From emotion processing to metacognition: mnemonic contributions in conversion/functional neurological symptoms

2018 ◽  
Author(s):  
Indrit Bègue
Keyword(s):  
Brain Lesion ◽  
Conversion Disorder ◽  
Neurological Symptoms ◽  
Neural Systems ◽  
Past Century ◽  
Self Monitoring ◽  
The Past ◽  
Functional Symptoms ◽  
Functional Neurological Symptoms ◽  
Functional Neurological Disorder

Functional neurological disorder (FND) is the term used (DSM-5) to refer to a disabling neuropsychiatric condition that is frequently encountered in medical practice, previously known as conversion disorder (CD) and described as Hysteria in the past century. It is characterised by neurological symptoms (e.g., weakness, numbness, tremor…) without evidence for any brain lesion. Early neurobiological accounts of this disorder were part of the foundation of psychiatry and neurology, but were then dominated by a purely psychodynamic perspective. The advent of neuroimaging in the last two decades has allowed a renewed interest in the “functional” brain underpinnings of these symptoms, with growing interest and increasing attempts to investigate them in a neuroscience perspective. In this brief review, I discuss recent evidence pointing to how top-down mechanisms may alter motor function in patients with motor FND/CD, through coupling with neural systems associated with internal self-monitoring, emotion regulation, and memory, and thus lead to the emergence of functional symptoms. More research however still needs to be undertaken to elucidate the causes (why they occur) of FND/CD, in addition to their neuro-anatomical substrates (how they occur).

The relationship between psychosocial trauma type and conversion (functional neurological) disorder symptoms: a cross-sectional study

2021 ◽  
pp. 103985622110092
Author(s):  
Shimaa K. Morsy ◽  
Daniela Huepe-Artigas ◽  
Ahmed M. Kamal ◽  
Maha Ali Hassan ◽  
Nashaat Adel Abdel-Fadeel ◽  
...  
Keyword(s):  
Neurological Disorder ◽  
Conversion Disorder ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Trauma Symptom ◽  
Functional Symptoms ◽  
Neurology Clinic ◽  
The Relationship ◽  
Trauma Type ◽  
Functional Neurological Disorder

Objective: Psychosocial trauma was associated with developing conversion disorder (also known as functional neurological disorder) before Freud, though why a particular symptom should arise is unknown. We aimed to determine if there was a relationship between trauma type and symptom. Methods: We retrospectively reviewed the medical records of patients attending Australia’s first functional neurology clinic, including referral, clinic letters and a clinic questionnaire. Results: There were 106 females, 43 males and five transgender patients. Sensory (51%), motor (47%) and seizures (39%) were the commonest functional symptoms. Most patients (92%) reported stressors associated with symptom onset. Multiple trauma/symptom type associations were found: patients with in-law problems experienced more cognitive symptoms ( p = .036), for example, while expressive speech problems more commonly followed relationship difficulties ( p = .021). Conclusion: Associations were found between type of traumatic events and type of symptoms in conversion disorder. This will require verification in a larger sample.

#3119 Diagnosis and management of functional neurological symptoms: Saudi Arabia experience

2021 ◽  
Vol 92 (8) ◽  
pp. A13.1-A13
Author(s):  
Lujain Khoja ◽  
Abeer Khoja ◽  
Saeed Shabaan ◽  
Haythum Tayeb
Keyword(s):  
Saudi Arabia ◽  
Conversion Disorder ◽  
Cross Sectional Study ◽  
Neurological Symptoms ◽  
Kingdom Of Saudi Arabia ◽  
Cross Sectional ◽  
Brain Functioning ◽  
Target Populations ◽  
Functional Neurological Symptoms ◽  
Dutch Experience

ObjectivesTo explore the opinion of todays neurologist and psychiatrist in the kingdom of Saudi Arabia regarding pathogenesis, diagnosis, treatment and outcome. It is a replication for Dutch experience with Functional Neurological symptoms Disorder (FND).MethodsA multi-centres Cross-sectional study was conducted in Saudi Arabia started from November 2019 and still ongoing. The target populations were a qualified psychiatrists or neurologists. Data were collected through an electronic questionnaire.ResultsThere were 70 respondents, 37.1% were female and 62.9% males. A 15.5% were Neurologists and 72.4% psychiatrists. Three questionnaires were taken out due to incompletion error. Most neurologists and psychiatrists believed that FND is a disorder of functioning of the nervous system together with psychogenic factors. However, 100% of psychiatrist believed that a prior psychological stress is a cause of the disorder (among other causes) while 86.84% of neurologists. Also found that, a 71% of patients who referred to neurologist were evaluated initially by a general practitioner, while 85% of the patients who referred to psychiatrist; were evaluated by neurologists. Eventually, most of the neurologists and the psychiatrists diagnosed patients by conversion disorder (13/38 of neurologist and 13/20 of psychiatrists).ConclusionOur preliminary conclusion is comparable for Dutch experience that is not considered purely a psychiatric disorder and counted disordered brain functioning together with psychogenic factors responsible for FNS. However, the majority of the psychiatrists in our study diagnose FND as conversion disorder.

An Integrated Approach to Other Functional Neurological Symptoms and Related Disorders

2017 ◽  
Author(s):  
Jon Stone ◽  
Alan Carson
Keyword(s):  
Psychological Symptoms ◽  
Somatic Symptoms ◽  
Integrated Approach ◽  
Neurological Symptoms ◽  
Functional Disorders ◽  
Educational Materials ◽  
Limb Weakness ◽  
Functional Symptoms ◽  
Nonepileptic Seizures ◽  
Functional Neurological Symptoms

Patients with dissociative (nonepileptic) seizures (DS) commonly, although not always, present with comorbid somatic and psychological symptoms. This chapter reviews the epidemiology, diagnosis, and treatment of other functional somatic symptoms and disorders in relation to DS with a particular emphasis on other functional neurological symptoms such as movement disorder and sensory disturbance. Clinical assessment is presented as the start of treatment in patients with multiple functional symptoms including DS. The chapter discusses the importance of making a diagnosis of functional disorders, especially those in neurological settings, using positive evidence from the physical examination, such as Hoover’s sign for limb weakness or the tremor entrainment test for tremor. Practical methods of explaining these diagnoses to patients are reviewed, emphasizing the importance of transparency, educational materials, and presenting a model that focuses on mechanism more than etiology. The chapter concludes with a review of the evidence for treatment of a range of functional disorders often comorbid with DS.

scholarly journals Functional neurological disorders in patients with brain tumours

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv12-iv12
Author(s):  
Charmaine Toh ◽  
Dorothy Joe ◽  
Katia Cikurel ◽  
Julia Johnson ◽  
Francesco Vergani ◽  
...  
Keyword(s):  
Brain Tumour ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Brain Tumours ◽  
Neurological Symptoms ◽  
Adult Brain ◽  
Case Review ◽  
Functional Neurological Symptoms ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Abstract Aims Signs and symptoms that develop in people with brain tumours are often attributed to their tumour. The prevalence and management of functional neurological symptoms in brain tumour patients have received little attention. This is surprising because functional neurological symptoms complicate management greatly and misdiagnosis can lead to inappropriate treatment and iatrogenic side-effects. Therefore, we investigated the presentation, diagnosis and management of functional neurological disorders (FND) in patients who had a brain or meningeal tumour. Method A retrospective case review was performed from 2017 - 2021 to identify adult brain tumour patients who developed a functional neurological disorder that caused significant disability necessitating expedited investigations. All patients attended a regional neuro-oncology centre. We recorded type of brain tumour and diagnostic investigations. The onset of functional symptoms was divided into three time windows: before tumour diagnosis, after diagnosis and before treatment or after tumour treatment. A neuropsychological review looked for evidence of previous adverse life events. Therapeutic interventions for functional neurological disorder and their outcomes were documented. The case review was combined with a systematic review of the literature to identify the published presentations of functional neurological disorder in the adult brain tumour population. MEDLINE, EMBASE and PsycINFO databases were searched for studies published between January 1980 and February 2021. Results Six patients (5 female, 1 male) were identified from the case review with a median age of 41 (range 29 - 56) years old. Four patients had non-epileptic attack disorder, which was diagnosed with videotelemetry of habitual attacks. One patient had a functional hemiparesis with normal central motor conduction time. One patient had a functional speech disorder with normal EEG. Half of these patients had functional neurological symptoms prior to surgery/oncological treatment. Five patients (83%) were referred for further neuropsychiatric or psychological evaluation. A history of significant psychological trauma prior to the brain tumour diagnosis was elicited in four (66%) patients. Conclusion Patients with either a brain or meningeal tumour may develop functional neurological symptoms. Our findings suggest the possibility that diagnosis of a brain tumour may precipitate a debilitating functional neurological disorder. The neurobiological basis for functional neurological disorders is being actively investigated. There are suggestions in the literature that some brain diseases increase the risk of developing a functional neurological disorder. Further work is needed to determine whether this is true for patients with brain tumours. Increased awareness of functional neurological disorders will improve management. Withdrawal of unnecessary treatment, such as anticonvulsant drugs, reduces the risk of iatrogenic side effects. Initiation of multi-disciplinary care pathways, e.g. physiotherapy, speech and language therapy and psychological treatments, promotes recovery. Collectively, these interventions improve our patients’ quality of life.

scholarly journals Functional neurological symptoms

2015 ◽  
Author(s):  
Alan Carson ◽  
Jon Stone
Keyword(s):  
Functional Neuroimaging ◽  
Controlled Trial ◽  
Epileptic Seizures ◽  
Conversion Disorder ◽  
Neurological Symptoms ◽  
Clinical Neurology ◽  
Current Time ◽  
Randomized Controlled ◽  
Functional Neurological Symptoms ◽  
Over Time

Functional neurological symptoms are a common cause of disability and distress in any neurological service. Varying terminology, including hysteria, conversion disorder, dissociative, non-organic, and psychogenic, reflects the shifting nature of medical thinking, over time, regarding these presentations. They also emphasize the importance of a historical understanding when grappling with this area. This chapter traces this history, from Briquet’s monumental treatise on hysteria in 1859 to a randomized controlled trial of non-epileptic seizures in 2010. In the process, familiar figures such as Freud and Janet are encountered and the electrical treatments of Yealland, for hysteria, are re-evaluated. The chapter highlights how the application of functional neuroimaging perhaps raises more questions than it answers, at the current time, but how it has also aided the reawakening of clinical and research interest in this core area of clinical neurology.

scholarly journals Conversion disorder and/or functional neurological disorder: How neurological explanations affect ideas of self, agency, and accountability

2020 ◽  
Vol 33 (5) ◽  
pp. 64-84
Author(s):  
Jonna Brenninkmeijer
Keyword(s):  
Neurological Disorder ◽  
English Language ◽  
Conversion Disorder ◽  
The Body ◽  
Neurological Symptoms ◽  
Self Control ◽  
Patient Reports ◽  
Long Time ◽  
Medically Unexplained ◽  
Functional Neurological Disorder

An estimated 15% of patients seen by neurologists have neurological symptoms, such as paralysis, tremors, dystonia, or seizures, that cannot be medically explained. For a long time, such patients were diagnosed as having conversion disorder (CD) and referred to psychiatrists, but for the last two decades or so, neurologists have started to pay more serious attention to this patient group. Instead of maintaining the commonly used label of conversion disorder – which refers to Freud’s idea that traumatic events can be converted into deviant behaviour – these neurologists use the term functional neurological disorder (FND) and explain that the problems are due to abnormal central nervous system functioning. The situation that some patients with medically unexplained neurological symptoms are diagnosed with CD and treated by psychiatrists while others are diagnosed with FND and stay under the control of neurologists provides a unique case for analysing how neurological and psychological explanations affect subjectivity. In this article, I compare patient reports from English-language websites from the past 15 years to find out how minds, bodies, brains, and selves act and interact in the accounts of both patient groups. I conclude that the change in label from CD to FND has not only influenced ideas of medically unexplained disorders, but also affected ideas of the self and the body; of self-control and accountability.

The zoonotic potential of bat-borne coronaviruses

2020 ◽  
Vol 4 (4) ◽  
pp. 365-381
Author(s):  
Ny Anjara Fifi Ravelomanantsoa ◽  
Sarah Guth ◽  
Angelo Andrianiaina ◽  
Santino Andry ◽  
Anecia Gentles ◽  
...  
Keyword(s):  
Genetic Material ◽  
Field Research ◽  
Sympatric Species ◽  
Animal Origin ◽  
Mammalian Host ◽  
Past Century ◽  
The Past ◽  
Novel Host ◽  
Horseshoe Bat ◽  
Human Infections

Seven zoonoses — human infections of animal origin — have emerged from the Coronaviridae family in the past century, including three viruses responsible for significant human mortality (SARS-CoV, MERS-CoV, and SARS-CoV-2) in the past twenty years alone. These three viruses, in addition to two older CoV zoonoses (HCoV-229E and HCoV-NL63) are believed to be originally derived from wild bat reservoir species. We review the molecular biology of the bat-derived Alpha- and Betacoronavirus genera, highlighting features that contribute to their potential for cross-species emergence, including the use of well-conserved mammalian host cell machinery for cell entry and a unique capacity for adaptation to novel host environments after host switching. The adaptive capacity of coronaviruses largely results from their large genomes, which reduce the risk of deleterious mutational errors and facilitate range-expanding recombination events by offering heightened redundancy in essential genetic material. Large CoV genomes are made possible by the unique proofreading capacity encoded for their RNA-dependent polymerase. We find that bat-borne SARS-related coronaviruses in the subgenus Sarbecovirus, the source clade for SARS-CoV and SARS-CoV-2, present a particularly poignant pandemic threat, due to the extraordinary viral genetic diversity represented among several sympatric species of their horseshoe bat hosts. To date, Sarbecovirus surveillance has been almost entirely restricted to China. More vigorous field research efforts tracking the circulation of Sarbecoviruses specifically and Betacoronaviruses more generally is needed across a broader global range if we are to avoid future repeats of the COVID-19 pandemic.

PCSK9 inhibition for LDL lowering and beyond – implications for patients with peripheral artery disease

VASA ◽  
2018 ◽  
Vol 47 (3) ◽  
pp. 165-176 ◽  
Author(s):  
Katrin Gebauer ◽  
Holger Reinecke
Keyword(s):  
Cardiovascular Risk ◽  
Risk Reduction ◽  
Ldl Receptor ◽  
Density Lipoprotein ◽  
Past Century ◽  
Pcsk9 Inhibitors ◽  
Cardiovascular Risk Reduction ◽  
Simultaneous Application ◽  
The Past ◽  
Pcsk9 Inhibition

Abstract. Low-density lipoprotein cholesterol (LDL-C) has been proven to be a causal factor of atherosclerosis and, along with other triggers like inflammation, the most frequent reason for peripheral arterial disease. Moreover, a linear correlation between LDL-C concentration and cardiovascular outcome in high-risk patients could be established during the past century. After the development of statins, numerous randomized trials have shown the superiority for LDL-C reduction and hence the decrease in cardiovascular outcomes including mortality. Over the past decades it became evident that more intense LDL-C lowering, by either the use of highly potent statin supplements or by additional cholesterol absorption inhibitor application, accounted for an even more profound cardiovascular risk reduction. Proprotein convertase subtilisin/kexin type 9 (PCSK9), a serin protease with effect on the LDL receptor cycle leading to its degradation and therefore preventing continuing LDL-C clearance from the blood, is the target of a newly developed monoclonal antibody facilitating astounding LDL-C reduction far below to what has been set as target level by recent ESC/EAS guidelines in management of dyslipidaemias. Large randomized outcome trials including subjects with PAD so far have been able to prove significant and even more intense cardiovascular risk reduction via further LDL-C debasement on top of high-intensity statin medication. Another approach for LDL-C reduction is a silencing interfering RNA muting the translation of PCSK9 intracellularly. Moreover, PCSK9 concentrations are elevated in cells involved in plaque composition, so the potency of intracellular PCSK9 inhibition and therefore prevention or reversal of plaques may provide this mechanism of action on PCSK9 with additional beneficial effects on cells involved in plaque formation. Thus, simultaneous application of statins and PCSK9 inhibitors promise to reduce cardiovascular event burden by both LDL-C reduction and pleiotropic effects of both agents.

Archaeology in the Past Century

1901 ◽  
Vol 51 (1309supp) ◽  
pp. 20976-20977
Author(s):  
W. M. Flinders Petrje
Keyword(s):  
Past Century ◽  
The Past
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