背景:以前在功能性神经障碍(FND)中已经显示出情感处理的差异;然而,机械相关性是不确定的。我们测试了高度唤醒情感刺激会导致主观功能神经症状(FNS)升高的假设,这将与自主神经反应性升高有关。还探讨了认知脱离的可能影响。
方法:诊断为FND(运动症状/癫痫发作;n=14)和健康对照(n=14)的个体观察为阳性,块中的负面和中性图像,同时被动地观察刺激(\'观看\')或分离自己(\'距离\')。FND组评定了他们的主要FNS,所有参与者都对主观身体(唤醒,疼痛,疲劳)和心理状态(积极/消极影响,解离),每个块后立即。连续监测皮肤电导(SC)和心率(HR)。
结果:在FND组中,与阳性和中性阻滞相比,阴性后FNS评分更高(p=0.002,ηp2=0.386);但是,这种影响在距离条件下相对于观察条件(p=0.018,ηp2=0.267)减弱。在负观察和中性距离条件下,SC和/或HR与FNS评级相关(r值=0.527-0.672,p值=0.006-0.035)。两组在主观影响或感知的唤醒方面没有差异(p值=0.541-0.919,ηp2=<0.001-0.015)。
结论:情绪上重要的事件可能对FNS产生影响,这与自主神经激活有关,而不是改变主观情感或感知的唤醒。这种影响可以通过认知脱离来调节。需要进一步的工作来确定这些过程在特定FND表型中的相关性和神经基础。
BACKGROUND: 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.
METHODS: 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.
RESULTS: FNS ratings were higher after Negative compared with Positive and Neutral blocks in the FND group (p=0.002, ηp 2=0.386); however, this effect was diminished in the Distance condition relative to the Watch condition (p=0.018, ηp 2=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, ηp 2=<0.001-0.015).
CONCLUSIONS: 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.