The question of symptom lateralization in conversion disorder

Are Anxiety and Depression Taking Sides with Knee-Pain in Osteoarthritis?

Introduction: Total knee arthroplasty (TKA) bears a potential of rendering patients unsatisfied with the operation as a result of negative affectivity related to osteoarthritis and TKA. Not only is pain a lateralized experience, but negative affect and other psychosomatic correlates of pain might also be processed on grounds of lateralization. Lateralization in this context is likely linked to the amygdalae, which display differential left/right patterns of association with psychopathology. What is noteworthy is that osteoarthritis itself is linked not only to negative effects but also to childhood abuse. Method: The present study tests lateralization of psychosomatic correlates of knee-pain using the brief symptom inventory-18 (BSI-18), the dissociative experiences scale (FDS-20), the pain catastrophizing scale (PCS), the Tampa scale of kinesiophobia (TSK), the childhood trauma screener (CTS) and WOMAC. More precisely, we were interested in predicting the side of operations by means of the above-mentioned constructs using binary logistic regression, based on 150 participants (78 left knees) awaiting TKA for knee-osteoarthritis. Results: Somatization (p = 0.003), childhood abuse (p = 0.04) and pain-catastrophizing (p = 0.04) predicted operations on the right side. Anxiety (p = 0.001) and kinesiophobia (p = 0.002) predicted operations on the left side. Conclusions: Knee-pain may be differentially modulated by its psychosomatic correlates as a result of lateralization and corresponding patterns of psychosomatic reagibility.

A lateralized model of the pain-depression dyad

Chronic pain and depression are two frequently co-occurring and debilitating conditions. Even though the former is treated as a physical affliction, and the latter as a mental illness, both disorders closely share neural substrates. Here, we review the association of pain with depression, especially when symptoms are lateralized on either side of the body. We also explore the overlapping regions in the forebrain implicated in these conditions. Finally, we synthesize these findings into a model, which addresses gaps in our understanding of comorbid pain and depression. Our lateralized pain-depression dyad model suggests that individuals diagnosed with depression should be closely monitored for pain symptoms in the left hemibody. Conversely, for patients in pain, with the exception of acute pain with a known source, referrals in today's pain centers for psychological evaluation should be part of standard practice, within the framework of an interdisciplinary approach to pain treatment.

P-wave and QT dispersion in patients with conversion disorder

OBJECTIVE

The aim of this study was to investigate QT dispersion (QTd), which is the noninvasive marker of ventricular arrhythmia and sudden cardiac death, and P-wave dispersion, which is the noninvasive marker of atrial arrhythmia, in patients with conversion disorder (CD).

PATIENTS AND METHODS

A total of 60 patients with no known organic disease who were admitted to outpatient emergency clinic and were diagnosed with CD after psychiatric consultation were included in this study along with 60 healthy control subjects. Beck Anxiety Inventory and Beck Depression Scale were administered to patients and 12-lead electrocardiogram measurements were obtained. Pd and QTd were calculated by a single blinded cardiologist.

RESULTS

There was no statistically significant difference in terms of age, sex, education level, socioeconomic status, weight, height, and body mass index between CD patients and controls. Beck Anxiety Inventory scores (25.2±10.8 and 3.8±3.2, respectively, P<0.001) and Beck Depression Scale scores (11.24±6.15 and 6.58±5.69, respectively, P<0.01) were significantly higher in CD patients. P-wave dispersion measurements did not show any significant differences between conversion patients and control group (46±5.7 vs 44±5.5, respectively, P=0.156). Regarding QTc and QTd, there was a statistically significant increase in all intervals in conversion patients (416±10 vs 398±12, P<0.001, and 47±4.8 vs 20±6.1, P<0.001, respectively).

CONCLUSION

A similar relation to that in literature between QTd and anxiety and somatoform disorders was also observed in CD patients. QTc and QTd were significantly increased compared to the control group in patients with CD. These results suggest a possibility of increased risk of ventricular arrhythmia resulting from QTd in CD patients. Larger samples are needed to evaluate the clinical course and prognosis in terms of arrhythmia risk in CD patients.

Lateralized, nonepileptic convulsions in an adult with cerebral palsy: Case report and review of the literature

The authors report a case of unilateral functional neurological symptoms (nonepileptic convulsions) in a 38-year-old man with mild, motor-predominant cerebral palsy. His convulsions are all lateralized to the same side as his paretic limbs. His episodes significantly decreased after several months of weekly psychodynamic-oriented psychotherapy. Functional neurological disorders have been rarely reported in children or adults with cerebral palsy. Among patients with brain injury, right-hemispheric brain disease may be more helpful than either handedness or the side of symptoms in clinically profiling patients with suspected functional disorders. This case raises biomechanistic questions about brain injury, the development of functional disorders, and the lateralization of functional symptoms.

Brain dysfunction in fibromyalgia and somatization disorder using proton magnetic resonance spectroscopy: a controlled study

OBJECTIVE

To evaluate the brain metabolite patterns in patients with fibromyalgia (FM) and somatization disorder (STD) compared with healthy controls through spectroscopy techniques and correlate these patterns with psychological variables.

METHOD

Design. Controlled, cross-sectional study. Sample. Patients were recruited from primary care in Zaragoza, Spain. The control group was recruited from hospital staff. Patients were administered questionnaires on pain catastrophizing, anxiety, depression, pain, quality of life, and cognitive impairment. All patients underwent Magnetic Resonance Imaging and magnetic resonance spectroscopy (MRS).

RESULTS

A significant increase was found in the glutamate + glutamine (Glx) levels in the posterior cingulate cortex (PCC): 10.73 (SD: 0.49) for FM and 9.67 (SD: 1.10) for STD 9.54 (SD: 1.46) compared with controls (P = 0.043). In the FM + STD group, a correlation between Glx and pain catastrophizing in PCC (r = 0.397; P = 0.033) and between quality of life and the myo-inositol/creatine ratio in the left hippocampus (r = -0.500; P = 0.025) was found. To conclude Glutamate seems to be relevant in the molecular processes involved in FM and STD. It also opens the door for Proton MRS ((1) H-MRS) in STD and suggests that reducing glutamatergic activity through pharmacological treatment could improve the outcome of patients with FM and STD.

CONCLUSION

Glutamate seems to be relevant in the molecular processes involved in FM and STD. It also opens the door for Proton MRS ((1) H-MRS) in STD and suggests that reducing glutamatergic activity through pharmacological treatment could improve the outcome of patients with FM and STD.

Differences in pain, psychological symptoms, and gender distribution among patients with left- vs right-sided chronic spinal pain

OBJECTIVE

To determine pain levels, function, and psychological symptoms in relation to predominant sidedness of pain (right or left) and gender in patients being treated for chronic spinal pain.

DESIGN

Prospective cohort study.

PATIENTS

Patients with chronic neck or low back pain undergoing a nerve block procedure in a specialty pain medicine clinic. INTERVENTIONS/OUTCOMES: Patients completed the Hospital Anxiety and Depression Scale and the Brief Pain Inventory just prior to the procedure. Pain history and demographic variables were collected from a chart review. Chi-square, Pearson correlations, and multivariate statistics were used to characterize the relationships between side of pain, gender, pain levels, pain interference, and psychological symptoms.

RESULTS

Among 519 subjects, men with left-sided pain (N = 98) were found to have significantly greater depression and anxiety symptoms and worse pain-related quality of life (P < 0.01), despite having similar pain levels as men with right-sided pain (N = 91) or women with left- or right-sided pain (N = 289). In men, psychological symptoms had a significantly greater correlation with pain levels than in women (P < 0.01).

CONCLUSION

In this sample, men with left-sided spinal pain report worse quality of life and more psychological symptoms than women. These data provide clinical evidence corroborating basic neuroscience findings indicating that the right cerebral hemisphere is preferentially involved in the processing of pain and negative affect. These data suggest that men appear more right hemisphere dominant in pain and affect processing. These findings have implications for multidisciplinary assessment and treatment planning in men.

Streamlined classification of psychopathological hand disorders: A literature review

In the surgical hand clinic, psychopathological hand disorders can be sorted into one of the following four categories: (1) factitious wound creation and manipulation; (2) factitious edema; (3) psychopathological dystonias, and (4) psychopathological sensory abnormalities and psychopathological Complex Regional Pain Syndrome. This article introduces these four categories. Pertinent literature that includes descriptions of each category's syndromes and diseases, demographic and psychological profiles, differential diagnoses, and appropriate treatment recommendations is reviewed.

Pain drawings and concepts of pain among patients with "half-body" complaints

OBJECTIVE

To explore main features of pain drawings and concepts about illness in patients seeking help for "half-body" complaints at two primary health care centres in different parts of Sweden.

METHODS

A qualitative study of pain-drawings and tape-recorded semi-structured interviews analysed by qualitative methods in 20 patients (4 men, 16 women, aged 37-68 years) from five health centers. Three of them were native Swedes and 17 were foreign-born.

RESULTS

All complained of pain in a left (three-fourth) or right (one-fourth) body-half, mainly in front. Some had general pain with a "worse side". Many said they had pain only on the "edges" and outlined the margins on the side of pain, but excluded the "face". Posterior drawings often received a line in the middle dividing the body in lateral halves. Pain was referred to as a "growing" thing - ("It") - that could spread ("jump") to the other side, grow and eventually paralyse them. "It" was believed as caused by body imbalance, natural factors or supernatural forces.

CONCLUSION

"Half-body" pain was an expression that in main was used by middle-aged patients to denote an initially superficial and frontal one-sided pain that could spread and become dangerous to their health.

PRACTICE IMPLICATIONS

Patients with half-body complaints should be taken seriously and met with respect by doctors and other health care personnel, particularly in cross-cultural consultations.

Are there physical risk factors for psychogenic non-epileptic seizures in patients with epilepsy?

Patients with epilepsy may have additional psychogenic non-epileptic seizures (PNES). It has been suggested that PNES are more common if patients with epilepsy are female, develop epilepsy later in life and have right-sided brain lesions. We examine whether these or other physical factors affect the risk of PNES in patients with epilepsy in a controlled study.

METHODS

Ninety consecutive patients with PNES and concurrent epilepsy (PNES+E group) and 90 consecutive patients with epilepsy alone (epilepsy group) were compared with regard to the variables sex, age at onset of epilepsy, epilepsy type (focal/generalised), location and lateralisation of epileptogenic zone, aetiology of epilepsy, interictal epileptiform potentials, magnetic resonance imaging (MRI) abnormalities, neuropsychological (NPS) deficits and intelligence quotient (IQ).

RESULTS

Female sex (P<0.001), abnormal visual memory (P=0.012), global NPS impairment (P=0.029), and low IQ category (P=0.005) were associated with a higher risk of PNES. Other variables did not differ between the groups.

CONCLUSIONS

In patients with epilepsy, female sex, poor visual memory or global neuropsychological underperformance and low IQ are associated with an increased risk of PNES. MRI changes, epileptiform EEG abnormalities and location of epileptogenic zone do not show a predilection for one hemisphere.