An Investgation About the Relationship Between Vasopressin and Oxytocin in Persistent Type Functional Neurological Symptom Disorder

Objective Functional neurogical symptom disorder (FNSD) is a somatic symptom disorder with loss of voluntary motor or sensory functions, which cannot be explained by another medical condition. The study aimed to examine the relationship of vasopressin and oxytocin in persistent type FNSD.Methods This study included 27 female patients between the ages of 20–57 who were diagnosed with FNSD according to DSM-5 and 27 healthy controls matched in terms of age and gender. Serum vasopressin and oxytocin levels were measured twice on the same day in fasting blood samples and the results were compared statistically.Results Vasopressin were lower in patients compared to controls while there was no difference between oxytocin levels. Childhood traumas were more common in patient group, and mean oxytocin level was lower in patients who exposed to childhood trauma, compared to controls. No significant difference was found between the groups in terms of vasopressin.Conclusion Changes in vasopressin and oxytocin balance in the pathogenesis of persistant FNSD, may likely to lead to physiological and behavioral consequences. Lower oxytocin levels may also be a marker of exposure to childhood trauma in FNSD. These neuropeptides plays important role in neuroendocrine balance of emotional behavior.

Eye movement desensitization and reprocessing treatment in functional neurological symptom disorder with psychogenic nonepileptic seizures: A study of two cases

Patients with functional neurological symptom disorder (FND) have many diverse symptoms including psychogenic nonepileptic seizures (PNES), positive movements such as tremor, dystonia, or gait abnormalities, loss of motor function such as leg or arm paresis, and loss of sensory functions, such as blindness, deafness, or loss of feeling in the limbs. Eye movement desensitization and reprocessing (EMDR) is a therapy method that includes some techniques arising from psychodynamic, cognitive, and behavioral approaches. EMDR is known as a proven psychotherapeutic approach in post-traumatic stress disorder, but there are also numerous studies reporting its efficacy in other psychiatric disorders and trauma-associated symptoms, in patients with comorbid psychiatric disorders. This article presents the outcome of EMDR treatment of two patients’ cases, a 13-year-old female and a 16-year-old male, who were diagnosed as FND with PNES, according to the DSM-5 diagnostic criteria. In both cases, there was a significant decrease in Adolescent Dissociative Experiences Scale scores and no pseudo seizures were found, even at the sixth-month follow-up visits. These case studies suggest that EMDR can be an effective method in the long-term treatment of FND with PNES and a useful alternative to other treatment methods.

#3113 Evaluating the PCL-C as a measure of trauma and PTSD symptoms in patients with functional neurological symptom disorder

AimsFunctional Neurological Symptom Disorder (FNSD) is common and disabling. Historically trauma was considered an essential aetiological factor, but the precise contribution of trauma to the disorder, and resulting disability, remains controversial. The PCL-C is a self-reported screening tool for PTSD symptoms based on DSM-IV criteria. A previous study in patients with FNSD demonstrated high scores on the PCL-C, with a reduction in scores following psychotherapy. However strong correlations with other psychological co-morbidities raised the possibility that the PCL-C may be capturing non-specific distress rather than indicators of previous traumatisation. The present study aimed to investigate (i) whether underlying factors measured by the PCL-C can distinguish specific trauma-memory-related symptoms from less specific emotion-regulation-related symptoms, (ii) the extent to which individual factors correlate with other psychopathology and health-related quality of life (HRQoL) measures and (iii) whether different factors change with psychotherapy, all in patients with FNSD.MethodsAn exploratory factor analysis of PCL-C responses from 473 FNSD patients pre-and post-psychotherapy was performed to generate1-4 factor models. The final factor model was determined through confirmatory factor analysis. Relationships between PCL-C factors, measures of comorbidities (depression, somatisation and anxiety) and HRQoL were assessed using regression analysis. Pre- and post-psychotherapy scores were compared.ResultsThe best model for the PCL-C comprised of two-factors: factor 1 (intrusive symptoms) explained 55.2% of the variance, whilst factor 2 (emotional dysregulation) explained 7.8% of the variance. Both factors reduced in severity after psychotherapy, but factor 2 reduced by more and correlated more strongly with a decrease in depression and anxiety than factor 1. Changes in depression, anxiety, somatic symptoms and mental HRQoL predicted 61.9% of the change in factor 2, but only 49.2% in factor 1. Improvements in mental HRQoL were strongly associated with a decrease in factor 2, but less so in factor 1.DiscussionThe factor analysis revealed the PCL-C represents two correlated but distinguishable symptom clusters in patients with FNSD: intrusive symptoms and emotional dysregulation. Both were elevated in our patient sample. The high level of intrusive symptoms suggests many patients with FNSD experience classical post-traumatic symptoms, which may indicate that subjective traumatic experiences contribute to pathogenesis and resulting disability. These symptoms showed some reduction with psychotherapy, but the greater reduction in emotional dysregulation symptoms and associated improvements in mental HRQoL suggest that psychotherapy may be more effective in reducing the burden of comorbidities and providing better coping strategies than in addressing core symptoms of the underlying disorder.

Family Conflicts Are Bitter Splits That Hurt: A Qualitative Inquiry Toward Understanding the Impact of Family Issues in Functional Neurological Symptom Disorder

Functional Neurological Symptom Disorder (FNSD) or Conversion Disorder, is a fairly common diagnosis among mental health patients in Pakistan. Despite its prevalence there's a dearth of research on the phenomenon, particularly on the experience of FNSD. The study was conducted with the aim to ascertain the lived experiences of individuals with Functional Neurological Symptom Disorder (FNSD) around stressful situations in their families in Pakistan. For this purpose, a total sample of 10 participants (Women = 8; Men = 2) were recruited from the psychiatry department of a tertiary care hospital in Lahore, Pakistan. Semi-structured interviews were conducted and analyzed through Interpretative Phenomenological Analysis (IPA). The two main themes revealed in the analyses were quarrels and unexpressed emotions. The sub-themes of quarrels included quarrels with family members, quarrels within family, parental/marital discord, and quarrels with extended family members. The subthemes for unexpressed emotions were hurt, anger, sadness, and jealousy. In conclusion, this study revealed that in Pakistan, stressors related to family serve as significant contributing factors in the development of FNSD.

Queen Square Guided Self Help for Functional Neurological Symptom Disorder

Objective: Functional Neurological Symptoms (FNS) are disabling symptoms without macro-structural cause. While inpatient treatment confers important benefits, it is resource intensive and hence it is important to optimize its efficiency. Methods: We developed a brief, internet-based preparatory therapy based on psychoeducation and CBT, termed the Queen Square Guided Self-help (QGSH) to maximize the efficacy of the inpatient FNS treatment at the National Hospital for Neurology and Neurosurgery. Results: The QGSH aims to ensure that prior to admission the patient understands 1) The diagnosis of FNS , 2) The five areas CBT model and 3) The use of Goal setting in rehabilitation. It has now run since 2017 and 191 patients have taken part in the inpatient FNS program, with 122 of these have participated in the QGSH. It runs for up to twelve weeks and includes original videos and patient worksheets, as well as signposting to existing published resources. Information is sent weekly by e-mail and content is delivered in the form of eleven modules built around online video sessions.Conclusion: We believe that the set of materials used in QGSH has the potential to benefit patients with FNS and can support clinicians wishing to develop their expertise. It could help with the development of new FNS services, and we are in the process of developing it into a standalone service. We hope that the experience of the Queen Square team can be used to help patients and clinicians to improve the provision of FNS services.