Department of Psychology, University of British Columbia, Canada.
Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School; USA.
J Psychosom Res. 2021 Dec;151:110661. doi: 10.1016/j.jpsychores.2021.110661. Epub 2021 Oct 30.
Reporting of unexpected symptoms after concussion might, in some people, reflect a Functional Neurological Disorder (FND), Somatic Symptom Disorder (SSD), or exaggeration (feigning). This study aimed to determine whether reporting unexpected symptoms after concussion was associated with risk factors for FND/SSD, exaggeration, or both.
Adults with persistent symptoms following concussion (N = 77; 61% women) rated the presence and severity of unexpected neurological symptoms (from the Screening for Somatoform Symptoms scale, e.g., paralysis) and somatic symptoms (from the Patient Health Questionnaire-15, e.g., stomach pain) that did not overlap with post-concussion symptom scale items. The independent variables were risk factors for exaggeration (neuropsychological performance validity test failure and personal injury litigation) and predisposing and perpetuating factors for developing FND and/or SSD (e.g., fear avoidance behavior).
When adjusting for all covariates, fear avoidance behavior was most strongly related to unexpected neurological symptoms (B = 0.11, 95% confidence interval = 0.05-0.18, p < .001), while current anxiety scores were most strongly related to unexpected somatic symptoms (B = 0.34, 95% confidence interval = 0.15-0.52, p < .001). Performance validity test failure and litigation were not significant predictors in either model.
Unexpected neurological and other somatic symptoms after concussion should not be dismissed as exaggeration. Psychological factors thought to perpetuate FND and SSD (e.g., fear avoidance behavior) may contribute to unexpected symptoms following concussion. More research is needed at the intersection of FND, SSD, and persistent post-concussive symptoms.
在某些人中，脑震荡后报告意外症状可能反映出功能性神经障碍（FND）、躯体症状障碍（SSD）或夸大（佯装）。本研究旨在确定脑震荡后报告意外症状是否与 FND/SSD、夸大或两者的风险因素相关。
患有持续性脑震荡后症状的成年人（N=77；61%为女性）评估了意外神经症状（来自躯体症状筛查量表，例如瘫痪）和躯体症状（来自患者健康问卷-15，例如腹痛）的存在和严重程度，这些症状与脑震荡后症状量表项目不重叠。自变量是夸大的风险因素（神经心理学表现有效性测试失败和人身伤害诉讼）以及 FND 和/或 SSD 的易患和持续因素（例如，恐惧回避行为）。
在调整所有协变量后，恐惧回避行为与意外神经症状的相关性最强（B=0.11，95%置信区间为 0.05-0.18，p<.001），而当前焦虑评分与意外躯体症状的相关性最强（B=0.34，95%置信区间为 0.15-0.52，p<.001）。表现有效性测试失败和诉讼在两个模型中都不是显著的预测因素。
脑震荡后出现意外的神经和其他躯体症状不应被视为夸大。被认为持续存在 FND 和 SSD 的心理因素（例如，恐惧回避行为）可能导致脑震荡后出现意外症状。需要在 FND、SSD 和持续性脑震荡后症状的交叉点进行更多研究。
