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Europe PubMed Central
Article . 2017
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Article . 2017
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Disrupted avoidance learning in functional neurological disorder: Implications for harm avoidance theories.

Authors: Laurel S. Morris; Benjaman To; Kwangyeol Baek; Yee-Chien Chang-Webb; Simon Mitchell; Daniela Strelchuk; Yevheniia Mikheenko; +5 Authors

Disrupted avoidance learning in functional neurological disorder: Implications for harm avoidance theories.

Abstract

Background Functional neurological disorder (FND) is an elusive disorder characterized by unexplained neurological symptoms alongside aberrant cognitive processing and negative affect, often associated with amygdala reactivity. Methods We examined the effect of negative conditioning on cognitive function and amygdala reactivity in 25 FND patients and 20 healthy volunteers (HV). Participants were first conditioned to stimuli paired with negative affective or neutral (CS +/CS −) information. During functional MRI, subjects then performed an instrumental associative learning task to avoid monetary losses in the context of the previously conditioned stimuli. We expected that FND patients would be better at learning to avoid losses when faced with negatively conditioned stimuli (increased harm avoidance). Multi-echo resting state fMRI was also collected from the same subjects and a robust denoising method was employed, important for removing motion and physiological artifacts. Results FND subjects were more sensitive to the negative CS + compared to HV, demonstrated by a reinforcement learning model. Contrary to expectation, FND patients were generally more impaired at learning to avoid losses under both contexts (CS +/CS −), persisting to choose the option that resulted in a negative outcome demonstrated by both behavioural and computational analyses. FND patients showed enhanced amygdala but reduced dorsolateral prefrontal cortex responses when they received negative feedback. Patients also had increased resting state functional connectivity between these two regions. Conclusions FND patients had impaired instrumental avoidance learning, findings that parallel previous observations of impaired action-outcome binding. FND patients further show enhanced behavioural and neural sensitivity to negative information. However, this did not translate to improved avoidance learning. Put together, our findings do not support the theory of harm avoidance in FND. We highlight a potential mechanism by which negative contexts interfere with adaptive behaviours in this under-explored disorder.

Highlights • Functional neurological disorder (FND) is a relatively common but elusive disorder characterized by unexplained neurological symptoms and negative affect. • One theory of FND symptomology is related to unconscious harm avoidance, in which symptom expression occurs to avoid a stressful situation. • We show that FND patients were more sensitive to negative information. However, this did not translate to increased harm avoidance as patients were impaired at goal-directed avoidance learning. • This study suggests that excessive negative conditioning in this group may engender deficient, rather than increased, goal-directed cognitive ability and loss avoidance.

Subjects by Vocabulary

Library of Congress Subject Headings: lcsh:Computer applications to medicine. Medical informatics lcsh:RC346-429 lcsh:R858-859.7 lcsh:Neurology. Diseases of the nervous system

Keywords

Adult, Male, Brain Mapping, Conditioning, Classical, Prefrontal Cortex, Regular Article, Fear, Middle Aged, Amygdala, Magnetic Resonance Imaging, Young Adult, Task Performance and Analysis, Avoidance Learning, Conditioning, Operant, Humans, Attention, Female, Conversion disorder, Functional neurological disorder, Aged

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    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    21
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
21
Top 10%
Average
Top 10%
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UKRI| Self-control and motivation in addictions
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  • Funder: UK Research and Innovation (UKRI)
  • Project Code: MR/P008747/1
  • Funding stream: MRC
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WT| Dissecting compulsivity.
Project
  • Funder: Wellcome Trust (WT)
  • Project Code: 093705
  • Funding stream: Neuroscience and Mental Health
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