Cortisol and α-amylase awakening response in children and adolescents with functional neurological (conversion) disorder, 2022, Chung et al

Abstract

Objective:
Stress system dysregulation is considered to have an important role in the aetiology of paediatric functional neurological (conversion) disorder. This study examined salivary cortisol and α-amylase awakening responses in children with functional neurological disorder to determine activation patterns of the hypothalamic–pituitary–adrenal axis and sympathetic system. A healthy cortisol awakening response involves a robust increase in cortisol within 30 minutes of awakening. Alpha-amylase awakening response is variable in children.

Methods:
Cortisol and α-amylase were measured in saliva from 32 patients with functional neurological disorder (26 girls and 6 boys, aged 11.3−16.1 years) and 31 healthy controls (23 girls and 8 boys, aged 8.6–17.7 years). Saliva samples were collected using a Salivette sampling device at two time points – upon awakening and 30 minutes after awakening.

Results:
Patients with functional neurological disorder showed a decrease in cortisol awakening response (–4 nmol.min/L) and controls showed an increase (107 nmol.min/L), t(55) = –.4.6, p < 0.001. Within the functional neurological disorder group, 57% showed an attenuated cortisol awakening response and 43% showed an obliterated/reversed cortisol awakening response: Cortisol awakening response was negatively correlated with adverse childhood experiences, r(58) = –0.6, p = 0.002, and subjective distress (total Depression Anxiety and Stress Scales score), r(58) = –0.4, p = 0.050. In controls, cortisol awakening response showed no correlation with adverse childhood experiences and a positive correlation with subjective distress, r(56) = 0.4, p = 0.023. Total cortisol remained similar between the functional neurological disorder and control group. No significant differences were observed between the functional neurological disorder and control group in any of the α-amylase analyses.

Discussion:
The results suggest dysregulation of the hypothalamic–pituitary–adrenal axis in children with functional neurological disorder. Hypothalamic–pituitary–adrenal dysregulation in children with functional neurological disorder may contribute to comorbid symptoms of fatigue, sleep disturbance and subjective loss of well-being because circadian rhythms and energy metabolism are disrupted. Hypothalamic–pituitary–adrenal dysregulation – and changes in glucocorticoid (cortisol) signalling at the molecular level – may also contribute to increased vulnerability for functional neurological disorder symptoms because of epigenetically mediated changes to neural networks implicated in functional neurological disorder.

Paywall, https://journals.sagepub.com/doi/10.1177/00048674221082520
Now open access

 

This can also be an artifact of sleep-activity cycles. If the "FND" participants usually sleep in later and have lower daily activity levels. If they were tested at a time they would normally be sleeping, this sort of result is expected without having any pathological disturbance in the HPA axis.

Cortisol is a feed-forward metabolic hormone, rather than a "stress" hormone. Stress reactivity is just an artifact of the fact that it is associated with anticipation of energy use.

 

Indeed. Unfortunate about the paywall but I'd assume that any research into cortisol really has to note that an issue with the adrenal gland could be just as likely as a 'neurological' until proper testing is done. Goodness knows how you can start asking about negative childhood experiences and be either reliable and count it as an objective measure or think that you've got any business relating it to measures taken without any detailing of where the fault in the HPA lies.

Are we really getting to the point where BPS is now calling the entire HPA axis 'mind', when how much of it actually lies outside the 'brain' and the feedback mechanisms are physiologically explained and therefore those interactions need to be just as discussed in any explanation?

 

They are busy gobbling everything up. Soon medicine will be entirely FND.

 

Yesterday I read a post on a thyroid forum (which I now can't find to get the exact wording) where a hypothyroid patient was told by an endocrinologist that levothyroxine [a hormone replacement] was a vitamin. It would appear that minimising everything health-related is part of a nationwide plan by the NHS to save money.

 

Yikes. At what point can we stop calling them medicine because they have become something else if that trajectory continues - some aren't far off. And what and how will spring up to replace the non-science they become, picking and choosing when and what for they are one or the other isn't being what they think they are either. 'vitamins' - why would someone do that?

 

This is what I also meant about FND appearing to take over microscopic brain injury which causes impaired neurological functioning of the brain.

The name FND confuses things even more like CFS/CF, etc.

 

It is worse when you realise they explicitly say that FND is the new name for hysteria. So all those WW1 soldiers who were said to have hysteria rather than bombardment brain injuries now have ... hysteria!

Stone has written a paper admiring the likes of Beard and Freud and the rest and said what a pity it was that their work was ignored for much of the 20th century.

 

Even worse than that is NICE is currently creating a brain injury guideline that includes FND.

So far from what I've read, sequelae brain injury symptoms are not completely understood but are well recognised by neurology. However, psychiatry argues the cause are somatic/conversion disorder instead.

Abnormal cortisol awakening response is also a recognised result of ABI.

Exactly, it doesn't make sense.

 

Just a riff but .. however many years ago (suspect some GPs did it earlier than others who were nudged by rules) GP became test for these red flags and dump all chronic illness in a bucket. Worse, label that bucket and make getting out of it very hard indeed. 'we don't do chronic illness'.

This just sounds like neurology's bucket. We do these bits, shove all these parts off to psychiatry and now need our own little labels for the chronic/stuff we don't do.

For all their talk about 'wellness' being their new mission, the reality is they've stopped 'health' for many and focus on programmes that 'make them act normal'.

Now we've all been in jobs with workload management issues or where the staff are only sufficient to cover 'part of the job done a certain way', hoops are inserted to 'manage queues/demand'. If it were just that you'd get it. Is it like the focus on prescriptions so some GPs would have 5 appts (starting with assume stress or nothing and come back in 2 weeks) over barn door diagnosis in order to avoid giving out a cheap prescription on the first round. When we are short on GPs.

How long before it pops because everyone is on that same book? Bit of a giveaway of 'mass 'medicine'' when most of the population is on the same 'treatment'. I think once they start saying that 35-50% of GP appointments are 'MUS' in their literature and footnotes I'm shocked that instead of 'explosion of x' you'd be wondering whether it is 1. a bucket and 2. why these 'treatments' aren't leading to a reduction.

Someone I know came back from abroad (several countries) with among other diagnoses one for an autoimmune arthritis, and despite going private was put through re-diagnosis akin to NHS guidelines and told their spine wasn't yet deformed enough for treatment - even though they'd been on higher level stuff for many years hence still working and lack of deformity spreading to their spine. To me this indicates it isn't 'just' fuzzy illnesses either.

Are thyroid drugs not cheaper than all of the charade (and certainly when you count the costs of lack of productivity/care etc)?

The unforgivable bit is messing with what science is and making black white etc. and calling it a step forward

 

Looks like what's going on to me. NHS Improvements even stated themselves if challenged on the grounds of ethics they can refer to the recommendations within the NICE guidelines.

That's probably why when post covid neurological symptoms and Long Covid emerged as a result of this pandemic a group of UK neuroscientists went out of their way to study the effects on the brain. I can loosely quote one's involvement as an attempt to stop conditions suffering the same fate as earlier ones had. The NHS does not want to link this stuff I'm sure it would constitute medical negligence.

 

I couldn't have said it better myself. Plus, blaming those who cannot 'act normal' as hypochondriacs.

 

"Slow-paced breathing improves HRV and calms the nervous system" is one of those articles of faith for all the wellness devotees and mind-body proponents, so I wouldn't be at all surprised if it turned out that the reality is a little more complex.

(My own HRV decreases with slow-paced breathing - my guess is I'm one of the subset of Long Covid patients who have impaired oxygen uptake/ventilatory efficiency. FWIW, my morning cortisol was normal the only time it was tested.)