Biological and perceived stress in motor functional neurological disorders
Biological and perceived stress in motor functional neurological disorders
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DOI：
10.1016/j.psyneuen.2017.08.023
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发表时间：
2017-11-01
影响因子：
3.7
通讯作者：
Aybek, Selma
中科院分区：
文献类型：
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作者：
Apazoglou, Kalliopi;Mazzola, Viridiana;Aybek, Selma
背景：目前解释运动神经功能障碍(FND)的模型整合了潜在症状产生的神经生物学机制和心理社会应激源的作用。成像研究表明，运动控制异常与情绪和压力调节受损有关。然而，关于生物应激在FND中的调节作用却知之甚少。方法：采用Trier社会应激测验对16例符合DSM-5标准的运动性FND患者和15名健康对照进行测试。用唾液皮质醇评价下丘脑-垂体-肾上腺轴(HPA)反应，用唾液α-淀粉酶评价自主交感反应。计算曲线下面积以反映背景水平(AUCG)和随时间的变化(AUCI)。结果：FND患者皮质醇和淀粉酶的背景水平(AUCG)均显著高于对照组。对压力的生物反应(Auci)在两组之间没有差异，但主观反应显示出与报告比对照组更高的压力水平的患者的交互作用。应激后，对照组的主观和客观交感神经值(淀粉酶)之间显示出很强的相关性，但患者没有。不良生活事件的数量和主观影响只与患者的皮质醇AUCG相关。结论：本研究证实了运动性FND患者的基础HPA轴和交感神经高觉醒状态与生活逆境相关。在社会压力中，仅在患者中观察到感受到的压力和生物标志物之间的分离，反映了内感觉能力的失调，这可能代表了这种疾病的一种内表型。
Background: Current models explaining motor functional neurological disorders (FND) integrate both the neurobiological mechanisms underlying symptoms production and the role of psychosocial stressors. Imaging studies have suggested abnormal motor control linked to impaired emotional and stress regulation. However, little is known on the biological stress regulation in FND. Our aim was to study the biological and perceived response to stress in patients with motor FND.Methods: Sixteen patients with motor FND (DSM-5 criteria) and fifteen healthy controls underwent the Trier Social Stress Test. Hypothalamo-pituitary-adrenal axis (HPA) response was evaluated with salivary cortisol and autonomous sympathetic response with salivary alpha-amylase. Area under the curve was computed to reflect background levels (AUCg) and change over time (AUCi). Life adversities and perceived subjective stress on a visual analog scale (VAS) were correlated with biological responses.Results: FND patients had significantly higher background levels (AUCg) of both stress markers (cortisol and amylase) than controls. The biological response (AUCi) to stress did not differ between groups for both markers but the subjective response showed an interaction effect with patients reporting higher levels of stress than controls. After stress, controls showed a strong correlation between subjective and objective sympathetic values (amylase) but not patients. The number and subjective impact of adverse life events correlated with cortisol AUCg in patients only.Conclusion: This study confirms a baseline HPA-axis and sympathetic hyperarousal state in motor FND related to life adversities. During a social stress, dissociation between perceived stress and biological markers was observed in patients only, reflecting a dysregulation of interoception capacity, which might represent an endophenotype of this disorder.