An Interesting Model For Functional Neurological Disorders: Integrative Approach to Psychogenic Dysphonia

Yıl 2022, , 353 - 357, 30.09.2022

Behice Han Almiş

https://doi.org/10.18863/pgy.1018579

Cited By: 1

Öz

Psychogenic Dysphonia is a symptom type of functional neurological disorders. Functional neurological disorder or conversion disorder, is a mental disorder that manifests itself with neurological symptoms that cannot be explained by a neurological condition or medical condition. With DSM-5, the diagnostic criteria of conversion disorder have changed and it is imperative to develop a new perspective on the diagnosis and treatment of conversion disorder. Nowadays, functional neurological disease definition has been used instead of the definition of conversion disorder. In addition, this disorder have recently been viewed from a different perspective. Thus, an integrative approach was required in the diagnosis, evaluation and treatment of these disorder. Studies on functional neurological disorders have uncovered psychogenic dysphonies. The present review aimed the analyzing the literatüre to illuminate diagnosis, evaluation and treatment approaches in the patients with psychogenic dysphonies. Psychogenic dysphonia is very interesting in terms of its formation with emotional distress as well as its response to a functional intervention such as standard circular laryngeal therapy. Therefore, psychogenic dysphonia is an interesting model for the diagnosis, evaluation and treatment of functional neurological disorders. As psychogenic dysphonia symptoms and psychological factors mutually affect each other, the combination of voice therapy and psychotherapy for symptoms seems to be the gold standard treatment for now.

Anahtar Kelimeler

Psychogenic dysphonia, functional neurological disorder, conversion disorder

Fonksiyonel Nörolojik Bozukluklar İçin İlginç Bir Model: Psikojenik Disfoniye Bütüncül Yaklaşım

Öz

Psikojenik disfoni, fonksiyonel nörolojik bozuklukların bir belirti tipidir. Fonksiyonel nörolojik bozukluk ya da konversiyon bozukluğu, nörolojik veya tıbbi bir hastalıkla açıklanamayan nörolojik belirtilerle kendini gösteren bir ruhsal bozukluktur. DSM-5 ile birlikte, konversiyon bozukluğu tanı kriterleri değişti ve konversiyon bozukluğu tanı ve tedavisine yeni bir bakış açısı geliştirmek şart oldu. Günümüzde konversiyon bozukluğu tanımı yerine fonksiyonel nörolojik bozukluk tanımlaması kullanılmaya başlandı. İlaveten, yakın zamanda bu bozukluğa farklı bir perspektiften bakılmaktadır. Böylece bu bozukluğun tanı, değerlendirme ve tedavisinde integratif yaklaşımlar gerekliliği doğdu. Fonksiyonel nörolojik hastalıklarda yapılan çalışmalar çoğunlukla psikojenik disfonileri içermemektedir. Bu derlemede psikojenik disfonili hastaların tanı, değerlendirme ve tedavisine yaklaşımları literatür ışığında tartışmak amaçlamıştır. Psikojenik disfoniler, oluşumunda emosyenel stresin rolüne rağmen standart sirkümlaringeal terapiye yanıt vermesi açısından ilginçtir. Bu nedenle foksiyonel nörolojik bozuklukların tanı, değerlendirme ve tedavisinde ilginç bir modeldir. Psikojenik disfoni semptomları ve psikolojik faktörler karşılıklı olarak birbirini etkilediği için ses terapisi ve psikoterapi kombinasyonu en iyi tedavi gibi görünmektedir.

Anahtar Kelimeler

Psikojenik disfoni, fonksiyonel nörolojik bozukluk, konversiyon bozukluğu

Kaynakça

• American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders. 5th ed. Washington (DC), American Psychiatric Association.
• Andresson K, Schalén L (1998). Etiology and treatment of psychogenic voice disorder: results of a follow-up study of thirty patients. J Voice, 12: 96–106.
• Arnsten AF (2015). Stress weakens prefrontal networks: molecular insults to higher cognition. Nat Neurosci, 18: 1376–1385.
• Baker J (2002). Psychogenic voice disorders—heroes or hysterics? Abrief overview with questions and discussion. Logoped Phoniatr Vocol, 27: 84–91.
• Baslet G, Dworetzky B, Perez DL, Oser M (2015). Treatment of psychogenic nonepileptic seizures: updated review and findings from a mindfulness based intervention case series. Clin EEG Neurosci, 46:54–64
• Baslet G, Seshadri A, Bermeo-Ovalle A, Willment K, Myers L (2016). Psychogenic nonepileptic seizures: an updated primer. Psychosomatics, 57:1–17.
• Becker B, Scheele D, Moessner R, Maier W, Hurlemann R (2013). Deciphering the neural signature of conversion blindness. Am J Psychiatry, 170: 121–122.
• Beghi M, Negrini PB, Perin C, Peroni F, Magaudda A, Cerri C (2015). Psychogenic non-epileptic seizures: so-called psychiatric comorbidity and underlying defense mechanisms. Neuropsychiatr Dis Treat, 11:2519–2527.
• Carson AJ, Ringbauer B, MacKenzie L, Warlow C, Sharpe M (2000). Neurological disease, emotional disorder, and disability: they are related: a study of 300 consecutive new referrals to a neurology outpatient department. J Neurol Neurosurg Psychiatry, 68: 202–206.
• Chastan N, Parain D (2010). Psychogenic paralysis and recovery after motor cortex transcranial magnetic stimulation. Mov Disord, 25:1501–1504.
• Davids T, Klein AM, Johns MM (2012). Current dysphonia trends in patients over the age of 65: is vocal atrophy becoming more prevalent? Laryngoscope, 122:332–335.
• Deka K, Chaudhury PK, Bora K, Kalita P (2007). A study of clinical correlates and socio-demographic profile in conversion disorder. Indian J Psychiatry, 49: 205–207.
• Elias A, Raven R, Butcher P, Littlejohns DW (1989). Speech therapy for psychogenic voice disorder: a survey of current practice and training. Br J Disord Commun, 24:61–76.
• Etkin A, Wager TD (2007). Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. Am J Psychiatry, 164: 1476–1488.
• Etkin A, Egner T, Kalisch R (2011). Emotional processing in anterior cingulate and medial prefrontal cortex. Trends Cogn Sci, 15: 85–93.
• Goldstein LH, Chalder T, Chigwedere C, Khondoker MR, Moriarty J, Toone BK, et al. (2010) Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology, 74:1986–1994.
• Hoge CW, Terhakopian A, Castro CA, Messer SC, Engel CC (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. Am J Psychiatry, 164:150–153.
• Kolbrunner J, Menet AD, Seifert E (2010). Psychogenic aphonia: no fixation even after a lengthy period of aphonia. Swiss Med Wkly, 140:12–17.
• Kompoliti K, Wilson B, Stebbins G, Bernard B, Hinson V (2014). Immediate vs delayed treatment of psychogenic movement disorders with short term psychodynamic psychotherapy: randomized clinical trial. Parkinsonism Relat Disord, 20:60–63.
• Kuyk J, Siffels MC, Bakvis P, Swinkels WAM (2008). Psychological treatment of patients with psychogenic non-epileptic seizures: an outcome study. Seizure, 17:595–603.
• LaFrance WC Jr, Baird GL, Barry JJ, Blum AS, Webb AF, Keitner GI et al (2014). Multicenter pilot treatment trial for psychogenic nonepileptic seizures: a randomized clinical trial. JAMA Psychiatry 2014; 71:997–1005.
• Maniecka-Aleksandrowicz B, Domeracka-Kołodziej A, Rózak-Komorowska A, Szeptycka-Adamus A (2006). Management and therapy in functional aphonia: analysis of 500 cases. Otolaryngol Pol, 60:191–197.
• Moene FC, Spinhoven P, Hoogduin KA, Dyck R (2002). A randomised controlled clinical trial on the additional effect of hypnosis in a comprehensive treatment programme for in-patients with conversion disorder of the motor type. Psychother Psychosom, 71:66–76.
• O’Neal MA, Baslet G (2018). Treatment for Patients With a Functional Neurological Disorder (Conversion Disorder): An Integrated Approach. Am J Psychiatry, 175(4): 307-314. Roy N (2003). Functional dysphonia. Curr Opin Otolaryngol Head Neck Surg, 11: 144–148.
• Sharpe M, Walker J, Williams C, Stone C, Cavanagh C, Murray G, et al. (2011) Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology, 77:564–572.
• Singh SP, Lee AS (1997). Conversion disorders in Nottingham: alive, but not kicking. J Psychosom Res 1997; 43: 425–430.
• Spengler FB, Becker B, Kendrick KM, Conrad R, Hurlemann R, Schade G (2017). Emotional Dysregulation in Psychogenic Voice Loss. Psychother Psychosom, 86:121–123.
• Stark EA, Parsons CE, Van Hartevelt TJ, Charquero-Ballester M, Mc-Manners H, Ehlers A, et al. (2015) Post-traumatic stress influences the brain even in the absence of symptoms: a systematic, quantitative meta-analysis of neuroimaging studies. Neurosci Biobehav Rev, 56: 207–221.
• Stone J, Sharpe M, Rothwell PM, Warlow CP (2003). The 12 year prognosis of unilateral functional weakness and sensory disturbance. J Neurol Neurosurg Psychiatry, 74: 591–596.
• Stone J, Carson A, Sharpe M (2005). Functional symptoms and signs in neurology: assessment and diagnosis. J Neurol Neurosurg Psychiatry, 76:2–12.
• Stone J, Smyth R, Carson A, Lewis S, Prescott R, Warlow C, et al. (2005) Systematic review of misdiagnosis of conversion symptoms and “hysteria”. BMJ, 331:989.
• Stone J (2014). Functional neurological disorders: the neurological assessment as treatment. Neurophysiol Clin, 44:363–373.
• Tezcaner ZÇ, Gökmen MF, Yıldırım S, Dursun G (2019). Clinical Features of Psychogenic Voice Disorder and the Efficiency of Voice Therapy and Psychological Evaluation. J Voice, 33(2):250-254.
• Tomasson K, Kent D, Coryell W (1991). Somatization and conversion disorders: comorbidity and demographics at presentation. Acta Psychiatr Scand, 84: 288–293.
• Van Houtte E, Van Lierde K, Claeys S (2011). Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. J Voice, 25:202–207.
• Voon V, Lang AE (2005). Antidepressant treatment outcomes of psychogenic movement disorder. J Clin Psychiatry, 66:1529–1534.
• Waller E, Scheidt CE (2004). Somatoform disorders as disorders of affect regulation: a study comparing the TAS-20 with non-self-report measures of alexithymia. J Psychosom Res, 57:239–247.
• Williams C, Kent C, Smith S, Carson A, Sharpe M, Cavanagh J (2011). Overcoming Functional Neurological Symptoms: A Five Areas Approach. London, Hodder Arnold.
• Zaroff CM, Myers L, Barr WB, Luciano D, Devinsky O (2004). Group psychoeducation as treatment for psychological nonepileptic seizures. Epilepsy Behav, 5:587–592.