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Emotional stimuli and motor conversion disorder

机译：情绪刺激和运动转换障碍

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Conversion disorder is characterized by neurological signs and symptoms related to an underlying psychological issue. Amygdala activity to affective stimuli is well characterized in healthy volunteers with greater amygdala activity to both negative and positive stimuli relative to neutral stimuli, and greater activity to negative relative to positive stimuli. We investigated the relationship between conversion disorder and affect by assessing amygdala activity to affective stimuli. We conducted a functional magnetic resonance imaging study using a block design incidental affective task with fearful, happy and neutral face stimuli and compared valence contrasts between 16 patients with conversion disorder and 16 age- and gender-matched healthy volunteers. The patients with conversion disorder had positive movements such as tremor, dystonia or gait abnormalities. We also assessed functional connectivity between the amygdala and regions associated with motor preparation. A group by affect valence interaction was observed. Post hoc analyses revealed that whereas healthy volunteers had greater right amygdala activity to fearful versus neutral compared with happy versus neutral as expected, there were no valence differences in patients with conversion disorder. There were no group differences observed. The time course analysis also revealed greater right amygdala activity in patients with conversion disorder for happy stimuli (t = 2.96, P = 0.006) (with a trend for fearful stimuli, t = 1.81, P = 0.08) compared with healthy volunteers, with a pattern suggestive of impaired amygdala habituation even when controlling for depressive and anxiety symptoms. Using psychophysiological interaction analysis, patients with conversion disorder had greater functional connectivity between the right amygdala and the right supplementary motor area during both fearful versus neutral, and happy versus neutral ‘stimuli’ compared with healthy volunteers. These results were confirmed with Granger Causality Modelling analysis indicating a directional influence from the right amygdala to the right supplementary motor area to happy stimuli (P < 0.05) with a similar trend observed to fearful stimuli (P = 0.07). Our data provide a potential neural mechanism that may explain why psychological or physiological stressors can trigger or exacerbate conversion disorder symptoms in some patients. Greater functional connectivity of limbic regions influencing motor preparatory regions during states of arousal may underlie the pathophysiology of motor conversion symptoms.
机译：转换障碍的特征是与潜在的心理问题有关的神经系统症状和体征。在健康志愿者中，杏仁核对情感刺激的活性具有良好的特征，相对于中性刺激，杏仁核对负刺激和阳性刺激均具有更大的活性，而相对于阳性刺激对负刺激具有更大的活性。我们通过评估杏仁核对情感刺激的活动，研究了转化障碍与情感之间的关系。我们进行了功能性磁共振成像研究，使用带有恐惧，快乐和中性的面部刺激的区组设计附带情感任务，并比较了16例转化障碍患者与16例年龄和性别匹配的健康志愿者之间的价差对比。患有转化障碍的患者有积极的运动，例如震颤，肌张力障碍或步态异常。我们还评估了杏仁核与运动准备相关区域之间的功能连接性。观察到一组通过影响价相互作用。事后分析显示，尽管健康的志愿者具有比预期的快乐和中性更高的对恐惧和中性的正确杏仁核活动能力，但转换障碍患者的化合价没有差异。没有观察到群体差异。时程分析还显示，与健康志愿者相比，快乐刺激转化障碍患者的右杏仁核活性更高（t = 2.96，P = 0.006）（有恐惧刺激的趋势，t = 1.81，P = 0.08）。即使控制抑郁症和焦虑症症状，也可能提示杏仁核习惯化受损。使用心理生理学相互作用分析，与健康志愿者相比，转换障碍患者在恐惧与中立“刺激”与幸福与中立“刺激”期间，右侧杏仁核与右侧辅助运动区之间的功能连接性更高。格兰杰因果关系模型分析证实了这些结果，表明从右侧杏仁核到右侧辅助运动区到快乐刺激的方向影响（P <0.05），与恐惧刺激的趋势相似（P = 0.07）。我们的数据提供了潜在的神经机制，可以解释为什么心理或生理压力源可以触发或加剧某些患者的转化障碍症状。在觉醒状态期间影响运动准备区域的边缘区域更大的功能连通性可能是运动转换症状的病理生理学的基础。

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