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.

功能性（解离性）神经症状障碍（FND）是指并非由已知的神经损伤或疾病引起的令人痛苦和失能的身体症状（例如癫痫、震颤、瘫痪）。 FND 患者的日常功能（例如工作、人际关系）存在困难，生活满意度降低。 FND 还与耻辱和获得治疗的障碍有关，部分原因是 FND 的原因尚不清楚，而且患者经常“陷入身心健康服务之间的差距”。至关重要的是，更好地科学地理解 FND，以便迅速改善治疗方案和结果。患有 FND 的人报告说，创伤和压力生活事件、人际关系面临挑战以及一系列心理健康症状（例如抑郁、焦虑）的发生率更高，与一般人群相比（Brown & Reuber，2016；Ludwig 等人，2019；Pick 等人，2016；2017）。研究表明，患有 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，但往往没有意识到这一点（Pick et al., 2016; 2017; 2018; 2019）。然而，人们尚不清楚这些心理因素如何导致 FND 症状，也不清楚它们与一些脑部扫描研究中报告的细微异常有何关系。需要更多的研究来探索这些心理因素的相关性，以及它们与 FND 症状和其他生物学特征的关系。根据研究证据，我最近提出，更强的情绪反应可能引发或恶化 FND 症状，因为更强的身体“战斗或逃跑”反应（“自主唤醒”）（Pick et al., 2019）。这可能是由于情绪大脑系统和涉及其他重要功能的大脑区域之间的沟通异常造成的，例如运动、感觉和自我/身体意识（例如，对自己身体或情绪状态的了解）。我最近的研究结果表明，一种称为“解离”的心理过程可能会直接引发 FND 症状（Pick et al., 2017; 2020）。分离广义上是指一个人的经历的不同方面之间的脱节（例如，感觉与自己的情绪或外部世界分离，感觉对自己的身体失去控制），并且经常发生在对压力经历和强烈的情绪反应的反应中。因此，分离可以潜在地解释情绪异常与 FND 症状之间的联系。拟议研究的主要目的是调查触发或恶化 FND 症状的因素，重点是情绪反应、自主神经唤醒和解离。第二个目标是评估这些过程是否与大脑功能的差异有关。将包括患有不同类型 FND（即癫痫或运动症状）的患者，并将其与具有常见心理健康症状（抑郁症）的人和没有明显精神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，包括参与者的主观“当下”体验（情绪、分离）、唤醒的物理测量（例如心率）和 FND 症状。将在实验室和现实生活中采取一些措施，以评估研究结果是否一致。大脑结构和功能也将在扫描仪中进行评估。研究结果将提供更多有关 FND 中生物和心理因素之间相互作用的信息，并将对改进或开发急需的新疗法产生重大影响。希望这项研究能够结合身心健康的观点，为研究和治疗这种复杂疾病的更综合方法提供基础。

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