Clinical differences between patients with psychogenic nonepileptic seizures and functional motor disorder.

OBJECTIVES: Why a patient might present with psychogenic nonepileptic seizures (PNES) as opposed to another functional neurological symptom is unknown. A recent review suggested that patients with PNES and functional motor disorders (FMD) differ on demographic and clinical factors of potential aetiological and mechanistic significance, arguing they might represent different disorders, though direct comparisons are limited. We sought to determine whether these factors differed in patients presenting with FMD and PNES at our clinic, as well as whether preceding medical complaints would differ between the two, particularly those affecting the limbs or head. METHODS: A retrospective chart review of all presentations with FMD or PNES patients to a functional neurology clinic, collecting demographic and clinical data, including medical and surgical history. RESULTS: Fifty-six patients with FMD and 52 with PNES were included. Significantly more patients with FMD had functional somatic syndromes (46% vs 27%, p = 0.036) and preceding medical events that affected their limbs than patients with PNES (34% vs 14%, p = 0.013); significantly more patients with PNES had dissociative symptoms (31% vs 4%, p < 0.001) and lifetime suicidal ideation (56% vs 32%, p = 0.013). SIGNIFICANCE: These results highlight the substantial comorbidities affecting FMD and PNES, but find clinical differences between the two groups that may be of aetiological or mechanistic significance.

The relationship between psychosocial trauma type and conversion (functional neurological) disorder symptoms: a cross-sectional study.

OBJECTIVE: Psychosocial trauma was associated with developing conversion disorder (also known as functional neurological disorder) before Freud, though why a particular symptom should arise is unknown. We aimed to determine if there was a relationship between trauma type and symptom. METHODS: We retrospectively reviewed the medical records of patients attending Australia's first functional neurology clinic, including referral, clinic letters and a clinic questionnaire. RESULTS: There were 106 females, 43 males and five transgender patients. Sensory (51%), motor (47%) and seizures (39%) were the commonest functional symptoms. Most patients (92%) reported stressors associated with symptom onset. Multiple trauma/symptom type associations were found: patients with in-law problems experienced more cognitive symptoms (p = .036), for example, while expressive speech problems more commonly followed relationship difficulties (p = .021). CONCLUSION: Associations were found between type of traumatic events and type of symptoms in conversion disorder. This will require verification in a larger sample.

Cognitive, emotional, and social factors promoting psychosocial adaptation: a study of latent profiles in people living in socially vulnerable contexts.

Introduction: Social adaptation is a multifaceted process that encompasses cognitive, social, and affective factors. Previous research often focused on isolated variables, overlooking their interactions, especially in challenging environments. Our study addresses this by investigating how cognitive (working memory, verbal intelligence, self-regulation), social (affective empathy, family networks, loneliness), and psychological (locus of control, self-esteem, perceived stress) factors interact to influence social adaptation. Methods: We analyzed data from 254 adults (55% female) aged 18 to 46 in economically vulnerable households in Santiago, Chile. We used Latent profile analysis (LPA) and machine learning to uncover distinct patters of socioadaptive features and identify the most discriminating features. Results: LPA showed two distinct psychosocial adaptation profiles: one characterized by effective psychosocial adaptation and another by poor psychosocial adaptation. The adaptive profile featured individuals with strong emotional, cognitive, and behavioral self-regulation, an internal locus of control, high self-esteem, lower stress levels, reduced affective empathy, robust family support, and decreased loneliness. Conversely, the poorly adapted profile exhibited the opposite traits. Machine learning pinpointed six key differentiating factors in various adaptation pathways within the same vulnerable context: high self-esteem, cognitive and behavioral self-regulation, low stress levels, higher education, and increased social support. Discussion: This research carries significant policy implications, highlighting the need to reinforce protective factors and psychological resources, such as self-esteem, self-regulation, and education, to foster effective adaptation in adversity. Additionally, we identified critical risk factors impacting social adaptation in vulnerable populations, advancing our understanding of this intricate phenomenon.

The neurocognitive impact of loneliness and social networks on social adaptation.

Social adaptation arises from the interaction between the individual and the social environment. However, little empirical evidence exists regarding the relationship between social contact and social adaptation. We propose that loneliness and social networks are key factors explaining social adaptation. Sixty-four healthy subjects with no history of psychiatric conditions participated in this study. All participants completed self-report questionnaires about loneliness, social network, and social adaptation. On a separate day, subjects underwent a resting state fMRI recording session. A hierarchical regression model on self-report data revealed that loneliness and social network were negatively and positively associated with social adaptation. Functional connectivity (FC) analysis showed that loneliness was associated with decreased FC between the fronto-amygdalar and fronto-parietal regions. In contrast, the social network was positively associated with FC between the fronto-temporo-parietal network. Finally, an integrative path model examined the combined effects of behavioral and brain predictors of social adaptation. The model revealed that social networks mediated the effects of loneliness on social adaptation. Further, loneliness-related abnormal brain FC (previously shown to be associated with difficulties in cognitive control, emotion regulation, and sociocognitive processes) emerged as the strongest predictor of poor social adaptation. Findings offer insights into the brain indicators of social adaptation and highlight the role of social networks as a buffer against the maladaptive effects of loneliness. These findings can inform interventions aimed at minimizing loneliness and promoting social adaptation and are especially relevant due to the high prevalence of loneliness around the globe. These findings also serve the study of social adaptation since they provide potential neurocognitive factors that could influence social adaptation.

Anaesthesia and the development of functional neurological disorder: A systematic review and case series.

OBJECTIVE: There are reports of functional neurological disorder (FND) developing after anaesthesia, though separating any aetiological role from other possible factors is challenging. We aimed to systematically review all published cases of post-anaesthetic FND to see if any common factors supported an anaesthetic role. We also aimed to identify all cases of post-anaesthetic FND arising in our FND clinic, to obtain an estimate of its frequency. METHODS: For the review, a systematic search for published cases of FND developing within 48 h of anaesthesia was conducted in June 2022. For the case series, the medical records of all patients attending an FND clinic in Melbourne between 2017 and 2019 were examined, and all cases with FND within 48 h of anaesthesia extracted. RESULTS: 36 published cases were identified for the review. Sixteen described preceding stressors and 16 psychiatric diagnoses, including 8 with previous FND. Thirty-two (92%) had undergone general anaesthesia, most commonly for obstetric procedures. Motor/sensory loss was the most common presentation, followed by seizures and coma. Most (80.5%) developed symptoms immediately on induction or cessation of anaesthesia. For the case series, 8 of 107 clinic patients (7.5%), developed FND within 48 h of anaesthesia. All had previous psychiatric diagnoses, including 3 with previous FND. Three underwent general anaesthesia and 3 procedural sedation, with seizures the most common presentation. All developed symptoms immediately on induction or cessation of anaesthesia. CONCLUSION: These cases provide some support for an aetiological role for anaesthesia: there is evidence for an anaesthetic 'model' for the symptoms of FND that arise, they largely arise with the onset or termination of anaesthesia, and they arise most frequently during general anaesthesia or sedation.

Rhythm on Your Lips.

The Iambic-Trochaic Law (ITL) accounts for speech rhythm, grouping of sounds as either Iambs-if alternating in duration-or Trochees-if alternating in pitch and/or intensity. The two different rhythms signal word order, one of the basic syntactic properties of language. We investigated the extent to which Iambic and Trochaic phrases could be auditorily and visually recognized, when visual stimuli engage lip reading. Our results show both rhythmic patterns were recognized from both, auditory and visual stimuli, suggesting that speech rhythm has a multimodal representation. We further explored whether participants could match Iambic and Trochaic phrases across the two modalities. We found that participants auditorily familiarized with Trochees, but not with Iambs, were more accurate in recognizing visual targets, while participants visually familiarized with Iambs, but not with Trochees, were more accurate in recognizing auditory targets. The latter results suggest an asymmetric processing of speech rhythm: in auditory domain, the changes in either pitch or intensity are better perceived and represented than changes in duration, while in the visual domain the changes in duration are better processed and represented than changes in pitch, raising important questions about domain general and specialized mechanisms for speech rhythm processing.

Enactive Approach and Dual-Tasks for the Treatment of Severe Behavioral and Cognitive Impairment in a Person with Acquired Brain Injury: A Case Study.

One of the most important sequela in persons who suffer from acquired brain injury is a behavioral disorder. To date, the primary approaches for the rehabilitation of this sequela are Applied Behavior Analysis, Cognitive-Behavior Therapy, and Comprehensive-Holistic Rehabilitation Programs. Despite this theoretical plurality, none of these approaches focuses on rehabilitating behavioral disorders considering the relation between affordance and environmental adaptation. To introduce this therapeutic view to neurorehabilitation, we apply the theoretical tenets of the enactive paradigm to the rehabilitation of a woman with severe behavioral and cognitive impairment. Over seventeen sessions, her behavioral and cognitive performance was assessed in relation to two seated affordances (seated on a chair and seated on a ball 65 cm in diameter) and the environmental adaptation while she was working on various cognitive tasks. These two seated affordances allowed to incorporate the theoretical assumptions of the enactive approach and to know how the behavior and the cognition were modified based on these two postural settings and the environmental adaptation. The findings indicate that the subject exhibited better behavioral (physical and verbal) and cognitive (matching success and complex task) performances when the woman worked on the therapeutic ball than when the woman was on the chair. The enactive paradigm applied in neurorehabilitation introduces a level of treatment that precedes behavior and cognition. This theoretical consideration allowed the discovery of a better relation between a seated affordance and the environmental adaptation for the improvement behavioral and cognitive performance in our case study.

Primary empathy deficits in frontotemporal dementia.

Loss of empathy is an early central symptom and diagnostic criterion of the behavioral variant frontotemporal dementia (bvFTD). Although changes in empathy are evident and strongly affect the social functioning of bvFTD patients, few studies have directly investigated this issue by means of experimental paradigms. The current study assessed multiple components of empathy (affective, cognitive and moral) in bvFTD patients. We also explored whether the loss of empathy constitutes a primary deficit of bvFTD or whether it is explained by impairments in executive functions (EF) or other social cognition domains. Thirty-seven bvFTD patients with early/mild stages of the disease and 30 healthy control participants were assessed with a task that involves the perception of intentional and accidental harm. Participants were also evaluated on emotion recognition, theory of mind (ToM), social norms knowledge and several EF domains. BvFTD patients presented deficits in affective, cognitive and moral aspects of empathy. However, empathic concern was the only aspect primarily affected in bvFTD that was neither related nor explained by deficits in EF or other social cognition domains. Deficits in the cognitive and moral aspects of empathy seem to depend on EF, emotion recognition and ToM. Our findings highlight the importance of using tasks depicting real-life social scenarios because of their greater sensitivity in the assessment of bvFTD. Moreover, our results contribute to the understanding of primary and intrinsic empathy deficits of bvFTD and have important theoretical and clinical implications.