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Tim Nicholson is a Reader in Neuropsychiatry at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London where he leads the Neuropsychiatry Research and Education Group (NREG). He is an Honorary Consultant Neuropsychiatrist at the South London and Maudsley NHS Foundation Trust. His clinical and research work focuses on Functional Neurological Disorder (FND), immunopsychiatry and broader neuropsychiatric disorders – including those resulting from COVID-19.He set up a pioneering specialist multidisciplinary clinic for FND in 2012 and has over 20 years of experience working clinically with FND and it was the topic of his PhD and the majority of his subsequent research activity including leading on studies into mechanisms, outcome measures and novel treatments such as Transcranial Magnetic Stimulation (TMS) and more recently psychedelics and Virtual Reality. He has also led and been involved in research investigating autoimmune causes of psychiatric symptoms, such as OCD and psychosis, and been involved in work seeking to understand the extent and causes of both acute and chronic neurological and psychiatric complications of COVID-19. He currently works in a multidisciplinary team clinic for Long COVID at King’s College Hospital providing neuropsychiatric input.He is on the executive committee of the Neuropsychiatry faculty of the Royal College of Psychiatrist and the British Neuropsychiatry Association. He is secretary of the Fellowship of Postgraduate Medicine and chairs the MSc in Clinical Neuropsychiatry at the IoPPN. He is co-chair of the patient liaison committee of the FND Society, on the committee of the UK FND network and on the medical advisory board of FND Hope, FND Action and Long COVID Support.Functional Neurological Disorder (FND) is a complex disorder at the junction of neurology and psychiatry and therefore body and mind as well as physical and mental health. There are several key, potentially even unique, features of FND which pose particular challenges to selecting which outcomes (aspects of a disorder and it’s impacts) we should be measuring and then how we should measure these in both clinical services and research settings.There is increasing awareness of the critical importance of selecting the most meaningful outcomes and the optimal methods and instruments to measure them. It is also increasingly recognised that consensus is need on these choices to standardise and harmonise data so it can be optimally collated and compared, especially for clinical trials to accelerate the development of evidence based treatments. Furthermore it is critical that the perspectives of patients, carers, research funders and clinical service commissioners are involved in this consensus process to compliment those of clinical and research experts.In this talk I will give an overview of the unique challenges to measuring FND, the subtle complexities and importance of this topic and the currently recommended best options. I will also summarise current and planned research efforts in measuring FND and related disorders to provide some potential insights into how these recommendations might evolve in the coming years.

Tim Nicholson is a Reader in Neuropsychiatry at the Institute of Psychiatry Psychology & Neuroscience (IoPPN), King’s College London where he leads the Neuropsychiatry Research and Education Group. He is an Honorary Consultant Neuropsychiatrist at the South London and Maudsley NHS Foundation Trust and King’s College Hospital NHS Foundation Trust where he currently runs a Long COVID clinic focusing on neuropsychiatric complications.His clinical work and research covers the full spectrum of neuropsychiatry, but with a particular interest in Functional Neurological Disorder (FND) and immunopsychiatry. More recently he has focused on both the acute and chronic neuropsychiatric sequelae of COVID-19 including leading the psychiatry reporting system of the Coronerve surveillance study, the neuropsychiatry working group of the COVID-CNS project and the PC-COS study developing a Core Outcome Set for Long COVID. At the start of the pandemic he set up a weekly JNNP blog to rapidly collate and summarise the rapidly emerging data on the neuropsychiatric complications of COVID that has developed into Neuropsychiatry.net – a dynamic and expanding group of clinicians and scientists of all levels and backgrounds interested in neuropsychiatry research and education specialising in online distributed teamwork producing large and high impact systematic reviews and meta-analyses as well as increasing education activities such as a trainee led online journal club.He also has a particular interest in psychopharmacology and wrote 6 editions of the practical prescribing guide Pocket Prescriber. He co-edits the specialist version of this book (Pocket Prescriber Psychiatry, Rogers et al) produced in collaboration with the British Association of Psychopharmacology, the 2nd edition of which is scheduled to be published later this year. He is on the executive committee of the RCPsych Neuropsychiatry Faculty, the BNPA, Chair of the MSc in Clinical Neuropsychiatry at the IoPPN and a council member of the Fellowship of Postgraduate Medicine.AbstractA wide range of complex sensorimotor features are a common yet relatively overlooked aspect of autistic spectrum disorders (ASD). Most clinical and research attention is understandably on social and cognitive function in ASD. I will give an overview of what we know about these sensorimotor features in terms of the range of clinical features and the potential mechanisms underlying them. I will argue that these features deserve more research attention which could not only lead to a greater understanding and better management of the full range of distressing and disabling symptoms experienced by people with ASD, but also potentially provide insights into both broader brain function and dysfunction and the aetiology and management of disorders with which ASD may overlap and/or commonly co-occur with including functional as well as organic disorders.

In contrast to mammalian matrix metalloproteinases (MMPs) that play important roles in the remodeling of the extracellular matrix in animals, the proteases responsible for dynamic modifications of the plant cell wall are largely unknown. A possible involvement of MMPs was addressed by cloning and functional characterization of Sl2-MMP and Sl3-MMP from tomato (Solanum lycopersicum). The two tomato MMPs were found to resemble mammalian homologs with respect to gelatinolytic activity, substrate preference for hydrophobic amino acids on both sides of the scissile bond, and catalytic properties. In transgenic tomato seedlings silenced for Sl2/3-MMP expression, necrotic lesions were observed at the base of the hypocotyl. Cell death initiated in the epidermis and proceeded to include outer cortical cell layers. In later developmental stages, necrosis spread, covering the entire stem and extending into the leaves of MMP-silenced plants. The subtilisin-like protease P69B was identified as a substrate of Sl2- and Sl3-MMP. P69B was shown to colocalize with Sl-MMPs in the apoplast of the tomato hypocotyl, it exhibited increased stability in transgenic plants silenced for Sl-MMP activity, and it was cleaved and inactivated by Sl-MMPs in vitro. The induction of cell death in Sl2/3-MMP-silenced plants depended on P69B, indicating that Sl2- and Sl3-MMP act upstream of P69B in an extracellular proteolytic cascade that contributes to the regulation of cell death in tomato.

Reproducible and standardised neurological assessment scales are important in quantifying research outcomes. These scales are often performed by non-neurologists and/or non-clinicians and must be robust, quantifiable, reproducible and comparable to a neurologist's assessment. COVID-CNS is a multi-centre study which utilised the Neurological Impairment Scale (NIS) as a core assessment tool in studying neurological outcomes following COVID-19 infection. We investigated the strengths and weaknesses of the NIS when used by non-neurology clinicians and non-clinicians, and compared performance to a structured neurological examination performed by a neurology clinician. Through our findings, we provide practical advice on how non-clinicians can be readily trained in conducting reproducible and standardised neurological assessments in a multi-centre study, as well as illustrating potential pitfalls of these tools.

Functional Neurological Disorder (FND) is at the complex interface of the body and mind and therefore also physical and mental health. It has been neglected by medicine so little is known about its mechanism or treatment. However, there have been recent critical developments, particularly establishing it is as common as Parkinson’s or multiple sclerosis and associated with poor outcomes and consequently associated with very high rates of disability and both health and social care costs.There have also been critical changes in its diagnosis. The historical requirement of identifying causative stressors has been removed as it is now clear that these are not found in a significant proportion of patients. Instead, there has been increased emphasis on identifying ‘positive neurological signs’ which allow its reliable distinction from other disorders. Such signs can also be explained to patients to help them to understand the basis of the diagnosis and how it can be caused by dysfunction of cognitive processes such as attention and illness representations, thereby increasing acceptance of a complex and stigmatised diagnosis. The widespread adoption of the acronym FND and therefore the term ‘functional’, an aetiologically neutral term, has also facilitated critical steps in uniting patients and clinicians.FND patients regularly have current and/or past comorbid symptoms presenting to other specialities such as fibromyalgia and Irritable Bowel Syndrome, which can be viewed as related disorders with overlapping mechanisms. Insights from FND research are therefore well positioned to inform the broader field of functional disorders which account for approximately 30% of morbidity and costs across medicine.

Tim Nicholson My undergraduate medical training was at the Royal Free Hospital and School of Medicine during which I did a BSc (UCL) and an MSc (Oxford) in Biological Anthropology to pursue my interest in evolutionary biology, particularly in the factors that have driven the evolution of human biology and behaviour. I was first exposed to neuropsychiatry as a neurology trainee on Hughlings Jackson ward at the National Hospital for Neurology at Queen square which inspired my clinical and academic interest in this area, particularly in the fields of CNS autoimmunity and functional / conversion disorders. I then trained as a psychiatrist at the Maudsley Hospital, including jobs on the Lishman (neuropsychiatry) unit and a research post at both the Institute of Psychiatry and the neuroimmunology department at the Institute of Neurology. I have just completed my PhD in psychological stressors and emotion processing in conversion disorder at the Institute of Psychiatry where I am an Academic Clinical Lecturer in the Section of Cognitive Neuropsychiatry. Autoimmune causes are on differential diagnosis lists for many neurological, some neuropsychiatric but few, if any, purely psychiatric presentations. Why is this? Do autoimmune processes preferentially affect parts of the brain resulting in neurological, rather than psychiatric, symptoms? I propose that this is unlikely and that soon autoimmunity will be found to be the cause of a proportion (albeit probably small) of an increasing number of neuropsychiatric and even some purely psychiatric presentations. In the last few years there has been some accumulating evidence in support of this with specific antibodies associated with neuropsychiatric and pure psychiatric presentations and I will briefly review the key papers.

[...]Chris was not only a GP; he was for many years involved in industrial medicine with a major nickel alloy factory in Hereford, provided occupational healthcare for the hospital staff, and he was the longest serving doctor at Hereford racecourse.