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Pick S, Millman LM, Sun Y, Short E, Stanton B, Winston JS, Mehta MA, Nicholson TR, Reinders AA, David AS, Edwards MJ, Goldstein LH, Hotopf M, Chalder T. Objective and subjective neurocognitive functioning in functional motor symptoms and functional seizures: preliminary findings. J Clin Exp Neuropsychol 2023; 45:970-987. [PMID: 37724767 PMCID: PMC11057846 DOI: 10.1080/13803395.2023.2245110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/30/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION This study aimed to provide a preliminary assessment of objective and subjective neurocognitive functioning in individuals with functional motor symptoms (FMS) and/or functional seizures (FS). We tested the hypotheses that the FMS/FS group would display poorer objective attentional and executive functioning, altered social cognition, and reduced metacognitive accuracy. METHOD Individuals with FMS/FS (n = 16) and healthy controls (HCs, n = 17) completed an abbreviated CANTAB battery, and measures of intellectual functioning, subjective cognitive complaints, performance validity, and comorbid symptoms. Subjective performance ratings were obtained to assess local metacognitive accuracy. RESULTS The groups were comparable in age (p = 0.45), sex (p = 0.62), IQ (p = 0.57), and performance validity (p-values = 0.10-0.91). We observed no impairment on any CANTAB test in this FMS/FS sample compared to HCs, although the FMS/FS group displayed shorter reaction times on the Emotional Bias task (anger) (p = 0.01, np2 = 0.20). The groups did not differ in subjective performance ratings (p-values 0.15). Whilst CANTAB attentional set-shifting performance (total trials/errors) correlated with subjective performance ratings in HCs (p-values<0.005, rs = -0.85), these correlations were non-significant in the FMS/FS sample (p-values = 0.10-0.13, rs-values = -0.46-0.50). The FMS/FS group reported more daily cognitive complaints than HCs (p = 0.006, g = 0.92), which were associated with subjective performance ratings on CANTAB sustained attention (p = 0.001, rs = -0.74) and working memory tests (p < 0.001, rs = -0.75), and with depression (p = 0.003, rs = 0.70), and somatoform (p = 0.003, rs = 0.70) and psychological dissociation (p-values<0.005, rs-values = 0.67-0.85). CONCLUSIONS These results suggest a discordance between objective and subjective neurocognitive functioning in this FMS/FS sample, reflecting intact test performance alongside poorer subjective cognitive functioning. Further investigation of neurocognitive functioning in FND subgroups is necessary.
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Affiliation(s)
- Susannah Pick
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - L.S. Merritt Millman
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Yiqing Sun
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Eleanor Short
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Biba Stanton
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Joel S. Winston
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Mitul A. Mehta
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Timothy R. Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | | | | | - Mark J. Edwards
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Laura H. Goldstein
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, UK
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Jungilligens J, Flohr MC, Lange M, Wellmer J, Popkirov S. The relationship of action, affect, and metacognition in functional seizures. J Clin Exp Neuropsychol 2023; 45:1003-1013. [PMID: 38007609 DOI: 10.1080/13803395.2023.2287778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Metacognition provides a lens through which individuals experience, interpret, and respond to their affective states and behavior; it might thus influence complex neuropsychiatric conditions such as functional seizures - events characterized by states of heightened affective arousal and the disinhibition of prepotent behavior. In this pilot study, we aimed to establish a better understanding of the role of metacognition in functional seizures and its relationship to affective arousal and behavioral disinhibition (i.e., problems in suppressing prepared behavior). We hypothesized that affective arousal is related to higher behavioral disinhibition as well as slower reaction times, that affect and action (performing vs. not performing a movement) are related to memory and metacognition, and that metacognition is related to illness characteristics. METHODS We used a combination of an emotional go/no-go and a metacognitive recognition task with affectively valenced and neutral images in 18 patients with functional seizures. We compared markers of behavioral inhibition as well as indices for memory and metacognitive performance between affective (vs. neutral) and action/go (vs. inhibition/no-go) conditions. RESULTS Contrary to our hypothesis, behavioral disinhibition was not different between conditions. However, we found slower reaction times for affectively valenced stimuli. Memory performance and metacognition were better for affectively valenced pictures and for pictures used in go trials (i.e., associated with action/performing the movement). Illness factors (illness duration, seizure frequency, levels of self-reported anxiety) were correlated with aspects of metacognition. CONCLUSIONS This pilot study offers first insights into alterations in metacognition related to action and affect in patients with functional seizures; specifically, that affectively valenced stimuli and active engagement are related to enhanced memory and metacognition. This relationship was also found with respect to illness factors. These results provide insight into potentially underlying pathomechanisms, although the lack of a control group limits evaluating the specificity of these findings.
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Affiliation(s)
- Johannes Jungilligens
- Behavioral Neurology Research Group, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Marie-Christin Flohr
- Behavioral Neurology Research Group, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
- Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Miriam Lange
- Behavioral Neurology Research Group, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
- Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Jörg Wellmer
- Ruhr Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Essen, Essen, Germany
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Fekih-Romdhane F, Azzi V, Obeid S, Gerges S, Sarray El Dine A, Malaeb D, Soufia M, Hallit S. Psychometric properties of an Arabic translation of the short form of the metacognition questionnaire (MCQ-30) in a non-clinical adult sample. BMC Psychiatry 2023; 23:795. [PMID: 37907838 PMCID: PMC10619295 DOI: 10.1186/s12888-023-05308-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Previous linguistic validations of the 30-item Metacognition Questionnaire (MCQ-30) have been performed in Western/Eastern populations, and no Arabic validated version exists to date for the wide Arabic-speaking populations in the Middle East-North African region and abroad. In this regard, we sought through the present study to test the psychometric properties of an Arabic translation of the MCQ-30 in a sample of Arabic-speaking community adults from Lebanon. METHODS The sample of this cross-sectional study consisted of 423 participants (mean age: 38.13 ± 11.03 years; 61.2% females). The Metacognition Questionnaire-short form, Teruel Orthorexia Scale and Emotion regulation questionnaire were used to assess metacognition, orthorexia nervosa and emotion regulation (cognitive reappraisal and expressive suppression) respectively. RESULTS Findings of Confirmatory Factor Analyses revealed that the five-factor model provided a good fit to the data. McDonald's ω coefficients ranged from 0.78 to 0.94 for the five MCQ-30 subscales, and was of 0.93 for the total score, hence supporting the adequacy of scale reliability. Results also supported configural, metric, and scalar equivalence of the five-factor model across gender groups. The MCQ-30 subscales showed patterns of correlations with the emotion regulation and disordered eating constructs in the expected directions, providing evidence of the criterion-related validity of the measure. In particular, positive emotion regulation strategies (i.e., cognitive reappraisal) were negatively correlated with cognitive self-consciousness and need to control thoughts; whereas maladaptive emotion regulation strategies (i.e., expressive suppression) showed positive correlations with lack of cognitive confidence, negative beliefs and need to control thoughts. Additionally, all metacognition dimensions (except for cognitive self-consciousness) were significantly and positively correlated with higher levels of orthorexia nervosa behaviors. CONCLUSIONS Our findings preliminarily suggest that the scale is valid, reliable, and can be recommended for use among the broad Arabic-speaking community worldwide.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, 2010, Tunisia.
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Vanessa Azzi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Sarah Gerges
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Abir Sarray El Dine
- Department of Biomedical Sciences, School of Arts and Sciences, Lebanese International University, Beirut, Lebanon
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Michel Soufia
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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Fassold ME, Locke SM, Landy MS. Feeling lucky? prospective and retrospective cues for sensorimotor confidence. PLoS Comput Biol 2023; 19:e1010740. [PMID: 37363929 DOI: 10.1371/journal.pcbi.1010740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
On a daily basis, humans interact with the outside world using judgments of sensorimotor confidence, constantly evaluating our actions for success. We ask, what sensory and motor-execution cues are used in making these judgements and when are they available? Two sources of temporally distinct information are prospective cues, available prior to the action (e.g., knowledge of motor noise and past performance), and retrospective cues specific to the action itself (e.g., proprioceptive measurements). We investigated the use of these two cues in two tasks, a secondary motor-awareness task and a main task in which participants reached toward a visual target with an unseen hand and then made a continuous judgment of confidence about the success of the reach. Confidence was reported by setting the size of a circle centered on the reach-target location, where a larger circle reflects lower confidence. Points were awarded if the confidence circle enclosed the true endpoint, with fewer points returned for larger circles. This incentivized accurate reaches and attentive reporting to maximize the score. We compared three Bayesian-inference models of sensorimotor confidence based on either prospective cues, retrospective cues, or both sources of information to maximize expected gain (i.e., an ideal-performance model). Our findings showed two distinct strategies: participants either performed as ideal observers, using both prospective and retrospective cues to make the confidence judgment, or relied solely on prospective information, ignoring retrospective cues. Thus, participants can make use of retrospective cues, evidenced by the behavior observed in our motor-awareness task, but these cues are not always included in the computation of sensorimotor confidence.
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Affiliation(s)
- Marissa E Fassold
- Dept. of Psychology, New York University, New York, New York, United States of America
| | - Shannon M Locke
- Laboratoire des Systèmes Perceptifs, Département d'Études Cognitives, École Normale Supérieure, PSL University, CNRS, Paris, France
| | - Michael S Landy
- Dept. of Psychology, New York University, New York, New York, United States of America
- Center for Neural Science, New York University, New York, New York, United States of America
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Verrel J, Chwolka F, Filevich E, Moyé J, Paulus T, Zittel S, Bäumer T, Münchau A, Weissbach A. Impaired Metacognition of Voluntary Movement in Functional Movement Disorder. Mov Disord 2023; 38:435-443. [PMID: 36606550 DOI: 10.1002/mds.29303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/22/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Motor symptoms in functional movement disorders (FMDs) are experienced as involuntary but share characteristics of voluntary action. Clinical and experimental evidence indicate alterations in monitoring, control, and subjective experience of self-performed movements. OBJECTIVE The objective of this study was to test the prediction that FMDs are associated with a reduced ability to make accurate (metacognitive) judgments about self-performed movements. METHODS We compared 24 patients with FMD (including functional gait disturbance, functional tremor, and functional tics) with 24 age- and sex-matched healthy control subjects in a novel visuomotor-metacognitive paradigm. Participants performed target-directed movements on a graphics tablet with restricted visual feedback, decided which of two visually presented trajectories was closer to their preceding movement, and reported their confidence in the visuomotor decision. We quantified individual metacognitive performance as participants' ability to assign high confidence preferentially to correct visuomotor decisions. RESULTS Patients and control subjects showed comparable motor performance, response accuracy, and use of the confidence scale. However, visuomotor sensitivity in the trajectory judgment was reduced in patients with FMD compared with healthy control subjects. Moreover, metacognitive performance was impaired in patients, that is, their confidence ratings were less predictive of the correctness of visuomotor decisions. Exploratory subgroup analyses suggest metacognitive deficits to be most pronounced in patients with a functional gait disturbance or functional tremor. CONCLUSIONS Patients with FMD exhibited deficits both when making visuomotor decisions about their own movements and in the metacognitive evaluation of these decisions. Reduced metacognitive insight into voluntary motor control may play a role in FMD pathophysiology and could lay the groundwork for new treatment strategies. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Julius Verrel
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Fabian Chwolka
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Elisa Filevich
- Bernstein Center for Computational Neuroscience, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
- Institute of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Josephine Moyé
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Theresa Paulus
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Simone Zittel
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Lübeck, Germany
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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Seow TXF, Rouault M, Gillan CM, Fleming SM. How Local and Global Metacognition Shape Mental Health. Biol Psychiatry 2021; 90:436-446. [PMID: 34334187 DOI: 10.1016/j.biopsych.2021.05.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 01/22/2023]
Abstract
Metacognition is the ability to reflect on our own cognition and mental states. It is a critical aspect of human subjective experience and operates across many hierarchical levels of abstraction-encompassing local confidence in isolated decisions and global self-beliefs about our abilities and skills. Alterations in metacognition are considered foundational to neurologic and psychiatric disorders, but research has mostly focused on local metacognitive computations, missing out on the role of global aspects of metacognition. Here, we first review current behavioral and neural metrics of local metacognition that lay the foundation for this research. We then address the neurocognitive underpinnings of global metacognition uncovered by recent studies. Finally, we outline a theoretical framework in which higher hierarchical levels of metacognition may help identify the role of maladaptive metacognitive evaluation in mental health conditions, particularly when combined with transdiagnostic methods.
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Affiliation(s)
- Tricia X F Seow
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom.
| | - Marion Rouault
- Institut Jean Nicod, Département d'études cognitives, PSL Research University, Paris, France; Laboratoire de neurosciences cognitives et computationnelles, Département d'études cognitives, PSL Research University, Paris, France.
| | - Claire M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Stephen M Fleming
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom; Department of Experimental Psychology, University College London, London, United Kingdom
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Neuroanatomical correlates of self-awareness of highly practiced visuomotor skills. Brain Struct Funct 2021; 226:2295-2306. [PMID: 34228220 DOI: 10.1007/s00429-021-02328-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 06/22/2021] [Indexed: 12/27/2022]
Abstract
Metacognition is the ability to introspect and control ongoing cognitive processes. Despite the extensive investigation of the brain architectures supporting metacognition for perception and memory, little is known about the neural basis of metacognitive capacity for motor function, a vital aspect of human behavior. Here, using functional and structural magnetic resonance imaging (MRI), we examined the brain substrates underlying self-awareness of handwriting, a highly practiced visuomotor skill. Results showed that experienced adult writers generally overestimated their handwriting quality, and such overestimation was more pronounced in men relative to women. Individual variations in self-awareness of handwriting quality were positively correlated with gray matter volume in the left fusiform gyrus, right middle frontal gyrus and right precuneus. The left fusiform gyrus and right middle frontal gyrus are thought to represent domain-specific brain mechanisms for handwriting self-awareness, while the right precuneus that has been reported in other domains likely represents a domain-general brain mechanism for metacognition. Furthermore, the activity of these structurally related regions in a handwriting task was not correlated with self-awareness of handwriting, suggesting the correlation with metacognition was independent of task performance. Together, this study reveals that metacognition for practiced motor skills relies on both domain-general and domain-specific brain systems, extending our understanding about the neural basis of human metacognition.
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Ricciardi L, Nisticò V, Andrenelli E, Cunha JM, Demartini B, Kirsch LP, Crucianelli L, Yogarajah M, Morgante F, Fotopoulou A, Edwards MJ. Exploring three levels of interoception in people with functional motor disorders. Parkinsonism Relat Disord 2021; 86:15-18. [PMID: 33819899 DOI: 10.1016/j.parkreldis.2021.03.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A three-level model of interoception has recently been defined. We aim to study the interoceptive processing in individuals with functional motor disorder (FMD). METHODS Twenty-two patients with FMD were compared to 23 healthy controls. They underwent a protocol measuring different levels of interoception including: accuracy (a heart-beat tracking task), awareness (participant's confidence level) and sensibility (the Body Awareness Questionnaire-BAQ). Depression, anxiety and alexithymia were assessed by means of validated clinical scales. RESULTS The FMD group showed a lower cardiac interoceptive accuracy and sensibility than healthy controls but they did not differ in terms of awareness (p = 0.03 and 0.005 respectively). They were aware of their poor performance in the accuracy task. Cardiac interoceptive accuracy positively correlated with the BAQ sub-scales "Predict Body Reaction" (r = 0.49, p = 0.001) and "Sleep-Wake Cycle" (r = 0.52, p < 0.001). A mediation analysis showed a significant indirect effect of group on cardiac interoceptive accuracy through BAQ "Predict Body Reaction" (b = -2.95, 95% BCa CI[-7.2;-0.2]). The direct effect of group on "Predict Body Reaction" was still significant (b = - 6.95, p = 0.02, 95% CI[-13.18;-0.73]). CONCLUSIONS People with FMD have impaired cardiac interoceptive accuracy and sensibility but no difference in metacognitive interoception compared to healthy controls.
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Affiliation(s)
- Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK; MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, Oxford, UK.
| | - 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
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, "Politecnica Delle Marche" University of Ancona, Ancona, Italy
| | - Joana Macedo Cunha
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Benedetta Demartini
- 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 II, A.O. San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Louise P Kirsch
- Institut des Systèmes Intelligents et de Robotique (ISIR), Sorbonne Université, Paris, France
| | - Laura Crucianelli
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden; Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Mahinda Yogarajah
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Aikaterini Fotopoulou
- Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Mark J Edwards
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Perez DL, Nicholson TR, Asadi-Pooya AA, Bègue I, Butler M, Carson AJ, David AS, Deeley Q, Diez I, Edwards MJ, Espay AJ, Gelauff JM, Hallett M, Horovitz SG, Jungilligens J, Kanaan RAA, Tijssen MAJ, Kozlowska K, LaFaver K, LaFrance WC, Lidstone SC, Marapin RS, Maurer CW, Modirrousta M, Reinders AATS, Sojka P, Staab JP, Stone J, Szaflarski JP, Aybek S. Neuroimaging in Functional Neurological Disorder: State of the Field and Research Agenda. Neuroimage Clin 2021; 30:102623. [PMID: 34215138 PMCID: PMC8111317 DOI: 10.1016/j.nicl.2021.102623] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/03/2021] [Indexed: 02/06/2023]
Abstract
Functional neurological disorder (FND) was of great interest to early clinical neuroscience leaders. During the 20th century, neurology and psychiatry grew apart - leaving FND a borderland condition. Fortunately, a renaissance has occurred in the last two decades, fostered by increased recognition that FND is prevalent and diagnosed using "rule-in" examination signs. The parallel use of scientific tools to bridge brain structure - function relationships has helped refine an integrated biopsychosocial framework through which to conceptualize FND. In particular, a growing number of quality neuroimaging studies using a variety of methodologies have shed light on the emerging pathophysiology of FND. This renewed scientific interest has occurred in parallel with enhanced interdisciplinary collaborations, as illustrated by new care models combining psychological and physical therapies and the creation of a new multidisciplinary FND society supporting knowledge dissemination in the field. Within this context, this article summarizes the output of the first International FND Neuroimaging Workgroup meeting, held virtually, on June 17th, 2020 to appraise the state of neuroimaging research in the field and to catalyze large-scale collaborations. We first briefly summarize neural circuit models of FND, and then detail the research approaches used to date in FND within core content areas: cohort characterization; control group considerations; task-based functional neuroimaging; resting-state networks; structural neuroimaging; biomarkers of symptom severity and risk of illness; and predictors of treatment response and prognosis. Lastly, we outline a neuroimaging-focused research agenda to elucidate the pathophysiology of FND and aid the development of novel biologically and psychologically-informed treatments.
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Affiliation(s)
- David L Perez
- Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Timothy R Nicholson
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz Iran; Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Indrit Bègue
- Division of Adult Psychiatry, Department of Psychiatry, University of Geneva, Geneva Switzerland; Service of Neurology Department of Clinical Neuroscience, University of Geneva, Geneva, Switzerland
| | - Matthew Butler
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alan J Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Quinton Deeley
- South London and Maudsley NHS Foundation Trust, London UK Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ibai Diez
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark J Edwards
- Neurosciences Research Centre, St George's University of London, London, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, USA
| | - Jeannette M Gelauff
- Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Silvina G Horovitz
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Johannes Jungilligens
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Germany
| | - Richard A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health Heidelberg, Australia
| | - Marina A J Tijssen
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, The Netherlands
| | - Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead Institute of Medical Research, University of Sydney Medical School, Sydney, NSW, Australia
| | - Kathrin LaFaver
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - W Curt LaFrance
- Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, RI, USA
| | - Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - Ramesh S Marapin
- Expertise Center Movement Disorders Groningen, University Medical Center Groningen, Groningen, University of Groningen, The Netherlands
| | - Carine W Maurer
- Department of Neurology, Stony Brook University Renaissance School of Medicine, Stony Brook, NY, USA
| | - Mandana Modirrousta
- Department of Psychiatry, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Petr Sojka
- Department of Psychiatry, University Hospital Brno, Czech Republic
| | - Jeffrey P Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic Rochester, MN, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, The University of Edinburgh, EH16 4SB, UK
| | - Jerzy P Szaflarski
- University of Alabama at Birmingham Epilepsy Center, Department of Neurology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Selma Aybek
- Neurology Department, Psychosomatic Medicine Unit, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
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10
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Thomsen BLC, Teodoro T, Edwards MJ. Biomarkers in functional movement disorders: a systematic review. J Neurol Neurosurg Psychiatry 2020; 91:1261-1269. [PMID: 33087421 DOI: 10.1136/jnnp-2020-323141] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 08/11/2020] [Accepted: 09/23/2020] [Indexed: 11/04/2022]
Abstract
Functional movement disorders (FMD) are proposed to reflect a specific problem with voluntary control of movement, despite normal intent to move and an intact neural capacity for movement. In many cases, a positive diagnosis of FMD can be established on clinical grounds. However, the diagnosis remains challenging in certain scenarios, and there is a need for predictors of treatment response and long-term prognosis.In this context, we performed a systematic review of biomarkers in FMD. Eighty-six studies met our predefined criteria and were included.We found fairly reliable electroencephalography and electromyography-based diagnostic biomarkers for functional myoclonus and tremor. Promising biomarkers have also been described for functional paresis, gait and balance disorders. In contrast, there is still a lack of diagnostic biomarkers of functional dystonia and tics, where clinical diagnosis is often also more challenging. Importantly, many promising findings focus on pathophysiology and reflect group-level comparisons, but cannot differentiate on an individual basis. Some biomarkers also require access to time-consuming and resource-consuming techniques such as functional MRI.In conclusion, there are important gaps in diagnostic biomarkers in FMD in the areas of most clinical uncertainty. There is also is a lack of treatment response and prognostic biomarkers to aid in the selection of patients who would benefit from rehabilitation and other forms of treatment.
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Affiliation(s)
- Birgitte Liang Chen Thomsen
- Neurology, Bispebjerg Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tiago Teodoro
- Neurosciences Research Centre, St George's University of London, London, UK.,Instituto de Medicina Molecular, University of Lisbon, Lisboa, Portugal
| | - Mark J Edwards
- Neurosciences Research Centre, St George's University of London, London, UK
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11
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Locke SM, Mamassian P, Landy MS. Performance monitoring for sensorimotor confidence: A visuomotor tracking study. Cognition 2020; 205:104396. [PMID: 32771212 PMCID: PMC7669557 DOI: 10.1016/j.cognition.2020.104396] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 11/22/2022]
Abstract
To best interact with the external world, humans are often required to consider the quality of their actions. Sometimes the environment furnishes rewards or punishments to signal action efficacy. However, when such feedback is absent or only partial, we must rely on internally generated signals to evaluate our performance (i.e., metacognition). Yet, very little is known about how humans form such judgements of sensorimotor confidence. Do they monitor their actual performance or do they rely on cues to sensorimotor uncertainty? We investigated sensorimotor metacognition in two visuomotor tracking experiments, where participants followed an unpredictably moving dot cloud with a mouse cursor as it followed a random horizontal trajectory. Their goal was to infer the underlying target generating the dots, track it for several seconds, and then report their confidence in their tracking as better or worse than their average. In Experiment 1, we manipulated task difficulty with two methods: varying the size of the dot cloud and varying the stability of the target's velocity. In Experiment 2, the stimulus statistics were fixed and duration of the stimulus presentation was varied. We found similar levels of metacognitive sensitivity in all experiments, which was evidence against the cue-based strategy. The temporal analysis of metacognitive sensitivity revealed a recency effect, where error later in the trial had a greater influence on the sensorimotor confidence, consistent with a performance-monitoring strategy. From these results, we conclude that humans predominantly monitored their tracking performance, albeit inefficiently, to build a sense of sensorimotor confidence.
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Affiliation(s)
- Shannon M Locke
- Laboratoire des Systèmes Perceptifs, Département d'Études Cognitives, École Normale Supérieure, PSL University, CNRS, 75005 Paris, France; Department of Psychology, New York University, New York, NY, United States.
| | - Pascal Mamassian
- Laboratoire des Systèmes Perceptifs, Département d'Études Cognitives, École Normale Supérieure, PSL University, CNRS, 75005 Paris, France
| | - Michael S Landy
- Department of Psychology, New York University, New York, NY, United States; Center for Neural Science, New York University, New York, NY, United States
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12
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Cretton A, Brown RJ, LaFrance WC, Aybek S. What Does Neuroscience Tell Us About the Conversion Model of Functional Neurological Disorders? J Neuropsychiatry Clin Neurosci 2020; 32:24-32. [PMID: 31619119 DOI: 10.1176/appi.neuropsych.19040089] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A dualistic mind-body understanding of functional neurological disorders (FNDs), also known as conversion disorders, has led to the view that the cause of the symptom should be either psychological (psychogenic) or physical (neurogenic-"organic"). One of the most influential psychological approaches is the Freudian model of conversion, which suggests that FNDs arise from a defense process in which emotional stress is converted into physical symptoms. This conversion theory has been challenged in recent years, accompanied by a shift in emphasis toward neuropathophysiological models of FND and away from historical psychological concepts. In this review, the authors consider the contemporary relevance of the conversion model from the neuroscientific perspective to reconcile the role of both psychological and biological factors in FND. A narrative review of recent neuroscientific findings pertaining to the conversion model of FND, encompassing neuroimaging, cognitive psychology, biological markers, and epigenetic studies, was performed. Research on the role of psychological stressors is discussed. Neurobiological mechanisms of repression of traumatic memories and their translation into physical symptoms are then explored. Finally, the role of physical symptoms as a potential protective defense mechanism against social stressors is considered. The authors argue that the conversion concept is consistent with recent neuroscientific research findings, and the model allows psychological and neurobiological concepts to be reconciled within a single account of FND that begins to resolve the dualistic mind-body dichotomy.
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Affiliation(s)
- Alexandre Cretton
- The Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland (Cretton, Aybek); the School of Health Sciences, University of Manchester, Manchester, United Kingdom (Brown); Manchester Academic Health Sciences Centre, Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom (Brown); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, R.I. (LaFrance)
| | - Richard J Brown
- The Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland (Cretton, Aybek); the School of Health Sciences, University of Manchester, Manchester, United Kingdom (Brown); Manchester Academic Health Sciences Centre, Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom (Brown); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, R.I. (LaFrance)
| | - W Curt LaFrance
- The Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland (Cretton, Aybek); the School of Health Sciences, University of Manchester, Manchester, United Kingdom (Brown); Manchester Academic Health Sciences Centre, Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom (Brown); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, R.I. (LaFrance)
| | - Selma Aybek
- The Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland (Cretton, Aybek); the School of Health Sciences, University of Manchester, Manchester, United Kingdom (Brown); Manchester Academic Health Sciences Centre, Greater Manchester Mental Health National Health Service Foundation Trust, Manchester, United Kingdom (Brown); and the Departments of Psychiatry and Neurology, Rhode Island Hospital, Brown University, Providence, R.I. (LaFrance)
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13
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Drane DL, Fani N, Hallett M, Khalsa SS, Perez DL, Roberts NA. A framework for understanding the pathophysiology of functional neurological disorder. CNS Spectr 2020; 26:1-7. [PMID: 32883381 PMCID: PMC7930164 DOI: 10.1017/s1092852920001789] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The symptoms of functional neurological disorder (FND) are a product of its pathophysiology. The pathophysiology of FND is reflective of dysfunction within and across different brain circuits that, in turn, affects specific constructs. In this perspective article, we briefly review five constructs that are affected in FND: emotion processing (including salience), agency, attention, interoception, and predictive processing/inference. Examples of underlying neural circuits include salience, multimodal integration, and attention networks. The symptoms of each patient can be described as a combination of dysfunction in several of these networks and related processes. While we have gained a considerable understanding of FND, there is more work to be done, including determining how pathophysiological abnormalities arise as a consequence of etiologic biopsychosocial factors. To facilitate advances in this underserved and important area, we propose a pathophysiology-focused research agenda to engage government-sponsored funding agencies and foundations.
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Affiliation(s)
- Daniel L. Drane
- Departments of Neurology and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, GA, USA
| | - Mark Hallett
- Human Motor Control Section, NINDS, National Institutes of Health, Bethesda, MD, USA
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, USA; Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, USA
| | - David L. Perez
- Cognitive Behavioral Neurology and Neuropsychiatry Units, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicole A. Roberts
- School of Social and Behavioral Sciences, Arizona State University, Phoenix, AZ, USA
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14
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Pick S, Rojas-Aguiluz M, Butler M, Mulrenan H, Nicholson TR, Goldstein LH. Dissociation and interoception in functional neurological disorder. Cogn Neuropsychiatry 2020; 25:294-311. [PMID: 32635804 DOI: 10.1080/13546805.2020.1791061] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: We aimed to examine susceptibility to dissociation and the impact of dissociation on interoceptive processing in individuals with functional neurological disorder (FND). We hypothesised that dissociative states would be elevated and interoceptive accuracy and awareness impaired at baseline in people with FND, and that such differences would be exacerbated following acute dissociation. Methods: Nineteen adults with FND were compared to 20 healthy controls. A modified heart-beat tracking task measured interoceptive accuracy and awareness (confidence) before and after a validated dissociation induction procedure. An exteroceptive processing control task was included. Mann-Whitney tests and r-values (effect size) were computed for between-group comparisons. Results: The FND group displayed elevated dissociation at baseline (p = 0.001, r = 0.528) compared to controls which increased following dissociation-induction (p < 0.001, r = 0.663). Interoceptive accuracy did not differ between groups at baseline (p = 0.967, r = 0.009); however, the FND group had lower accuracy scores post-induction (p = 0.021, r = 0.379). A negative correlation (trend) between change scores for dissociation and interoceptive accuracy was noted (rs = -0.411, p = 0.057). Confidence ratings on interoceptive and exteroceptive processing tasks were lower in the FND group (p-values < 0.05 or <0.01, r-values 0.331-0.489). Conclusions: Individuals with FND experienced greater susceptibility to dissociation, metacognitive deficits and impaired interoceptive accuracy than controls after acute dissociation.
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Affiliation(s)
- Susannah Pick
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maya Rojas-Aguiluz
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Morgan Butler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Heather Mulrenan
- GKT School of Medical Education, King's College London, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura H Goldstein
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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15
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Cascino G, Canna A, Monteleone AM, Russo AG, Prinster A, Aiello M, Esposito F, Salle FD, Monteleone P. Cortical thickness, local gyrification index and fractal dimensionality in people with acute and recovered Anorexia Nervosa and in people with Bulimia Nervosa. Psychiatry Res Neuroimaging 2020; 299:111069. [PMID: 32203897 DOI: 10.1016/j.pscychresns.2020.111069] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 01/12/2023]
Abstract
Eating disorders (EDs) have a possible neurodevelopmental pathogenesis. Our study aim was to assess regional cortical thickness (CT), local gyrification index (lGI) and fractal dimensionality (FD), as specific markers of cortical neurodevelopment in ED females. Twenty-two women with acute anorexia nervosa (acuAN), 10 with recovered anorexia nervosa (recAN), 24 with bulimia nervosa (BN) and 35 female healthy controls (HC) underwent a 3T MRI scan. All data were processed by FreeSurfer. Compared to recAN group women with acuAN showed a lower CT in multiple areas, while compared to HC they showed lower CT in temporal regions. BN group showed higher CT values in temporal and paracentral areas compared to HC. In multiple cortical areas, AcuAN group showed greater values of lGI compared to recAN group and lower values of lGI compared to HC. The BN group showed lower lGI in left medial orbitofrontal cortex compared to HC. No significant differences were found in FD among the groups. Present results provide evidence of CT and lGI alterations in patients with AN and, for the first time, in those with BN. Although these alterations could be state-dependent phenomena, they may underlie psychopathological aspects of EDs.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Via Salvador Allende, 84081 Baronissi, Italy.
| | - Antonietta Canna
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Via Salvador Allende, 84081 Baronissi, Italy
| | | | - Andrea Gerardo Russo
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Via Salvador Allende, 84081 Baronissi, Italy
| | - Anna Prinster
- Biostructure and Bioimaging Institute, National Research Council, Naples, Italy
| | | | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Via Salvador Allende, 84081 Baronissi, Italy
| | - Francesco Di Salle
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Via Salvador Allende, 84081 Baronissi, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Via Salvador Allende, 84081 Baronissi, Italy
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16
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Bègue I, Vaessen M, Hofmeister J, Pereira M, Schwartz S, Vuilleumier P. Confidence of emotion expression recognition recruits brain regions outside the face perception network. Soc Cogn Affect Neurosci 2019; 14:81-95. [PMID: 30481350 PMCID: PMC6318466 DOI: 10.1093/scan/nsy102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022] Open
Abstract
Metacognitive beliefs about emotions expressed by others are crucial to social life, yet very little studied. To what extent does our confidence in emotion expression recognition depend on perceptual or other non-perceptual information? We obtained behavioral and magnetic resonance imaging measures while participants judged either the emotion in ambiguous faces or the size of two lines flanking these faces, and then rated their confidence on decision accuracy. Distinct behavioral and neural mechanisms were identified for confidence and perceptual decision in both tasks. Participants overestimated their emotion recognition (ER) accuracy, unlike visual size judgments. Whereas expression discrimination recruited several areas in the face-processing network, confidence for ER uniquely engaged the bilateral retrosplenial/posterior cingulate complex and left parahippocampal gyrus. Further, structural white matter connectivity of the former region predicted metacognitive sensitivity. These results highlight a key role for brain mechanisms integrating perception with contextual mnemonic information in the service of confidence during ER.
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Affiliation(s)
- Indrit Bègue
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Switzerland.,Swiss Center for Affective Studies, University of Geneva, Switzerland.,Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland
| | - Maarten Vaessen
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Switzerland
| | - Jeremy Hofmeister
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Switzerland
| | - Marice Pereira
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Switzerland
| | - Sophie Schwartz
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Switzerland.,Swiss Center for Affective Studies, University of Geneva, Switzerland
| | - Patrik Vuilleumier
- Department of Neuroscience, Faculty of Medicine, University of Geneva, Switzerland.,Swiss Center for Affective Studies, University of Geneva, Switzerland
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17
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Bègue I, Adams C, Stone J, Perez DL. Structural alterations in functional neurological disorder and related conditions: a software and hardware problem? Neuroimage Clin 2019; 22:101798. [PMID: 31146322 PMCID: PMC6484222 DOI: 10.1016/j.nicl.2019.101798] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 01/01/2023]
Abstract
Functional neurological (conversion) disorder (FND) is a condition at the interface of neurology and psychiatry. A "software" vs. "hardware" analogy describes abnormal neurobiological mechanisms occurring in the context of intact macroscopic brain structure. While useful for explanatory and treatment models, this framework may require more nuanced considerations in the context of quantitative structural neuroimaging findings in FND. Moreover, high co-occurrence of FND and somatic symptom disorders (SSD) as defined in DSM-IV (somatization disorder, somatoform pain disorder, and undifferentiated somatoform disorder; referred to as SSD for brevity in this article) raises the possibility of a partially overlapping pathophysiology. In this systematic review, we use a transdiagnostic approach to review and appraise the structural neuroimaging literature in FND and SSD. While larger sample size studies are needed for definitive characterization, this article highlights that individuals with FND and SSD may exhibit sensorimotor, prefrontal, striatal-thalamic, paralimbic, and limbic structural alterations. The structural neuroimaging literature is contextualized within the neurobiology of stress-related neuroplasticity, gender differences, psychiatric comorbidities, and the greater spectrum of functional somatic disorders. Future directions that could accelerate the characterization of the pathophysiology of FND and DSM-5 SSD are outlined, including "disease staging" discussions to contextualize subgroups with or without structural changes. Emerging neuroimaging evidence suggests that some individuals with FND and SSD may have a "software" and "hardware" problem, although if structural alterations are present the neural mechanisms of functional disorders remain distinct from lesional neurological conditions. Furthermore, it remains unclear whether structural alterations relate to predisposing vulnerabilities or consequences of the disorder.
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Affiliation(s)
- Indrit Bègue
- Department of Psychiatry, University of Geneva, Switzerland; Service of Adult Psychiatry, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Switzerland; Laboratory for Behavioral Neurology and Imaging of Cognition, Geneva Neuroscience Center, University of Geneva, Switzerland
| | - Caitlin Adams
- Functional Neurology Research Group, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Inpatient Psychiatry Division, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, Western General Hospital, NHS Lothian and University of Edinburgh, Edinburgh, UK
| | - David L Perez
- Functional Neurology Research Group, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
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18
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Ospina JP, Jalilianhasanpour R, Perez DL. The role of the anterior and midcingulate cortex in the neurobiology of functional neurologic disorder. HANDBOOK OF CLINICAL NEUROLOGY 2019; 166:267-279. [PMID: 31731915 DOI: 10.1016/b978-0-444-64196-0.00014-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Functional neurologic disorder (FND)/conversion disorder is a prevalent and disabling condition at the intersection of neurology and psychiatry. Clinicians often report feeling ill-equipped treating patients with FND, perpetuated by a historically limited understanding of neurobiologic disease mechanisms. In this review, we summarize the neuroimaging literature across the spectrum of sensorimotor FND, including functional imaging studies during rest, sensorimotor performance, and emotional-processing tasks as well as structural magnetic resonance imaging findings. Particular attention is given to studies implicating the anterior and middle cingulate cortex and related salience network structures (insula, amygdala, and periaqueductal gray) in the neurobiology of FND. Neuroimaging studies identify cingulo-insular functional alterations during rest, motor performance, and emotion processing in FND populations. The literature also supports that patients with FND exhibit heightened amygdalar and periaqueductal gray reactivity to emotionally valenced stimuli, enhanced coupling between amygdalar and motor control areas, and increased amygdalar volumes. The structural neuroimaging literature also implicates cingulo-insular areas in the pathophysiology of FND, though these findings require replication and clarification. While more research is needed to fully elucidate the pathophysiology of FND, salience network alterations appear present in some FND populations and can be contextualized using biopsychosocial models for FND.
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Affiliation(s)
- Juan Pablo Ospina
- Department of Neurology, Cognitive Behavioral Neurology Unit, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Rozita Jalilianhasanpour
- Department of Neurology, Cognitive Behavioral Neurology Unit, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - David L Perez
- Departments of Neurology and Psychiatry, Cognitive Behavioral Neurology and Neuropsychiatry Units, Functional Neurology Research Group, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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