Widespread cortical PET abnormalities in an adolescent related to a PNES dissociative state, PTSD, ADHD, and domestic violence exposure.
Dejan Stevanovic, Leposava Brajkovic, Madhur Kumar Srivastava, Ivan Krgovic, Jasna Jancic
Scandinavian Journal of Child and Adolescent Psychiatry and Psychology 2018 DOI: 10.21307/sjcapp-2018-011 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 17-year-old female adolescent with psychogenic non-epileptic seizures, PTSD, ADHD, and chronic domestic violence exposure |
| Topics | Default mode network PTSD |
| Keywords | Dissociation Inhibitory control Trauma |
| Key findings | The authors report widespread cortical PET abnormalities in a 17-year-old girl with PNES, dissociative states, PTSD, and ADHD exposed to chronic domestic violence. Resting-state imaging showed regional hypometabolism with peak metabolism in the posterior cingulate gyrus and medial posterior parietal lobe; during dissociation, global metabolism rose slightly but the regional pattern was unchanged. They propose these findings may indicate alterations in large-scale brain networks. |
Abstract
Accumulated evidence indicates that exposure to trauma is associated with the development of cognitive impairments and psychiatric symptoms in children and adolescents. In this case study of a female adolescent of 17 years, we aimed to evaluate how cortical positron emission tomography (PET) abnormalities relate to psychogenic non-epileptic seizure (PNES) dissociative state, post-traumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), and domestic violence exposure. Detailed psychiatric and neuropsychological assessment was performed initially, followed by a PET study. The PET imaging was carried out in the resting-state and in the dissociative-state. The adolescent was suffering from multiple episodes of unconsciousness, all found to be psychogenic; thus, PNES was diagnosed. However, at the psychopathology symptom level, the adolescent had heightened impulsivity, hyperactivity, hyperarousal, anxiety, somatic, and dissociative/ functional neurological symptoms present separately or concurrently at some point during her life; thus, the criteria for PTSD and ADHD were also fulfilled. In the resting state, significant hypometabolism was observed in the occipital, occipitotemporal, polar, and mesial parts of the temporal regions bilaterally, fronto-parietal medial and lateral pericental regions, and fronto-temporal and insular region on the left. The most intense metabolism was observed in the posterior cingulate gyrus and the medial parts of the posterior parietal lobe. In the dissociative state, there was a slight increase in the metabolism of the brain globally compared with the resting state, but with identical distribution of the regional changes observed. Widespread cortical PET abnormalities were found, possibly indicating alterations in large-scale brain networks, in a patient with PNES and a dissociative state, PTSD, and ADHD, who was exposed to chronic domestic violence.
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