Capability Opportunity Motivation-Behaviour (COM-B) model within the Behavioural Change Wheel (BCW) guiding topic selection for the exploration of underlying processes of HCPs' behaviours and care decisions for SD management. Data were analysed thematically using a framework synthesis, and subsequently mapped onto the BCW to identify barriers for effective management and recommend potential interventions. We identified four themes: HCPs' clinical opinions about SD, the current practice of SD management in neuro-oncology clinics, gaps in the current practice, and suggested areas for improvements. HCPs perceived SD as a prevalent yet secondary issue of low priority in neuro-oncology care. SD was unrecognised, and inadequately managed in usual clinical settings. Interventional options included modifying the use of corticosteroids or prescribing sedatives. When mapped onto the BCW, themes identified main barriers as a lack of awareness among HCPs about SD warranting care, due to the absence of screening tools and limited knowledge and resources for therapeutic interventions. Multidisciplinary HCPs need training in the routine use of appropriate sleep assessment tools, and access to clear management pathways. More professional resources are needed to educate staff in implementing appropriate interventions for people with malignant brain tumours who are experiencing SD.

Irreversible Primary Visual Cortex Impairment in a Mouse Model of High-Risk Schizophrenia.

PurposeAlthough visual deficits can be observed at any stage of schizophrenia, few studies have focused on visual cortex alterations in individuals at high risk of schizophrenia. This study aimed to investigate the pathological changes of the primary visual cortex in a prenatal mouse model of MK801-induced high-risk schizophrenia.MethodsThe high-risk schizophrenia model was generated by MK801 injection into pregnant mice. The male offspring without schizophrenia-like behaviors in early adulthood were defined as the high-risk mouse model of schizophrenia (HRMMS) and divided into two groups. One HRMMS group received the antipsychotic agent risperidone beginning at postnatal week 4 and another group did not receive any treatment. After treatment for 4 weeks, in vivo two-photon calcium imaging was performed to characterize the primary visual cortex activity. The novel object recognition test and the prepulse inhibition apparatus test were also implemented to assess the cognitive and behavioral performance, respectively.ResultsBoth groups of HRMMS mice, with or without antipsychotic treatment, had decreased neuronal calcium activity, demonstrating primary visual cortex impairment. More notably, antipsychotic treatment did not normalize the impaired neuronal activities in the primary visual cortex. Correspondingly, the treatment did not improve the cognitive or behavioral impairment.ConclusionVisual cortex impairment might be a prominent feature of individuals at high risk of schizophrenia that cannot be normalized by early treatment with antipsychotic medication, indicating the presence of independent regulatory pathways for visual perception disturbance in schizophrenia. Thus, visual system impairment in schizophrenic patients must be further studied.

A Case Report in Teenager Age: Is Lying Position a Trigger of Visual Sensations In Alice in Wonderland Syndrome?

Alice in Wonderland Syndrome (AIWS) was named after the description of Lewis Carroll in his novel. In 1955, John Todd, a psychiatrist described this entity for the first time. Todd described it as “Alice's Adventures in Wonderland” by Lewis Carroll. The author Carroll suffered from severe migraine attacks. Alice in Wonderland Syndrome is a disorienting condition of seizures affecting the visual perception. AIWS is a neurological form of seizures influencing the brain, thereby causing a disturbed perception. Patients describe visual, auditory and tactile hallucinations and disturbed perceptions. The causes for AIWS are still not known exactly. Cases of migraine, brain tumors, depression episodes, epilepsy, delirium, psychoactive drugs, ischemic stroke, EBV, mycoplasma and malaria infections are correlating with AIWS like seizures. Neuroimaging studies reveal disturbance of brain regions including the temporoparietal junction, the temporal lobe and the occipital lobe as typical localization of the visual pathway. We present the case of a 17 years-old teenager from Canada, who describes his experience with AIWS-like visual disturbances in detail. The case report shed light on the presence of a lying position in Alice in Wonderland like visual sensations.