Campbell Malcolm C, Smakowski Abigail, Rojas-Aguiluz Maya, Goldstein Laura H, Cardeña Etzel, Nicholson Timothy R, Reinders Antje A T S, Pick Susannah
Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and Central and North West London NHS Foundation Trust, London, UK.
Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
BJPsych Open. 2022 Dec 1;9(1):e2. doi: 10.1192/bjo.2022.597.
Studies have reported elevated rates of dissociative symptoms and comorbid dissociative disorders in functional neurological disorder (FND); however, a comprehensive review is lacking.
To systematically review the severity of dissociative symptoms and prevalence of comorbid dissociative disorders in FND and summarise their biological and clinical associations.
We searched Embase, PsycInfo and MEDLINE up to June 2021, combining terms for FND and dissociation. Studies were eligible if reporting dissociative symptom scores or rates of comorbid dissociative disorder in FND samples. Risk of bias was appraised using modified Newcastle-Ottawa criteria. The findings were synthesised qualitatively and dissociative symptom scores were included in a meta-analysis (PROSPERO CRD42020173263).
Seventy-five studies were eligible (FND = 3940; control = 3073), most commonly prospective case-control studies ( = 54). Dissociative disorders were frequently comorbid in FND. Psychoform dissociation was elevated in FND compared with healthy ( = 0.90, 95% CI 0.66-1.14, = 70%) and neurological controls ( = 0.56, 95% CI 0.19-0.92, = 67%). Greater psychoform dissociation was observed in FND samples with seizure symptoms versus healthy controls ( = 0.94, 95% CI 0.65-1.22, = 42%) and FND samples with motor symptoms ( = 0.40, 95% CI -0.18 to 1.00, = 54%). Somatoform dissociation was elevated in FND versus healthy controls ( = 1.80, 95% CI 1.25-2.34, = 75%). Dissociation in FND was associated with more severe functional symptoms, worse quality of life and brain alterations.
Our findings highlight the potential clinical utility of assessing patients with FND for dissociative symptomatology. However, fewer studies investigated FND samples with motor symptoms and heterogeneity between studies and risk of bias were high. Rigorous investigation of the prevalence, features and mechanistic relevance of dissociation in FND is needed.
研究报告称，功能性神经障碍（FND）中分离症状和共病性分离障碍的发生率有所升高；然而，目前缺乏全面的综述。
系统回顾FND中分离症状的严重程度和共病性分离障碍的患病率，并总结它们的生物学和临床关联。
我们检索了截至2021年6月的Embase、PsycInfo和MEDLINE数据库，将FND和分离相关的术语进行组合。如果研究报告了FND样本中的分离症状评分或共病性分离障碍的发生率，则该研究符合纳入标准。使用改良的纽卡斯尔-渥太华标准评估偏倚风险。对研究结果进行定性综合分析，并将分离症状评分纳入荟萃分析（PROSPERO注册号：CRD42020173263）。
75项研究符合纳入标准（FND组=3940例；对照组=3073例），最常见的是前瞻性病例对照研究（n=54项）。FND中经常合并分离障碍。与健康对照组（标准化均值差=0.90，95%置信区间0.66-1.14，P=70%）和神经疾病对照组（标准化均值差=0.56，95%置信区间0.19-0.92，P=67%）相比，FND中的心理性分离症状有所升高。与健康对照组相比，有癫痫症状的FND样本（标准化均值差=0.94，95%置信区间0.65-1.22，P=42%）和有运动症状的FND样本（标准化均值差=0.40，95%置信区间-0.18至1.00，P=54%）中观察到更高的心理性分离症状。与健康对照组相比，FND中的躯体形式分离症状有所升高（标准化均值差=1.80，95%置信区间1.25-2.34，P=75%）。FND中的分离症状与更严重的功能症状、更差的生活质量和大脑改变有关。
我们的研究结果强调了评估FND患者分离症状的潜在临床实用性。然而，较少有研究调查有运动症状的FND样本，且研究之间存在异质性，偏倚风险较高。需要对FND中分离症状的患病率、特征和机制相关性进行严格研究。
