Correlates of health-related quality of life in adults with psychogenic nonepileptic seizures: A systematic review.

Psychogenic nonepileptic seizures (PNES) often have a debilitating effect on patients' lives. Patients, family members, and clinicians have yet to fully understand the mechanisms and treatment of this disorder. Although reviews exist about epileptic seizures, there have been no systematic reviews of studies focusing on the impact of PNES. This review considers research on factors associated with the health-related quality of life (HRQoL) of patients with PNES. Searches of Medline, PsycINFO, CINAHL, and Cochrane Library were conducted. Search terms identified studies that examined factors associated with HRQoL in PNES. Factors fell into three categories: (1) seizure and somatic factors, (2) psychological factors, and (3) coping strategies and family functioning. Fourteen articles were included. The majority of studies were cross-sectional and were of weak to moderate quality. Depressive symptoms were negatively associated with HRQoL. Other factors associated with poorer HRQoL included dissociation, somatic symptoms, escape-avoidance coping strategies, and family dysfunction. Variables such as seizure frequency and demographic factors were not significantly associated with HRQoL. Psychological and interpersonal factors, not seizure reduction, are important for the HRQoL of patients with PNES. The avoidance of emotions is proposed as a perpetuating factor in the difficulties associated with poorer HRQoL. A biopsychosocial approach has relevance for both the clinical and theoretical understanding of PNES. Larger scale research on psychological and relational factors is needed to inform therapeutic approaches to enhance HRQoL in patients with PNES.

Case report: Adult with bipolar disorder and autism treated with ketamine assisted psychotherapy.

Background: Evidence has increased in recent years regarding the potential for ketamine to serve as a novel treatment option for a range of conditions, particularly depression (unipolar and bipolar). However, research regarding ketamine as a potential therapeutic for Autism Spectrum Disorder (ASD) is lacking, despite high overlap with bipolar depression and theoretical foundations for its use. Case presentation: A 29-year-old man with bipolar disorder and Autism Spectrum Disorder, type 2 diabetes, presented with mood swings and suicidal thoughts, and anger outbursts occurring daily. The patient was referred by a psychiatrist due to irritability and outbursts during the previous 5 months. These outbursts were unable to be controlled by the medications prescribed, included yelling and screaming, and the patient was unable to speak with the psychiatrist. The patient underwent ketamine assisted psychotherapy with 6 initial IV infusions of ketamine over a 1 month period followed by 2 booster IV ketamine infusions. Following ketamine treatment, dramatic reductions in outbursts were observed as well as reductions in anxiety, suicidality, and depression scores. Conclusion: This case study adds to the scant literature regarding ketamine treatment for individuals with bipolar disorder and ASD. We did not find ASD to be a contraindication for IV ketamine and ketamine assisted psychotherapy. Reductions in anger outbursts, anxiety, suicidality, and depression suggest ketamine treatment might be tailored to individuals with bipolar disorder and ASD, and additional systematized research is warranted. Although potential mechanisms of action are not clear, these data add to the discussion regarding clinical practice considerations and the potential for ketamine to improve quality of life and associated metrics.

Planar aromatic anchors control the electrical conductance of gold|molecule|graphene junctions.

The synthesis of a family of alkanethiol molecules with planar aromatic head groups, designed to anchor molecules effectively to graphene electrodes, is reported. Characterisation of self-assembled monolayers of these molecules on a gold surface via conductive atomic force microscopy shows that when an aromatic head group is present, the conductance G graphene obtained using a graphene coated probe is higher than the conductance G Pt obtained using a platinum (Pt) probe. For Pt probe and graphene probe junctions, the tunnelling decay constant of benzyl ether derivatives with an alkanethiol molecular backbone is determined as ß = 5.6 nm-1 and 3.5 nm-1, respectively. The conductance ratio G graphene/G Pt increases as the number of rings present in the aromatic head unit, n, increases. However, as the number of rings increases, the conductance path length increases because the planar head groups lie at an angle to the plane of the electrodes. This means that overall conductance decreases as n increases. Density functional theory-based charge transport calculations support these experimental findings. This study confirms that planar aromatic head groups can function as effective anchoring units for graphene electrodes in large area molecular junctions. However, the results also indicate that the size and geometry of these head groups must be considered in order to produce effective molecular designs.