1
|
Nisticò V, Ilia N, Conte F, Broglia G, Sanguineti C, Lombardi F, Scaravaggi S, Mangiaterra L, Tedesco R, Gambini O, Priori A, Maravita A, Demartini B. Forearm bisection task suggests an alteration in body schema in patients with functional movement disorders (motor conversion disorders). J Psychosom Res 2024; 178:111610. [PMID: 38359638 DOI: 10.1016/j.jpsychores.2024.111610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/16/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVES To explore potential alterations of the Body Schema, the implicit sensorimotor representation of one's own body, in patients with Functional Movement Disorders (FMD, Motor Conversion Disorders), characterized by neurological symptoms of altered voluntary motor function that cannot be explained by typical medical conditions. This investigation is prompted by the potential dissociation from their reportedly intact sense of ownership. METHODS 10 FMD patients and 11 healthy controls (HC) underwent the Forearm Bisection Task, aimed at assessing perceived body metrics, which consists in asking the subject, blindfolded, to repeatedly point at the perceived middle point of their dominant forearm with the index finger of their contralateral hand, and a psychometric assessment for anxiety, depression, alexithymia, and tendency to dissociation. RESULTS FMD patients bisected their forearm more proximally (with an increased shift towards their elbow equal to 7.5%) with respect to HC; average bisection point was positively associated with anxiety levels in the whole sample, and with the tendency to dissociation in the FMD group. CONCLUSIONS FMD patients perceive their forearm as shorter than HC, suggesting an alteration of their Body Schema. The Body Schema can go through short- and long-term updates in the life course, mainly related to the use of each body segment; we speculate that, despite FMD being a disorder of functional nature, characterized by variability and fluctuations in symptomatology, the lack of sense of agency over a body part might be interpreted by the nervous system as disuse and hence influence the Body Schema, as deficits of organic etiology do.
Collapse
Affiliation(s)
- Veronica Nisticò
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy; Dipartimento di Psicologia, Università degli Studi di Milano - Bicocca, Milano, Italy.
| | - Neofytos Ilia
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Francesca Conte
- Dipartimento di Psicologia, Università degli Studi di Milano - Bicocca, Milano, Italy
| | - Giovanni Broglia
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Claudio Sanguineti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Francesco Lombardi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Silvia Scaravaggi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Laura Mangiaterra
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy
| | - Roberta Tedesco
- Unità di Psichiatria, Servizio Psichiatrico di Diagnosi e Cura, Ospedale Civile di Legnano, ASST Ovest Milanese, Milano, Italy
| | - Orsola Gambini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy; Unità di Psichiatria 52, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Alberto Priori
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy; "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy; III Clinica Neurologica, Presidio San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Angelo Maravita
- Dipartimento di Psicologia, Università degli Studi di Milano - Bicocca, Milano, Italy
| | - Benedetta Demartini
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, Università degli Studi di Milano, Milano, Italy; Unità di Psichiatria, Servizio Psichiatrico di Diagnosi e Cura, Ospedale Civile di Legnano, ASST Ovest Milanese, Milano, Italy
| |
Collapse
|
2
|
Marotta A, Lasalvia A, Fiorio M, Zanalda E, Di Sciascio G, Palumbo C, Papola D, Barbui C, Tinazzi M. Psychiatrists' attitudes towards functional neurological disorders: results from a national survey. Front Psychiatry 2023; 14:1216756. [PMID: 37520227 PMCID: PMC10375048 DOI: 10.3389/fpsyt.2023.1216756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Functional neurological disorder (FND) presents motor, sensory, and cognitive symptoms characterized by clinical signs incongruent with known neurological disease. Together with other health professionals, like neurologists, psychiatrists can play an essential role in diagnosing and managing these disorders. Hence, understanding their opinion and clinical experience with FND is of utmost importance to catch potential educational needs and improve healthcare services for patients. This study aims at assessing the knowledge, opinion, and clinical approach of Italian psychiatrists to FND. Methods Members of the Italian Society of Psychiatry completed a 14-item web-based survey investigating their approach to FND. Results. Overall, 174 questionnaires were completed. Our main findings suggest that Italian psychiatrists have a psychogenetic conceptualization of FND. "Conversion disorders", in fact, is the term most frequently used by Italian psychiatrists to refer to FND, thus implying a psychological etiology of these disorders. Congruently with this view, psychotherapy associated with pharmacological therapy is considered the most appropriate treatment by psychiatrists, while physiotherapy is an under-recognized treatment option for FND. Discussion The present study highlights that a psychogenetic view of FND dominates among Italian psychiatrists. This could be due to out-of-date knowledge about the pathophysiology of this group of disorders. Promoting education about novel approaches to FND would be of crucial importance to improving care for patients suffering from this condition.
Collapse
Affiliation(s)
- Angela Marotta
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Antonio Lasalvia
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Enrico Zanalda
- Department of Mental Health ASL TO3 and AOU San Luigi Gonzaga, Collegno, Italy
| | | | | | - Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
3
|
Perez DL, Hoch DB, Cohen JN. Case 10-2023: A 27-Year-Old Man with Convulsions. N Engl J Med 2023; 388:1210-1218. [PMID: 36988597 DOI: 10.1056/nejmcpc2211365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Affiliation(s)
- David L Perez
- From the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Massachusetts General Hospital, and the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Harvard Medical School - both in Boston
| | - Daniel B Hoch
- From the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Massachusetts General Hospital, and the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Harvard Medical School - both in Boston
| | - Jonah N Cohen
- From the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Massachusetts General Hospital, and the Departments of Neurology (D.L.P., D.B.H.) and Psychiatry (D.L.P., J.N.C.), Harvard Medical School - both in Boston
| |
Collapse
|
4
|
Paredes-Echeverri S, Guthrie AJ, Perez DL. Toward a possible trauma subtype of functional neurological disorder: Impact on symptom severity and physical health. Front Psychiatry 2022; 13:1040911. [PMID: 36458126 PMCID: PMC9706184 DOI: 10.3389/fpsyt.2022.1040911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND As a group, individuals with functional neurological disorder (FND) report an approximately 3-fold increase in adverse life experiences (ALEs) compared to healthy controls. In patients with FND, studies have identified a positive correlation between symptom severity and the magnitude of ALEs. While not all individuals with FND report ALEs, such findings raise the possibility of a trauma-subtype of FND. OBJECTIVE This study investigated if patients with FND, with or without probable post-traumatic stress disorder (PTSD) and/or significant childhood maltreatment, differed in their symptom severity and physical health. MATERIALS AND METHODS Seventy-eight patients with FND were recruited (functional seizures, n = 34; functional movement disorder, n = 56). Participants completed self-report measures of symptom severity [Somatoform Dissociation Questionniare-20 (SDQ-20), Screening for Somatoform Disorders: Conversion Disorder subscale (SOMS:CD), Patient Health Questionniare-15 (PHQ-15)], physical health [Short Form Health Survey-36 (SF36-physical health)], childhood maltreatment [Childhood Trauma Questionnaire (CTQ)], and PTSD [PTSD Checklist-5 (PCL-5)]; a psychometric battery of other common predisposing vulnerabilities was also completed. To adjust for multiple comparisons, a Bonferroni correction was applied to all univariate analyses. RESULTS Patients with FND and probable PTSD (n = 33) vs. those without probable PTSD (n = 43) had statistically significant increased scores on all symptom severity measures - as well as decreased physical health scores. In secondary post-hoc regression analyses, these findings remained significant adjusting for age, sex, race, college education, and: pathological dissociation; alexithymia; attachment styles; personality characteristics; resilience scores; functional seizures subtype; or moderate-to-severe childhood abuse and neglect scores; SOMS:CD and SDQ-20 findings also held adjusting for depression and anxiety scores. In a separate set of analyses, patients with FND and moderate-to-severe childhood abuse (n = 46) vs. those without moderate-to-severe childhood abuse (n = 32) showed statistically significant increased SDQ-20 and PHQ-15 scores; in post-hoc regressions, these findings held adjusting for demographic and other variables. Stratification by childhood neglect did not relate to symptom severity or physical health scores. CONCLUSION This study provides support for a possible trauma-subtype of FND. Future research should investigate the neurobiological and treatment relevance of a FND trauma-subtype, as well as continuing to delineate clinical characteristics and mechanisms in individuals with FND that lack a history of ALEs.
Collapse
Affiliation(s)
- Sara Paredes-Echeverri
- Functional Neurological Disorder Research Group, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Andrew J Guthrie
- Functional Neurological Disorder Research Group, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - David L Perez
- Functional Neurological Disorder Research Group, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.,Functional Neurological Disorder Unit, Division of Cognitive Behavioral Neurology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.,Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| |
Collapse
|