Abstract
Anxiety disorders and conversion disorders are one of the most common causes of functional disorders of the nervous system. Concepts of recent years have reduced the accent on the role of psychosocial stressors with the corresponding increase in neurobiological neurobiological explanations for this disease. However, much evidence still confirms the role of psychosocial disorders (eg, stressful life events, interpersonal difficulties) as important risk factors for functional neurological disorders (FND). Therefore, there is a need to integrate psychosocial and neurobiological factors (eg, sensorimotor and cognitive functions) into modern models of FND. Altered emotional processing of information may be the key to the relationship between psychosocial risk factors and the main features of FND. In this article we summarize and critically evaluate experimental studies of emotional processing in FND, using behavioral, psychophysiological and / or neurovisual tests in combination with tasks for affective processing. The current approach suggests that enhanced subconscious (implicit) processing of emotionally expressed stimuli associated with increased limbic reactivity (eg, in the amygdala) may promote the initiation of major affective/defensive responses in the hypothalamic and brainstem pathways (eg, periaqueductal grey matter) [54]. In parallel, the areas of the brain associated
with affect can simultaneously have a devastating effect on the circuits of neurocirculation that are involved in volitional motor control, awareness and emotional regulation (eg, sensorimotor, sensory, central executive networks). Limbic-paralymbic disorders in patients may be one of several neurobiological adaptations associated with early, severe, and/or prolonged psychosocial disturbances. Considering the effect of pregabalin on the amygdala, there are theoretical justifications and practical experience of its use for the correction of anxiety and conversion disorders.
References
2. Apazoglou K., Mazzola V., Wegrzyk J., et al. Biological and perceived stress in motor functional neurological disorders // Psychoneuroendocrinology. — 2017. — 85. — P. 142-50. doi:10.1016/j.psyneuen.2017.08.023.
3. Atmaca M., Aydin A., Tezcan E., et al. Volumetric investigation of brain regions in patients with conversion disorder // Prog. Neuropsychopharmacol. Biol. Psychiatry. — 2006. — 30. — P. 708-13. doi:10.1016/j.pnpbp.2006.01.011.
4. Atmaca M., Baykara S., Mermi O., et al. Pituitary volumes are changed in patients with conversion disorder // Brain. Imaging Behav. — 2016. — 10. — P. 92-5. doi:10.1007/s11682-015-9368-6.
5. Atmaca M., Yildirim H., Sec S., et al. Pituitary volumes in hypochondriac patients // Prog. Neuropsychopharmacol. Biol. Psychiatry. — 2010. — 34. — P. 344-7. doi:10.1016/j.pnpbp.2009.12.012.
6. Aybek S., Nicholson T.R., Draganski B., et al. Grey matter changes in motor conversion disorder // J. Neurol. Neurosurg. Psychiatry. — 2014. — 85. — P. 236-8. doi:10.1136/jnnp‑2012-304158.
7. Aybek S., Nicholson T.R., O’Daly O., et al. Emotion-motion interactions in conversion disorder: an FMRI study // PLoS One. — 2015. — 10. — P. e0123273. doi:10.1371/journal.pone.0123273.
8. Aybek S., Nicholson T.R., Zelaya F., et al. Neural correlates of recall of life events in conversion disorder // JAMA Psychiatry. — 2014.—71. — P. 52- 60. doi:10.1001/jamapsychiatry.2013.2842.
9. Bakvis P., Roelofs K., Kuyk J., et al. Trauma, stress, and preconscious threat processing in patients with psychogenic nonepileptic seizures // Epilepsia. — 2009. — 50. — P. 1001-11. doi:10.1111/j.1528-1167.2008.01862.x.
10. Bakvis P., Spinhoven P., Giltay E.J., et al. Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures // Epilepsia. — 2010. — 51. — P. 752-9. doi:10.1111/j.1528-1167.2009.02394.x.
11. Bakvis P., Spinhoven P., Putman P., et al. The effect of stress induction on working memory in patients with psychogenic nonepileptic seizures // Epilepsy Behav. — 2010. — 19. — P. 448-54. doi:10.1016/j.yebeh.2010.08.026.
12. Bakvis P., Spinhoven P., Roelofs K. Basal cortisol is positively correlated to threat vigilance in patients with psychogenic nonepileptic seizures // Epilepsy Behav. — 2009. — 16 . — P. 558-60. doi:10.1016/j.yebeh.2009.09.006.
13. Bakvis P., Spinhoven P., Zitman F.G., et al. Automatic avoidance tendencies in patients with psychogenic non-epileptic seizures // Seizure. — 2011. — 20. — P. 628-34. doi:10.1016/j.seizure.2011.06.006.
14. Blakemore R.L., Sinanaj I., Galli S., et al. Aversive stimuli exacerbate defensive motor behaviour in motor conversion disorder // Neuropsychologia. — 2016. — 93. — P. 229-41. doi:10.1016/j.neuropsychologia.2016.11.005.
15. Bodde N.M., Brooks J.L., Baker G.A., et al. Psychogenic non-epileptic seizures — definition, etiology, treatment and prognostic issues: a critical review // Seizure. — 2009. — 18. — P. 543-53. doi:10.1016/j.seizure.2009.06.006.