Histeriden Fonksiyonel Nörolojik Belirti Bozukluğuna: Klinik Tanı ve Nörobiyolojideki Gelişmeler

Öz

Fonksiyonel nörolojik belirti bozukluğunun (FNBB) isimlendirilmesinde geçmişten günümüze kadar yapılan değişiklikler tarihsel süreçte etiyolojiye ilişkin anlayışın değişimini yansıtmaktadır. Günümüzde halen altta yatan başka bir olası nörolojik hastalık tanısının dışlanmasında zorluklar yaşanmakta, bozukluğa yol açan psikolojik mekanizma konusunda bir fikir birliği bulunmamakta ve buna bağlı olarak tanı koyma ile ilgili sorunlar devam etmektedir. Fonksiyonel görüntüleme çalışmalarının sonuçları psikanalitik kuramın konversiyon modelinde yer alan bastırma ve döndürme (konversiyon) mekanizmalarının nöral karşılıklarının olabileceğini düşündürmekle beraber, bu modelin her hasta için açıklayıcı olamayacağına işaret etmektedir. Özellikle dorsolateral prefrontal korteks (dlPFK), amigdala, temporoparietal bileşke (TPB), insula, ön singulat yapıları ve aralarındaki bağlantılar ön plana çıkmaktadır. Bulgular istenmeyen bir anının hatırlanmasının dlPFK ve hipokampus arasındaki bağlantılar aracılığıyla engellenebileceğini düşündürmektedir. Ayrıca amigdalada saptanan değişiklikler ve amigdala ile motor alanlar arasında tespit edilen artmış bağlantısallık, duygu düzenlemenin bozulması ve duygular ile motor sistem arasında anormal bir bağlantı olması ihtimali ile ilişkilendirilmektedir. Temporoparietal bileşkede gösterilen değişikliklerin ise hareketin faili olma hissinin bozulması ile ilişkili olabileceği öne sürülmektedir. Ancak bu araştırmaların sonuçlarının ‘hastalığa yatkınlığı’ mı, ‘hastalığın ortaya çıkışını’ mı yoksa ‘hastalığa ikincil telafi edici değişiklikleri’ mi temsil ettiği henüz aydınlatılamamıştır. Psikososyal stresörlere beynin ve zihnin nasıl yanıt verdiğini anlamaya çalışmak için FNBB’yi araştırmak beyin-zihin ilişkisini anlamak adına önemli bir kavşak olabilir. Bu derlemede terminoloji ve bakış açısındaki değişimin tarihçesi, psikanalizin kuruluşuna eşlik eden bu bozukluğa psikanalizin bakış açısı ve nörobilimdeki gelişmeler ışığında histeriye dair ne gibi bulgular ortaya konduğunun sunulması amaçlanmaktadır.

Anahtar Kelimeler

• Konversiyon Bozukluğu
• Fonksiyonel Nörolojik Belirti Bozukluğu
• Fonksiyonel Nörogörüntüleme

From Hysteria to Functional Neurological Symptom Disorder: Developments in Clinical Diagnosis and Neurobiology

Abstract

Changes in the nomenclature of functional neurological symptom disorders (FND) from the past to the present represent historical changes in understanding etiology. Today, there is still difficulty in excluding potential underlying neurological disorders. In addition, there is no consensus on the psychological mechanism leading to the disorder. As a result, diagnostic problems continue to exist. While functional neuroimaging studies show that suppression and conversion mechanisms, which are the concepts of the psychoanalytical theory, may have neural counterparts, neurobiological data suggests that the conversion model cannot be explanatory for every patient. The dorsolateral prefrontal cortex (dlPFC), amygdala, temporoparietal junction (TPJ), insula, anterior cingulate structures, and their connections come to the fore. The fact that the connections between the dlPFC and the hippocampus can prevent the recall of an unwanted memory, as well as the changes detected in the amygdala in these disorders and the increased connectivity between the amygdala and the motor areas, suggest an abnormal connection between emotions and the motor system. It is addressed how changes in the TPJ are related to the loss of the sense of agency. However, it is unclear whether the findings of these studies suggest a "predisposition", "onset of disorder", or "compensatory changes secondary to disorder". Exploring FND to learn how the brain and mind react to psychosocial stressors can be a turning point in understanding the brain-mind connection. The goal of this review is to present the history of the changes in terminology and perspective on this disorder that followed the establishment of psychoanalysis, as well as what kind of evidence has been presented regarding hysteria in light of advances in neuroscience

Keywords

• Conversion disorder
• functional neurological symptom disorder
• functional neuroimaging

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