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Van Patten R, Mordecai K, LaFrance WC. The role of neuropsychology in the care of patients with functional neurological symptom disorder. J Int Neuropsychol Soc 2024:1-8. [PMID: 38813659 DOI: 10.1017/s1355617724000249] [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] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Functional neurological symptom disorder (FNSD) is a neuropsychiatric condition characterized by signs/symptoms associated with brain network dysfunction. FNSDs are common and are associated with high healthcare costs. FNSDs are relevant to neuropsychologists, as they frequently present with chronic neuropsychiatric symptoms, subjective cognitive concerns, and/or low neuropsychological test scores, with associated disability and reduced quality of life. However, neuropsychologists in some settings are not involved in care of patients with FNSDs. This review summarizes relevant FNSD literature with a focus on the role of neuropsychologists. METHODS A brief review of the literature is provided with respect to epidemiology, public health impact, symptomatology, pathophysiology, and treatment. RESULTS Two primary areas of focus for this review are the following: (1) increasing neuropsychologists' training in FNSDs, and (2) increasing neuropsychologists' role in assessment and treatment of FNSD patients. CONCLUSIONS Patients with FNSD would benefit from increased involvement of neuropsychologists in their care.
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Affiliation(s)
- Ryan Van Patten
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | | | - W Curt LaFrance
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
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de Vroege L, van Dijl TL, Woudstra-de Jong JE, Videler AC, Kop WJ. Personality traits related to cognitive functioning in patients with functional neurological disorder. J Clin Exp Neuropsychol 2023; 45:1014-1023. [PMID: 38623749 DOI: 10.1080/13803395.2024.2335599] [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: 07/05/2023] [Accepted: 02/04/2024] [Indexed: 04/17/2024]
Abstract
Cognitive symptoms are prevalent in patients with functional neurological disorder (FND). Several studies have suggested that personality traits such as neuroticism may play a pivotal role in the development of FND. FND has also been associated with alexithymia: patients with FND report difficulties in identifying, analyzing, and verbalizing emotions. Whether or not alexithymia and other personality traits are associated with cognitive symptomatology in patients with FND is unknown. In the current study, we explored whether the Big Five personality model factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and alexithymia were associated with cognitive functioning in FND. Twenty-three patients with FND were assessed using a neuropsychological assessment and questionnaire assessment to explore personality traits (Neuroticism-Extraversion-Openness Five-Factor Inventory) and alexithymia (Bermond-Vorst Alexithymia Questionnaire). The results indicated that high conscientiousness was associated with lower planning scores (ρ = -0.52, p = .012) and high scores on alexithymia were associated with lower scores on verbal memory scores (ρ = -0.46, p = .032) and lower sustained attention scores (ρ = -0.45, p = .046). The results did not remain significant after controlling for multiple testing. The preliminary results of our study suggest that personality and cognitive symptomatology in patients with FND are topics that should be further explored in future studies, as cognitive symptomology can affect treatment results.
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Affiliation(s)
- Lars de Vroege
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
- Tranzo department, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Timothy L van Dijl
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
- Tranzo department, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | | | - Arjan C Videler
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
- Tranzo department, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Personacura, Clinical Centre of Excellence for Personality and Developmental Disorders in Older Adults, GGz Breburg, Tilburg, The Netherlands
| | - Willem J Kop
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, The Netherlands
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
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de Vroege L, Woudstra-de Jong JE, Videler AC, Kop WJ. Personality factors and cognitive functioning in patients with somatic symptom and related disorders. J Psychosom Res 2022; 163:111067. [PMID: 36332534 DOI: 10.1016/j.jpsychores.2022.111067] [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: 10/04/2021] [Revised: 10/07/2022] [Accepted: 10/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Somatic symptom and related disorders (SSRD) are often complicated by cognitive symptoms, including reduced information processing speed, memory, and planning. Depression has been related to poor cognitive functioning in SSRD, but the role of underlying personality factors is poorly understood. This study investigates the association between personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness) with cognitive functioning in patients with SSRD. METHODS Data from 366 patients with SSRD from a tertiary care expert center (mean age = 42.1 years (SD = 13.4), 59.6% women) were analyzed using a cross-sectional design. Neuropsychological assessments included measures of information processing speed, memory, attention, and executive function. Personality factors were assessed using the NEO-FFI and depressive symptoms using the PHQ-9. RESULTS Regression analyses showed associations between neuroticism with poorer performance on visual memory (B = -0.09, SE = 0.04, β = -0.14, p = .019), and planning (B = -0.09. SE = 0.02, β = -0.23, p < .001). Extraversion was also inversely associated with visual memory (B = -0.13, SE = 0.05, β = -0.18, p = .011) and planning (B = -0.07, SE = 0.03, β = -0.17, p = .021) and openness was associated with better visual memory (B = 0.17, SE = 0.05, β = 0.19, p = .002). These associations were attenuated but remained significant after adjusting for depressive symptoms. CONCLUSION Neuroticism, extraversion, and low openness were associated with lower cognitive functioning (particularly planning and visual memory) in patients with SSRD, which remained significant after taking depressive symptoms into account.
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Affiliation(s)
- Lars de Vroege
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands.
| | - Jarinne E Woudstra-de Jong
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Arjan C Videler
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands; PersonaCura, Clinical Center of Excellence for Personality Disorders and Autism in Older Adults, GGz Breburg, Tilburg, The Netherlands.
| | - Willem J Kop
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS), Tilburg University, Tilburg, the Netherlands.
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van der Feltz-Cornelis C, Brabyn S, Ratcliff J, Varley D, Allgar V, Gilbody S, Clarke C, Lagos D. Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/functional neurological disorder (CD/FND): The CANDO clinical feasibility study. Brain Behav Immun Health 2021; 13:100228. [PMID: 34589743 PMCID: PMC8474571 DOI: 10.1016/j.bbih.2021.100228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Conversion disorder/functional neurological disorder (CD/FND) occurs often in neurological settings and can lead to long-term distress, disability and demand on health care services. Systemic low-grade inflammation might play a role, however, the pathogenic mechanism is still unknown. AIM 1) To explore the feasibility to establish and assess a cohort of CD/FND with motor symptoms, involving persons with lived experience (PPI). 2) To generate proof of concept regarding a possible role for cytokines, microRNA, cortisol levels and neurocognitive symptoms in patients with motor CD/FND. METHOD Feasibility study. RESULTS The study showed active involvement of patients despite high clinical illness burden and disability, neurocognitive symptoms, childhood adverse experiences (ACE) and current life events. The study provided valuable knowledge regarding the feasibility of conducting a study in these patients that will inform future study phases. In the sample there were elevated levels of IL6, IL12, IL17A, IFNg, TNFa and VEGF-a, suggesting systemic low-grade inflammation. Also, microRNAs involved in inflammation and vascular inflammation were correlated with TNFa and VEGFa respectively, suggesting proof of concept for an epigenetic mechanism. Owing to the COVID-19 outbreak, the patient sample was limited to 15 patients. CONCLUSION It is a novelty that this study is conducted in the clinical setting. This innovative, translational study explores stress-related SLI in CD/FND patients and the feasibility of a larger project aiming to develop new treatments for this vulnerable population. Given the positive findings, there is scope to conduct further research into the mechanism of disease in CD/FND.
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de Vroege L, Vergeest A, Kop WJ. Letter to the Editor - Towards an Outpatient Model of Care for Motor Functional Neurological Disorders: A Neuropsychiatric Perspective [Letter]. Neuropsychiatr Dis Treat 2021; 17:1055-1056. [PMID: 33880027 PMCID: PMC8053526 DOI: 10.2147/ndt.s312567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lars de Vroege
- Clinical Center of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands.,Tilburg School of Behavioral and Social Sciences, Tranzo Department, Tilburg University, Tilburg, the Netherlands
| | - Anne Vergeest
- Clinical Center of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands.,Tilburg School of Behavioral and Social Sciences, Tranzo Department, Tilburg University, Tilburg, the Netherlands
| | - Willem Johan Kop
- Clinical Center of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands
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de Vroege L, Koppenol I, Kop WJ, Riem MME, van der Feltz-Cornelis CM. Neurocognitive functioning in patients with conversion disorder/functional neurological disorder. J Neuropsychol 2020; 15:69-87. [PMID: 32223071 PMCID: PMC8048909 DOI: 10.1111/jnp.12206] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/03/2020] [Indexed: 01/25/2023]
Abstract
Neurocognitive symptoms are common in individuals with somatic symptom and related disorders (SSRD), but little is known about the specific impairments in neurocognitive domains in patients with conversion disorder (CD)/functional neurological disorder (FND). This study examines neurocognitive functioning in patients with CD/FND compared to patients with other SSRD. The sample consisted of 318 patients. Twenty‐nine patients were diagnosed with CD/FND, mean age 42.4, standard deviation (SD) = 13.8 years, 79.3% women, and 289 patients had other SSRD (mean age 42.1, SD = 13.3, 60.2% women). Patients completed a neuropsychological test battery that addressed a broad range of neurocognitive domains, including information processing speed, attention and executive functioning. Patients with CD/FND had clinically significant neurocognitive deficits in all neurocognitive domains based on normative data comparison. Patients with CD/FND also performed significantly worse than patients with other SSRD on information processing speed (Digit Symbol Substitution Test (V = .115, p = .035), Stroop Color–Word Test (SCWT) card 1 (V = .190, p = .006), and SCWT card 2 (V = .244, p < .001). No CD/FND vs. other SSRD differences were observed in other neurocognitive domains. These findings indicate the patients with CD/FND perform worse on information processing speed tests compared to patients with other SSRD.
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Affiliation(s)
- Lars de Vroege
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, the Netherlands.,Tilburg School of Social and Behavioral Sciences, Tranzo Department, Tilburg University, the Netherlands
| | - Iris Koppenol
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, the Netherlands
| | - Willem Johan Kop
- Clinical Centre of Excellence for Body, Mind, and Health, GGz Breburg, Tilburg, the Netherlands.,Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, the Netherlands
| | - Madelon M E Riem
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, the Netherlands
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de Vroege L, Timmermans A, Kop WJ, van der Feltz-Cornelis CM. Neurocognitive dysfunctioning and the impact of comorbid depression and anxiety in patients with somatic symptom and related disorders: a cross-sectional clinical study. Psychol Med 2018; 48:1803-1813. [PMID: 29198246 DOI: 10.1017/s0033291717003300] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prevalence and severity of neurocognitive dysfunctioning of patients with somatic symptom and related disorders (SSRD) is unknown. Furthermore, the influence of comorbid depression and anxiety has not been evaluated. This study examines neurocognitive dysfunctioning of patients with SSRD and explores if comorbid depression and anxiety is associated with specific neurocognitive dysfunctioning. METHODS Cross-sectional study with consecutive patients suffering from SSRD visiting an outpatient specialty mental health care Centre of Excellence for SSRD. Extensive neuropsychological assessment and assessment of depression and anxiety symptom levels using the Patient-Health-Questionnaire-9 and General Anxiety Disorder questionnaire-7 were performed at intake. Multivariate analysis was performed. RESULTS The study sample consisted of 201 SSRD patients, with a mean age of 43 years (Standard deviation = 13) years; 37.8% were male. Neurocognitive dysfunction in the domains information processing speed, sustained and divided attention, working memory, verbal and visual memory were reported, compared with normative data. Comorbid depression and anxiety occurred frequently within the sample (75.1% and 65.7%, respectively). Neurocognitive dysfunctioning was worse in patients suffering from comorbid depression [multivariate F (7,161) = 2.839, p = 0.008] but not in patients with comorbid anxiety. CONCLUSIONS Poor neurocognitive performance of patients with SSRD is common and worsens in case of comorbid depression. This may explain treatment dropout of patients with SSRD from neurocognitive behavioral therapy. Research on novel interventions is needed targeting neurocognitive functioning of patients with SSRD, particularly those with comorbid depression.
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Affiliation(s)
- Lars de Vroege
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
| | - Anique Timmermans
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
| | - Willem J Kop
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Christina M van der Feltz-Cornelis
- Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands
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