Moene F C, Landberg E H, Hoogduin K A, Spinhoven P, Hertzberger L I, Kleyweg R P, Weeda J
Psychiatric Hospital, De Grote Rivieren, Overkampweg 115, 3318 AR, Dordrecht, The Netherlands.
J Psychosom Res. 2000 Jul;49(1):7-12. doi: 10.1016/s0022-3999(99)00107-5.
The percentage of patients initially diagnosed with a conversion disorder and later identified as having an organic disorder has been decreasing in recent studies.
Consecutive patients with a diagnosis of conversion disorder were referred for psychiatric diagnosis and treatment. Research questions were: (1) What incidence of neurological disorder is revealed by neurological reassessment and by which diagnostic technique is the final diagnosis established? (2) What differences can be observed between true-positive and the false-positive results?
Ten (11.8%) of the 85 patients examined appeared to suffer from a neurological disorder. In this sample, variables discriminating between the true positives and false positives were: (1) prior suspicion of neurological disorder; (2) older age at referral; (3) older age at onset of symptoms; (4) longer duration of symptoms; and (5) use of medication. Three variables contributed significantly to the prediction of organic disorder: prior suspicion of neurological disorder; age at onset of symptoms; and duration of symptoms.
Although our results are in line with those of other recent studies, the percentage of false positives was still high. The data further emphasize the dangers of making a diagnosis of conversion disorder in the absence of positive evidence. It is important to continue to provide follow up for patients with a diagnosis of conversion disorder. Unfortunately, unreliable psychiatric indications, like certain behavioral characteristics, are still used in the diagnostic process. The results show that a general neurological examination is still a valuable diagnostic instrument in addition to modern diagnostic techniques.
在最近的研究中，最初被诊断为转换障碍且后来被确定患有器质性疾病的患者比例一直在下降。
连续诊断为转换障碍的患者被转介进行精神科诊断和治疗。研究问题为：（1）神经学重新评估揭示的神经疾病发病率是多少，最终诊断是通过哪种诊断技术确定的？（2）真阳性和假阳性结果之间可以观察到哪些差异？
85名接受检查的患者中有10名（11.8%）似乎患有神经疾病。在这个样本中，区分真阳性和假阳性的变量为：（1）先前对神经疾病的怀疑；（2）转诊时年龄较大；（3）症状出现时年龄较大；（4）症状持续时间较长；以及（5）用药情况。三个变量对器质性疾病的预测有显著贡献：先前对神经疾病的怀疑、症状出现时的年龄以及症状持续时间。
虽然我们的结果与其他近期研究一致，但假阳性的比例仍然很高。这些数据进一步强调了在没有阳性证据的情况下诊断转换障碍的危险性。对诊断为转换障碍的患者继续进行随访很重要。不幸的是，在诊断过程中仍使用不可靠的精神科指标，如某些行为特征。结果表明，除了现代诊断技术外，一般的神经学检查仍然是一种有价值的诊断工具。
