Lifespan News

The Miriam Hospital has appointed Maria Ducharme, MS, RN, NE-BC, senior vice president of patient care services and chief nursing officer effective immediately. (Read more…)

A new survey of child psychiatrists indicates that insomnia is a major problem among children in mental health treatment (Read more…)

Commentaries by physicians and researchers from Rhode Island Hospital are sometimes published in scientific journals. Recently, W. Curt LaFrance Jr., MD, MPH, director of neuropsychiatry and behavioral neurology, was published in three major neurologic and psychiatric journals.

The first commentary is in the American Journal of Psychiatry (AJP). The American Psychiatric Association is currently working on a revised edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-V). The DSM is a publication used by clinicians and researchers that provides standard criteria for the classification of mental disorders. LaFrance and colleagues’ commentary in AJP focuses on their recommendations for changes to be considered in the DSM-V for a condition known as conversion disorder. Their article calls for changes in the diagnostic criteria.

Patients with conversion disorder frequently present to neurologists, psychiatrists, emergency departments and primary care physicians but are often misdiagnosed or not recognized as such. Conversion disorder presents with signs and symptoms such as weakness, seizures or abnormal movements. The disorder is currently classified as a condition in which symptoms cannot be attributed to a medical condition, are not feigned and are judged to be associated with psychological factors. In the commentary, LaFrance and colleagues note that the current DSM-IV diagnostic criteria relegate conversion disorder to a diagnosis of exclusion. The proposed new criteria recommend the incorporation of signs and symptoms consistent with a conversion presentation.

Many patients with conversion disorders see numerous physicians and have extensive workups over time. Because the symptoms overlap neurology and psychiatry, many patients, unfortunately, “fall through the cracks,” when their diagnosis is not made. LaFrance and his colleagues hope that with clearer diagnostic criteria, more physicians will more readily be able to make the diagnosis of conversion disorder and can direct the patient to appropriate treatment. (Reference: Stone J, LaFrance Jr WC, Levenson JL, Sharpe M. Issues for DSM-5: Conversion disorder. Am J Psychiatry 2010;167(6):626-7.)

LaFrance’s second commentary appeared in the journal Archives of Neurology. This article focuses on the need to “speak plainly” about psychogenic disorders, also known as conversion disorders. While they are common conditions, many physicians are not aware of the serious consequences of conversion disorders and may dismiss the patient with conversion symptoms. Patients with conversion disorders can be difficult to assess, and LaFrance and his colleague note that because there is no readily available effective treatment, it exposes the vulnerability of physicians. Also, it is often difficult for a patient and their family to accept that there is no medical or neurological cause for the condition, especially when they might be referred to a mental health provider for treatment. The commentary calls upon neurologists to be aware of the challenges these patients may present, and then talk directly, respectfully and openly with the patient and family about the diagnosis. (Reference: Friedman JH, LaFrance Jr WC. Psychogenic disorders: the need to speak plainly. Arch Neurol 2010;67(6):753-5.)

The final commentary from LaFrance appeared in Neurology and focused on psychogenic nonepileptic seizures (PNES). PNES are a specific manifestation of conversion disorder. This condition involves short-term changes that can include movements, thoughts and behavior that can resemble epileptic seizures, yet they differ from epileptic seizures in the way the brain behaves during these episodes. In his commentary, LaFrance notes that some clinicians have requested the term “seizures” be removed from the name of this disorder and changed to “attacks.” LaFrance recommends that the word “seizure” should stand based on “misinformed defense that seizures are, by definition, epileptic.” LaFrance says that the word seizure is actually derived from the Greek, meaning, to take hold, and by definition, a seizure is a sudden onset of symptoms.

Nonepileptic is merely one type of seizure. He says that if there is confusion as to what type of seizure it is, clinicians then should better explain the type and the specific diagnosis. Openly communicating the diagnosis to fellow doctors would help distinguish between epileptic and nonepileptic seizures and would help in bridging the gap between neurology and psychiatry among treatment providers. Clearly explaining what PNES are to patients can build a rapport with patients and their families and may improve treatment outcomes. (Reference: LaFrance Jr WC. Psychogenic nonepileptic “seizures” or “attacks?” It’s not just semantics: Seizures. Neurology 2010;75(1):87-8.)

In his research, teaching and clinical care, LaFrance hopes to help demystify patients with a conversion disorder diagnosis and to equip treatment providers with effective treatments for this challenging patient population.

Speaker of the House Nancy Pelosi recently joined Congressman Patrick J. Kennedy at Bradley Hospital to discuss the role played by research and development in Rhode Island’s economic recovery. The roundtable discussion featured state health care leaders, the Rhode Island Economic Development Corporation, and top researchers from Rhode Island institutions of higher learning and medical research, including Bradley Hospital and Rhode Island Hospital. These institutions represent common recipients of the $515 million in federal funding spent in Rhode Island each year on research and development.

The latest quarterly report from the Council of Economic Advisers shows that the American Recovery and Reinvestment Act (ARRA) has created or saved 11,000 jobs for Rhode Islanders, “With Rhode Island the home to exemplary institutions like Brown University, the University of Rhode Island, Lifespan and the Providence VA Medical Center, a significant portion of the federal funding spent in Rhode Island goes to support research and development – 22 percent,” said Kennedy. “Not only are these institutions making extraordinary advances in medicine and technology, but the federal funding they receive constitutes substantial investments in our economy and creates quality jobs in research and support.”

Since the passage of the ARRA, which was signed into law by President Obama on February 17, 2009, Rhode Island institutions – including Bradley Hospital – have received millions of dollars worth of federal grants to fund cutting-edge research and development projects in the state. Overall, Lifespan – including researchers from Rhode Island Hospital and The Miriam Hospital – has received 27 grants – totaling $9.3 million – from the National Institutes of Health (NIH) that were funded by the ARRA.

To date, NIH grants funded by the Recovery Act are alone responsible for creating 89 jobs in Rhode Island.

Speaker Pelosi praised Rhode Island for the various institutions that already work together on research. “The emphasis that you have placed on collaboration is a lesson that should be learned by the rest of the country.”

Congressman Kennedy added, “In fighting for federal dollars for research and development, we also stand to restore the lives of those who risked their own – our veterans. Many of our troops returning home suffer from PTSD and traumatic brain injury. With greater coordination between the National Institutes of Health, the Department of Defense, and the VA, we can better utilize the resources committed to research and development that are making breakthroughs every day in research facilities like those here in Rhode Island.”

Daniel J. Wall, president and chief executive officer, Bradley Hospital; Gregory K. Fritz, MD, academic director, Bradley Hospital; Timothy J. Babineau, MD, president and chief executive officer, Rhode Island Hospital and The Miriam Hospital; and G. Rees Cosgrove, MD, chief of neurosurgery, Rhode Island Hospital and The Miriam Hospital, all participated in the roundtable discussion.

The Miriam Hospital has again earned the elite Gold Seal of Approval™ (Read more…)