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Functional Foreign Accent Syndrome in suspected Conversion Disorder: A case study

Keulen, S., Mariën, P., van Dun, K. , D'aes, T., de Page, L., de Vroege, L., Van Schuerbeek, P., Raeymaekers, H., De Mey, J., Bastiaanse, R., van der Feltz-Cornelis, C., Paquier, P., Van Overwalle, F. & Verhoeven, J. ORCID: 0000-0002-0738-8517 (2020). Functional Foreign Accent Syndrome in suspected Conversion Disorder: A case study. European Journal of Psychiatry, 35(1), pp. 46-55. doi: 10.1016/j.ejpsy.2020.08.002


Background and objectives: We provide a case analysis for a 28-year-old, native Dutch-speaking lady who developed Foreign Accent Syndrome (FAS), a few weeks after falling down the staircase. In addition to FAS, which gave the impression she spoke with a German accent, German(-like) words and structures occurred. Speech symptoms were aggravated by increased stress, fatigue or emotional pressure, and this triggered jargon speech. It was hypothesized her FAS and jargon developed on a functional basis.

Methods: An in-depth analysis of the patient's medical background, neuropsychological and neurolinguistic tests and psychodiagnostic exams were done. The patient participated in an fMRI experiment. In a syllable repetition paradigm, motor speech activations were compared to those of healthy individuals, to see whether they were altered, which would be expected in case of a neurological etiology.

Results: Medical history disclosed prior traumatic experiences for which she sought help, but no neurological incidents. Repeated neuropsychological and neurolinguistic tests showed deficits in recent memory and executive functioning. The patient demonstrated great difficulties with picture naming. Clinically, language switching and mixing as well as recurring jargon speech was found. Formal psychodiagnostic tests did not identify a clear disorder, but psychodiagnostic interviews were consistent with a DSM-5 conversion disorder. The fMRI study demonstrated that speech network activations corresponded to those found in healthy participants.

Conclusion: The clinical neurolinguistic characteristics, outcome of the fMRI experiment, together with the clinical psychodiagnostic findings were strongly indicative for an underlying functional etiology for the FAS and jargon speech, presenting as symptoms of conversion disorder.

Publication Type: Article
Additional Information: © 2020 Asociación Universitaria de Zaragoza para el Progreso de la Psiquiatría y la Salud Mental. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
Publisher Keywords: Foreign Accent Syndrome; FAS; Language mixing; Language switching; Jargon; fMRI; Speech; Accent; Functional disorder; Conversion disorder
Subjects: B Philosophy. Psychology. Religion > BF Psychology
P Language and Literature
Q Science > QP Physiology
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments: School of Health & Psychological Sciences > Language & Communication Science
SWORD Depositor:
[thumbnail of FINAL Revision Final Adapted Manuscript Keulen et al.pdf]
Text - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

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