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Resignation Syndrome: Catatonia? Culture-Bound?
Centre for Research Ethics and Bioethics (CRB), Uppsala University, Uppsala, Sweden; Department of Women’s and Children’s Health, Division of Neonatology, Karolinska Institute Solna, Stockholm, Sweden.
Department of Women’s and Children’s Health, Division of Neonatology, Karolinska Institute Solna, Stockholm, Sweden.
Centre for Research Ethics and Bioethics (CRB), Uppsala University, Uppsala, Sweden.
Örebro University, School of Medical Sciences.
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2016 (English)In: Frontiers in Behavioral Neuroscience, ISSN 1662-5153, E-ISSN 1662-5153, Vol. 10, article id 7Article in journal (Refereed) Published
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Abstract [en]

Resignation syndrome (RS) designates a long-standing disorder predominately affecting psychologically traumatized children and adolescents in the midst of a strenuous and lengthy migration process. Typically a depressive onset is followed by gradual withdrawal progressing via stupor into a state that prompts tube feeding and is characterized by failure to respond even to painful stimuli. The patient is seemingly unconscious. Recovery ensues within months to years and is claimed to be dependent on the restoration of hope to the family. Descriptions of disorders resembling RS can be found in the literature and the condition is unlikely novel. Nevertheless, the magnitude and geographical distribution stand out. Several hundred cases have been reported exclusively in Sweden in the past decade prompting the Swedish National Board of Health and Welfare to recognize RS as a separate diagnostic entity. The currently prevailing stress hypothesis fails to account for the regional distribution and contributes little to treatment. Consequently, a re-evaluation of diagnostics and treatment is required. Psychogenic catatonia is proposed to supply the best fit with the clinical presentation. Treatment response, altered brain metabolism or preserved awareness would support this hypothesis. Epidemiological data suggests culture-bound beliefs and expectations to generate and direct symptom expression and we argue that culture-bound psychogenesis can accommodate the endemic distribution. Last, we review recent models of predictive coding indicating how expectation processes are crucially involved in the placebo and nocebo effect, delusions and conversion disorders. Building on this theoretical framework we propose a neurobiological model of RS in which the impact of overwhelming negative expectations are directly causative of the down-regulation of higher order and lower order behavioral systems in particularly vulnerable individuals.

Place, publisher, year, edition, pages
Frontiers Media SA , 2016. Vol. 10, article id 7
Keywords [en]
catatonia, migration, culture-bound syndrom, pervasive refusal, psychogenic, apathy, hopelessness, predictive coding
National Category
Neurology Psychology
Research subject
Neurology; Psychology
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URN: urn:nbn:se:oru:diva-48478DOI: 10.3389/fnbeh.2016.00007ISI: 000368984400001PubMedID: 26858615Scopus ID: 2-s2.0-84957587754OAI: oai:DiVA.org:oru-48478DiVA, id: diva2:906068
Available from: 2016-02-23 Created: 2016-02-23 Last updated: 2018-07-10Bibliographically approved

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Engström, Ingemar

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