Somatic Symptom Perception and Interoception

Models of chronic somatic symptoms assume that abnormalities in interoception are related to the development and maintenance of symptom distress. Different models, however, disagree on the exact nature of the assumed abnormality: cognitive-behavioral models stress a hypervigilant cognitive style (predicting higher interoceptive accuracy) whereas predictive processing models assume a less detailed sensory processing (predicting lower interoceptive accuracy). This study aimed at testing the relationship between interoception and symptom perception. Using structural equation modeling, associations between cardiac interoception and symptom perception were tested in a sample of students ( n = 316) and a second heterogeneous sample ( n = 340, including 63 patients with either pathological health anxiety or a somatoform disorder according to DSM-IV). Stronger sensory symptom perceptions in the cardiorespiratory system were associated with lower interoceptive accuracy in sample 2. The findings are more in line with the predictive processing approach, suggesting less detailed and more biased interoception being associated with chronic somatic symptom distress.

Neural correlates of shared sensory symptoms in autism and attention-deficit/hyperactivity disorder

Symptoms of autism spectrum disorder and attention-deficit/hyperactivity disorder often co-occur. Among these, sensory impairment, which is a core diagnostic feature of autism spectrum disorder, is often observed in children with attention-deficit/hyperactivity disorder. However, the underlying mechanisms of symptoms that are shared across disorders remain unknown. To examine the neural correlates of sensory symptoms that are associated with autism spectrum disorder and attention-deficit/hyperactivity disorder, we analysed resting-state functional MRI data obtained from 113 people with either autism spectrum disorder or attention-deficit/hyperactivity disorder (n = 78 autism spectrum disorder, mean age = 29.5; n = 35 attention-deficit/hyperactivity disorder, mean age = 31.2) and 96 neurotypical controls (mean age = 30.6, range: 20–55 years) using a cross-sectional study design. First, we used a multi-dimensional approach to examine intrinsic brain functional connectivity related to sensory symptoms in four domains (i.e. low registration, sensation seeking, sensory sensitivity and sensation avoidance), after controlling for age, handedness and head motion. Then, we used a partial least squares correlation to examine the link between sensory symptoms related to intrinsic brain functional connectivity and neurodevelopmental symptoms measured using the Autism Spectrum Quotient and Conners’ Adult Attention-Deficit/Hyperactivity Disorder Rating Scale, regardless of diagnosis. To test whether observed associations were specific to sensory symptoms related to intrinsic brain functional connectivity, we conducted a control analysis using a bootstrap framework. The results indicated that transdiagnostic yet distinct intrinsic brain functional connectivity neural bases varied according to the domain of the examined sensory symptom. Partial least squares correlation analysis revealed two latent components (latent component 1: q < 0.001 and latent component 2: q < 0.001). For latent component 1, a set of intrinsic brain functional connectivity was predominantly associated with neurodevelopmental symptom-related composite score (r = 0.64, P < 0.001), which was significantly correlated with Conners’ Adult Attention-Deficit/Hyperactivity Disorder Rating Scale total T scores (r = −0.99, q < 0.001). For latent component 2, another set of intrinsic brain functional connectivity was positively associated with neurodevelopmental symptom-related composite score (r = 0.58, P < 0.001), which was eventually positively associated with Autism Spectrum Quotient total scores (r = 0.92, q < 0.001). The bootstrap analysis showed that the relationship between intrinsic brain functional connectivity and neurodevelopmental symptoms was relative to sensory symptom-related intrinsic brain functional connectivity (latent component 1: P = 0.003 and latent component 2: P < 0.001). The current results suggest that sensory symptoms in individuals with autism spectrum disorder and those with attention-deficit/hyperactivity disorder have shared neural correlates. The neural correlates of the sensory symptoms were associated with the severity of both autism spectrum disorder and attention-deficit/hyperactivity disorder symptoms, regardless of diagnosis.

Phenotypes of neuropathic pain

Невропатическая боль (НБ) возникает вследствие прямого повреждения или болезни соматосенсорной нервной системы. Целью настоящего исследования было проведение анализа базы данных пациентов с НБ для поиска групп пациентов имеющих сходные профили сенсорных симптомов, а также определение взаимосвязи между наличием и выраженностью этих симптомов с интенсивностью боли, тяжестью нарушений сна, степенью ограничений повседневной активности и тяжестью нарушений общего соматического здоровья. Материал и методы. Проведен кластерный и сравнительный анализ базы данных больных с НБ (n = 6506), полученной в скрининговом когортном двухэтапном исследовании пациентов, обратившихся за амбулаторной помощью к врачу неврологу. Результаты и обсуждение. Анализ методом К-средних выявил 3 кластера сенсорных симптомов, не связанных с этиологическими причинами НБ. Фенотипы (кластеры) НБ отличались по интенсивности боли, степени тяжести нарушений сна, степени снижения повседневной активности и тяжести нарушений общего соматического здоровья. Выводы. В реальной клинической практике фенотипическая стратификация НБ важна не только с позиций механизм-обоснованого подхода к её терапии, но и для прогнозирования интенсивности боли и степени ухудшения качества жизни у конкретного больного. Neuropathic pain (NeP) is caused by a direct damage or disease of the somatosensory nervous system. The aim of this study was to conduct an additional analysis of the database of patients with NeP to identify groups of patients with similar profiles of the sensory symptom and to determine the relationship between the presence and severity of these symptoms and the intensity of pain, severity of sleep disorders, degree of limitations in daily activity, and severity of disorders in general physical health. Material and methods. Cluster and comparative analyses were performed of the database of patients with NeP (n = 6506). The database was obtained in a two-stage screening cohort study of patients who had sought outpatient care of a neurologist. Results and discussion. The analysis using the K-means method provided 3 clusters of sensory symptoms not related with etiological causes of NeP. The phenotypes (clusters) differed in pain intensity, severity of sleep disorders, degree of decline in daily activity, and severity of disorders in general somatic health. Conclusions. In real clinical practice, the phenotypic stratification of NeP is important not only from the standpoint of the mechanism-based approach to its treatment but also for predicting the intensity of pain and the degree of deterioration of the quality of life in a particular patient.

Impact of Childhood Psychosocial Stressors on Adolescence Period and Its Management: A Case Study of Conversion Disorder

Functional Neurological Symptom Disorder, previously called as Conversion disorder, is very common psychological disorder in eastern countries like Pakistan. This case study is describing how psychosocial factors produce stress and made a young girl dysfunctional in all aspect of life. The patient F.Z was18 years old unmarried girl and educated up till intermediate. She was unemployed and last born among 6 siblings; 4 sisters and 2 brothers. She was brought to the psychiatry indoor ward with speech symptom; un-able to speak (aphonia), sensory symptom; could not see (psychogenic blindness) and more over since last few months she had paralysis of lower limbs. Apart from those symptoms she reported poor appetite, remained sad and tearful. She was assessed thro-ugh both informal and formal psychological assessmentIt was interpreted that she had insecure, disturbed childhood and had lots of stressors in her life which caused severe maladjustment, interpersonal conflict, feeling of rejection and loneliness. According to DSM-5 she was diagnosed with Functional Neurological Symptom Disorder with comorbid Depressive Symptoms. The intervention plan comprised of psychodynamic, behavioral and cognitive approaches; techniques include catharsis, free association, anxiety reduction techniques, cognitive restructuring, graded task, mastery and pleasure technique, family psycho-education along with physiotherapy and physical exercise. Thirteen (13) therapeutic sessions were conducted along with anti-depressants and the patient showed marked improvement in all areas of her daily life. Family was psycho-educated to bring her for follow-up sessions.