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Executive functions and dissociative symptoms in conversion disorder patients
P.1.j. Basic and clinical neuroscience − Cognitive neuroscience Methods: We have compared metacognitive abilities of students on the first and sixth year of Medical faculty in Nis. We have covered 40 students in first and 40 in the sixth year, regardless of gender or age. We used the survey “metacognitive awareness inventory” [4]. The survey consists of 52 questions that are answered with true or false and which are grouped into 8 groups that resemble parts that include in metacognitive knowledge and regulation, and those are: declarative knowledge, procedural knowledge, conditional knowledge, planning, information management strategies, debugging strategies, comprehension monitoring and evaluation. We compared the average number of positive responses by group, we compared the groups with the t-test and with the number of positive answers that most students gave (pik), and the answers by the groups. Results: Comparing the average we found a significant difference only in planning (mean = 4.825 SD = 1.47 to mean = 4.15 SD = 1.61, p = 0.03) and information management strategies (mean = 8.65 SD = 1.16 to mean = 7.9 SD = 1.65, p = 0.01), where first year students on average have outperformed sixth year students. Conclusion: The level of education is not in direct correlation with metacognition. A slight decline in planning and information menagement can even point to the negative impact of education on metacognitive abilities. Our opinion is that education is not likely to affect the metacognition, and that the first year students are probably metacognitive better at start (we took into account the results on an faculty entrance exam where first year students have had much better results). There is also the possibility that pre and post graduate depression affects students at the last years. We think it would be good for students at the beginning and during studies to point to strategies for learning and mastering material. References [1] Metcalfe, J., Shimamura, A.P., 1994 Knowing about knowing. Metacognition. Cambridge, MA: MIT Press. [2] Rosen, L.D., Lim, A.F., Carrier, L.M., Cheever, N.A., 2011 An empirical examination of the educational impact of message-induced task switching in the classroom. Educational implications and strategies to enhance learning. Psicolog´ıa Educativa 17(2), 163–177. [3] Flavell, J.H., 1979 Metacognition and cognitive monitoring. A new area of cognitive-development inquiry. American Psychologist 34 (10), 906– 911. [4] Schraw, G., Dennison, R.S., 1994 Metacognition awerness inventory. Assessing metacognitive awareness. Contemporary Educational Psychology 19, 460–475.
P.1.j.018 Executive functions and dissociative symptoms in conversion disorder patients
S333
not well understood [3]. There have been many recent studies indicate that cognitive performance may be inadequate in CD and trying to utilize neuroimaging or other neurophysiological measures in an attempt to understand the underlying functional neuroanatomical bases of CD [4,5]. In our study we hypothesized that the performance of Wisconsin Card Sorting Test (WCST) in CD patients will be worse than controls and the performance will be negatively correlated with increased severity of symptoms of depression, anxiety and dissociation. In this context, relationship of the executive functions, anxiety and depression levels, the severity of dissociative symptoms evaluated in patients with CD. Methods: In this study, 51 CD patients admitted to outpatient psychiatry unit and 49 healthy without any Axis-I psychiatric disorder were enrolled. To those Hamilton Depression Rating Scale (HAM-D) scores of 13, Hamilton Anxiety Rating Scale (HAM-A) scores 5 and under, Montreal Cognitive Assessment Scale (MoCA) score of 21 and above WCST and other scales were given. CD was diagnosed with SCID-I. Socio-demographic data was collected with semi-structured form developed by researchers. The data obtained from patients and control group were compared. Results: The CD patients and healthy controls were similar in terms of MoCA and WCST scores (p > 0.05) however the HAM-D, HAM-A, DES scores were significantly higher in patients group (p < 0.01). There were negative correlation between HAM-D scores of the CD patients and WCST correct response number (p < 0.01) and conceptual response level (p < 0.05), and positive correlation with the number of errors (p < 0.01) and the number of completion the first category (p < 0.05). Disease duration of CD patients correlated negatively with WCST correct number (p < 0.05), perseverative response rate (p < 0.01) and the percentage of conceptual response (p < 0.05); Duration of disease was positively correlated with the total number of errors (p < 0.01), the number of perseverative errors (p < 0.01) and the percentage of perseverative errors (p < 0.01). There were no significant differences between DES and WCST scores between the patient and control group (p > 0.05). Results were considered using SPSS for Windows software, version 14.0 and statistical significance was ascertained by t-test, Mann–Whitney U or Chisquare tests and partial correlation analyses, as appropriate. Significance was measured at P < 0.05 and p < 0.01. Conclusions: According to our findings, the patients with CD having lower levels of anxiety and depression showed no executive dysfunction. There was no significant difference in MoCA and WCST points of the CD patients and control group however we detected significantly higher HAM-D, HAM-A and DES scores in the patients’ group. References
H.M. Basar1 ° , N. Fistikci2 1 B¨uy¨uk¸cekmece Government ˙ Hospital, Psychiatry, Istanbul, Turkey; 2 Bakırk¨oy Research and Training Hospital for Psychiatry- Neurology and Neurosurgery, ˙ Psychiatry, Istanbul, Turkey Background: Conversion disorder (CD) have been known to physicians since ancient times and consists of neurological dysfunction. It can manifest as a wide spectrum of symptoms, such as partial loss of voluntary motor control, altered bodily sensations, non-epileptic seizures, paralysis of one or more limbs, tremor or involuntary movement, blindness, deafness, or various other deficits that occurs in the absence of any identifiable neurological or organic causes [1,2]. Despite a long history of speculations about the causes of CD, the mechanisms behind the syndrome are
[1] Matthew, J.B., Ghaffar, O., Staines, W.R., Downar, J., Feinstein, A, 2014. Functional neuroimaging of conversion disorder: The role of ancillary activation. Neuroimage Clin 6, 333–339. [2] Aybek, S., Hubschmid, M., Vuilleumier, P., Burkhard, P.R., Berney, A., Vingerhoets, F.J., 2008. Hysteria: an historical entity, a psychi-atric condition or a neurological disease? Rev Med Suisse 4(156), 1151– 1156. [3] Vuilleumier, P., 2005. Hysterical conversion and brain function. Prog Brain Res 150, 309–329. [4] Carson, A.J., Brown, R., David, A.S., Duncan, R., Edwards, M.J., Goldstein, L.H., et al., 2012. Functional (conversion) neurological symptoms: research since the millennium. Journal of Neurology, Neurosurgery, and Psychiatry 83, 842–850. http://dx.doi.org/ 10.1136/jnnp2011–30186022661497. [5] Black, D.N., Seritan, A.L., Taber, K.H., et al., 2004. Conversion hysteria: lessons from functional imaging. J Neuropsychiatry Clin Neurosci 16(3), 245–251.
P.1.j.018 Executive functions and dissociative symptoms in conversion disorder patients
S333
not well understood [3]. There have been many recent studies indicate that cognitive performance may be inadequate in CD and trying to utilize neuroimaging or other neurophysiological measures in an attempt to understand the underlying functional neuroanatomical bases of CD [4,5]. In our study we hypothesized that the performance of Wisconsin Card Sorting Test (WCST) in CD patients will be worse than controls and the performance will be negatively correlated with increased severity of symptoms of depression, anxiety and dissociation. In this context, relationship of the executive functions, anxiety and depression levels, the severity of dissociative symptoms evaluated in patients with CD. Methods: In this study, 51 CD patients admitted to outpatient psychiatry unit and 49 healthy without any Axis-I psychiatric disorder were enrolled. To those Hamilton Depression Rating Scale (HAM-D) scores of 13, Hamilton Anxiety Rating Scale (HAM-A) scores 5 and under, Montreal Cognitive Assessment Scale (MoCA) score of 21 and above WCST and other scales were given. CD was diagnosed with SCID-I. Socio-demographic data was collected with semi-structured form developed by researchers. The data obtained from patients and control group were compared. Results: The CD patients and healthy controls were similar in terms of MoCA and WCST scores (p > 0.05) however the HAM-D, HAM-A, DES scores were significantly higher in patients group (p < 0.01). There were negative correlation between HAM-D scores of the CD patients and WCST correct response number (p < 0.01) and conceptual response level (p < 0.05), and positive correlation with the number of errors (p < 0.01) and the number of completion the first category (p < 0.05). Disease duration of CD patients correlated negatively with WCST correct number (p < 0.05), perseverative response rate (p < 0.01) and the percentage of conceptual response (p < 0.05); Duration of disease was positively correlated with the total number of errors (p < 0.01), the number of perseverative errors (p < 0.01) and the percentage of perseverative errors (p < 0.01). There were no significant differences between DES and WCST scores between the patient and control group (p > 0.05). Results were considered using SPSS for Windows software, version 14.0 and statistical significance was ascertained by t-test, Mann–Whitney U or Chisquare tests and partial correlation analyses, as appropriate. Significance was measured at P < 0.05 and p < 0.01. Conclusions: According to our findings, the patients with CD having lower levels of anxiety and depression showed no executive dysfunction. There was no significant difference in MoCA and WCST points of the CD patients and control group however we detected significantly higher HAM-D, HAM-A and DES scores in the patients’ group. References
H.M. Basar1 ° , N. Fistikci2 1 B¨uy¨uk¸cekmece Government ˙ Hospital, Psychiatry, Istanbul, Turkey; 2 Bakırk¨oy Research and Training Hospital for Psychiatry- Neurology and Neurosurgery, ˙ Psychiatry, Istanbul, Turkey Background: Conversion disorder (CD) have been known to physicians since ancient times and consists of neurological dysfunction. It can manifest as a wide spectrum of symptoms, such as partial loss of voluntary motor control, altered bodily sensations, non-epileptic seizures, paralysis of one or more limbs, tremor or involuntary movement, blindness, deafness, or various other deficits that occurs in the absence of any identifiable neurological or organic causes [1,2]. Despite a long history of speculations about the causes of CD, the mechanisms behind the syndrome are
[1] Matthew, J.B., Ghaffar, O., Staines, W.R., Downar, J., Feinstein, A, 2014. Functional neuroimaging of conversion disorder: The role of ancillary activation. Neuroimage Clin 6, 333–339. [2] Aybek, S., Hubschmid, M., Vuilleumier, P., Burkhard, P.R., Berney, A., Vingerhoets, F.J., 2008. Hysteria: an historical entity, a psychi-atric condition or a neurological disease? Rev Med Suisse 4(156), 1151– 1156. [3] Vuilleumier, P., 2005. Hysterical conversion and brain function. Prog Brain Res 150, 309–329. [4] Carson, A.J., Brown, R., David, A.S., Duncan, R., Edwards, M.J., Goldstein, L.H., et al., 2012. Functional (conversion) neurological symptoms: research since the millennium. Journal of Neurology, Neurosurgery, and Psychiatry 83, 842–850. http://dx.doi.org/ 10.1136/jnnp2011–30186022661497. [5] Black, D.N., Seritan, A.L., Taber, K.H., et al., 2004. Conversion hysteria: lessons from functional imaging. J Neuropsychiatry Clin Neurosci 16(3), 245–251.