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Impaired emotional and behavioural awareness and control in patients with dissociative seizures

Published online by Cambridge University Press:  18 October 2019

Johannes Jungilligens Open the ORCID record for Johannes Jungilligens [Opens in a new window] ,
Jörg Wellmer ,
Uwe Schlegel ,
Henrik Kessler ,
Nikolai Axmacher Open the ORCID record for Nikolai Axmacher [Opens in a new window]  and
Stoyan Popkirov Open the ORCID record for Stoyan Popkirov [Opens in a new window]
Johannes Jungilligens*
Affiliation:
Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany Department of Neuropsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr University Bochum, Bochum, Germany
Jörg Wellmer
Affiliation:
Ruhr-Epileptology, Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
Uwe Schlegel
Affiliation:
Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
Henrik Kessler
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
Nikolai Axmacher
Affiliation:
Department of Neuropsychology, Faculty of Psychology, Institute of Cognitive Neuroscience, Ruhr University Bochum, Bochum, Germany
Stoyan Popkirov
Affiliation:
Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
*
Author for correspondence: Johannes Jungilligens, E-mail: johannes.jungilligens@rub.de
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Abstract

Background

Dissociative seizures (DS) are brief episodes of disrupted awareness and behavioural control that may resemble epileptic seizures. They are thought to arise in the context of impaired emotion processing and disinhibition. In a multi-perspective neuropsychological study, we aim to assess specific metacognitive traits and behavioural features involved in the affective and cognitive underpinnings of DS (emotion recognition and regulation, inhibition, interoception and sense of agency).

Methods

Twenty prospectively recruited patients with video-EEG-confirmed DS and 20 healthy controls underwent comprehensive neuropsychological and psychiatric testing using validated questionnaires and structured interviews. Behavioural experimental data was obtained using a custom-made emotional go/no-go task, a digital Libet clock setup and a heartbeat counting paradigm.

Results

Emotion recognition, as quantified in the emotional go/no-go task, was impaired in the DS group, and correlated with alexithymic traits. Behavioural inhibition, especially under conditions that would require emotion regulation, was also reduced in the emotional go/no-go task compared to controls and was correlated with neuropsychometric measures of emotion regulation. Data from the Libet clock experiment suggested impaired behavioural awareness in DS patients. No evidence of impaired interoceptive awareness was found in the heartbeat counting task.

Conclusion

These results represent comprehensive experimental evidence for alterations in emotional and behavioural awareness and control in patients with DS that yield empirical evidence for current psychopathological models. Our findings offer a more detailed understanding of key pathogenic factors in DS and provide theoretical support for recently developed cognitive-behavioural therapies for DS.

Keywords

behavioural awarenessdissociative seizuresemotion regulationemotional awarenessinteroceptionmetacognitionpathophysiologypsychogenic non-epileptic seizures
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 16 , December 2020 , pp. 2731 - 2739
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Copyright
Copyright © Cambridge University Press 2019

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