Binder Laurence M, Campbell Keith A
Oregon Health and Sciences University, Portland, OR, USA.
J Clin Exp Neuropsychol. 2004 May;26(3):369-92. doi: 10.1080/13803390490510095.
Several illnesses expressed somatically that do not have clearly demonstrated pathophysiological origin and that are associated with neuropsychological complaints are reviewed. Among them are nonepileptic seizures, fibromyalgia, chronic fatigue syndrome, Persian Gulf War unexplained illnesses, toxic mold and sick building syndrome, and silicone breast implant disease. Some of these illnesses may be associated with objective cognitive abnormalities, but it is not likely that these abnormalities are caused by traditionally defined neurological disease. Instead, the cognitive abnormalities may be caused by a complex interaction between biological and psychological factors. Nonepileptic seizures serve as an excellent model of medically unexplained symptoms. Although nonepileptic seizures clearly are associated with objective cognitive abnormalities, they are not of neurological origin. There is evidence that severe stressors and PTSD are associated with immune system problems, neurochemical changes, and various diseases; these data blur the distinctions between psychological and organic etiologies. Diagnostic problems are intensified by the fact that many patients are poor historians. Patients are prone to omit history of severe stressors and psychiatric problems, and the inability to talk about stressors increases the likelihood of suffering from physiological forms of stress.
本文综述了几种以躯体症状表现为主、病理生理起源尚未明确证实且与神经心理学主诉相关的疾病。其中包括非癫痫性发作、纤维肌痛、慢性疲劳综合征、海湾战争综合征、有毒霉菌与病态建筑综合征以及硅凝胶乳房植入物疾病。这些疾病中的一些可能与客观认知异常有关，但这些异常不太可能由传统定义的神经系统疾病引起。相反，认知异常可能是由生物和心理因素之间的复杂相互作用导致的。非癫痫性发作是医学上无法解释的症状的一个典型例子。虽然非癫痫性发作显然与客观认知异常有关，但它们并非源于神经系统。有证据表明，严重应激源和创伤后应激障碍与免疫系统问题、神经化学变化及各种疾病有关；这些数据模糊了心理病因和器质性病因之间的区别。许多患者病史陈述不佳这一事实加剧了诊断问题。患者容易遗漏严重应激源和精神问题的病史，而无法谈论应激源会增加遭受生理性应激的可能性。
