Novel approaches to the investigation of psychobiological mechanisms in functional neurological disorder

研究功能性神经障碍心理生物学机制的新方法

• 批准号: MR/V032771/1
• 负责人: Susannah Pick
• 金额: $ 174.63万
• 依托单位: King's College London
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FV032771%2F1
• 关键词: Novel; approaches; investigation; psychobiological; mechanisms

Functional (dissociative) neurological symptom disorder (FND) is defined by distressing and disabling physical symptoms (e.g., seizures, tremor, paralysis) that are not caused by a known neurological injury or illness. People with FND have difficulties in daily functioning (e.g., work, relationships) and reduced life satisfaction. FND is also associated with stigma and barriers to accessing treatment, partly because the causes of FND are not well understood and patients often 'fall through the gaps' between physical and mental health services. It is crucial that FND is better understood scientifically, so that treatment options and outcomes improve rapidly.People with FND report higher rates of trauma and stressful life events, challenging personal relationships and a range of mental health symptoms (e.g., depression, anxiety), compared to the general population (Brown & Reuber, 2016; Ludwig et al., 2019; Pick et al., 2016; 2017). Studies have shown that people with FND experience difficulties in recognising and regulating emotions, potentially having stronger physical reactions to stressors, yet often being unaware of this (Pick et al., 2016; 2017; 2018; 2019). However, it is not well understood how these psychological factors contribute to FND symptoms, nor how they relate to subtle abnormalities reported in some brain scan studies. More research is needed to explore the relevance of these psychological factors, and how they relate to symptoms and other biological features in FND.On the basis of research evidence, I recently proposed that stronger emotional reactions could trigger or worsen FND symptoms, because of a greater physical 'fight or flight' response ('autonomic arousal') (Pick et al., 2019). This could be due to abnormalities in communication between emotional brain systems and brain areas involved in other important functions, such as movement, sensation and self/body awareness (e.g., knowledge of one's own bodily or emotional states). My findings have recently suggested that a psychological process called 'dissociation' might directly trigger FND symptoms (Pick et al., 2017; 2020). Dissociation broadly refers to a disconnection between different aspects of a person's experience (e.g., feeling detached from one's emotions or the outside world, feeling in less control over one's body) and often occurs in response to stressful experiences and strong emotional reactions. Dissociation could therefore potentially explain the connection between emotional abnormalities and FND symptoms. The primary aim of the proposed research is to investigate factors that trigger or worsen FND symptoms, with a focus on emotional responses, autonomic arousal and dissociation. A second aim is to assess whether these processes are linked to differences in brain functioning. Patients with different types of FND (i.e., seizures or movement symptoms) will be included and compared to people with common mental health symptoms (depression) and people with no significant mental or physical health disorders, to examine potential similarities and differences to these groups. A variety of relevant features will be measured, including participants' subjective 'in-the-moment' experiences (emotions, dissociation), physical measures of arousal (e.g., heart rate), and FND symptoms. Some measures will be taken in both laboratory and real-life settings, to assess whether findings are consistent. Brain structure and functioning will also be assessed in a scanner.The results of the research will provide more information about the interaction between biological and psychological factors in FND and will have considerable implications for improving or developing new treatments, which are much needed. It is hoped that the research will provide a basis for a more integrated approach to studying and treating this complex disorder, combining both physical and mental health perspectives.

功能（解离）神经系统症状障碍（FND）是由不受已知神经损伤或疾病引起的痛苦和残疾的身体症状（例如，癫痫发作，震颤，瘫痪）的定义。患有FND的人在日常运作（例如工作，人际关系）和生活满意度降低方面遇到困难。 FND还与污名和获得治疗的障碍有关，部分原因是FND的原因尚不清楚，并且患者经常在身心健康服务之间“跌入差距”。至关重要的是，FND可以更好地理解科学理解，因此治疗方案和结果迅速改善。与FND相比，FND的人报告了更高的创伤和压力性生活事件的率，挑战个人关系以及一系列心理健康症状（例如，抑郁症，焦虑症）（例如，与一般人群相比，与一般人群相比，研究表明，有FND的人在识别和调节情绪方面遇到困难，可能对压力源产生更强烈的身体反应，但常常没有意识到这一点（Pick等，2016; 2017; 2017; 2018; 2018; 2019）。但是，尚不清楚这些心理因素如何导致FND症状，也不了解它们与某些脑扫描研究中报道的微妙异常有关。需要进行更多的研究来探索这些心理因素的相关性，以及它们与FND中的症状和其他生物学特征的关系。在研究证据的基础上，我最近提出，由于更强烈的情绪反应可能会触发或恶化FND症状，因为更大的身体“搏斗或飞行”反应更大（“自动抗唤醒”）（“自动唤起”（“选择自主”）（选择等等。，2019年）。这可能是由于情绪大脑系统和其他重要功能的大脑区域之间的沟通异常，例如运动，感觉和自我/身体意识（例如，了解自己的身体或情感状态）。我的发现最近提出，称为“解离”的心理过程可能直接触发FND症状（Pick等，2017; 2020）。分离广泛地指一个人的经历的不同方面之间的断开（例如，感觉与自己的情绪或外界分离，对身体的控制较少），并且经常是为了应对压力的经历和强烈的情感反应而发生。因此，解离可能可以解释情绪异常与FND症状之间的联系。拟议研究的主要目的是研究触发或恶化FND症状的因素，重点是情绪反应，自主性唤醒和解离。第二个目的是评估这些过程是否与大脑功能的差异有关。患有不同类型的FND（即癫痫发作或运动症状）的患者将被包括在内，并将其与具有常见心理健康症状（抑郁症）的患者和没有重大心理或身体健康障碍的人进行比较，以检查与这些群体的潜在相似性和差异。将测量各种相关特征，包括参与者“主观”的内在体验（情绪，分离），唤醒（例如心率）和FND症状的物理测量。在实验室和现实生活环境中，将采取一些措施，以评估发现是否一致。大脑结构和功能也将在扫描仪中进行评估。该研究的结果将提供有关FND中生物学和心理因素之间相互作用的更多信息，并将对改善或开发新的治疗方法产生相当大的影响，这是急需的。希望这项研究能为研究和治疗这种复杂疾病的更一体化方法提供基础，并将其结合在一起。

项目成果

Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures: A Pilot Investigation.

功能性运动症状和功能性癫痫发作的病因和症状触发因素：一项试点调查。

• DOI: 10.1176/appi.neuropsych.20230103
• 发表时间: 2024
• 期刊: The Journal of neuropsychiatry and clinical neurosciences
• 作者: Millman LSM

Functional neurological disorder is a feminist issue.

• DOI: 10.1136/jnnp-2022-330192
• 发表时间: 2023-10
• 期刊: Journal of neurology, neurosurgery, and psychiatry

Predisposing, precipitating and perpetuating factors in functional neurological disorder

功能性神经系统疾病的诱发、诱发和持续因素

• 发表时间: 2023
• 作者: Millman LSM

Altered interoceptive sensibility with intact interoceptive accuracy and awareness in functional neurological disorder

功能性神经系统疾病的内感受性改变，内感受准确性和意识完整

• 发表时间: 2023
• 作者: Millman LSM