Psychiatric comorbidity

Sarah A [subject #432], Painting, 2005. © 2005 Sarah A (larger image see here) [more]

The experiences of persistent aura can be profoundly isolating, and this is only made worse when combined with the additional experiences of social stigma. The persistent aura has effects not only on the sufferer, but also on the loved ones, family, friends and colleagues. In addition to fears aroused by persistent aura symptoms, psychiatric comorbidity, mainly anxiety and depression, are common in persistent aura without infarction. Anxiety and depression preceding the onset of persistent aura may have acted as trigger of the given complication of migraine. Likewise, the increased stress level associated with a trauma leading to Post Traumatic Stress Disorder can trigger an episode of persistent aura. More often comorbid anxiety and depression develop as reactions to the chronic stress resulting from the persistent aura experiences and the frequently existing uncertainty of diagnosis and prognosis, which may in turn trigger further episodes of persistent aura, thus leading to a vicious circle with an ever increasing worsening of both neurological and psychiatric status. Comorbid sleep disorders include recurrent nightmares, sleep paralysis and rapid eye movements behaviour disorder. Comorbid substance abuse and dependance raise the differential diagnosis with HPPD as well as the question whether first drug use may act as trigger of another episode of persistent aura in some subjects with previous history of persistent aura without infarction. The autist artists Donna Williams and Alison Hale have mentioned persistent visual snow in their autobiographies. However, a case series of 8 participants in Sofia Greene's internet survey with a comorbidity of Asperger's disorder and persistent aura without infarction suggests that visual snow has to be attributed to the latter rather than to the former.

References

Hale A. My World is Not Your World. Archimedes Press, Essex 1998.
Williams D. Nobody Nowhere: the Extraordinary Autobiography of an Autistic Girl. Avon Books, New York 1992.

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