Background Functional neurological disorder (FND) and migraine are common disorders accounting for substantial health-related quality of life (HRQoL) impairment, yet comparative data are sparse. Methods We performed a single-centre cross-sectional study of adult patients with a diagnosis of FND or migraine followed in a tertiary neurology outpatient clinic. Patients with both conditions were excluded. Data were collected through an online questionnaire and hospital records. Variables included age, sex, timing of diagnosis and treatment, comorbid pain-related and psychiatric disorders, psychological distress assessed through Hospital Anxiety and Depression Scale, and Patient Global Impression of Change (PGIC) after treatment. The primary outcome measure—HRQoL—was assessed using the SF-36. Multivariable linear regression models explored the independent association between diagnosis (FND vs migraine) and HRQoL. Results Sixty-eight patients were included (27 with FND; 41 patients with migraine; mean age 31.1 years). Unadjusted analyses showed significantly lower HRQoL in FND across all SF-36 domains, with clinically meaningful effect sizes. FND was associated with greater psychological distress and lower perceived improvement. After adjustment for psychological distress and pain-related comorbidities, FND was still associated with worse scores in the physical functioning, physical role limitations, and social functioning domains of the SF-36. Conclusions This study highlights that impairments in physical and social functioning are independent from psychiatric comorbidities in FND probably reflecting disease-specific mechanisms and a widespread impact of this condition. Yet, transdiagnostic factors—particularly psychological distress and comorbid chronic pain largely account for HRQoL impairment in both FND and migraine, with relevance for multidisciplinary treatment approaches.
Background Multiple sclerosis (MS) is an immune-mediated central nervous system disorder; relapsing-remitting MS (RRMS) is the most common form. Self-perceived health-related quality of life (HRQoL) has been linked to psycho-behavioral and immunological factors, but their interplay remains unclear. We examined psycho-behavioral, clinical, and immunological correlates of perceived physical and mental health. Methods In this cross-sectional study, 85 patients with RRMS (78% female; mean age 40.6 ± 10.3 years; predominantly mild disability) were assessed for fatigue, sleep quality, daytime sleepiness, anxiety/depression symptoms, and perceived cognitive dysfunction. Blood samples were analyzed for complete blood counts and, in a subgroup, lymphocyte subpopulations; the systemic immune-inflammation index (SII) was calculated. HRQoL was measured using the SF-36 Physical and Mental Component Summaries (PCS and MCS). Hierarchical linear regression models included sociodemographic, clinical, and treatment-class covariates, with sensitivity analyses. Results Disability, fatigue, and depressive symptoms were associated with lower PCS, and sleep disturbances and depressive symptoms with lower MCS. Higher lymphocyte count was associated with higher MCS (β = +0.268, p = 0.006; ΔR2 = 0.030), consistently across all four sensitivity analyses. SII was not significantly associated with either outcome. In exploratory flow-cytometry analyses (n = 33–34), NK cells were associated with PCS (β = +0.345, p = 0.003), but not significantly with MCS. Conclusions HRQoL in RRMS showed psychological and clinical associations, with an additional lymphocyte-MCS association. The clinical relevance of the immune findings, including the exploratory NK-PCS association, requires further investigation.
Objectives Research has shown that a large number of people experience negative emotional reactions due to the climate crisis. These range from a non-pathological response to a clinically significant one. These negative emotional reactions are termed climate anxiety, eco anxiety, or eco-distress. However, the prevalence of clinical symptoms of eco-distress is unknown. From a public health perspective, there is a clear need to determine its extent. To this end, we analyzed the prevalence of clinical symptoms of eco-distress and identified significant predictors in a representative German sample. Methods We assessed prevalence as the percentage of participants exhibiting moderate or severe clinical symptoms of eco-distress, measured with a modified version of the PHQ-4. Predictors of higher levels of eco-distress were tested via a hurdle model that estimated both (i) predictors of showing any signs of eco-distress using a logistic regression model, and (ii) predictors of higher levels of eco-distress through a Poisson distribution truncated to exclude zero. Results Of n = 2504 participants, n = 57 (2.3%) reported moderate or severe clinical symptoms of eco-distress. Moreover, n = 788 (32%) indicated experiencing at least one clinical symptom of depression or anxiety on several days over the last two weeks. Current mental health impairments, younger age, and identifying as female predicted eco-distress. Parenthood was not a significant predictor and results regarding socioeconomic factors were mixed. Conclusion The percentage of people reporting moderate or severe clinical symptoms of eco-distress of clinical significance is small but meaningful. As eco-distress is more prevalent in persons with current mental health impairments, psychosocial support and suitable interventions should be integrated into standard mental healthcare.
Introduction Negative treatment expectations are central to nocebo effects and shape symptom perception as a transdiagnostic mechanism relevant to persisting physical symptoms. Little is known about how such expectations form, how they respond to threatening treatment information across somatic and visceral pain domains, and which dispositional factors moderate this process. Methods Using data from the randomized NOVIS trial, 101 healthy participants (52 females; 18–36 years) completed a multiple-threat pain paradigm involving visceral (rectal distension) and somatic (cutaneous heat) stimuli. Participants received either negative information (nocebo: 50% probability of a pain-enhancing infusion) or neutral information (control) regarding an intravenous treatment that was always saline. Generalized expectations of symptom worsening and side effects, as well as symptom-specific pain expectations, were assessed prior to treatment. Bayesian cumulative probit and linear models estimated the effects of treatment information and moderation by pain catastrophizing, somatosensory amplification, and negative affect. Results Negative information induced expectations of symptom worsening and side effects. Effects on symptom-specific expectations were modality-dependent: anticipated unpleasantness increased for somatic but not visceral pain. Pain catastrophizing and somatosensory amplification were associated with elevated negative expectations independent of treatment information. Somatosensory amplification, pain catastrophizing, and trait negative affect each moderated the effect of negative information on somatic pain unpleasantness expectations. Conclusion Nocebo-related expectations differed between generalized and symptom-specific expectations and depended on symptom modality and psychological vulnerability. Individuals with heightened bodily vigilance, catastrophizing, and negative affect, may be particularly vulnerable to nocebo effects as a psychological mechanism implicated in persisting physical symptoms. Trial registration number German Clinical Trials Register (DRKS) – ID: 00024410
