Anger regulation in patients with functional neurological disorder: A systematic review.

BACKGROUND: Functional neurological disorder (FND) has been associated with predisposing psychological factors, including dysregulation of anger-related processes. This paper provides a systematic review of the literature on anger regulation in FND. We evaluated anger-related research on patient self-report, observational, and laboratory based measures in FND. The review also addresses adverse childhood experiences and their relation with anger regulation, and the effects of therapies targeting anger regulation in FND. METHODS: MEDLINE, EMBASE, and PsycINFO were searched for both quantitative and qualitative research, published in a peer-reviewed journal with a sample size of at least 5 (registered under Prospero protocol CRD42022314340). RESULTS: A total of 2200 articles were identified. After screening, 54 studies were included in this review (k = 20 questionnaire-based studies, k = 12 laboratory studies, k = 21 using other methods, and k = 1 used both questionnaires and other methods) representing data of 2502 patients with FND. Questionnaire-based studies indicated elevated levels of state anger and trait hostility in patients with FND. Laboratory studies showed a higher tendency to avoid social threat cues, attentional bias towards angry faces, difficulties reliving anger, and preoccupation with frustrating barriers among FND patients versus controls. No specific childhood experiences were identified related to anger regulation in FND, and too few small and uncontrolled studies were available (k = 2) to assess the effects of anger-related interventions in FND. The overall quality of the studies was fair (k = 31) to poor (k = 18). Five studies (k = 5) were rated as having a good quality. CONCLUSIONS: This review suggests that patients with FND have maladaptive anger regulation compared to individuals without FND. The findings also highlight the need for further research on the prevalence and consequences of anger-related processes in the development, diagnosis and treatment of FND.

Alexithymia and facial emotion recognition in patients with functional neurological disorder.

OBJECTIVES: Patients with functional neurological disorder (FND) are known to have difficulties recognizing and processing emotions. Problems recognizing internal emotional states (alexithymia) are common in FND, but little is known about recognizing emotions expressed by other people. This study investigates whether patients with FND have higher levels of alexithymia and reduced facial emotion recognition compared to healthy controls. METHODS: Patients with FND (n = 31, mean age=42.7 [SD=14.8] years, 54.8% women) were compared to healthy controls (n = 33, mean age=45.1 [SD=16.2] years, 63.6% women). The Bermond-Vorst Alexithymia Questionnaire (BVAQ) was used for the assessment of alexithymia and the Ekman 60 Faces Test (EFT) for facial emotion recognition. RESULTS: Patients with FND had higher levels of alexithymia than healthy controls (BVAQ=71.8 [SD=19.8] versus 59.3 [SD=20.3], p = .02, Cohen's d=0.62). Facial emotion recognition did not significantly differ between FND patients and controls (EFT total score FND: 46.1 [SD=5.9], Controls: 47.5 [SD=5.5], p = .34, Cohen's d=0.24). Only recognition of surprise differed between patients and controls (FND: 8.4 [SD=1.8], Controls: 9.2 [SD=1.0), p = .03, Cohen's d= 0.56). Higher levels of alexithymia were associated with poorer facial emotion recognition, but this relationship was not statistically significant (FND: ß= -0.20, p = .28; Controls: ß=-0.03; p = .87). CONCLUSIONS: The current data confirm prior observations that patients with FND have higher alexithymia levels than controls without FND. Difficulties recognizing emotions among patients with FND primarily involves recognition of internal emotional states rather than recognition of facially expressed emotions by others. These findings require replication in a larger and more divers sample.

['Home away from house': an example of a reduplicative paramnesia]. / Een patiënt die dacht dat zijn huis in een ander land stond; reduplicatieve paramnesie.

We describe a 78-year old male patient with Parkinson’s disease and without a past psychiatric history, who had hallucinations and a very particular form of a delusional misidentification syndrome. His belief that he was not at home and that his home was on a different location, even in another country, is a form of 'reduplicative paramnesia'. This delusion is seen more often in association with neurodegenerative disease, for example in Parkinson’s disease. We describe the characteristics of this delusion, provide possible explanations and delineate several therapeutic options.

Grapheme-color synesthesia interferes with color perception in a standard Stroop task.

This study examined the proposed automatic and involuntary nature of synesthetic experiences in grapheme-color synesthetes by comparing behavioral and blood-oxygen level dependent (BOLD) responses in a synesthetic and a standard version of the Stroop task. Clear interference effects in terms of slower reaction times and stronger BOLD responses in the rostral cingulate zone (RCZ) were found in synesthetes performing the synesthetic version of the Stroop task. Surprisingly, less interference was found in synesthetes compared with controls performing the standard Stroop task. This smaller interference effect, expressed as the difference in reaction time between incongruent and neutral stimuli, was explained in terms of experienced interference during the neutral condition of the Stroop task in synesthetes. This was confirmed by stronger BOLD responses in the RCZ for synesthetes specifically in the neutral condition. To the best of our knowledge, this is the first study to show different performance of synesthetes in a standard Stroop task and the presented data can be seen as strong evidence for the automatic and involuntary nature of synesthetic experiences.