Section of Cognitive Neuropsychiatry, Department of Psychological Medicine, Institute of Psychiatry, London, UK.
J Neurol Neurosurg Psychiatry. 2011 Nov;82(11):1267-73. doi: 10.1136/jnnp.2008.171306. Epub 2010 Oct 29.
The diagnosis of conversion disorder is problematic. Since doctors have conceptually and practically differentiated the symptoms from neurological ('organic') disease it has been presumed to be a psychological disorder, but the psychological mechanism, and how this differs from feigning (conscious simulation), has remained elusive. Although misdiagnosis of neurological disease as conversion disorder is uncommon, it remains a concern for clinicians, particularly for psychiatrists who may be unaware of the positive ways in which neurologists can exclude organic disease. The diagnosis is anomalous in psychiatry in that current diagnostic systems require that feigning is excluded and that the symptoms can be explained psychologically. In practice, feigning is very difficult to either disprove or prove, and a psychological explanation cannot always be found. Studies of childhood and adult psychological precipitants have tended to support the relevance of stressful life events prior to symptom onset at the group level but they are not found in a substantial proportion of cases. These problems highlight serious theoretical and practical issues not just for the current diagnostic systems but for the concept of the disorder itself. Psychology, physiology and functional imaging techniques have been used in attempts to elucidate the neurobiology of conversion disorder and to differentiate it from feigning, but while intriguing results are emerging they can only be considered preliminary. Such work looks to a future that could refine our understanding of the disorder. However, until that time, the formal diagnostic requirement for associated psychological stressors and the exclusion of feigning are of limited clinical value. Simplified criteria are suggested which will also encourage cooperation between neurology and psychiatry in the management of these patients.
转换障碍的诊断存在问题。由于医生从概念和实践上已经将症状与神经（“器质性”）疾病区分开来，因此它被认为是一种心理障碍，但心理机制以及与装病（有意识地模拟）的区别仍然难以捉摸。虽然将神经疾病误诊为转换障碍并不常见，但它仍然是临床医生关注的问题，特别是对于可能不知道神经病学家可以排除器质性疾病的积极方法的精神科医生。该诊断在精神病学中是异常的，因为当前的诊断系统要求排除装病，并可以从心理上解释症状。实际上，很难证明或证明装病，并且并不总能找到心理解释。对儿童和成人心理诱因的研究倾向于支持在症状出现之前在群体水平上与生活压力事件相关的相关性，但在很大一部分病例中并未发现。这些问题突出了严重的理论和实践问题，不仅是当前的诊断系统，而且是该疾病本身的概念。已经使用心理学，生理学和功能影像学技术来阐明转换障碍的神经生物学，并将其与装病区分开来，但是，尽管出现了有趣的结果，但它们只能被认为是初步的。这项工作着眼于未来，可以使我们对该疾病的认识更加完善。但是，在那之前，与相关心理压力源相关的正式诊断要求以及排除装病的要求在临床上的价值有限。建议简化标准，这也将鼓励神经病学和精神病学在这些患者的治疗中进行合作。
