Functional Neurological Symptom Disorder
Conditions
Keywords
Sluggish Cognitive Tempo, Cognitive Disengagement Syndrome, Conversion Disorder, Functional Neurological Symptom Disorder, Dissociation, Attention, Daydreaming
Brief summary
This cross-sectional observational case-control study aims to investigate symptoms of sluggish cognitive tempo (SCT), also known as cognitive disengagement syndrome (CDS), in adults diagnosed with Functional Neurological Symptom Disorder/Conversion Disorder (FNSD/CD). The study compares SCT/CDS symptoms between patients with FNSD/CD and healthy controls and evaluates their relationship with clinical variables. It is hypothesized that individuals diagnosed with FNSD/CD will exhibit higher levels of SCT/CDS symptoms compared to healthy controls.
Detailed description
Sluggish Cognitive Tempo (SCT), also referred to as Cognitive Disengagement Syndrome (CDS), is characterized by symptoms such as excessive daydreaming, mental fogginess, lethargy, slowed behavior, confusion, and reduced alertness. Research indicates that SCT/CDS symptoms are distinct from attention deficit hyperactivity disorder (ADHD), although some overlap may occur. Studies suggest that SCT/CDS may be influenced more by environmental and neurocognitive factors than by heritability. Functional Neurological Symptom Disorder (FNSD), also known as Conversion Disorder (CD), is characterized by neurological symptoms that cannot be explained by an identifiable neurological disease. These symptoms may include motor dysfunction (weakness, tremor, gait abnormalities), non-epileptic seizures, sensory disturbances, or mixed presentations. Although symptoms are not attributable to structural neurological pathology, they cause significant functional impairment. The etiology of FNSD remains unclear. Proposed mechanisms include altered functional connectivity between emotional processing networks and motor/sensory regions, impaired memory and attention processing, and stress-related neurobiological dysregulation. Neurocognitive models suggest that attention and memory impairments may be present in individuals with FNSD, particularly under stress. Despite increasing research on SCT/CDS in ADHD and other psychiatric conditions, SCT/CDS symptoms have not been systematically studied in adults with FNSD. Considering the hypothesized cognitive and attentional involvement in FNSD, SCT/CDS symptoms may be present in this population. This study is designed as a cross-sectional case-control study conducted at the Psychiatry Outpatient Clinic of Elazığ Mental Health and Diseases Hospital. Participants will include adults aged 18-65 years diagnosed with FNSD according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria and a matched healthy control group without psychiatric diagnoses. Participants will complete a sociodemographic and clinical information form and validated psychometric scales, including: Barkley's Adult Sluggish Cognitive Tempo Scale (Turkish version), Somatoform Dissociation Questionnaire, Adult ADHD Self-Report Scale. No invasive or interventional procedures will be performed. Group comparisons will be conducted using appropriate parametric or non-parametric tests. Correlation and regression analyses will be performed when necessary. Statistical significance will be defined as p ≤ 0.05. Power analysis indicates that a minimum of 24 participants per group (total n=48) is required to achieve 80% power at alpha=0.05.
Interventions
None listed
Sponsors
Elazığ Mental Health and Diseases Hospital
Study design
Observational model
CASE_CONTROL
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Inclusion Criteria for the Functional Neurological Symptom Disorder (FNSD) Group: 1. Meeting the diagnostic criteria for FNSD/CD according to DSM-5-TR at the time of admission 2. Being between 18-65 years of age 3. Absence of additional psychiatric disorders 4. Absence of alcohol/substance use disorder 5. Absence of neurological disorders affecting cognition 6. Being in remission with FNSD/CD 7. Completing sociodemographic data fully 8. Willingness to complete the forms and scales. 9. Willingness to participate in the study *
Exclusion criteria
for the FNSD Group: 1. Being under 18 or over 65 years of age 2. Not meeting the diagnostic criteria for FNSD/CD according to DSM-5-TR 3. Active alcohol/substance use 4. Having neurological diseases affecting cognitive functions (such as Alzheimer's disease, delirium, Parkinson's disease) 5. Not being willing to participate in the study 6. Incomplete sociodemographic data 7. Not being willing to complete forms and scales. * Inclusion Criteria for the Healthy Control (HC) Group 1. Being between 18-65 years of age 2. Not having any psychiatric disorder 3. Not having an alcohol/substance use disorder 4. Not having a neurological disorder affecting cognition 5. Completing sociodemographic data in full 6. Being willing to complete the forms and scales. 7. Being willing to participate in the study *
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Barkley's Adult Sluggish Cognitive Tempo Ratings Scale -Turkish Version (SCT) | At hospital admission (baseline) | Adult Sluggish Cognitive Tempo Ratings Scale (SCT) was developed by choosing the symptom sets used in prior studies of SCT in children and adolescents. It is a self-report scale and included the following nine items: "1. Prone to daydreaming when I should be concen trating"; "2. I have trouble staying alert or awake in boring situations"; "3. I am easily confused"; "4. I am easily bored"; "5. My mind is spacey or in a fog"; "6. I am lethargic, more tired than others"; "7. I am underactive or have less energy than others"; "8. I am a slow- moving"; "9. I don't seem to process information as quickly or as accurately as others.".Barkley suggested using the number of SCT symptoms answered often or very often as a total score and 5 or higher total score as a cutoff point for having elevated SCT. |
| Somatoform Dissociation Questionnaire (SDQ-20) | At hospital admission (baseline) | The Somatoform Dissociation Questionnaire is a self-assessment scale which is administered to psychiatric patients, individuals with traumatic experiences, and non-clinical populations for screening purposes. The self-administered scale contains 20 questions, each answered with a scale of 1 to 5 options. Studies in Turkey have reported that individuals with a total score of 40 or higher have a high probability of having a dissociative disorder. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Adult ADHD Self-Report Scale (ASRS) | At hospital admission (baseline) | The Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Self-Report Scale is a 5-point Likert-type scale (0-4 = never, rarely, sometimes, often, very often) to identify current ADHD symptoms. The scale consists 18 items: nine for attention deficit (Items 1,2,3,4,7,8,9,10,11) and nine for hyperactivity/impulsivity (Items 5,6,12,13,14,15,16,17,18). Stepwise regression analysis demonstrated that 6 items of the scale could predict the diagnosis of ADHD better, and these 6 items were listed under section A. Higher scores are associated with higher ADHD severity. |
Countries
Turkey (Türkiye)
Contacts
CONTACTMehmet Hamdi ÖRÜM, MD, Assoc Prof, Psychiatrist
Outcome results
None listed