A biological measure of stress levels in patients with functional movement disorders

Carine W. Maurer*, Kathrin LaFaver, Rezvan Ameli, Ryan Toledo, Mark Hallett

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Introduction: While the presence of co-existing psychological stressors has historically been used as a supportive factor in the diagnosis of functional neurological disorders, many patients with functional neurological disorders deny the presence of these stressors. The stress response circuitry in these patients remains largely unexplored. Methods: We performed an observational study examining biological stress levels in patients with functional movement disorders as compared with matched healthy controls. Specifically, we compared levels of circulating cortisol, the end-product of the hypothalamic-pituitary-adrenal axis. Salivary cortisol samples were collected from patients with "clinically definite" functional movement disorders (n = 33) and their age- and sex-matched controls (n = 33). Collections were performed at five standardized time points, reflecting participants' diurnal cortisol cycles. To rule out confounders, participants also underwent extensive psychological assessment including Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Hamilton Anxiety Rating Scale, and Hamilton Rating Scale for Depression. Results: Patients with functional movement disorders did not differ from matched controls with respect to levels of circulating cortisol. Conclusion: We demonstrate that current stress levels are not altered in patients with functional movement disorders. Our results warrant careful review of current management of patients with functional neurological symptoms, and suggest that the insistence on heightened stress levels in these patients is unjustified.

Original languageEnglish (US)
Pages (from-to)1072-1075
Number of pages4
JournalParkinsonism and Related Disorders
Volume21
Issue number9
DOIs
StatePublished - Sep 1 2015

Keywords

  • Conversion disorder
  • Cortisol
  • Functional movement disorders
  • Hypothalamic-pituitary adrenal axis
  • Psychogenic movement disorders
  • Stress

ASJC Scopus subject areas

  • Neurology
  • Geriatrics and Gerontology
  • Clinical Neurology

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