Functional Neurological Disorder?

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October 14, 2020 | 12 Comments

A recent RxISK post on SSRI triggered Movement Disorders – My Doctor Thinks I’m Faking It – put together by Stevie Lewis, attracted less attention than we expected.

This may be because it featured strange movements and few of us figure we are in a good position to make sense of strange movements.

The movements we featured don’t make sense to many neurologists, even sympathetic ones, either.  The most constructive response to Stevie’s post has been that there aren’t many paroxysmal spasmodic disorders in neurology and so it’s not clear how to categorise these movements.

Ironically, the original Hippocratic writings, which laid the basis for neurology, don’t talk about convulsions or fits even though they describe epilepsy – they talk about spasms.

And lots of people who take antidepressants have paroxysms of spasms.  Many people know about – myoclonic jerks – where a leg jerks out of the blue most often when we are about to fall asleep.  It has been known for decades this is more likely to happen in someone taking an antidepressant and not just happen once off but sometimes with a volley of jerks.

A 1959 paper on a series of imipramine patients reported:   One of these patients was a 39-year-old man who had previously been well… Prior to treatment he did not manifest symptoms of somatic abnormality, and the EEG was also normal. During the first 5 days of treatment he suffered from universal motor restlessness in the form of unintentional, coarse jerking movements. This disturbance intensified in spite of reduction in the dosage to such an extent that the patient was hardly able to descend the stairs or feed himself. When at its height, there were myoclonic jerks and jerky, throwing movements of the head and extremities. His gait reminded one of ataxia [impaired coordination] and on the whole he resembled a case of Huntington’s chorea. The pattern returned to normal shortly after [imipramine] had been stopped.

The paper reported that 1 in 5 patients… manifested motor disturbances.

Increasing attention is now being given to Osmotic Demyelination Syndrome and the role of antidepressants and other drugs in triggering this through their action on sodium ions and currents – see Grey Hair etc and Could your Antidepressant cause Dementia.

The point behind ODS is that it can strike anywhere in the nervous system which means that it can give completely different presentations from one person to the next – one person may seem to have atypical Parkinson’s, another atypical Steele-Richardson syndrome, and another atypical Motor Neurone Disease (ALS).

These difficulties play a part in the way neurologists respond to us when we present – a flavour of which can be got from responses to a post by Stevie Lewis on the Let’s Talk Withdrawal facebook page in June 2017 talking about neurological problems on withdrawal.

Neurologists

A significant number of people who have posted here mention that they have been referred to neurologists.  I was wondering if some of you would be willing to share in more detail about that experience.  We all have experiences in common with GP’s not believing that antidepressants lead us to suffer from adverse reactions and withdrawal.  Is it the same with the neurologists you have seen?  So my questions are:

  1. How many times have you seen a neurologist?
  2. What symptoms did you have that led to the referral?
  3. What drugs specifically do you think caused your problems?
  4. What was the neurologist’s diagnosis?
  5. What was the neurologist’s opinion about the role of the drug(s)?

KL

I saw neurologists many times for migraines. All they ever did was to put me on mind-altering drugs against my desire to have my mind altered.

FF

I have seen one neurologist (private) and waiting to see one on the NHS. Private neurologist was terrible. I am 4 years off a benzodiazepines and left unable to walk properly or to assimilate written information and speech. Also some other issues and my brain certainly does not feel right. Neurologist said that the drugs had nothing to do with my signs and symptoms. He tried to imply my sxs were psychological and I basically told him not to dare to suggest that. He did a cursory examination. He ordered an MRI scan at my request and nerve conduction tests. These were designed to eliminate possibilities and not to detect any current problems. He refused to discuss the subject of the drugs or to answer my questions. I wrote to him and told him I had no desire to see him again. He diagnosed neurological functional impairment but of course functional means “no biological basis” I have no doubt at all that he was lying to me.

I wrote to a neurologist in Edinburgh, Dr Jon Stone, about misinformation on his website about A/Ds. He said in his reply that he treated patients for A/D damage but his website portrayed A/Ds as unproblematic. There is no doubt that neurologists, GPs and psychiatrists are involved in covering this up to protect themselves legally.

MH

3 neurologists 3 different diagnosis. First one csf leak.  Second this lady thinks she is in protracted withdrawal and if not probable it is most likely (in writing) ignored by GP. Third this is functional and if you don’t stop blaming a drug you will not recover.

PW

I was 1st referred to a neurologist in 1988 for “recognised” benzo symptoms that were misdiagnosed as MS & attempted lumbar punctures went terribly wrong. I was wrongly injected twice with the Valium sedative injection into my spinal cord. Over the yrs as all symptoms were appearing to increase but for no obvious reason, and with my GP insisting all was psychological/ somatic – was referred to a neurologist who said dystonias & to keep me on low dose diazepam as it caused the least side effects.

Then after c6 yrs due to increasing muscle rigidities, heart palpitations, anxiety & insomnia my GP suddenly insisted I was an addict & only taking the meds to suit my lazy increasingly bedridden lifestyle. But GP ignored the neurologist. Instead continued yoyoing & then completely restricted meds, & as I & my physical symptoms worsened, he insisted withdrawal & that cold turkey was best. I’d had a mix of meds mainly D’pam & T-pam & pain relief since the injury for 27 yrs.

Cold Turkey resulted in massive seizure with complete paralysis etc & with a locked in type syndrome 8.3 yrs ago. Since then I’ve been left with all new brain & spinal cord problems, intermittent paralysis & a constant torturous autoimmune-type deterioration. With significant physical evidence.

I’ve been referred to neurologist very many times in the past 9 years, once before withdrawal when toxic & once after w/d & before seizure, with brain zaps & in particular emails & info sent from Prof Ashton warning of sx & esp c/t seizures. To date despite regular neuro appts for 9 years – with 8 episodes in hospital with serious brain & s/cord activity, paralysis, 45min scissor jerks, blackouts, foot drop, etc etc – 5 consultant neurologists & their associated teams each still dismiss & refuse direct benzodiazepine expert contact & information from Prof Ashton & CITA. & despite the BMA statement October 2016, I’m still told – never heard of anyone else suffering from these meds, & therefore all must be psychological. After massive seizure neuro said “either something very sinister going on or she’s a good actor. Time will tell. I prefer to think good actor”. He also said he knew Prof A & would speak to her. Instead refused her contact & CITAs nurse expert too who offered to come to talk at the hospital & explain & inform all neuro staff. 8 yrs on & with 8 episodes in hospital I’m visibly physically deteriorating & very much worse.

Neuros all insist it’s not the meds & because it’s a psychiatric medicine – therefore symptoms are not believed as real & must be all psychological.

AF

I was getting horrific tension headaches as saw a Neurologist in the 1990’s I was on benzo’s at the time… I had an MRI Scan… The Neurologist knew I was on benzo’s and over the counter pain killers Syndol… He reiterated I had classic tension headache symptoms and recommended continuing with the benzo and taking Amitriptyline! Found Amitryptyline disgusting so did not take it.  I’m wondering if it was passed off as Psychosomatic! The equivalent now is probably MUS…

SW

A neurologist diagnosed Dystonia in my neck!

EW

Not many if any doctors or specialists, neurologists or psychiatrists, etc., will ever blame psych drugs on severe drug related injuries. They do not want big pharma, medical associations, and colleagues, etc., coming down on them for blowing the whistle, nor do they want to testify in court on your behalf. Forget trying to get a medical diagnosis for your injuries, unless you find a willing naturopath to help you. And naturopaths are in fear for their lives, as they are being systematically killed by big pharma. Unfortunately, we’re on our own, and really there’s no cure but detoxing and time.

IV

I saw them 2 times, and they said it is impossible to meds damaged me and it is in my head

FM

I was not believed at all at UCLH neurology.

ZZ

I was diagnosed with non-epileptic dissociative seizures and complex regional pain syndrome, my trauma history is noted and when I brought up psych-meds, he said that is possible, I was referred to neuro-psychiatry, but I didn’t attend out of fear, I had a follow up and my case was closed.

PD

I’ve seen 4 different ones, the first was before I took any meds and I had paresthesia – strange sensations in my legs.  After a scan he basically said you’re fine go and enjoy your life. The second said the paresthesia (idiopathic – meaning you have it but we dont know why) may have been due to a virus and could go away over time, but as my MRI scan and nerve conductance studies were normal then to go away.

The third was after a failed trial on Citalopram and Sertraline gave me a movement disorder, he claimed I had “migraine with aura” plus anxiety and a myoclonus/movement disorder, no comment was made that it was due to meds but he did save my bacon as amitriptyline sorted the problem. I definitely did not have the movement disorder before trying Citalopram/Sertraline. I came off Amitriptyline due to a heart problem and had rebound and the movement disorder slowly came back.

I saw an NHS neurologist (the 4th) who said I have FND (Functional Neurological Disorder) and seemed to discredit the “Migraine with Aura ” diagnosis. So I am left somewhat confused on the diagnosis, all I know is there was some problem with my CNS before I took meds but that meds made it a whole lot worse. My mum had Parkinsons so I suspect I may not have great dopamine chemistry if one is to believe such things. And I suspect it is related to my gut function, over use of antibiotics and perotinitis at age 21. Now 54.

And from the Let’s Talk Withdrawal facebook page on 02 August 2020 following publication of  the Rxisk My Doctor Thinks I’m Faking it article.  

EH

I’ve been seeing a neurologist after having to struggle for a long time for an appointment. I’ve had cognitive tests which show problems but which have still been watered down. The neurologist told me my severe facial muscle spasms were hemifacial spasms. She also attributed it to anxiety and mood. The dishonesty has been astonishing. She doesn’t want to say it’s tardive dystonia. I first got diagnosed with hemifacial spasms and got referred to a ENT specialist for Botox for the neck Dystonia and it was he that diagnosed me with tardive dyskinesia. My facial movements have improved greatly even the eye pulling but unfortunately the TD has spread to other muscles in my body from my neck. It mainly effects my neck, arm, pelvic floor, lower back and buttock muscles but I do get the odd random spasms in my chest, stomach muscles and feet.

LT

Thank you Stevie. The video of you is a mirror image of me when my movements start. Thankfully not happened in a while now and hopefully as I’m tapering slow it will not come back.

What’s Up Doc?

A common theme coming from those being seen is expressed above by FF – neurologists are engaged in a cover-up.  The words engaged and cover-up suggests something deliberate.

The question is – is it any more deliberate than belief in a religion whether it be atheism, progressivism, islam or christianity.  Few of us can live without beliefs.

But we do seem to have a new belief system in medicine.  If you bring a problem to them, doctors are increasingly incapable of seeing anything other than a disease for which they can only use the sacraments that are indicated.

A sacrament is something that can only do good.  It cannot harm.  The sacraments are how doctors heal people.

If we go to them suicidal, anxious, or depressed, they see Depression and Anxiety for which the treatments are anxiolytics and antidepressants – they do not see toxicity because there is no treatment licensed for toxicity.  This is true for good doctors like those who were treating Stephen O’Neill.

There is no entry in the Holy Book for them to follow if they make a diagnosis of drug induced toxicity.

In the same way, if you are jerking or having spasms, they consult the Holy Books and if your condition doesn’t map onto what is there, it must be a mental problem.

Twenty years ago, neurologists came up with the idea of Functional Neurological Disorder relatively recently.  This began life as something like Medically Unexplained Symptoms.  For some people at least these were genuine efforts to concede that the doctor didn’t know what was going on but its very difficult to hang onto this position and the default is into seeing the patient as the problem rather than a problem in the patient.

And so, now, if there is no treatment approved for SSRI induced movement disorders, most of them will feel the only way to get you treated is to refer you to a psychologist or psychiatrist, when what we want is to be seen and perhaps even to be regarded as an interesting specimen that might warrant close attention.

A century ago, F Scott Fitzgerald remarked that it is a sign of a sophisticated mind to be able to entertain two contradictory thoughts at the same time.  Up to 40 years ago, doctors used to be able to do this easily – even though they weren’t all that bright.  Now the brightest of the bright young things who get into medicine find this difficult.

Managing this rather than trying to expose a cover-up is the problem that those of us on the receiving end need to learn to grapple with.

 

 



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Comments

  1. Real ‘lorraine’

    Simon Wessely Retweeted

    Tom Pollak
    @tompollak

    It’s breathtaking to see how much awareness and understanding of FND has changed, even in the 12 yrs I’ve been a doctor. Testament to amazing patient activism in the face of enormous stigma but also to a body of researchers who excel at both the science and at communicating it.

    FNDHopeUK
    @FNDHopeUK

    “FND Hope UK’s Patron @reallorraine launches our new exciting campaign #FNDandUs, keep watching our channels for the campaign and find out more at http://fndhope.org/fndandus

    https://twitter.com/FNDHopeUK/status/1316665119150166018

    you’ve never heard of …

    Reply

  2. News
    Doxycycline: Coroner calls for MHRA to review side effects after student jumped from plane
    BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4102 (Published 22 October 2020)

    Clare Dyer

    A senior coroner has demanded action from the Medicines and Healthcare Products Regulatory Agency after a student who had taken an antimalarial drug jumped from a plane to her death.

    Alana Cutland, 19, a natural sciences student at Cambridge University, was doing an internship in Madagascar when she had several attacks of paranoia.

    She had spoken to her parents and was about to fly home to the UK after cutting her internship short in July 2019 when she travelled in the Cessna light aircraft. She opened one of the plane’s doors and, despite attempts by the pilot and the other passenger to restrain her, …

    Reply

    • Here is the full text of the BMJ piece

      A senior coroner has demanded action from the Medicines and Healthcare Products Regulatory Agency after a student who had taken an antimalarial drug jumped from a plane to her death.

      Alana Cutland, 19, a natural sciences student at Cambridge University, was doing an internship in Madagascar when she had several attacks of paranoia.

      She had spoken to her parents and was about to fly home to the UK after cutting her internship short in July 2019 when she travelled in the Cessna light aircraft. She opened one of the plane’s doors and, despite attempts by the pilot and the other passenger to restrain her, leapt from the plane.

      An inquest into her death determined that the cause was “traumatic injuries following a fall from a plane” but heard that she had been prescribed doxycycline as an antimalarial drug.

      Tom Osborne, senior coroner for Milton Keynes, wrote in his inquest report, “The deceased was prescribed doxycycline as an antimalarial medication for use whilst in Madagascar. It was quite apparent from the evidence that she had a psychotic reaction as a result of taking the drug and yet there is nothing on the drug information leaflet that either highlights or mentions this possibility.

      “If she or her parents had been aware of this possible side effect they may have been able to intervene earlier to avoid her death. In my view the information sent out with the drug should be reviewed. In my opinion action should be taken to prevent future deaths and I believe . . . your organisation [has] the power to take such action.”

      Doxycycline is a tetracycline antibiotic that can also be used to prevent malaria. The National Institute for Health and Care Excellence website lists anxiety as a rare side effect but doesn’t mention psychotic reactions.

      Coroners are under a duty to send reports, known as regulation 28 reports, to individuals or organisations they believe to be in a position to take action if their investigation reveals a risk that other deaths will occur in similar circumstances.

      An MHRA spokesperson said it had been granted an extension to the deadline for replying to the coroner’s demand for action “in order to seek independent expert advice.” The spokesperson added, “We are currently reviewing the available evidence on the suspected association between doxycycline and psychotic disorder. This is because psychotic disorders are not currently a recognised side effect of this drug.

      “We have informed the coroner that our review is ongoing, and any regulatory action will be communicated to healthcare professionals and patients. Malaria can be a very serious, sometimes fatal, infection. It is important that people travelling to areas that pose a risk of infection receive appropriate antimalarial prophylaxis.

      “Doxycycline has been authorised for the prevention of malaria and also for the treatment of bacterial infections and skin disorders such as acne for over 50 years. During that time many millions of people have taken it. The balance of benefits and risks for doxycycline is considered to be positive. Patient safety is our highest priority so, as with all medicines, we keep the product information for doxycycline under review.”

      Reply

  3. We’ve just had a prescription for Doxycycline un our house. My husband was prescribed an antibiotic for a chest infection but was no better a couple of weeks after completing the course. Face to face discussions are rare at the moment of course, so, after sending a report to eConsult explaining the situation, Brian had a phonecall from one of the surgery nurses explaining that “the doctor has prescribed a course of a different antibiotic which will be at the pharmacy this afternoon”.
    On picking up the prescription I felt that the name of the “new antibiotic” was familiar. Once home I looked through the blogs on David’s site and there it was – ‘Doxycycline and Stephen O’Neill’.
    Luckily Brian was mentally fine on it but was annoyed that noone had explained what this “new antibiotic” was – neither nurse nor pharmacist had uttered a word about it. Anyway, as time went on he complained of a pain in an elbow and knee. This got to a point where even the weight of the duvet was uncomfortable. Out came the PIL once more and, sure enough, ‘joint and muscle aches’ were there on the ‘stop taking immediately and inform your doctor’ list. He had only one tablet left but, even so, eConsulted once more to explain. Back came the message to throw the last tablet away!
    If the PIL info was so important that taking a last tablet was not advisable, shouldn’t someone have just hinted that reading the PIL info in this instance was very important? Another example of dishing these drugs out like smarties without a care about the possible reactions I guess.

    Reply

  4. A lot of these posts mention benzodiazepines. I had a terrible experience with clonazepam many years ago. I was only on it for 4 1/2 months. But it affected me in many ways for up to 2 years, I believe. The effects were the worst when I first discontinued the drug. Symptoms included:

    Difficulty tolerating-

    -riding in a car on a winding road
    -watching tv if images were flashed in quick succession and/or dialogue was fast
    -social situations, like a restaurant
    -being at a store, like Target, because the stimulation caused too much anxiety
    -making a phone call to a friend because it was too nerve wracking

    After being on clonazepam for a few months, then discontinuing it, I was a raw nerve for months and months, maybe years (it faded very gradually).

    My anxiety after discontinuing the med was 3 times what it was compared to what it was before I started the med.

    Also, during the ”after med” period I experienced months and months and months and months of daily suicidal thinking. This was something else that was new. Previous to taking clonazepam, I had experienced suicidal thoughts. But they were limited to a few hours here or there once in a while.

    I ended up having to go into the hospital during the end of the clonazepam taper. That was a first.

    Clonazepam darn near precipitated a suicide attempt. I am very lucky that I didn’t sink quite that low. But it’s not because I’m a hero, IMO. I simply feel fortunate.

    Please note that I took the clonazepam as prescribed. Also, I wasn’t drinking or taking any recreational drugs at the time either. I was, however, taking Zoloft.

    But I’m grateful to report that I have a pretty good life today. A wife, kids, house, and 2 cats.

    Thank you for reading.

    Reply

  6. Mary, thank you for your interesting post – a Recap and a Knee-Cap…

    An MHRA spokesperson said it had been granted an extension to the deadline for replying to the coroner’s demand for action “in order to seek independent expert advice.”

    A series of case reports presented by Atigari, Hogan, and Healy (2013) document the unexpected onset of depression and suicidality among 3 doxycycline users with no history of neuropsychiatric disorders or symptoms.  After initiation of doxycycline treatment, all 3 users became depressed and suicidal, followed by suicidal actions and death in 2 of the 3 patients.

    https://mentalhealthdaily.com/2018/08/04/doxycycline-causes-depression-anxiety-suicidal-ideation/

    https://rxisk.org/wp-content/uploads/2020/01/2013-doxycycline-bcr-2013-200723.full_.pdf

    In less than 5 minutes of sending the aforementioned text message, Patient A jumped off a school building near his home which resulted in death.  No warning signs of suicide (e.g. abnormal behaviors, statements, etc.) were noticed by Patient A’s family and friends leading up to his death.

    this case supports the idea that doxycycline may cause depression and suicidality.

     Patient C commit suicide via hanging.  This case further supports the idea that doxycycline can cause severe depression and suicidality in select persons.

    A month after Stephen’s inquest, an horrific death of a young woman grabbed the attention of many people, not just in the UK.  The drug she was on – doxycycline – was immediately in the frame. I was asked to provide a report and another coroner had to come to a conclusion.  Could he find a Sanity Clause?

    https://davidhealy.org/doxycycline-and-stephen-oneill/

    Welcome to AntiDepAware

    Latest news: Coroner submits PFD Report following death of student who jumped from light aircraft in Madagascar after being prescribed Doxycycline

    5 CORONER’S CONCERNS The MATTERS OF CONCERNS are as follows: The deceased was prescribed doxycycline as an antimalarial medication for used whilst in Madagascar. It was quite apparent from the evidence that she had a psychotic reaction as a result of taking the drug and yet there is nothing on the drug information leaflet that either highlights or mentions this possibility. If she or her parents have been aware of this possible side-effect they may have been able to intervene earlier to avoid her death. In my view the information sent out with the drug should be reviewed.

    https://www.judiciary.uk/wp-content/uploads/2020/10/Alana-Cutland-2020-0151_Redacted.pdf

    “The balance of benefits and risks for doxycycline is considered to be positive. …

    Reply

  7. 04 November 2020
    Jill Nickens
    Founder, Akathisia Alliance for Education and Research
    P.O. Box 180415, Utica, MI 48318
    Respond to this article
    Read all responses to this articleA functional neurological misdiagnosis, akathisia, and suicide
    Re: Recognising and explaining functional neurological disorder Jon Stone, Chris Burton, Alan Carson. 371:doi 10.1136/bmj.m3745
    Dear Editor,

    The purpose of this response is to shed light on the significant harm that can be caused by a functional neurological disorder (FND) misdiagnosis, especially in the case of akathisia, and to challenge the authors’ claim that it is rarely misdiagnosed.

    In Psychogenic Explanations of Physical Illness: Time to Examine the Evidence (2016) [1], Wilshire and Ward state what should be obvious, “Medical practitioners simply cannot assume that the current knowledge of disease and its markers is 100% perfect or that all complaints not otherwise accounted for must have a psychological origin.” Stone, et al. cite a “systematic review” from 2005 [2], also co-authored by Stone, which concluded that only 4% of patients diagnosed with FND are misdiagnosed. This was based upon the fact that the patients included in the study had not later been diagnosed with an established organic neurological disorder. Although the authors seemingly use this statistic to purport the accuracy of the FND clinical assessment, it simply proves there was still no medical explanation for the patients’ symptoms years later, not that one did not exist.

    As founder of the Akathisia Alliance for Education and Research, I represent thousands of people who are being misdiagnosed with FND by clinicians who have little to no knowledge of medication-induced akathisia. This is causing catastrophic harm in many cases. Already suffering from the suicidality inherent in akathisia, the FND misdiagnosis can result in loss of family support, abandonment, mistreatment, homelessness, involuntary hospitalizations, and forced drugging with medications that exacerbate the symptoms and increase the likelihood of suicide.

    Patients with akathisia are being misdiagnosed by neurology as psychogenic/functional primarily because their motor symptoms can be distractible and suppressible, yet these are positive, documented features of this medication-induced disorder (Factor, Jankovic, 2020) [3]. It is well documented that certain neurotransmitters and neuropeptides affect physiological as well as psychological processes (Shu-Heng, Li-Peng, Xu, et al., 2020; Bamalan, Al-Khalili, 2020) [4,5]. Thus, it stands to reason that side effects and withdrawal symptoms of commonly prescribed medications such as antiemetics, antipsychotics, antidepressants, benzodiazepines, etc., could be multi-systemic and organic, and undetectable upon clinical assessment.

    On behalf of the many people being harmed by the FND diagnosis, I hope the authors and their colleagues will begin spending more time looking for an explanation for “medically unexplained symptoms” and less time training clinicians based on the assumption that every possible neurological disorder has already been discovered. Many lives could be saved.
    04 November 2020
    Respond to this

    And in Evidence-Based Medicine another cause of concern is below, especially perhaps as Andrea Cipriani is involved
    ie in
    Evidence-Based Mental Health
    Home Archive Volume 23, Issue 4
    Article Text
    Association between mental disorders and somatic conditions: protocol for an umbrella review
    http://orcid.org/0000-0001-5877-8075Samuele Cortese1,2,3,4,5,6, http://orcid.org/0000-0003-4877-7233Marco Solmi7,8, Gonzalo Arrondo9, http://orcid.org/0000-0001-5179-8321Andrea Cipriani10,11, Paolo Fusar-Poli8,12,13,14, Henrik Larsson15,16, Christoph Correll17,18,19
    Author affiliations
    Abstract
    Introduction Although several systematic reviews (SRs)/meta-analyses (MAs) on the association between specific mental disorders and specific somatic conditions are available, an overarching evidence synthesis across mental disorders and somatic conditions is currently lacking. We will conduct an umbrella review of SRs/MAs to test: 1) the strength of the association between individual mental disorders and individual somatic conditions in children/adolescents and adults; 2) to which extent associations are specific to individual mental and somatic conditions .

    Methods and analysis We will search a broad set of electronic databases and contact study authors. We will include SRs with MA or SRs reporting the effect size from individual studies on the association between a number of somatic and mental conditions (as per the International Classification of Diseases, 11th Revision). We will follow an algorithm to select only one SR or MA when more than one are available on the same association. We will rate the quality of included SRs/MAs using the AMSTAR-2 tool. We will assess to which extent mental disorders are selectively associated with specific somatic conditions or if there are transdiagnostic, across-spectra or diagnostic spectrum-specific associations between mental disorders and somatic conditions based on the Transparent, Reporting, Appraising, Numerating, Showing (TRANSD) recommendations.
    Discussion The present umbrella review will shed light on the association between mental health disorders and somatic conditions, providing useful data for the care of patients with mental health disorders, in particular for early detection and intervention. This work might also add insight to the pathophysiology of mental health conditions, and contribute to the current debate on the value of a transdiagnostic approach in psychiatry.

    Contributors SC drafted the protocol. SC, MS, AC, PF-P and CC elaborated the algorithm. SC, MS, GA, AC, HL, PF-P and CC critically revised the first draft of the protocol.

    Reply

  8. Alana Cutland: Parents’ shock over malaria drug behind plane fall

    By Phil Shepka

    BBC News

    6 hours ago

    https://www.bbc.co.uk/news/uk-england-beds-bucks-herts-54818652

    The parents of a student who fell from a plane after a psychotic reaction to an anti-malaria drug were “shocked” to find its side effects were “virtually undocumented”.

    Alana Cutland, 19, from Milton Keynes, died after the fall in July 2019 in Madagascar.

    A coroner has asked for a review of the information sent out with doxycycline.

    The Medicines and Healthcare Products Regulatory Agency (MHRA) said it was gathering “further information”.

    The Cambridge University student was at the end of her second year studying biological natural sciences when she visited the African island for a research internship.

    She opened the door during a flight between Anjajavay and Antananarivo and fell to her death, a prevention of future deaths report by senior coroner for Milton Keynes Tom Osborne said.

    Mr Osborne said it is believed that she “suffered a psychotic/delirium event that led to her behaviour and death”.

    He said it was “quite apparent” the reaction was as a result of taking the drug and yet there was “nothing on the drug information leaflet that either highlights or mentions this possibility.”

    “If she or her parents have been aware of this possible side-effect they may have been able to intervene earlier to avoid her death,” he added.

    Her parents Neil and Alison Cutland said it was “tragic” that Alana’s death was “essentially caused by the side effects of doxycycline”.

    “We realise that such drugs have an important role to play, but it shocked us to discover that such a severe side effect could be virtually undocumented,” they said in a statement.

    Doxycycline has been authorised as an anti-malaria drug for more than 50 years. It is also prescribed to treat bacterial infections and skin disorders.

    An MHRA spokeswoman said they had reviewed the “suspected association between doxycycline and psychotic disorder” after the coroner’s report and work was “continuing”.

    She said: “Our independent expert committee has advised that the available evidence is currently insufficient to support a causal association, and has asked us to gather further information.”

    Mr and Mrs Cutland said they have been “surrounded by the love and support of countless people” since their daughter’s death.

    “We rejoice in Alana’s life: her amazing talent for modern dance and ballet, her academic achievements that made us so proud, and the sheer sense of fun that she brought to every room that she walked into.”

    They said they were “hugely grateful” after raising more than £33,000 towards a grant fund in her name at Robinson College for female science undergraduates and a school extension in Anjajavay “where the villagers went to extraordinary lengths to search for her”.

    “We think of Alana every single day and miss her dearly. It gives us comfort to know that her legacy is already so significant and will truly change lives in Madagascar and Cambridge through the power of education.”

    Reply

  9. The following podcast, gives us insight, as to how many Veterans suffer mentally/physically, from many years of intense duty.

    https://podcasts.apple.com/au/podcast/justin-sheffield-u-s-navy-seal-afghanistan-iraq-somalia/id268683465

    Justin, reaches many, from his adversity and is able to help many Veterans through the All Eagles Oscar Foundation, he has set up.
    We must not forget our Veterans and how over prescribing can take a toll on their mental well being.
    After 14 years of combat as US Navy Seal Veteran, Justin Scheffield, highlights how wars have impacted his life.
    Mentally and physically, he has tried to adjust to life after combat.
    Sadly, when he returned back home, he felt like committing suicide.
    Being home more, after service, he was prescribed a lot of medication where he felt like a zombie. This was very problematic.
    Justin goes on to explain that you have to be very careful with what you take because you are going to be prescribed all kinds of things.
    Justin is trying to educate people about over prescribing of medicines.
    Justin said he can get Oxy from the VA for pain however, he chooses not to. He chooses to use other things.
    Many Veterans suffer from PTSD and want to keep it a secret. It is a state of being, that is not good.
    The medication had helped for a while however, many have killed themselves because of being at home and being depressed.
    Now, Veterans have a new therapy which guides the military, guys, buddies and people who listen to his podcast.
    Justin had a feelings of suicide for a long time.
    Part of it is feeling like a failure and he was physically hurting all the time.
    A lot of the time he was thinking what he was going to do.
    At times, he felt like a failure and a looser.
    PTSD is something that a lot of Veterans are ashamed of.
    Part of his job is to talk to Veterans who have been through this. Many have kept it a secret because they are not going to look tough anymore because they have this problem.
    PTSD makes people not sleep, they sweat and have nightmares. Justin goes on to saying that it’s this state of being, that is just not good. It is treatable.
    Time and space helps.
    Friends and teammates get together for therapy instead of taking a pill to sleep or other pills to help them deal with the trauma.
    Some of the things they are doing with the Foundation is phenomenal.
    Multiple friends and teammates, from all different branches of service have been treated and they have experienced positive results.
    Justin, goes on to say that it is not a cure however, Veterans sleep on their own, without medication and are able to focus instead of taking some other prescribed medication.
    The medication is good for a short time – it helps however, how many men are killing themselves?
    Justin knows many guys who have killed themselves and going military wide – It is crazy!
    Part of the feeling is that you are on top and you are at war and then all of a sudden it is all over. Suddenly, you are at home.
    Justin was shooting people. They are in for his life and then reality hits him and he is at home, sitting in his living room, thinking what is he supposed to do? This is a morbid feeling that many Veterans face.
    All of this has an effect on your physical and mental well being.
    There is a lot of shame associated with feeling like a failure and failing your team.
    Justin goes on to explaining that he was just another guy they relied on and now you can’t be that guy for them or their family. It is so easy to get to suicide.
    Once Justin found the therapy he needed, with the strength of his wife, family, faith and all the resources he had, he decided to turn things around and do something positive to help others.
    That is when the All Eagles Oscar Foundation comes in. The Foundation stands for: All of us are OK.
    Justin started the Foundation because when he went through treatment, there was nothing to pay for it.
    There are several foundations that are helping many Veterans.
    Sadly, there have been many Veterans that have wanted to commit suicide.
    When Justin takes them under his wing, he witnesses amazing results.
    Justin had good friends, family and children.
    He had a lot of reasons to not end his precious life.
    He had to talk to a lot of Veterans out of a negative mindset they have.
    Veterans end up doing many good things for other people.
    Justin is a huge advocate for cannabis (CBD).
    Justin said it certainly helps with pain and anxiety.
    Sadly, the pharmaceuticals are making too much money off Veterans.
    Many of the Veterans are put in the brain treatment centre and are being treated with magnetic resonance therapy. As you relax or fall asleep, magnetic resonance therapy, repairs your cells on a molecular level. It restores the cells to their greatest level of vibration. Or simply put, it helps your body work the way it was meant to.
    Over time, it influences neuron dysfunction back to everything working.
    The Foundation produces amazing results.
    Veterans have hope, that there are answers for them.
    It is sad to know that many Veterans are killing themselves, more than in combat.
    The Foundation helps Veterans overcome this.
    Thank you, Justin for helping our fellow man, re-enter civilian life, with hope and dignity. Justin gives as an honest insight into the dilemmas that many Veterans and their families face after intense military service.

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