King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
J Neurol Neurosurg Psychiatry. 2024 Apr 12;95(5):461-470. doi: 10.1136/jnnp-2023-332364.
Differences in affective processing have previously been shown in functional neurological disorder (FND); however, the mechanistic relevance is uncertain. We tested the hypotheses that highly arousing affective stimulation would result in elevated subjective functional neurological symptoms (FNS), and this would be associated with elevated autonomic reactivity. The possible influence of cognitive detachment was also explored.
Individuals diagnosed with FND (motor symptoms/seizures; n=14) and healthy controls (n=14) viewed Positive, Negative and Neutral images in blocks, while passively observing the stimuli ('Watch') or detaching themselves ('Distance'). The FND group rated their primary FNS, and all participants rated subjective physical (arousal, pain, fatigue) and psychological states (positive/negative affect, dissociation), immediately after each block. Skin conductance (SC) and heart rate (HR) were monitored continuously.
FNS ratings were higher after Negative compared with Positive and Neutral blocks in the FND group (p=0.002, η =0.386); however, this effect was diminished in the Distance condition relative to the Watch condition (p=0.018, η =0.267). SC and/or HR correlated with FNS ratings in the Negative-Watch and Neutral-Distance conditions (r values=0.527-0.672, p values=0.006-0.035). The groups did not differ in subjective affect or perceived arousal (p values=0.541-0.919, η =<0.001-0.015).
Emotionally significant events may exert an influence on FNS which is related to autonomic activation rather than altered subjective affect or perceived arousal. This influence may be modulated by cognitive detachment. Further work is needed to determine the relevance and neural bases of these processes in specific FND phenotypes.
先前的研究表明，功能性神经障碍（FND）患者在情感处理方面存在差异；然而，其机制相关性尚不确定。我们检验了以下假设：高度激发的情感刺激会导致主观功能性神经症状（FNS）升高，并且这与自主反应性升高有关。还探索了认知脱离的可能影响。
将 FND（运动症状/癫痫发作；n=14）和健康对照组（n=14）的个体分别观看积极、消极和中性图片块，同时被动地观察刺激（“观看”）或与刺激分离（“距离”）。FND 组对其主要 FNS 进行评分，所有参与者在每个块结束后立即对主观身体（唤醒、疼痛、疲劳）和心理状态（积极/消极影响、分离）进行评分。连续监测皮肤电导（SC）和心率（HR）。
与积极和中性块相比，FND 组在消极块后 FNS 评分更高（p=0.002，η=0.386）；然而，在距离条件下，这种影响相对于观看条件减弱（p=0.018，η=0.267）。在消极-观看和中性-距离条件下，SC 和/或 HR 与 FNS 评分相关（r 值=0.527-0.672，p 值=0.006-0.035）。两组在主观情感或感知唤醒方面没有差异（p 值=0.541-0.919，η=0.001-0.015）。
有意义的情感事件可能对 FNS 产生影响，这与自主激活有关，而不是与改变的主观情感或感知唤醒有关。这种影响可能受到认知分离的调节。需要进一步的工作来确定这些过程在特定的 FND 表型中的相关性和神经基础。
