Increased Amygdala Activity Associated With Cognitive Reappraisal Strategy in Functional Neurologic Disorder.

Thomas Hassa,Roger Schmidt,Mircea Ariel Schoenfeld,Christian Merkel,Stefan Spiteri

doi:10.3389/fpsyt.2021.613156

Abstract

Cognitive reappraisal is an emotion regulation strategy to reduce the impact of affective stimuli. This regulation could be incomplete in patients with functional neurologic disorder (FND) resulting in an overflowing emotional stimulation perpetuating symptoms in FND patients. Here we employed functional MRI to study cognitive reappraisal in FND. A total of 24 FND patients and 24 healthy controls employed cognitive reappraisal while seeing emotional visual stimuli in the scanner. The Symptom Checklist-90-R (SCL-90-R) was used to evaluate concomitant psychopathologies of the patients. During cognitive reappraisal of negative IAPS images FND patients show an increased activation of the right amygdala compared to normal controls. We found no evidence of downregulation in the amygdala during reappraisal neither in the patients nor in the control group. The valence and arousal ratings of the IAPS images were similar across groups. However, a subgroup of patients showed a significant higher account of extreme low ratings for arousal for negative images. These low ratings correlated inversely with the item “anxiety” of the SCL-90-R. The increased activation of the amygdala during cognitive reappraisal suggests altered processing of emotional stimuli in this region in FND patients.

Highlights

Patients with functional neurologic disorder (FND) present all varieties of neurological symptoms [1] that are not attributable to structural lesions
Emotion processing plays a pivotal role in this context: epidemiologic data suggest that altered emotion processing is correlated with FND [6, 7] and a large number of imaging studies provide a wealth of evidence for altered emotion regulatory networks in FND [8]
In a preceding study we found that an increased activation of the amygdala in FND by emotional stimulation was functionally connected to a symptom-specific neuronal network [19]

Summary

Introduction

Patients with functional neurologic disorder (FND) present all varieties of neurological symptoms [1] that are not attributable to structural lesions. Several etiological models of the disorder were proposed from a psychological point of view to fill this gap [2, 3]. This is due to the missing somatic model of explanation and to the fact that patients with FND exhibit distinctive psychological features [4] and striking common life events [5]. Emotion processing plays a pivotal role in this context: epidemiologic data suggest that altered emotion processing is correlated with FND [6, 7] and a large number of imaging studies provide a wealth of evidence for altered emotion regulatory networks in FND [8].

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Discussion

Conclusion