Specific Biases for Identifying Facial Expression of Emotion in Children and Adolescents With Conversion Disorders

Kozlowska, Kasia; Brown, Kerri J.; Palmer, Donna M.; Williams, Lea M.

doi:10.1097/psy.0b013e318286be43

Cited by 27 publications

(39 citation statements)

References 58 publications

(51 reference statements)

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“…Reduced accuracy for recognising emotional facial expressions and reduced phasic skin conductance responses (SCRs) was observed in FND-seiz participants in one study 15. Altered reaction times for explicit identification of sad and happy faces have also been reported in children and adolescents with FND,32 alongside elevated heart rate (HR) and reduced heart rate variability (HRV) in the same sample 33. Additionally, avoidant behavioural responses to angry faces have been observed in FND-seiz 34.…”

Section: Emotional Processing In Fnd: a Narrative Reviewmentioning

confidence: 93%

Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda

Pick

Goldstein

Perez

et al. 2018

J Neurol Neurosurg Psychiatry

199

167

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Functional neurological disorder (FND) is a common and highly disabling disorder, but its aetiology remains enigmatic. Conceptually, there has been reduced emphasis on the role of psychosocial stressors in recent years, with a corresponding increase in neurobiological explanations. However, a wealth of evidence supports the role of psychosocial adversities (eg, stressful life events, interpersonal difficulties) as important risk factors for FND. Therefore, there is a need to integrate psychosocial (environmental) and neurobiological factors (eg, sensorimotor and cognitive functions) in contemporary models of FND. Altered emotional processing may represent a key link between psychosocial risk factors and core features of FND. Here, we summarise and critically appraise experimental studies of emotional processing in FND using behavioural, psychophysiological and/or neuroimaging measures in conjunction with affective processing tasks. We propose that enhanced preconscious (implicit) processing of emotionally salient stimuli, associated with elevated limbic reactivity (eg, amygdala), may contribute to the initiation of basic affective/defensive responses via hypothalamic and brainstem pathways (eg, periaqueductal grey). In parallel, affect-related brain areas may simultaneously exert a disruptive influence on neurocircuits involved in voluntary motor control, awareness and emotional regulation (eg, sensorimotor, salience, central executive networks). Limbic-paralimbic disturbances in patients with FND may represent one of several neurobiological adaptations linked to early, severe and/or prolonged psychosocial adversity. This perspective integrates neurobiological and psychosocial factors in FND and proposes a research agenda, highlighting the need for replication of existing findings, multimodal sampling across emotional response domains and further examination of emotional influences on sensorimotor and cognitive functions in FND populations.

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Section: Emotional Processing In Fnd: a Narrative Reviewmentioning

confidence: 93%

Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda

Pick

Goldstein

Perez

et al. 2018

J Neurol Neurosurg Psychiatry

199

167

View full text Add to dashboard Cite

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“…First, in a study using a facial emotion-identification task, patients from the current cohort demonstrated faster reaction times than controls, (Kozlowska et al, 2013a) suggesting increased motor readiness with concomitant activation of the motor and sympathetic systems. Second, in a study assessing integrative capacity within narratives (Kozlowska et al, 2011) and in a study assessing cognitive function, (Kozlowska et al, 2015a) patients demonstrated difficulties in integrating autobiographical information and also decreased performance on cognitive tasks dependent on prefrontal cortex (PFC) function.…”

Section: Introductionmentioning

confidence: 90%

“…Fifty-seven children and adolescents with functional neurological symptom disorder (41 girls; 16 boys) aged 8.5–18 years were recruited between August 16, 2006, and August 16, 2010, from a paediatric tertiary-care hospital in New South Wales, Australia, and took part in a series of studies (Kozlowska et al, 2013a, Kozlowska et al, 2011, Kozlowska et al, 2015a, Kozlowska and Williams, 2010). Because data for the auditory oddball were missing for seven patients, seven other patients matched for age and sex—recruited during August 17, 2010, to April 31, 2014—replaced the 7 patients for whom there was no data, yielding 41 girls and 16 boys aged 8.43–18 years (mean: 13.46 years, SD: 2.14).…”

Section: Methodsmentioning

confidence: 99%

“…Written informed consent was obtained from all patients and their parents. Details on the recruitment protocols, screening for inclusion and exclusion criteria, assessment for organic pathology, and other aspects of clinical characteristics have been reported previously (Kozlowska et al, 2013a, Kozlowska et al, 2011, Kozlowska et al, 2015a, Kozlowska and Williams, 2010). …”

Section: Methodsmentioning

confidence: 99%

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Cortical arousal in children and adolescents with functional neurological symptoms during the auditory oddball task

Kozlowska

Melkonian

Spooner³

et al. 2017

NeuroImage: Clinical

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ObjectiveStress, pain, injury, and psychological trauma all induce arousal-mediated changes in brain network organization. The associated, high level of arousal may disrupt motor-sensory processing and result in aberrant patterns of motor function, including functional neurological symptoms. We used the auditory oddball paradigm to assess cortical arousal in children and adolescents with functional neurological symptom disorder.MethodElectroencephalogram (EEG) data was collected in fifty-seven children and adolescents (41 girls; 16 boys, aged 8.5–18 years) with acute functional neurological symptoms and age- sex- matched controls during a conventional auditory oddball task. The high-resolution fragmentary decomposition technique was used to analyse the amplitude of event-related potentials (ERPs) to target tones at midline sites (Fz, Cz, and Pz).ResultsCompared to age- and sex-matched controls, and across all three midline sites, children and adolescents with functional neurological symptoms showed increased amplitude of all ERP components (P50, N100, P200, N200, and P300) (t-value range 2.28–8.20; p value-range 0.023 to < 0.001) to the emotionally-neutral auditory stimulus.ConclusionsOur findings add to a growing literature indicating that a baseline state of high arousal may be a precondition for generating functional neurological symptoms, a finding that helps explain why a range of psychological and physiological stressors can trigger functional neurological symptoms in some patients. Interventions that target cortical arousal may be central to the treatment of paediatric patients with functional neurological symptom disorder.

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“…In addition, there has recently been a study of children with CD which found shorter reaction times to negative emotional faces compared to neutral faces consistent with a state of increased vigilance and motor readiness to emotional stimuli [10]. Further evidence of an abnormal state of emotional arousal in CD also comes from findings of elevated basal cortisol levels in the seizure variant of CD [11] that correlate with attentional bias towards threatening stimuli [12].…”

Section: Introductionmentioning

confidence: 93%

Emotion-Motion Interactions in Conversion Disorder: An Fmri Study

Nicholson¹,

Aybek²,

O’Daly³

et al. 2015

J Neurol Neurosurg Psychiatry

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ObjectivesTo evaluate the neural correlates of implicit processing of negative emotions in motor conversion disorder (CD) patients. MethodsAn event related fMRI task was completed by 12 motor CD patients and 14 matched healthy controls using standardised stimuli of faces with fearful and sad emotional expressions in comparison to faces with neutral expressions. Temporal changes in the sensitivity to stimuli were also modelled and tested in the two groups. ResultsWe found increased amygdala activation to negative emotions in CD compared to healthy controls in region of interest analyses, which persisted over time consistent with previous findings using emotional paradigms. Furthermore during whole brain analyses we found significantly increased activation in CD patients in areas involved in the 'freeze response' to fear (periaqueductal grey matter), and areas involved in self-awareness and motor control (cingulate gyrus and supplementary motor area). ConclusionsIn contrast to healthy controls, CD patients exhibited increased response amplitude to fearful stimuli over time, suggesting abnormal emotional regulation (failure of habituation / sensitization). Patients with CD also activated midbrain and frontal structures that could reflect an abnormal behavioral-motor response to negative including threatening stimuli. This suggests a mechanism linking emotions to motor dysfunction in CD.

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Specific Biases for Identifying Facial Expression of Emotion in Children and Adolescents With Conversion Disorders

Abstract: The observation of faster reaction times to sad faces in children and adolescents with conversion disorders suggests increased vigilance and motor readiness to emotional signals that are potential threats to self or to close others. These effects may occur before conscious processing.

Cited by 27 publications

References 58 publications

Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda

Emotional processing in functional neurological disorder: a review, biopsychosocial model and research agenda

Cortical arousal in children and adolescents with functional neurological symptoms during the auditory oddball task

Emotion-Motion Interactions in Conversion Disorder: An Fmri Study

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