Is conversion disorder biologically related with depression?: a DST study

Tunca, Zeliha; Fidaner, Hüray; Cimilli, Can; Kaya, Nezaket; Biber, Bengi; Yeşil, Sena; Özerdem, Ayşegül

doi:10.1016/0006-3223(95)00474-2

Cited by 17 publications

(19 citation statements)

References 19 publications

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“…There were no significant group differences in CAR, but in line with previous findings (Tunca et al.,1996) our patients with PNES seemed to show somewhat increased post‐DST cortisol. Tunca et al. (1996) did not, however, control for psychotropic medication and smoking, and when we adjusted for these factors our post‐DST effects disappeared.…”

Section: Discussionsupporting

confidence: 92%

“…So far, only two studies have investigated basal activity of the HPA axis in PNES, and the results are conflicting. Tunca et al. (1996) did not find increased basal cortisol levels in a sample of 25 patients with conversion disorder (including 20 patients with PNES) compared to healthy controls (HCs) but did find decreased cortisol suppression after dexamethasone administration.…”

mentioning

confidence: 65%

“…Based on Tunca et al. (1996, 2000), we predicted that we would find increased HPA‐axis activity (as evidenced by increased basal diurnal cortisol levels, increased CAR, and increased post‐DST cortisol) in patients with PNES compared to HCs.…”

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confidence: 99%

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Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures

et al. 2010

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SUMMARYPurpose: Several studies have indicated that psychogenic nonepileptic seizures (PNES) are associated with psychological trauma, but only a few studies have examined the associations with neurobiologic stress systems, such as the hypothalamus-pituitary-adrenal (HPA) axis and its end-product cortisol. We tested several relevant HPAaxis functions in patients with PNES and related them to trauma history. Methods: Cortisol awakening curve, basal diurnal cortisol, and negative cortisol feedback (using a 1 mg dexamethasone suppression test) were examined in 18 patients with PNES and 19 matched healthy controls (HCs) using saliva cortisol sampling on two consecutive days at 19 time points. Concomitant sympathetic nervous system (SNS) activity was assessed by analyzing saliva a-amylase (sAA). Results: Patients with PNES showed significantly increased basal diurnal cortisol levels compared to HCs. This effect was driven mainly by patients reporting sexual trauma who showed a trend toward higher cortisol levels as compared to patients without a sexual trauma report. Importantly, the increased basal diurnal cortisol levels in patients were not explained by depression, medication, or smoking, or by current seizures or group differences in SNS activity. Discussion: This is the first study showing that basal hypercortisolism in patients with PNES is independent of the acute occurrence of seizures. In addition, basal hypercortisolism was more pronounced in traumatized patients with PNES as compared to nontraumatized patients with PNES. These findings suggest that HPA-axis activity provides a significant neurobiologic marker for PNES.

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Section: Discussionsupporting

confidence: 92%

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confidence: 65%

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Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures

et al. 2010

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“…Kalin et al, 1998a,b;Nunez et al, 1996). Deregulations of the HPA-axis were also found in patients with conversion disorder on a dexamethasone suppression test (Tunca et al, 1996). Compared to controls, patients with conversion disorder showed increased post-dexamethasone cortisol levels, which is indicative of impaired suppression of cortisol.…”

Section: Discussionmentioning

confidence: 90%

Hyperactive action monitoring during motor-initiation in conversion paralysis: An event-related potential study

Roelofs

Bruijn

Galen

2006

Biological Psychology

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Conversion paralysis (CP) is featured by a stress-induced tonic immobility. Although the neural correlates of this psychiatric condition remain largely unexplored, previous reports showed CP to be associated with anterior cingulate cortex (ACC) hyperactivity. We examined the ACC action monitoring function by recording event-related potentials (ERPs) when conversion patients (n = 6) with unilateral arm paresis made speeded responses with their affected and healthy arms on a flankers task. During this task, pre-response ACC action monitoring is reflected in the N2 ERP component, which is increased when incongruent stimuli lead to simultaneously activated competing response tendencies. The results showed that the N2 congruency effects were significantly increased for responses with affected hands compared to healthy hands. There were no such results for post-response monitoring. This study is the first to present electrophysiological correlates of action monitoring in CP and suggests ACC to be hyperactive when movements with affected arms are to be initiated. #

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“…At the moment, there are only indirect indications for altered HPA-axis functioning from a study by Rief et al (1998), showing elevated basal levels of psychophysiological arousal and cortisol in patients with somatization syndrome compared with healthy control subjects. Also, using a dexamethasone suppression test, Tunca et al (1996) found postdexamethasone cortisol levels to be significantly higher in 25 patients with conversion disorder compared with healthy controls, which is suggestive of impaired suppression of cortisol in conversion disorder. To our knowledge, there are no studies available addressing the glucocorticoid stress responsiveness of conversion patients after stress induction.…”

Section: Discussionmentioning

confidence: 92%

The Impact of Early Trauma and Recent Life-Events on Symptom Severity in Patients With Conversion Disorder

Roelofs¹,

Spinhoven²,

Sandijck³

et al. 2005

Journal of Nervous &Amp; Mental Disease

110

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Abstract:Although the presence of psychological stress factors in the evolution of conversion symptoms forms an important criterion for the DSM-IV diagnosis of conversion disorder, little is known about the nature and timing of these stress factors. Fifty-four patients with conversion disorder and 50 control patients with an affective disorder were screened for life events experienced in the year before the symptom onset. Conversion patients did not differ from control patients in the number or severity of life events, but showed a significant relation between the recent life events and the severity of conversion symptoms. Especially life events with respect to work and relationships contributed to this effect. These results remained when controlling for the previously found effects of childhood traumatization on the severity of conversion symptoms. The findings imply that conversion symptoms may be elicited by a complex of early and later negative life events and that traditional unifactorial trauma-theories of conversion disorder should be replaced by multifactorial stress models.

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Is conversion disorder biologically related with depression?: a DST study

Cited by 17 publications

References 19 publications

Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures

Basal hypercortisolism and trauma in patients with psychogenic nonepileptic seizures

Hyperactive action monitoring during motor-initiation in conversion paralysis: An event-related potential study

The Impact of Early Trauma and Recent Life-Events on Symptom Severity in Patients With Conversion Disorder

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