School of Social and Behavioral Sciences, Arizona State University, Phoenix (Roberts, Burleson, Torres, Parkhurst, Mitchell, Duncan, Mintert); and Banner-University Medical Center Neuroscience Institute, Phoenix (Garrett, Wang).
J Neuropsychiatry Clin Neurosci. 2020 Winter;32(1):95-100. doi: 10.1176/appi.neuropsych.19040084. Epub 2019 Oct 30.
Dysfunction in emotional processes is a hypothesized contributor to functional neurological disorders (FNDs), yet few studies have evoked real-time emotion during multimethod assessment incorporating subjective, behavioral, and psychophysiological indicators. This approach may reveal clinical and neurobiological vulnerability to FND and clarify how dysfunctional emotional processes serve as perpetuating factors.
Eleven participants with video-EEG-confirmed diagnoses of psychogenic nonepileptic seizures (PNES) were compared with 49 seizure-free trauma control subjects (TCs) with or without clinically elevated posttraumatic stress symptoms (25 clinically elevated [TC-clin], 24 not clinically elevated [TC-nonclin]). Participants recalled and described memories evoking anger, shame, happiness, and neutral feelings.
Even though PNES patients and TCs reported similar amounts of emotional experience, PNES patients reported more difficulty reliving emotions and were less likely to complete the relived shame task. During and after reliving happiness, PNES and TC-clin groups showed respiratory sinus arrhythmia (RSA) decreases, indicating parasympathetic withdrawal, whereas the TC-nonclin group showed RSA increases.
Findings from this pilot study are consistent with previous research and clinical observations that emotional engagement may be more effortful for PNES patients. Patterns of RSA change, which may also point to greater effortful engagement, were similar in PNES and TC-clin groups, suggesting that traumatic stress reactions may play a part. At the same time, experience of greater difficulty or avoidance may be even greater among PNES patients. Especially when regulatory resources are already limited, accumulated effort, coupled with self-threatening contexts such as shame, may be particularly problematic for those with PNES and perhaps other FNDs.
情绪过程障碍是功能性神经障碍（FND）的一个假设致病因素，但很少有研究在多方法评估中实时唤起情绪，该方法结合了主观、行为和心理生理指标。这种方法可能揭示 FND 的临床和神经生物学脆弱性，并阐明功能失调的情绪过程如何作为持续因素。
11 名经视频脑电图确诊的癔症性非癫痫性发作（PNES）患者与 49 名无癫痫发作的创伤对照组（TC）患者进行了比较，这些 TC 患者伴有或不伴有临床显著的创伤后应激症状（25 名临床显著[TC-clin]，24 名非临床显著[TC-nonclin]）。参与者回忆并描述了引发愤怒、羞耻、幸福和中性情绪的记忆。
尽管 PNES 患者和 TC 报告的情绪体验量相似，但 PNES 患者报告说，重新体验情绪的难度更大，且更不可能完成重新体验的羞耻任务。在重新体验幸福的过程中和之后，PNES 和 TC-clin 组的呼吸窦性心律失常（RSA）减少，表明副交感神经撤退，而 TC-nonclin 组的 RSA 增加。
这项初步研究的结果与之前的研究和临床观察一致，即情绪参与可能对 PNES 患者更费力。RSA 变化模式，这也可能指向更费力的参与，在 PNES 和 TC-clin 组中相似，这表明创伤后应激反应可能起作用。与此同时，在 PNES 患者中，可能会经历更大的困难或回避。特别是当调节资源已经有限时，累积的努力，再加上羞耻等自我威胁的情境，对那些患有 PNES 症和其他可能的 FND 症的人来说可能是特别成问题的。
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