Lane Zac Paul, Singer Adam, Roffwarg David Elliot, Messias Erick
Department of Psychiatry, Medical College of Georgia, Augusta, Georgia 30909, USA.
Clin Schizophr Relat Psychoses. 2011 Jan;4(4):258-61. doi: 10.3371/CSRP.4.4.6.
Following a stroke, a patient may present with varying degrees of neurological impairment, depending on the area of the brain which is damaged. Specifically, damage to the left cortical hemisphere may result in aphasia. The characteristic speech in a patient with an aphasia caused by a stroke can be similar to the speech in some patients with schizophrenia or other psychotic disorders. In a new patient without a reliable history who presents with suspected aphasia, it is important to include psychotic disorders as part of the differential diagnosis. Failure to differentiate psychotic disorders from aphasia could result in either a lack of treatment that would improve the patient's thought process, thought content, or language, or in a delayed treatment for a stroke, respectively. While a number of psychotic disorders exist and must be differentiated from one another in accordance with DSM-IV guidelines, speech abnormalities in patients with schizophrenia are well described in the literature. For this reason, schizophrenia is the psychotic disorder of focus in this paper. This case report illustrates a clinical situation where a patient required both a psychiatric and neurological consultation in order to determine the etiology of his language disorder. The purpose of this paper is to emphasize the need to consider both psychiatric disorders and aphasia in patients with unknown histories who present with language abnormalities, and to help the clinician critically examine the patient's speech so that, in conjunction with other clinical data, the correct diagnosis can be made and appropriate treatment initiated.
中风后，患者可能会出现不同程度的神经功能缺损，这取决于受损的脑区。具体而言，左侧皮质半球受损可能导致失语症。中风所致失语症患者的特征性言语可能与一些精神分裂症或其他精神障碍患者的言语相似。对于一名无可靠病史且疑似失语症的新患者，将精神障碍纳入鉴别诊断很重要。未能区分精神障碍和失语症可能分别导致缺乏改善患者思维过程、思维内容或语言的治疗，或导致中风治疗延迟。虽然存在多种精神障碍，必须根据《精神疾病诊断与统计手册》第四版的指南相互鉴别，但精神分裂症患者的言语异常在文献中有充分描述。因此，精神分裂症是本文重点关注的精神障碍。本病例报告描述了一种临床情况，即一名患者需要精神科和神经科会诊以确定其语言障碍的病因。本文的目的是强调对于有语言异常且病史不明的患者，需要同时考虑精神障碍和失语症，并帮助临床医生严谨检查患者的言语，以便结合其他临床数据做出正确诊断并开始适当治疗。
