News from UofL Physicians

Health-care providers and researchers with the University of Louisville are available to discuss any of the following health topics this week:

Motor Retraining therapy at UofL Physicians provides hope for patients with functional movement disorders

“You know when you relax and you have a little twitch? Imagine that except a hundred times bigger and over and over again so you could never fall asleep.”

That is how Julia Semple described her experience with functional movement disorder (FMD).

“It started with my head sort of twitching back and forth, like when you shake your head ‘no.’ It was completely involuntary,” Semple said. “It progressed to other areas of my body over time.”

The symptoms interfered with Semple’s sleep as well as her work as a massage therapist and dancer. Unable to detect a physical cause for the symptoms, physicians and other health providers told her they likely were caused by stress. After nearly 10 years, she finally learned she suffers from FMD.

Semple then learned of the Motor Retraining program (MoRe), developed by Kathrin LaFaver, M.D. a neurologist and director of the Parkinson’s Disease and Movement Disorders Clinic at UofL Physicians. One of only a few such programs in existence for the treatment of FMD, MoRe combines neurological treatment, psychological counseling and physical and occupational therapy during a week-long inpatient therapy at Frazier Rehab Institute, a part of KentuckyOne Health. The program aims to improve patients’ motor symptoms, help them regain control over abnormal movements and develop better coping skills.

Functional movement disorders are common conditions involving abnormal movements – jerking, tremor or issues with gait or speech. The problems are due to miscommunications in the central nervous system. Patients often complain of fatigue and difficulties with concentration and thinking.

“Functional disorders are in the borderland between neurology and psychiatry, and there is a lack of treatment programs for the conditions. Diagnostic tests do not reveal a cause for the FMD, so patients experiencing symptoms often are told by neurologists that ‘nothing is wrong,’ and may be referred to a psychiatrist,” LaFaver said.

Semple is one of more than 70 patients from 25 states who have undergone week-long inpatient therapy for FMD in the MoRe program at UofL. More than 85 percent of patients undergoing the treatment have shown improvement in their symptoms, and 69 percent report the improvement of symptoms was maintained after six months.

Self-inflicted gunshot wound survivors may deny suicide attempt, face barriers to care

Researchers have found that more than one-third of patients who denied that their self-inflicted gunshot wound resulted from a suicide attempt most likely had indeed tried to kill themselves, and commonly were sent home from the hospital without further mental health treatment.

The findings indicate there are significant barriers to treatment for people who have made suicide attempts, and highlight the need to improve assessment and intervention for survivors of self-inflicted gunshot wounds, especially while hospitalized for their injury.

Stephen O’Connor, Ph.D., associate director of the University of Louisville Depression Center, and other researchers analyzed electronic medical records from 128 survivors of self-inflicted gunshot wounds treated at a trauma center in Nashville, Tenn., between 2012 and 2015 to identify factors associated with denying a suicide attempt to medical staff. Twenty-nine percent of patients denied their injuries resulted from a suicide attempt. Of those cases, 43 percent had questionable circumstances, and the denial of suicide attempt was coded as a suspected false denial.

The study noted cases that appeared to be obvious false denials of suicide. Clinician quotations from medical transcripts included “he shot himself when confronted by police” and “left voicemails on wife’s phone saying goodbye,” according to the study.

O’Connor said people likely deny suicide attempt because of the stigma surrounding the act, not wanting the incident documented on medical records and the reluctance to be admitted to inpatient psychiatric care because of family or job responsibilities.

Mental health providers use investigative skills during psychiatric consultations with a hospitalized patient to determine whether a self-inflicted gunshot wound was a suicide attempt.

They consider the injury, circumstances surrounding it and aspects of a patient’s life, including interpersonal issues, financial problems and a history of suicide attempts, O’Connor said.

Hospitalized patients who denied a suicide attempt were nearly 11 times more likely to be discharged to home rather than to inpatient psychiatric care.

Beer with a Scientist, April 18:  The epic battle between superbugs and humans – and our unexpected allies

We have been bombarded with the notion that bacteria are bad for us. You probably also have heard that germs are becoming more and more resistant to antibiotics, leaving us vulnerable to diseases that we thought were conquered. As scientists develop ever-more-powerful medications to fight bacterial infections, the bacteria are fighting back, and sometimes seem to be winning.

Will we eventually enter a post-antibiotic era where simple infections can kill us?

Deborah Yoder-Himes, Ph.D., assistant professor in the Department of Biology at the University of Louisville, assures us we are not yet doomed, but we do need to have a battle plan. At the next Beer with a Scientist, Yoder-Himes will discuss how most bacteria are actually good for us, how pathogenic bacteria evolve to resist our most potent medications and how science can preserve our ability to fight illness-causing infections.

“If we take steps now to combat the rising rates of antibiotic resistance, develop new antibiotics and secure these medicines for future use, we can win the war against these bugs,” Yoder-Himes said.

Beer with a Scientist is a free monthly program organized by UofL researcher Levi Beverly, Ph.D., to bring science to the public in an informal setting. The next talk begins at 8 p.m. on Wednesday, April 18, at Against the Grain Brewery, 401 E. Main St. in Louisville. A 30-minute presentation will be followed by an informal Q&A session.