Individualism and collectivism

Abstract Purpose of Review Functional neurological disorder (FND) is a multi-network brain disorder that encompasses a broad range of neurological symptoms. FND is common in pediatric practice. It places substantial strains on children, families, and health care systems. Treatment begins at assessment, which requires the following: the medical task of making the diagnosis, the interpersonal task of engaging the child and family so that they feel heard and respected, the communication task of communicating and explaining the diagnosis, and the logistical task of organizing treatment. Recent Findings Over the past decade, three treatment approaches—Retraining and Control Therapy (ReACT), other cognitive-behavioral therapies, and multidisciplinary rehabilitation—have been evaluated in the USA, Canada, and Australia. Of children treated in such programs, 63 − 95% showed full resolution of FND symptoms. The common thread across the programs is their biopsychosocial approach—consideration of biological, psychological, relational, and school-related factors that contribute to the child’s clinical presentation. Summary Current research strongly supports a biopsychosocial approach to pediatric FND and provides a foundation for a stepped approach to treatment. Stepped care is initially tailored to the needs of the individual child (and family) based on the pattern and severity of FND presentation. The level of care and type of intervention may then be adjusted to consider the child’s response, over time, to treatment or treatment combinations. Future research is needed to confirm effective treatment targets, to inform the development of stepped care, and to improve methodologies that can assess the efficacy of stepped-care interventions. 

/pdf/treatment-approaches-for-functional-neurological-disorders-hkicfs5u.pdf

Treatment Approaches for Functional Neurological Disorders in Children

As members of a multidisciplinary team of professionals who treat children and adolescents with functional neurological (conversion) disorder (FND), we highlight the pressing need to develop an FND-informed culture of care that takes into account recent advances in our understanding of this group of patients. Stories of clinical encounters in health care settings from around the world—told by children and adolescents with FND, their parents, and health professionals—portray an outdated culture of care characterized by iatrogenic stigma, erosion of empathy and compassion within the clinician-patient relationship, and a lack of understanding of FND and its complex neurobiology. After a brief exploration of the outdated culture, we share our counterstories: how we and our colleagues have worked, and continue to work, to create an FND-informed culture in the health systems where we practice. We discuss the therapeutic use of child-friendly language. We also discuss a range of structural, educational, and process interventions that can be used to promote FND-informed beliefs and attitudes, FND-informed clinician-patient encounters, and FND-informed referral processes, treatment pathways, and therapeutic interventions.

Changing the culture of care for children and adolescents with functional neurological disorder.

The education sector has been identified as one of the key players in globalization processes and implementation of the UN Agenda 2030. The role of education, including higher education, involves not only raising awareness among young people and educators about the sustainable development goals (SDGs) and global environmental changes, but also in mobilizing them for partnerships towards fulfilment of these goals (as defined in SDG-17) and dealing with the challenges of globalization. The purpose of this article is to analyze the engagement of HEIs in internationalization of education, realization of the UN Agenda 2030 and supporting the implementation of SDGs, using as an example the work of the UNAI at the university level. First, the article provides a short literature review on empirical and theoretical aspects of the internationalization of HEIs, looking at how international institutions impact internationalization, organizational culture and the formulation of educational process and international cooperation activities at HEIs. Second, it analyzes organizational tools for internationalization by looking at the international experience and activities of university networks such as UNAI and the impact of those networks on the internationalization of universities. Third, it presents a case study of the work of an international university network, using the example of UNAI Hub at Al-Farabi Kazakh National University, and discusses how the UNAI programs have impacted the perception of internationalization and organizational culture at the university.

/pdf/engaging-in-the-internationalization-of-education-and-sdgs-19030znx9u.pdf

Engaging in the internationalization of education and SDGs: Case study on the global hub of UNAI on sustainability

Objectives Psychogenic non-epileptic seizures (PNES) have been hypothesized to emerge in the context of neural networks instability. To explore this hypothesis in children, we applied a graph theory approach to examine connectivity in neural networks in the resting-state EEG in 35 children with PNES, 31 children with other functional neurological symptoms (but no PNES), and 75 healthy controls. Methods The networks were extracted from Laplacian-transformed time series by a coherence connectivity estimation method. Results Children with PNES (vs. controls) showed widespread changes in network metrics: increased global efficiency (gamma and beta bands), increased local efficiency (gamma band), and increased modularity (gamma and alpha bands). Compared to controls, they also had higher levels of autonomic arousal (e.g., lower heart variability); more anxiety, depression, and stress on the Depression Anxiety and Stress Scales; and more adverse childhood experiences on the Early Life Stress Questionnaire. Increases in network metrics correlated with arousal. Children with other functional neurological symptoms (but no PNES) showed scattered and less pronounced changes in network metrics. Conclusion The results indicate that children with PNES present with increased activation of neural networks coupled with increased physiological arousal. While this shift in functional organization may confer a short-term adaptive advantage-one that facilitates neural communication and the child's capacity to respond self-protectively in the face of stressful life events-it may also have a significant biological cost. It may predispose the child's neural networks to periods of instability-presenting clinically as PNES-when the neural networks are faced with perturbations in energy flow or with additional demands.

/pdf/activation-of-functional-brain-networks-in-children-with-dt7dm3u7rt.pdf

Activation of Functional Brain Networks in Children With Psychogenic Non-epileptic Seizures.

Psychogenic nonepileptic seizures in children-Prospective validation of a clinical care pathway & risk factors for treatment outcome.

The purpose of this study was to determine psychophysiology and dissociative characteristics of psychogenic non-epileptic seizures (PNES) in a clinical pediatric setting. A retrospective chart review was conducted over a 5-year period that included children meeting criteria for probable, clinically established or documented PNES. Of these, 33 patients (81%) underwent psychophysiology assessment as part of standardized care and were selected for study inclusion. Ages ranged from 10 to 17 years inclusive (70% female). The majority of patients were found to have some form of autonomic decompensation at baseline (82%) and lack of autonomic recovery from a cognitive stressor (58%). Inhibition of electrodermal skin response to laboratory stressor was associated with significantly longer duration of PNES illness (t=2.65, p=.013), while elevated heart rate (above 90th percentile) was associated with significantly higher frequency of PNES events in the month preceding diagnosis (t=3.1, p=.004). High levels of dissociation and hyperventilation symptoms were self-reported by adolescent patients (n=19) with a moderate degree of positive association (r=0.35, p=.038). The majority of patients (n= 25, 89%) were taught to correct respiratory CO2 levels during a single biofeedback training session. Conclusions: Child PNES populations appear to be characterized by chronic autonomic hyperarousal reflecting severity of their symptoms, which can feasibly be targeted for behavioral treatment.

Psychogenic non-epileptic seizures in children - psychophysiology & dissociative characteristics.

Our study explores the relationships between psychological and driving-related personality traits, fluid intelligence and cognitive abilities for drivers whose driving licence has been revoked due to intoxicated driving (alcohol and/or drugs). We were able to show that highly significant impacts on cognitive functions derive from the participants’ age and fluid intelligence. In addition, driving-related personality traits such as emotional instability, a sense of responsibility and self-control contributed significantly to some of the cognitive abilities that are important for fitness to drive. Additionally, the mediating effects of fluid intelligence in the model are discussed. Traffic psychologists can use this knowledge in their assessment of drivers, mainly regarding the possible compensation of cognitive deficits regarding the fitness to drive.

/pdf/assessing-psychological-fitness-to-drive-for-intoxicated-2edtgg9y3l.pdf

Assessing Psychological Fitness to Drive for Intoxicated Drivers: Relationships of Cognitive Abilities, Fluid Intelligence, and Personality Traits.

The United Nations Academic Impact (UNAI) Initiative has set forth 10 Basic Principles for higher education. In the present study, a 10 item self-report questionnaire measuring personal endorsement of these principles has been tested by self-report questionnaires with university and post-graduate students from Austria, China, Cyprus, India, Nigeria, and Slovakia (total N = 976, N = 627 female, mean age 24.7 years, s = 5.7). Starting from the assumptions of Moral Foundations Theory (MFT), we expected that personal attitudes toward the UNAI Basic Principles would be predicted by endorsement of various moral foundations as suggested by MFT and by the individual's degree of globalization. Whereas for the Austrian, Cypriot, and Nigerian sub- samples this assumption was largely confirmed, for the Chinese, Indian, and Slovak sub- samples only small amounts of the variance could be explained by regression models. All six sub-samples differed substantially with regard to their overall questionnaire responses: by five discriminant functions 83.6% of participants were classified correctly. We conclude that implementation of UNAI principles should adhere closely to the cultural requirements of the respective society and, where necessary should be accompanied by thorough informational campaigns about UN educational goals.

/pdf/adopting-basic-principles-of-the-united-nations-academic-dl9uox68r2.pdf

Adopting basic principles of the United Nations Academic Impact initiative (UNAI): Can cultural differences be predicted from value orientations and globalization?

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Psychogenic nonepileptic seizures in children-Prospective validation of a clinical care pathway & risk factors for treatment outcome.

Psychogenic non-epileptic seizures in children - psychophysiology & dissociative characteristics.

Assessing Psychological Fitness to Drive for Intoxicated Drivers: Relationships of Cognitive Abilities, Fluid Intelligence, and Personality Traits.

Adopting basic principles of the United Nations Academic Impact initiative (UNAI): Can cultural differences be predicted from value orientations and globalization?