SARA ECHEVERRI - Academia.edu (original) (raw)

Papers by SARA ECHEVERRI

Research paper thumbnail of Towards a Trauma Subtype of Functional Neurological Disorder: Impact on Symptom Severity and Physical Health (P5-12.007)

Research paper thumbnail of Corrigendum: Toward a possible trauma subtype of functional neurological disorder: impact on symptom severity and physical health

Research paper thumbnail of Toward a possible trauma subtype of functional neurological disorder: impact on symptom severity and physical health

Frontiers in Psychiatry

BackgroundAs a group, individuals with functional neurological disorder (FND) report an approxima... more BackgroundAs a group, individuals with functional neurological disorder (FND) report an approximately 3-fold increase in adverse life experiences (ALEs) compared to healthy controls. In patients with FND, studies have identified a positive correlation between symptom severity and the magnitude of ALEs. While not all individuals with FND report ALEs, such findings raise the possibility of a trauma-subtype of FND.ObjectiveThis study investigated if patients with FND, with or without probable post-traumatic stress disorder (PTSD) and/or significant childhood maltreatment, differed in their symptom severity and physical health.Materials and methodsSeventy-eight patients with FND were recruited (functional seizures, n = 34; functional movement disorder, n = 56). Participants completed self-report measures of symptom severity [Somatoform Dissociation Questionniare-20 (SDQ-20), Screening for Somatoform Disorders: Conversion Disorder subscale (SOMS:CD), Patient Health Questionniare-15 (PHQ-...

Research paper thumbnail of A new science of emotion: implications for functional neurological disorder

Brain

Functional neurological disorder reflects impairments in brain networks leading to distressing mo... more Functional neurological disorder reflects impairments in brain networks leading to distressing motor, sensory and/or cognitive symptoms that demonstrate positive clinical signs on examination incongruent with other conditions. A central issue in historical and contemporary formulations of functional neurological disorder has been the mechanistic and aetiological role of emotions. However, the debate has mostly omitted fundamental questions about the nature of emotions in the first place. In this perspective article, we first outline a set of relevant working principles of the brain (e.g. allostasis, predictive processing, interoception and affect), followed by a focused review of the theory of constructed emotion to introduce a new understanding of what emotions are. Building on this theoretical framework, we formulate how altered emotion category construction can be an integral component of the pathophysiology of functional neurological disorder and related functional somatic sympt...

Research paper thumbnail of Using the Biopsychosocial Model to Guide Patient-Centered Neurological Treatments

Seminars in Neurology

The biopsychosocial model was defined by George L. Engel to propose a holistic approach to patien... more The biopsychosocial model was defined by George L. Engel to propose a holistic approach to patient care. Through this model, physicians can understand patients in their context to aid the development of tailored, individualized treatment plans that consider relevant biological, psychological, and social–cultural–spiritual factors impacting health and longitudinal care. In this article, we advocate for the use of the biopsychosocial model in neurology practice across outpatient and inpatient clinical settings. To do so, we first present the history of the biopsychosocial model, and its relationships to precision medicine and deep phenotyping. Then, we bring the neurologist up-to-date information on the components of the biopsychosocial clinical formulation, including predisposing, precipitating, perpetuating, and protective factors. We conclude by detailing illustrative neurological case examples using the biopsychosocial model, emphasizing the importance of considering relevant psyc...

Research paper thumbnail of Sensory Processing Difficulties in Patients with Functional Neurological Disorder: Occupational Therapy Management Strategies and Two Cases

Seminars in Pediatric Neurology, 2022

Functional neurological disorder (FND) is a condition at the intersection of neurology and psychi... more Functional neurological disorder (FND) is a condition at the intersection of neurology and psychiatry, with some patients experiencing sensory hypersensitivities and other sensory processing difficulties. It has been postulated that poor integration and modulation of sensory information with cognitive, affective and behavioral processes may play a role in the pathophysiology of FND. In this article, we first succinctly review the role for occupational therapy (OT) in the multidisciplinary therapeutic approach to managing patients with FND. After highlighting previously published data identifying sensory processing difficulties in patients with FND, we subsequently outline the components of the sensory-based outpatient OT program for FND at the Massachusetts General Hospital. Here, we detail how occupational therapists assess and treat sensory modulation difficulties with the aid of resources like the Adolescent/Adult Sensory Profile (AASP), The Canadian Occupational Performance Measure (COPM), and the Sensory-Motor Preference Checklist. We then report on 2 clinical cases representative of the sensory modulation difficulties endorsed by some patients with FND, illustrating how developing an individualized, sensory-based treatment plan can help improve functional neurological symptoms and overall participation in activities of daily living. Prospective, controlled research is needed to further operationalize OT-based sensory modulation interventions, as well as define the tolerability and efficacy of this intervention for pediatric and adult populations with FND.

Research paper thumbnail of Are Functional (Psychogenic Nonepileptic) Seizures the Sole Expression of Psychological Processes?

Current Topics in Behavioral Neurosciences, 2021

Functional [psychogenic nonepileptic/dissociative] seizures (FND-seiz) and related functional neu... more Functional [psychogenic nonepileptic/dissociative] seizures (FND-seiz) and related functional neurological disorder subtypes were of immense interest to early founders of modern-day neurology and psychiatry. Unfortunately, the divide that occurred between the both specialties throughout the mid-twentieth century placed FND-seiz at the borderland between the two disciplines. In the process, a false Cartesian dualism emerged that labeled psychiatric conditions as impairments of the mind and neurological conditions as disturbances in structural neuroanatomy. Excitingly, modern-day neuropsychiatric perspectives now consider neurologic and psychiatric conditions as disorders of both brain and mind. In this article, we aim to integrate neurologic and psychiatric perspectives in the conceptual framing of FND-seiz. In doing so, we explore emerging relationships between symptoms, neuropsychological constructs, brain networks, and neuroendocrine/autonomic biomarkers of disease. Evidence suggests that the neuropsychological constructs of emotion processing, attention, interoception, and self-agency are important in the pathophysiology of FND-seiz. Furthermore, FND-seiz is a multi-network brain disorder, with evidence supporting roles for disturbances within and across the salience, limbic, attentional, multimodal integration, and sensorimotor networks. Risk factors, including the magnitude of previously experienced adverse life events, relate to individual differences in network architecture and neuroendocrine profiles. The time has come to use an integrated neuropsychiatric approach that embraces the closely intertwined relationship between physical health and mental health to conceptualize FND-seiz and related functional neurological disorder subtypes.

Research paper thumbnail of Autonomic, Endocrine, and Inflammation Profiles in Functional Neurological Disorder: A Systematic Review and Meta-Analysis

The Journal of Neuropsychiatry and Clinical Neurosciences, 2021

Functional neurological disorder (FND) is a core neuropsychiatric condition. To date, promising y... more Functional neurological disorder (FND) is a core neuropsychiatric condition. To date, promising yet inconsistently identified neural circuit profiles have been observed in patients with FND, suggesting important gaps remain in our systems-level neurobiological understanding. As such, other important physiological variables including autonomic, endocrine and inflammation findings need to be contextualized for a more complete mechanistic picture. Here, we performed a systematic review and meta-analysis of available case-control and cohort studies in FND. PubMed, PsycINFO and Embase databases were searched from January 1, 1900 to September 1, 2020 for studies that investigated autonomic, endocrine and/or inflammation markers in patients with FND. Sixty-six of 2,056 screened records were included in the review representing 1,699 patients, with data from 23 articles used in meta-analyses. Findings show that children/adolescents with FND vs. healthy controls (HCs) have increased resting heart rate; there is also a tendency towards reduced resting heart rate variability in patients with FND across the lifespan vs. HCs. In adults, peri-ictal heart rate differentiated those with functional seizures from individuals with epileptic seizures. Other autonomic and endocrine profiles in patients with FND were heterogeneous, with several studies highlighting the importance of individual differences. Inflammation research in FND remains in its early stages. Moving forward, there is a need to use larger sample sizes to consider *

Research paper thumbnail of Briquet syndrome revisited: implications for functional neurological disorder

Brain Communications, 2020

With the creation of the Somatic Symptom and Related Disorders category of the Diagnostic and Sta... more With the creation of the Somatic Symptom and Related Disorders category of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition in 2013, the functional neurological (symptom) disorder diagnostic criteria underwent transformative changes. These included an emphasis on ‘rule-in’ physical examination signs/semiological features guiding diagnosis and the removal of a required proximal psychological stressor to be linked to symptoms. In addition, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder, somatoform pain disorder and undifferentiated somatoform disorder conditions were eliminated and collapsed into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition somatic symptom disorder diagnosis. With somatic symptom disorder, emphasis was placed on a cognitive-behavioural (psychological) formulation as the basis for diagnosis in individuals reporting distressing bodily symptoms such as pain and/or fatigue...

Research paper thumbnail of Towards a Trauma Subtype of Functional Neurological Disorder: Impact on Symptom Severity and Physical Health (P5-12.007)

Research paper thumbnail of Corrigendum: Toward a possible trauma subtype of functional neurological disorder: impact on symptom severity and physical health

Research paper thumbnail of Toward a possible trauma subtype of functional neurological disorder: impact on symptom severity and physical health

Frontiers in Psychiatry

BackgroundAs a group, individuals with functional neurological disorder (FND) report an approxima... more BackgroundAs a group, individuals with functional neurological disorder (FND) report an approximately 3-fold increase in adverse life experiences (ALEs) compared to healthy controls. In patients with FND, studies have identified a positive correlation between symptom severity and the magnitude of ALEs. While not all individuals with FND report ALEs, such findings raise the possibility of a trauma-subtype of FND.ObjectiveThis study investigated if patients with FND, with or without probable post-traumatic stress disorder (PTSD) and/or significant childhood maltreatment, differed in their symptom severity and physical health.Materials and methodsSeventy-eight patients with FND were recruited (functional seizures, n = 34; functional movement disorder, n = 56). Participants completed self-report measures of symptom severity [Somatoform Dissociation Questionniare-20 (SDQ-20), Screening for Somatoform Disorders: Conversion Disorder subscale (SOMS:CD), Patient Health Questionniare-15 (PHQ-...

Research paper thumbnail of A new science of emotion: implications for functional neurological disorder

Brain

Functional neurological disorder reflects impairments in brain networks leading to distressing mo... more Functional neurological disorder reflects impairments in brain networks leading to distressing motor, sensory and/or cognitive symptoms that demonstrate positive clinical signs on examination incongruent with other conditions. A central issue in historical and contemporary formulations of functional neurological disorder has been the mechanistic and aetiological role of emotions. However, the debate has mostly omitted fundamental questions about the nature of emotions in the first place. In this perspective article, we first outline a set of relevant working principles of the brain (e.g. allostasis, predictive processing, interoception and affect), followed by a focused review of the theory of constructed emotion to introduce a new understanding of what emotions are. Building on this theoretical framework, we formulate how altered emotion category construction can be an integral component of the pathophysiology of functional neurological disorder and related functional somatic sympt...

Research paper thumbnail of Using the Biopsychosocial Model to Guide Patient-Centered Neurological Treatments

Seminars in Neurology

The biopsychosocial model was defined by George L. Engel to propose a holistic approach to patien... more The biopsychosocial model was defined by George L. Engel to propose a holistic approach to patient care. Through this model, physicians can understand patients in their context to aid the development of tailored, individualized treatment plans that consider relevant biological, psychological, and social–cultural–spiritual factors impacting health and longitudinal care. In this article, we advocate for the use of the biopsychosocial model in neurology practice across outpatient and inpatient clinical settings. To do so, we first present the history of the biopsychosocial model, and its relationships to precision medicine and deep phenotyping. Then, we bring the neurologist up-to-date information on the components of the biopsychosocial clinical formulation, including predisposing, precipitating, perpetuating, and protective factors. We conclude by detailing illustrative neurological case examples using the biopsychosocial model, emphasizing the importance of considering relevant psyc...

Research paper thumbnail of Sensory Processing Difficulties in Patients with Functional Neurological Disorder: Occupational Therapy Management Strategies and Two Cases

Seminars in Pediatric Neurology, 2022

Functional neurological disorder (FND) is a condition at the intersection of neurology and psychi... more Functional neurological disorder (FND) is a condition at the intersection of neurology and psychiatry, with some patients experiencing sensory hypersensitivities and other sensory processing difficulties. It has been postulated that poor integration and modulation of sensory information with cognitive, affective and behavioral processes may play a role in the pathophysiology of FND. In this article, we first succinctly review the role for occupational therapy (OT) in the multidisciplinary therapeutic approach to managing patients with FND. After highlighting previously published data identifying sensory processing difficulties in patients with FND, we subsequently outline the components of the sensory-based outpatient OT program for FND at the Massachusetts General Hospital. Here, we detail how occupational therapists assess and treat sensory modulation difficulties with the aid of resources like the Adolescent/Adult Sensory Profile (AASP), The Canadian Occupational Performance Measure (COPM), and the Sensory-Motor Preference Checklist. We then report on 2 clinical cases representative of the sensory modulation difficulties endorsed by some patients with FND, illustrating how developing an individualized, sensory-based treatment plan can help improve functional neurological symptoms and overall participation in activities of daily living. Prospective, controlled research is needed to further operationalize OT-based sensory modulation interventions, as well as define the tolerability and efficacy of this intervention for pediatric and adult populations with FND.

Research paper thumbnail of Are Functional (Psychogenic Nonepileptic) Seizures the Sole Expression of Psychological Processes?

Current Topics in Behavioral Neurosciences, 2021

Functional [psychogenic nonepileptic/dissociative] seizures (FND-seiz) and related functional neu... more Functional [psychogenic nonepileptic/dissociative] seizures (FND-seiz) and related functional neurological disorder subtypes were of immense interest to early founders of modern-day neurology and psychiatry. Unfortunately, the divide that occurred between the both specialties throughout the mid-twentieth century placed FND-seiz at the borderland between the two disciplines. In the process, a false Cartesian dualism emerged that labeled psychiatric conditions as impairments of the mind and neurological conditions as disturbances in structural neuroanatomy. Excitingly, modern-day neuropsychiatric perspectives now consider neurologic and psychiatric conditions as disorders of both brain and mind. In this article, we aim to integrate neurologic and psychiatric perspectives in the conceptual framing of FND-seiz. In doing so, we explore emerging relationships between symptoms, neuropsychological constructs, brain networks, and neuroendocrine/autonomic biomarkers of disease. Evidence suggests that the neuropsychological constructs of emotion processing, attention, interoception, and self-agency are important in the pathophysiology of FND-seiz. Furthermore, FND-seiz is a multi-network brain disorder, with evidence supporting roles for disturbances within and across the salience, limbic, attentional, multimodal integration, and sensorimotor networks. Risk factors, including the magnitude of previously experienced adverse life events, relate to individual differences in network architecture and neuroendocrine profiles. The time has come to use an integrated neuropsychiatric approach that embraces the closely intertwined relationship between physical health and mental health to conceptualize FND-seiz and related functional neurological disorder subtypes.

Research paper thumbnail of Autonomic, Endocrine, and Inflammation Profiles in Functional Neurological Disorder: A Systematic Review and Meta-Analysis

The Journal of Neuropsychiatry and Clinical Neurosciences, 2021

Functional neurological disorder (FND) is a core neuropsychiatric condition. To date, promising y... more Functional neurological disorder (FND) is a core neuropsychiatric condition. To date, promising yet inconsistently identified neural circuit profiles have been observed in patients with FND, suggesting important gaps remain in our systems-level neurobiological understanding. As such, other important physiological variables including autonomic, endocrine and inflammation findings need to be contextualized for a more complete mechanistic picture. Here, we performed a systematic review and meta-analysis of available case-control and cohort studies in FND. PubMed, PsycINFO and Embase databases were searched from January 1, 1900 to September 1, 2020 for studies that investigated autonomic, endocrine and/or inflammation markers in patients with FND. Sixty-six of 2,056 screened records were included in the review representing 1,699 patients, with data from 23 articles used in meta-analyses. Findings show that children/adolescents with FND vs. healthy controls (HCs) have increased resting heart rate; there is also a tendency towards reduced resting heart rate variability in patients with FND across the lifespan vs. HCs. In adults, peri-ictal heart rate differentiated those with functional seizures from individuals with epileptic seizures. Other autonomic and endocrine profiles in patients with FND were heterogeneous, with several studies highlighting the importance of individual differences. Inflammation research in FND remains in its early stages. Moving forward, there is a need to use larger sample sizes to consider *

Research paper thumbnail of Briquet syndrome revisited: implications for functional neurological disorder

Brain Communications, 2020

With the creation of the Somatic Symptom and Related Disorders category of the Diagnostic and Sta... more With the creation of the Somatic Symptom and Related Disorders category of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition in 2013, the functional neurological (symptom) disorder diagnostic criteria underwent transformative changes. These included an emphasis on ‘rule-in’ physical examination signs/semiological features guiding diagnosis and the removal of a required proximal psychological stressor to be linked to symptoms. In addition, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition somatization disorder, somatoform pain disorder and undifferentiated somatoform disorder conditions were eliminated and collapsed into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition somatic symptom disorder diagnosis. With somatic symptom disorder, emphasis was placed on a cognitive-behavioural (psychological) formulation as the basis for diagnosis in individuals reporting distressing bodily symptoms such as pain and/or fatigue...