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Baglioni V, Esposito D, Bernardi K, Novelli M, Zaccaria V, Galosi S, Pisani F. Misdiagnosis of functional neurological symptom disorders in paediatrics: Narrative review and relevant case report. Clin Child Psychol Psychiatry 2024; 29:1026-1042. [PMID: 38515429 DOI: 10.1177/13591045241240805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Functional neurological symptom disorders (FNSD) pose a common challenge in clinical practice, particularly in pediatric cases where the clinical phenotypes can be intricate and easily confused with structural disturbances. The frequent coexistence of FNSDs with other medical disorders often results in misdiagnosis. In this review, we highlight the distinctions between FNSD and various psychiatric and neurological conditions. Contrary to the misconception that FNSD is a diagnosis of exclusion, we underscore its nature as a diagnosis of inclusion, contingent upon recognizing specific clinical features. However, our focus is on a critical learning point illustrated by the case of a 14-year-old male initially diagnosed with FNSD, but subsequently found to have a rare primary monogenic movement disorder (paroxysmal kinesigenic dyskinesia, PKD). The crucial takeaway from this case is the importance of avoiding an FNSD diagnosis based solely on psychiatric comorbidity and suppressible symptoms. Instead, clinicians should diligently assess for specific features indicative of FNSD, which were absent in this case. This emphasizes the importance of making a diagnosis of inclusion. Extended follow-up and clinical-oriented genetic testing might help identify comorbidities, prevent misdiagnosis, and guide interventions in complex cases, which cannot be simply classified as "functional" solely because other conditions can be excluded.
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Affiliation(s)
- Valentina Baglioni
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Dario Esposito
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Katerina Bernardi
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Maria Novelli
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Valerio Zaccaria
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Serena Galosi
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
| | - Francesco Pisani
- Child Neurology and Psychiatry Unit, Department of Human Neuroscience, Sapienza University, Italy
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Sammartino-Arbour A, Dufour A, Frenette V, Forget MF, Bruneau MA, Ducharme S, Camicioli R, Nguyen QD, Desmarais P. The Association Between Somatic Symptom Disorders and Neurocognitive Disorders: A Systematic Review. Am J Geriatr Psychiatry 2023; 31:33-43. [PMID: 35970734 DOI: 10.1016/j.jagp.2022.07.007] [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: 04/19/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Onset of neuropsychiatric symptoms in older adults may represent prodromal manifestations of neurodegenerative disorders. The association between the onset of somatic symptom and related disorders (SSRD) and the subsequent development of neurodegenerative disorders remains unclear. A critical review of studies describing the association between SSRD and neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Frontotemporal dementia, and Lewy body dementia was performed. OBJECTIVE To critically review studies describing the association between SSRD and neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Frontotemporal dementia, and Lewy body dementia. METHODS A systematic review of Web of Science Core databases was carried out from inception of databases up to May 2021 to identify observational studies pertaining to both SSRD and neurodegenerative disorders. Data was extracted and compiled regarding subjects enrolled, age at onset of the SSRD and at onset of the neurodegenerative disorders, and specific SSRD manifestations and underlying neuropathologies reported. RESULTS Thirteen articles were included. Of the 123 identified subjects with SSRD at baseline, 34.1% developed a neurodegenerative disorder, with 80.9% of these being a Lewy body spectrum disorder. The interval between onset of SSRD manifestations and subsequent development of a neurodegenerative disorder was less than 3 years for half of the cases. Of the 1,494 subjects with a neurodegenerative disorder at baseline retrieved, SSRD manifestations were reported in 33.4% of Lewy body spectrum disorders cases. Onset of SSRD manifestations antedated or was concomitant to the diagnosis of the Lewy body spectrum disorder in 65.6% of cases. CONCLUSION While limited, current evidence suggests a possible association between late-onset SSRD and the subsequent development of neurodegenerative disorders, notably Lewy body spectrum disorders.
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Affiliation(s)
- Alexandra Sammartino-Arbour
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ariane Dufour
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Valérie Frenette
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Marie-France Forget
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Marie-Andrée Bruneau
- Department of Psychiatry (MAB), Université de Montréal, Montréal, Québec, Canada
| | - Simon Ducharme
- Department of Psychiatry (SD), Douglas Mental Health University Institute & Douglas Research Centre, McGill University, Montréal, Québec, Canada; McConnel Brain Imaging Centre (SD), Montreal Neurological Institute, McGill University, Montréal, Québec, Canada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute University of Alberta (RC), Edmonton, Alberta, Canada
| | - Quoc Dinh Nguyen
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Innovation Hub (QDN), Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Philippe Desmarais
- Department of Medicine (ASA, AD, VF, MFF, QDN, PD), Division of Geriatrics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Department of Neurosciences (PD), Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
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Pimentel LH, Mutarelli EG. Diagnostic pitfalls in functional neurological disorders. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:324-327. [PMID: 35976310 PMCID: PMC9491422 DOI: 10.1590/0004-282x-anp-2022-s120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
The diagnosis of functional neurological disorders is a major challenge in neurologist practice. Some clinical strategies can facilitate the recognition of functional disorders, but several pitfalls make their diagnosis difficult. Here we highlight the following points of attention during evaluation of patients with functional disorder: not all bizarre behavior is functional; not every event triggered by an emotional factor is a functional disorder; not every topographic incongruity is a functional disorder; patients may present functional and organic symptoms at the same time; psychiatric comorbid condition is not always evident in the history of a functional disorder; problematic communication at the time of diagnosis can compromise treatment and prognosis. In conclusion, we emphasize that special attention to these possible pitfalls facilitate the correct diagnosis and management of functional neurological disorders.
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Affiliation(s)
- Lucio Huebra Pimentel
- Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil
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Misdiagnosis of an underlying medical condition as Conversion Disorder/Functional Neurological Disorder (CD/FND) still occurs. Gen Hosp Psychiatry 2020; 65:43-46. [PMID: 32464427 DOI: 10.1016/j.genhosppsych.2020.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 11/22/2022]
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Braus BR, Rummans TA, Lapid MI, Morgan RJ, Sampson SM, Handler EM, Dimsdale JE. Clinicians and Cognitive Bias: A Case of Frontotemporal Dementia Misdiagnosed as Conversion Disorder. Am J Psychiatry 2019; 176:690-693. [PMID: 31474126 DOI: 10.1176/appi.ajp.2018.18050551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Benjamin R Braus
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Teresa A Rummans
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Maria I Lapid
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Robert J Morgan
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Shirlene M Sampson
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Elliot M Handler
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
| | - Joel E Dimsdale
- The Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn. (Braus, Rummans, Lapid, Morgan, Sampson, Handler); and the Department of Psychiatry, University of California San Diego School of Medicine, San Diego (Dimsdale)
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Bejerot S, Hesselmark E, Mobarrez F, Wallén H, Hietala MA, Nybom R, Wetterberg L. Neuromyelitis optica spectrum disorder with increased aquaporin-4 microparticles prior to autoantibodies in cerebrospinal fluid: a case report. J Med Case Rep 2019; 13:27. [PMID: 30696485 PMCID: PMC6352324 DOI: 10.1186/s13256-018-1929-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/18/2018] [Indexed: 11/15/2022] Open
Abstract
Background Neuromyelitis optica spectrum disorders are severe autoimmune inflammatory diseases of the central nervous system associated with the presence of immunoglobulin G antibodies against the water channel protein aquaporin-4. During exacerbation, specific aquaporin-4 immunoglobulin G may be produced intrathecally. We measured extracellular aquaporin-4 microparticles in the cerebrospinal fluid of a patient who later developed the typical symptoms and signs of a neuromyelitis optica spectrum disorder. Case presentation A 17-year-old South American girl developed acute severe motor and vocal tics and difficulties in walking, peripheral numbness, muscle pain, and bilateral headache. At age 22, she had a multitude of motor and psychiatric symptoms. Over the years, she fulfilled the diagnostic criteria for anorexia nervosa, depression, sleep disorder, obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, development coordination disorder, attention-deficit/hyperactivity disorder, hypomania, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, conversion disorder, psychosis, and schizotypal personality syndrome. At age 24, she was found to have elevated titers of aquaporin-4 antibodies in serum, suggestive of probable neuromyelitis optica. She subsequently developed visual impairment, and swollen optic nerves were verified by magnetic resonance imaging. She was thus treated with a chimeric monoclonal antibody targeted against the pan-B-cell marker CD20 (rituximab), and almost all symptoms, including the psychiatric symptoms, rapidly decreased. We found a significant increase of extracellular microparticles of aquaporin-4 in cerebrospinal fluid sampled from our patient when she was 22 years old, 2 years before the full clinical development of neuromyelitis optica. Conclusions Microparticles of aquaporin-4 represent subcellular arrangements that may influence the pathogenesis of neuromyelitis optica spectrum disorders and may serve as biomarkers for the underlying cellular disturbances. The increase of aquaporin-4 microparticles in cerebrospinal fluid may be used for early diagnostic purposes; for prevention; and for evaluation of effective treatment, long-term follow-up studies, and elucidating the pathophysiology in neuromyelitis optica spectrum disorders. Further studies of aquaporin-4 microparticles in cerebrospinal fluid of patients with neuromyelitis optica and similar neuropsychiatric disorders are thus called for. Electronic supplementary material The online version of this article (10.1186/s13256-018-1929-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne Bejerot
- Department of Clinical Neuroscience, Karolinska Institutet, SE-112 81, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden.,Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Eva Hesselmark
- Department of Clinical Neuroscience, Karolinska Institutet, SE-112 81, Stockholm, Sweden
| | - Fariborz Mobarrez
- Unit of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Håkan Wallén
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Max Albert Hietala
- Department of Clinical Neuroscience, Karolinska Institutet, SE-112 81, Stockholm, Sweden
| | - Rolf Nybom
- Department of Clinical Neuroscience, Karolinska Institutet, SE-112 81, Stockholm, Sweden
| | - Lennart Wetterberg
- Department of Clinical Neuroscience, Karolinska Institutet, SE-112 81, Stockholm, Sweden.
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Suthar N, Nebhinani N, Paul K. Neuropsychiatric Symptoms as Early Manifestation of Progressive Supranuclear Palsy. Indian J Psychol Med 2018; 40:492-494. [PMID: 30275628 PMCID: PMC6149302 DOI: 10.4103/ijpsym.ijpsym_46_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Navratan Suthar
- Department of Psychiatry, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
| | - Karandeep Paul
- Department of Psychiatry, All India Institute of Medical Science, Jodhpur, Rajasthan, India
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Leonhart R, de Vroege L, Zhang L, Liu Y, Dong Z, Schaefert R, Nolte S, Fischer F, Fritzsche K, van der Feltz-Cornelis CM. Comparison of the Factor Structure of the Patient Health Questionnaire for Somatic Symptoms (PHQ-15) in Germany, the Netherlands, and China. A Transcultural Structural Equation Modeling (SEM) Study. Front Psychiatry 2018; 9:240. [PMID: 29997528 PMCID: PMC6028697 DOI: 10.3389/fpsyt.2018.00240] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/17/2018] [Indexed: 02/05/2023] Open
Abstract
Background: Persistent somatic symptoms are associated with psychological distress, impaired function, and medical help-seeking behavior. The Patient Health Questionnaire (PHQ)-15 is used as a screening instrument for somatization and as a monitoring instrument for somatic symptom severity. A bifactorial model has been described, with one general factor and four orthogonal specific symptom factors. The objective of the present study was to assess and to clarify the factor structure of the PHQ-15 within and between different countries in Western Europe and China. Method: Cross-sectional secondary data analysis performed in three patient data samples from two Western European countries (Germany N = 2,517, the Netherlands N = 456) and from China (N = 1,329). Confirmatory factor analyses (CFA), and structural equation modeling (SEM) analysis were performed. Results: The general factor is found in every sample. However, although the outcomes of the PHQ-15 estimate severity of somatic symptoms in different facets, these subscales may have different meanings in the European and Chinese setting. Replication of the factorial structure was possible in the German and Dutch datasets but not in the dataset from China. For the Chinese dataset, a bifactorial model with a different structure for the cardiopulmonary factor is suggested. The PHQ-15 could discern somatization from anxiety and depression within the three samples. Conclusion: The PHQ-15 is a valid questionnaire that can discern somatization from anxiety and depression within different cultures like Europe or China. It can be fitted to a bifactorial model for categorical data, however, the model can only be recommended for use of the general factor. Application of the orthogonal subscales in non-European samples is not corroborated by the results. The differences cannot be ascribed to differences in health care settings or by differences in concomitant depression or anxiety but instead, a cultural factor involving concepts of disease may play a role in this as they may play a role in the translation of the questionnaire. Further research is needed to explore this, and replication studies are needed regarding the factorial structure of the PHQ-15 in China.
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Affiliation(s)
- Rainer Leonhart
- Department Social Psychology and Methodology, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Lars de Vroege
- Clinical Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Lan Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yang Liu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Zaiquan Dong
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Rainer Schaefert
- Division of Internal Medicine, Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.,Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sandra Nolte
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Burwood, VIC, Australia
| | - Felix Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christina M van der Feltz-Cornelis
- Clinical Centre of Excellence for Body Mind and Health, GGz Breburg, Tilburg, Netherlands.,Department Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
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