Fonksiyonel Nörolojik Semptom Bozukluğunda Bilişsel Davranışçı Tedavinin Bilişsel Hatalar Üzerine Etkisi

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

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

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

___

  • 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.