Selma Aybek1, Timothy R Nicholson1, Fernando Zelaya2, Owen G O'Daly2, Tom J Craig3, Anthony S David1, Richard A Kanaan4. 1. Section of Cognitive Neuropsychiatry, Institute of Psychiatry, King's College London, London, England. 2. Department of Neuroimaging, Institute of Psychiatry, King's College London, London, England. 3. Department of Health Services and Population Research, Institute of Psychiatry, King's College London, London, England. 4. Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Victoria, Australia.
Abstract
IMPORTANCE: Freud argued that in conversion disorder (CD) the affect attached to stressful memories is "repressed" and "converted" into physical symptoms, although this has never been subject to scientific study to our knowledge. OBJECTIVE: To examine the neural correlates of recall of life events judged to be of causal significance in CD. DESIGN, SETTING, AND PARTICIPANTS: Case-control study. Academic research setting among 12 patients with motor CD and 13 healthy control subjects. MAIN OUTCOMES AND MEASURES: Stressful life events were assessed using the Life Events and Difficulties Schedule and rated by a blinded panel for their likelihood to cause CD based on the threat posed and the extent to which subsequent illness might allow escape from some of their consequences (termed escape). Recall of those events (escape condition) was compared with recall of equally threatening control events from the same epoch (severe condition) in a functional magnetic resonance imaging task. RESULTS: Relative to controls, patients showed significantly increased left dorsolateral prefrontal cortex and decreased left hippocampus activity during the escape vs severe condition, accompanied by increased right supplementary motor area and temporoparietal junction activity. Relative to controls, patients failed to activate the right inferior frontal cortex during both conditions, and connectivity between amygdala and motor areas (supplementary motor area and cerebellum) was enhanced. CONCLUSIONS AND RELEVANCE: These data offer support for the notion that the way adverse events are processed cognitively can be associated with physical symptoms in CD. Abnormal emotion (dorsolateral prefrontal cortex and right inferior frontal cortex) and memory control (hippocampus) are associated with alterations in symptom-related motor planning and body schema (supplementary motor area and temporoparietal junction).
IMPORTANCE: Freud argued that in conversion disorder (CD) the affect attached to stressful memories is "repressed" and "converted" into physical symptoms, although this has never been subject to scientific study to our knowledge. OBJECTIVE: To examine the neural correlates of recall of life events judged to be of causal significance in CD. DESIGN, SETTING, AND PARTICIPANTS: Case-control study. Academic research setting among 12 patients with motor CD and 13 healthy control subjects. MAIN OUTCOMES AND MEASURES: Stressful life events were assessed using the Life Events and Difficulties Schedule and rated by a blinded panel for their likelihood to cause CD based on the threat posed and the extent to which subsequent illness might allow escape from some of their consequences (termed escape). Recall of those events (escape condition) was compared with recall of equally threatening control events from the same epoch (severe condition) in a functional magnetic resonance imaging task. RESULTS: Relative to controls, patients showed significantly increased left dorsolateral prefrontal cortex and decreased left hippocampus activity during the escape vs severe condition, accompanied by increased right supplementary motor area and temporoparietal junction activity. Relative to controls, patients failed to activate the right inferior frontal cortex during both conditions, and connectivity between amygdala and motor areas (supplementary motor area and cerebellum) was enhanced. CONCLUSIONS AND RELEVANCE: These data offer support for the notion that the way adverse events are processed cognitively can be associated with physical symptoms in CD. Abnormal emotion (dorsolateral prefrontal cortex and right inferior frontal cortex) and memory control (hippocampus) are associated with alterations in symptom-related motor planning and body schema (supplementary motor area and temporoparietal junction).
Authors: Alexander Lehn; Jeannette Gelauff; Ingrid Hoeritzauer; Lea Ludwig; Laura McWhirter; Stevie Williams; Paula Gardiner; Alan Carson; Jon Stone Journal: J Neurol Date: 2015-09-26 Impact factor: 4.849
Authors: Benjamin Williams; Rozita Jalilianhasanpour; Nassim Matin; Gregory L Fricchione; Jorge Sepulcre; Matcheri S Keshavan; W Curt LaFrance; Bradford C Dickerson; David L Perez Journal: J Psychiatr Res Date: 2018-04-06 Impact factor: 4.791
Authors: Jorge Sepulcre; David L Perez; Ibai Diez; Laura Ortiz-Terán; Benjamin Williams; Rozita Jalilianhasanpour; Juan Pablo Ospina; Bradford C Dickerson; Matcheri S Keshavan; W Curt LaFrance Journal: J Neurol Neurosurg Psychiatry Date: 2019-03-08 Impact factor: 10.154
Authors: Juan Pablo Ospina; Anna G Larson; Rozita Jalilianhasanpour; Benjamin Williams; Ibai Diez; Amar Dhand; Bradford C Dickerson; David L Perez Journal: J Affect Disord Date: 2019-07-30 Impact factor: 4.839
Authors: Steven A Epstein; Carine W Maurer; Kathrin LaFaver; Rezvan Ameli; Stephen Sinclair; Mark Hallett Journal: Psychosomatics Date: 2016-04-29 Impact factor: 2.386