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The Effect of Cognitive Behavioral Therapy on Cognitive Errors in Functional Neurological Symptom Disorder

Yıl 2021, , 20 - 27, 30.04.2021
https://doi.org/10.33713/egetbd.817732

Öz

Objective: Our aim is to compare the effects of pharmacotherapy (PT) and the combination of PT and cognitive behavioral therapy (CBT) on cognitive errors in patients diagnosed with functional neurological symptom disorder (FNSD).
Material and Method: In this prospective study, FNSD diagnosis was made according to DSM-5. Subtypes were determined by evaluating the clinical and somatoform dissociation questionnaire (SDQ) together. Cognitive errors were evaluated with the cognitive distortions scale (CDS), and the general condition of the patient was evaluated with the global assessment scale (GAS).
Results: The PT group consisted of 37 patients, and the PT+CBT group consisted of 20 patients. There was no significant difference between the groups in terms of mean age (p=0.312) and mean duration of education (p=0.345). Before the treatment, there was no significant difference between the groups in terms of CDS-IP (p=0.085), CDS-PA (p=0.145), SDQ (p=0.132) and GAS (p=0.421). Significant differences were found in both PT (p=0.011) and PT+CBT (p<0.001) groups in terms of CDS-IP values before and after treatment. While there was no significant difference between PT group before and after treatment in terms of CDS-PA (p=0.101), there was a significant difference in the PT+CBT group (p=0.048). According to the post-treatment values, there was a significant difference between the groups in terms of GAS (p=0.001) and CDS-IP (p<0.001).
Conclusion: This study is important as it shows that CBT reduces cognitive errors associated with interpersonal relationships (IP). This significant change was not detected in cognitive errors associated with personal achievement (PA). Combination of CBT with drug therapy is more effective in reducing cognitive errors.

Kaynakça

  • 1. Karadag AS, Kalenderoglu A, Orum MH. Optical coherence tomography findings in conversion disorder: are there any differences in the etiopathogenesis of subtypes? Arch Clin Psychiatry. 2018;45(6):154-60.
  • 2. Perez DL, Barsky AJ, Daffner K, Silbersweig DA. Motor and somatosensory conversion disorder: a functional unawareness syndrome? J Neuropsychiatry Clin Neurosci. 2012;24(2):141-51.
  • 3. Boeckle M, Liegl G, Jank R, Pieh C. Neural correlates of conversion disorder: overview and meta-analysis of neuroimaging studies on motor conversion disorder. BMC Psychiatry. 2016;16:195.
  • 4. Hingray C, Biberon J, El-Hage W, De Toffol B. Psychogenic non-epileptic seizures (PNES). Rev Neurol (Paris). 2016;172(4-5):263-9.
  • 5. Tsui P, Deptula A, Yuan DY. Conversion disorder, functional neurological symptom disorder, and chronic pain: comorbidity, assessment, and treatment. Curr Pain Headache Rep. 2017;21(6):29.
  • 6. Leary PM. Conversion disorder. Handb Clin Neurol. 2013;112:883-7.
  • 7. O'Neal MA, Baslet G. Treatment for patients with a functional neurological disorder (conversion disorder): an integrated approach. Am J Psychiatry. 2018;175(4):307-14.
  • 8. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17-31.
  • 9. Kozlowska K, Palmer DM, Brown KJ, Scher S, Chudleigh C, Davies F, Williams LM. Conversion disorder in children and adolescents: a disorder of cognitive control. J Neuropsychol. 2015;9(1):87-108.
  • 10. American Psychiatric Association. (2013). Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: APP.
  • 11. Nijenhuis ERS, Spinhoven P, Van Dyck R, Van Der Hart O, Vanderlinden J. the development and psychometric characteristics of the somatoform dissociation questionnaire (SDQ-20). J Nerv Ment Dis. 1996;184(11):688-94.
  • 12. Sar V, Kundakçι, T, Kιzιltan E, Bakim B, Bozkurt O. Differentiating dissociative disorders from other diagnostic groups through somatoform dissociation in Turkey. J Trauma Dissociation. 2000;1(4):67-80.
  • 13. Özdel K, Taymur I, Guriz SO, Tulaci RG, Kuru E, Turkcapar MH. Measuring cognitive errors using the cognitive distortions scale (CDS): Psychometric properties in clinical and non-clinical samples. Plos ONE. 2014;9(8):E105956.
  • 14. Endicott J, Spitzer RL, Psychiatric Rating Scales. In Comprehensive Textbook Of Psychiatry, 5th Ed.; Kaplan HI, Sadock BJ Eds.; Williams & Wilkins: Baltimore, Maryland: 1989; pp. 2391-09.
  • 15. Waller E, Scheidt CE. Somatoform disorders as disorders of affect regulation: A study comparing the tas-20 with non-self-report measures of alexithymia. J Psychosom Res. 2004;57:239-47.
  • 16. Voon V, Lang AE. Antidepressant treatment outcomes of psychogenic movement disorder. J Clin Psychiatry. 2005;66:1529-34.
  • 17. Sharpe M, Walker J, Williams C, Stone J, Cavanagh J, Murray G, et al. Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology. 2011;77:564-72.
  • 18. Lafrance WC Jr, Baird GL, Barry JJ, Blum AS, Webb AF, Keitner GI, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014;71:997-1005.
  • 19. Örüm MH. The relationship between cognitive errors and psychiatric symptoms in obsessive-compulsive disorder. Med J Ankara Tr Res Hosp. 2020;53(1):29-35.
  • 20. Orum MH. Investigation of the relationship between cannabis use, opioid use and cognitive errors. Medicine Science. 2020;9(2):362-9.
  • 21. Örüm MH. Cognitive error characteristics of rumination and cleaning dimensions of obsessive-compulsive disorder. Anadolu Psikiyatri Derg. 2020;21(6):592-9.
  • 22. Örüm MH, Kara MZ, Kuştepe A, Kalenderoğlu A. Bilişsel hatalar ve dikkat-eksikliği hiperaktivite bozukluğu belirtilerinin madde kullanım özellikleri ile ilişkisi. Bağımlılık Dergisi–Journal Of Dependence. 2019;20(2):47-60.
  • 23. Rachman S. The evolution of behaviour therapy and cognitive behaviour therapy. Behav Res Ther. 2015;64:1-8.

Fonksiyonel Nörolojik Semptom Bozukluğunda Bilişsel Davranışçı Tedavinin Bilişsel Hatalar Üzerine Etkisi

Yıl 2021, , 20 - 27, 30.04.2021
https://doi.org/10.33713/egetbd.817732

Öz

Amaç: Amacımız fonksiyonel nörolojik semptom bozukluğu (FNSD) tanılı hastalarda farmakoterapi (FT) ve FT ile bilişsel davranışçı tedavi (BDT) kombinasyonunun bilişsel hatalar üzerine etkisini karşılaştırmaktır.
Gereç ve Yöntem: Bu ileriye yönelik çalışmada FNSD tanısı DSM-5’e göre konuldu. Alt tipler klinik ve somatoform dissosiyasyon ölçeği (SDÖ)’nin birlikte değerlendirilmesiyle belirlendi. Bilişsel hatalar düşünce özellikleri ölçeği (DÖÖ) ile, hastanın genel durumu global değerlendirme ölçeği (GAS) ile değerlendirildi.
Bulgular: FT grubu 37 hastadan, FT+BDT grubu 20 hastadan oluşuyordu. Gruplar arasında ortalama yaş (p=0,312), ortalama eğitim süresi (p=0,345) açısından anlamlı farklılık saptanmadı. Tedavi öncesinde, DÖÖ-IP (p=0,085), DÖÖ-PA (p=0,145), SDÖ (p=0,132) ve GAS (p=0,421) açısından gruplar arasında anlamlı farklılık saptanmadı. Hem FT (p=0,011), hem de FT+BDT (p<0,001) grubunda DÖÖ-IP açısından tedavi öncesi ve sonrası değerler açısından anlamlı farklılık ortaya çıktı. DÖÖ-PA açısından FT grubundan tedavi öncesi ve sonrası arasında anlamlı farklılık saptanmazken (p=0,101); FT+BDT grubunda anlamlı farklılık saptandı (p=0,048). Tedavi sonrası değerlere göre, gruplar arasında GAS (p=0,001) ve DÖÖ-IP (p<0,001) açısından anlamlı farklılık ortaya çıktı.
Sonuç: Bu çalışma, BDT'nin kişilerarası ilişkilerle (IP) ilişkili bilişsel hataları azalttığını göstermesi açısından önemlidir. Bu anlamlı değişiklik kişisel başarı (PA) ile ilişkili bilişsel hatalarda saptanmadı. BDT'nin ilaç tedavisiyle kombinasyonu bilişsel hataları azaltmada daha etkilidir.

Kaynakça

  • 1. Karadag AS, Kalenderoglu A, Orum MH. Optical coherence tomography findings in conversion disorder: are there any differences in the etiopathogenesis of subtypes? Arch Clin Psychiatry. 2018;45(6):154-60.
  • 2. Perez DL, Barsky AJ, Daffner K, Silbersweig DA. Motor and somatosensory conversion disorder: a functional unawareness syndrome? J Neuropsychiatry Clin Neurosci. 2012;24(2):141-51.
  • 3. Boeckle M, Liegl G, Jank R, Pieh C. Neural correlates of conversion disorder: overview and meta-analysis of neuroimaging studies on motor conversion disorder. BMC Psychiatry. 2016;16:195.
  • 4. Hingray C, Biberon J, El-Hage W, De Toffol B. Psychogenic non-epileptic seizures (PNES). Rev Neurol (Paris). 2016;172(4-5):263-9.
  • 5. Tsui P, Deptula A, Yuan DY. Conversion disorder, functional neurological symptom disorder, and chronic pain: comorbidity, assessment, and treatment. Curr Pain Headache Rep. 2017;21(6):29.
  • 6. Leary PM. Conversion disorder. Handb Clin Neurol. 2013;112:883-7.
  • 7. O'Neal MA, Baslet G. Treatment for patients with a functional neurological disorder (conversion disorder): an integrated approach. Am J Psychiatry. 2018;175(4):307-14.
  • 8. Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17-31.
  • 9. Kozlowska K, Palmer DM, Brown KJ, Scher S, Chudleigh C, Davies F, Williams LM. Conversion disorder in children and adolescents: a disorder of cognitive control. J Neuropsychol. 2015;9(1):87-108.
  • 10. American Psychiatric Association. (2013). Diagnostic And Statistical Manual Of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: APP.
  • 11. Nijenhuis ERS, Spinhoven P, Van Dyck R, Van Der Hart O, Vanderlinden J. the development and psychometric characteristics of the somatoform dissociation questionnaire (SDQ-20). J Nerv Ment Dis. 1996;184(11):688-94.
  • 12. Sar V, Kundakçι, T, Kιzιltan E, Bakim B, Bozkurt O. Differentiating dissociative disorders from other diagnostic groups through somatoform dissociation in Turkey. J Trauma Dissociation. 2000;1(4):67-80.
  • 13. Özdel K, Taymur I, Guriz SO, Tulaci RG, Kuru E, Turkcapar MH. Measuring cognitive errors using the cognitive distortions scale (CDS): Psychometric properties in clinical and non-clinical samples. Plos ONE. 2014;9(8):E105956.
  • 14. Endicott J, Spitzer RL, Psychiatric Rating Scales. In Comprehensive Textbook Of Psychiatry, 5th Ed.; Kaplan HI, Sadock BJ Eds.; Williams & Wilkins: Baltimore, Maryland: 1989; pp. 2391-09.
  • 15. Waller E, Scheidt CE. Somatoform disorders as disorders of affect regulation: A study comparing the tas-20 with non-self-report measures of alexithymia. J Psychosom Res. 2004;57:239-47.
  • 16. Voon V, Lang AE. Antidepressant treatment outcomes of psychogenic movement disorder. J Clin Psychiatry. 2005;66:1529-34.
  • 17. Sharpe M, Walker J, Williams C, Stone J, Cavanagh J, Murray G, et al. Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology. 2011;77:564-72.
  • 18. Lafrance WC Jr, Baird GL, Barry JJ, Blum AS, Webb AF, Keitner GI, et al. Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry. 2014;71:997-1005.
  • 19. Örüm MH. The relationship between cognitive errors and psychiatric symptoms in obsessive-compulsive disorder. Med J Ankara Tr Res Hosp. 2020;53(1):29-35.
  • 20. Orum MH. Investigation of the relationship between cannabis use, opioid use and cognitive errors. Medicine Science. 2020;9(2):362-9.
  • 21. Örüm MH. Cognitive error characteristics of rumination and cleaning dimensions of obsessive-compulsive disorder. Anadolu Psikiyatri Derg. 2020;21(6):592-9.
  • 22. Örüm MH, Kara MZ, Kuştepe A, Kalenderoğlu A. Bilişsel hatalar ve dikkat-eksikliği hiperaktivite bozukluğu belirtilerinin madde kullanım özellikleri ile ilişkisi. Bağımlılık Dergisi–Journal Of Dependence. 2019;20(2):47-60.
  • 23. Rachman S. The evolution of behaviour therapy and cognitive behaviour therapy. Behav Res Ther. 2015;64:1-8.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Orijinal Araştırma
Yazarlar

Mehmet Hamdi Örüm 0000-0002-4154-0738

Yayımlanma Tarihi 30 Nisan 2021
Kabul Tarihi 10 Nisan 2021
Yayımlandığı Sayı Yıl 2021

Kaynak Göster

EndNote Örüm MH (01 Nisan 2021) Fonksiyonel Nörolojik Semptom Bozukluğunda Bilişsel Davranışçı Tedavinin Bilişsel Hatalar Üzerine Etkisi. Ege Tıp Bilimleri Dergisi 4 1 20–27.

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