Attentional avoidance of emotions in functional movement disorders

Anger regulation in patients with functional neurological disorder: A systematic review

BACKGROUND

Functional neurological disorder (FND) has been associated with predisposing psychological factors, including dysregulation of anger-related processes. This paper provides a systematic review of the literature on anger regulation in FND. We evaluated anger-related research on patient self-report, observational, and laboratory based measures in FND. The review also addresses adverse childhood experiences and their relation with anger regulation, and the effects of therapies targeting anger regulation in FND.

METHODS

MEDLINE, EMBASE, and PsycINFO were searched for both quantitative and qualitative research, published in a peer-reviewed journal with a sample size of at least 5 (registered under Prospero protocol CRD42022314340).

RESULTS

A total of 2200 articles were identified. After screening, 54 studies were included in this review (k = 20 questionnaire-based studies, k = 12 laboratory studies, k = 21 using other methods, and k = 1 used both questionnaires and other methods) representing data of 2502 patients with FND. Questionnaire-based studies indicated elevated levels of state anger and trait hostility in patients with FND. Laboratory studies showed a higher tendency to avoid social threat cues, attentional bias towards angry faces, difficulties reliving anger, and preoccupation with frustrating barriers among FND patients versus controls. No specific childhood experiences were identified related to anger regulation in FND, and too few small and uncontrolled studies were available (k = 2) to assess the effects of anger-related interventions in FND. The overall quality of the studies was fair (k = 31) to poor (k = 18). Five studies (k = 5) were rated as having a good quality.

CONCLUSIONS

This review suggests that patients with FND have maladaptive anger regulation compared to individuals without FND. The findings also highlight the need for further research on the prevalence and consequences of anger-related processes in the development, diagnosis and treatment of FND.

Trait-related neural basis of attentional bias to emotions: a tDCS study

Negative emotional stimuli can strongly bias attention, particularly in individuals with high levels of dispositional negative affect (NA). The current study investigated whether the prefrontal cortex (PFC), a brain region involved in the top-down regulation of emotional processing, plays a different role in controlling attention to emotions, depending on the individual NA. Sham and anodal transcranial direct current stimulation (tDCS) was delivered over the right or left PFC while assessing attentional bias (AB) to emotions (happy, angry, sad faces) in individuals with higher and lower trait NA. When tDCS was inactive (sham), individuals with higher trait NA showed AB toward angry and away from sad faces, while individuals with lower trait NA presented with no AB. Right anodal-tDCS abolished the AB toward angry faces and induced an AB toward sad faces in individuals with higher trait NA, while no effect was found in individuals with lower trait NA. Left anodal-tDCS abolished any AB in individuals with higher trait NA and induced an AB away from happy faces in individuals with lower trait NA. These findings confirm a critical role of trait NA in AB to emotions and demonstrate a different involvement of PFC in emotional processing based on dispositional affect.

Emotional arousal in patients with functional movement disorders: A pupillometry study

OBJECTIVE

Pathophysiology explanations for functional movement disorders often assume a role for emotional hyperarousal. Pupillometry is a validated method for evaluation of emotional arousal by detecting changes in pupil size in response to emotional stimuli. In a case-control study design, we aimed to study objective and subjective emotional arousal using pupillometry and affective ratings. To assess attentional engagement by affective stimuli, we used videooculographic tracking of eye movement patterns (scanpath).

METHODS

Twenty-five female patients with functional movement disorders (mean age: 40.9 [SD 12.7] years) and 23 age matched healthy female controls participated in the study. Using infrared high-resolution eye-tracker, both pupil size and eye movement pattern in response to emotionally charged erotic, adventure, threat, victim, and neutral pictures were recorded along with subjective ratings of emotional valence and arousal of the presented pictures.

RESULTS

A between-group comparison showed significantly smaller pupil dilation to adventure stimuli compared to neutral stimuli in patients compared to controls (P < 0.004, bootstrap, uncorr., adj. η2 = 0.00). No significant difference in pupillary response to other stimuli and scanpath parameters was found between the groups. Patients rated significantly lower emotional arousal to erotic pictures than controls (P < 0.001, bootstrap, uncorr., adj. η2 = 0.09).

CONCLUSION

This study did not find evidence of autonomous or subjective emotional hyperarousal. The mismatch between objective autonomic measures and subjective arousal ratings in patients is of pathophysiological interest and in line with recent findings of impaired interoception in functional movement disorders.

Updates in Functional Movement Disorders: from Pathophysiology to Treatment Advances

Purpose of Review

This review discusses advances in functional movement disorders (FMD) over the past 3 years, with a focus on risk factors, diagnosis, pathophysiology, neuroimaging studies, and treatment.

Recent Findings

The past decade has brought a revived interest in functional movement disorders, with a growing number of studies exploring pathophysiological mechanisms. Here, we review recent studies demonstrating changes in attention, emotional and sensorimotor function in FMD. Through international collaborative efforts, progress has been made in defining biomarkers and outcome measures, an important prerequisite towards standardization of diagnosis and reporting of outcomes in clinical trials. Of particular interest are neuroimaging studies demonstrating functional and structural changes in motor and emotional brain circuits, deepening our understanding of FMD as a neurocircuit disorder and potentially paving the way towards new treatments. Currently available treatment modalities have shown successful outcomes via outpatient, inpatient, and virtual delivery.

Summary

The last 3 years have seen tremendous efforts to better understand, diagnose, and treat FMD. The disease model has been broadened to include a biopsychosocial formulation, and insights on the pathophysiology on FMD are informing treatment efforts. Several international multidisciplinary research collaborations are underway to define biomarkers and best outcome measures, highlighting the path towards improved standardization of future treatment trials. Additionally, the rise of telemedicine during the COVID-19 pandemic has reduced geographic barriers and paved the way for virtual therapy sessions and self-guided programs.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11910-022-01192-9.

Attentional bias to emotions after prolonged endurance exercise is modulated by age

Physical exercise has an impact in biasing attention to positive or negative emotional stimuli. While attentional shift to emotions varies with age, evidence is lacking on the effect of prolonged endurance exercise on age-related attentional bias to emotions. This study aims at filling this knowledge gap, by applying a dot-probe task to measure attentional bias to emotions before and after a half-marathon in healthy participants of different ages (age range 21-65 years). State anxiety, positive and negative affect were also assessed. Younger adults showed attentional bias towards anger and away from sadness after the race, supporting the hypothesis of the congruency between the high-arousing task and the associated emotion (anger) in the modulation of attention. Conversely, older adults showed a bias away from anger, likely representing an attempt to maintain an optimal emotional level after the competition. This study sheds new light on how age impacts on emotional mechanisms involved in prolonged endurance exercise and suggests that regulatory processes in response to stress may be involved differently, depending on age.

Microstructural integrity of affective neurocircuitry in patients with dissociative seizures is associated with emotional task performance, illness severity and trauma history

PURPOSE

To identify variations in white matter tract integrity related to behavioural control in response to emotional stimuli in patients with dissociative seizures (DS) and healthy controls (HC), and examine associations with illness characteristics and psychological trauma history.

METHODS

Twenty DS patients and 20 HC completed an emotional go/no-go task and questionnaires, and then underwent diffusion tensor imaging (DTI).

RESULTS

Patients had higher false alarm rates in response to negative emotional stimuli than HC. Task performance was correlated with self-reported difficulties in emotional awareness and regulation in everyday life. White matter analysis using tract-based spatial statistics revealed no between-group differences. In patients, fractional anisotropy (FA) in the right uncinate fasciculus, right and left fornix/stria terminalis, and corpus callosum were correlated with task performance. Similar results were found for radial diffusivity (RD), but not mean (MD) or axial diffusivity (AD). In HC, task performance was associated with AD and RD of fewer and smaller clusters in the corpus callosum and right fornix/stria terminalis, and none for FA or MD. Probabilistic tractography of thus identified tracts revealed that mean FA values were correlated with illness parameters (right fornix/stria terminalis with age at onset; posterior corpus callosum with seizure frequency), and psychological trauma history (traumatic experiences during adolescence with anterior corpus callosum).

CONCLUSIONS

Patients with DS show impaired behavioural control in response to emotional stimuli. Microstructural variations in task-related neurocircuitry show associations with illness parameters and psychological trauma history. Future studies using psychiatric controls should examine the specificity of these findings.

Hedonicity in functional motor disorders: a chemosensory study assessing taste

The aim of this study was to explore hedonicity to basic tastes in patients with functional motor disorders (FMDs) that are often associated with impairment in emotional processing. We recruited 20 FMD patients and 24 healthy subjects, matched for age and sex. Subjects were asked to rate the hedonic sensation (i.e., pleasant, neutral, and unpleasant) on a - 10 to +10 scale to the four basic tastes (sweet, sour, salty, and bitter) at different concentrations, and neutral stimuli (i.e., no taste stimulation) by means of the Taste Strips Test. Anxiety, depression, and alexithymia were assessed. FMD patients rated the highest concentration of sweet taste (6.7 ± 2.6) as significantly more pleasant than controls (4.7 ± 2.5, p = 0.03), and the neutral stimuli significantly more unpleasant (patients: - 0.7 ± 0.4, controls: 0.1 ± 0.4, p = 0.013). Hedonic ratings were not correlated to anxiety, depression, or alexithymia scores. Hedonic response to taste is altered in FMD patients. This preliminary finding might result from abnormal interaction between sensory processing and emotional valence.