Background Functional neurological disorder (FND) is a common and disabling neuropsychiatric condition, which disproportionally affects women compared with men. While the etiopathogenesis of this disorder remains elusive, immune dysregulation is emerging as one potential mechanism. To begin to understand the role of immune dysfunctions in FND, we assessed the prevalence of several common autoimmune diseases (ADs) in a large cohort of patients with FND and examined the influence of psychiatric comorbidities and biological sex. Methods Using a large biorepository database (Mass General Brigham Biobank), we obtained demographic and clinical data of a cohort of 643 patients diagnosed with FND between January 2015 and December 2021. The proportion of ADs was calculated overall, by sex and by the presence of psychiatric comorbidities. Results The overall prevalence of ADs in our sample was 41.9%, with connective tissue and autoimmune endocrine diseases being the most commonly observed ADs. Among patients with FND and ADs, 27.7% had ≥2 ADs and 8% met criteria for multiple autoimmune syndrome. Rates of ADs were significantly higher in subjects with comorbid major depressive disorder and post-traumatic stress disorder (p= 0.02). Women represented the largest proportion of patients with concurrent ADs, both in the overall sample and in the subgroups of interest (p’s < 0.05). Conclusions This study is unique in providing evidence of an association between FND and ADs. Future studies are needed to investigate the mechanisms underlying this association and to understand whether FND is characterised by distinct dysregulations in immune response. Data are available upon reasonable request. Requests should be made to the corresponding author.

中文翻译：

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功能性神经系统疾病中自身免疫性疾病的患病率：精神合并症和生物性别的影响

背景 功能性神经系统疾病 (FND) 是一种常见的致残性神经精神疾病，与男性相比，其对女性的影响尤为严重。虽然这种疾病的发病机制仍然难以捉摸，但免疫失调正在成为一种潜在的机制。为了开始了解免疫功能障碍在 FND 中的作用，我们评估了一大群 FND 患者中几种常见自身免疫性疾病 (AD) 的患病率，并检查了精神合并症和生物性别的影响。方法 使用大型生物样本库数据库（麻省总医院布里格姆生物库），我们获得了 2015 年 1 月至 2021 年 12 月期间诊断为 FND 的 643 名患者的人口统计和临床数据。AD 的比例是按性别和是否存在总体计算的。精神科合并症。结果我们的样本中 AD 的总体患病率为 41.9%，其中结缔组织和自身免疫内分泌疾病是最常见的 AD。在患有 FND 和 AD 的患者中，27.7% 的 AD ≥2 次，8% 符合多发性自身免疫综合征的标准。患有重度抑郁症和创伤后应激障碍的受试者的 AD 发生率显着更高 (p = 0.02)。无论是在总体样本中还是在感兴趣的亚组中，女性在同时患有 AD 的患者中所占比例最大（p < 0.05）。结论 这项研究的独特之处在于提供了 FND 与 AD 之间关联的证据。未来的研究需要调查这种关联的机制，并了解 FND 是否以免疫反应的明显失调为特征。数据可根据合理要求提供。如有请求，请向通讯作者提出。