Vermeulen Marinus, van der Linden Els A M
Academisch Medisch Centrum, afd. Neurologie, Amsterdam, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(49):A5406.
As described in the DSM-IV-TR, conversion disorder encompasses neurological symptoms not due to a recognised neurological disease. Some authors have suggested abandoning the label 'conversion disorder' and replacing it with the phrase 'functional neurological symptoms'. Two requirements for the diagnosis, namely, the association of psychological factors and the exclusion of feigning, produce several problems and should therefore not be included in the new criteria. Based on studies of the functional anatomy of perception and movement, it is likely that functional neurological symptoms are interpreted by patients as being involuntary and occurring spontaneously. In the current diagnostic criteria, the emphasis is on the exclusion of other disorders; clinical features that support the diagnosis have been proposed for the new criteria. Psychiatrists should be consulted if depression or anxiety disorders are suspected. If recovery comes to a standstill, such patients should be referred to psychologists who are experienced in cognitive behavioural therapy for patients with functional neurological symptoms.
如《精神疾病诊断与统计手册第四版，修订版》（DSM-IV-TR）所述，转换障碍包括并非由公认的神经系统疾病引起的神经症状。一些作者建议摒弃“转换障碍”这一术语，代之以“功能性神经症状”。该诊断的两个要求，即心理因素的关联和诈病的排除，产生了若干问题，因此不应纳入新的标准。基于对感知和运动功能解剖学的研究，功能性神经症状很可能被患者解释为非自主性的且自发出现的。在当前的诊断标准中，重点在于排除其他疾病；已为新的标准提出了支持该诊断的临床特征。如果怀疑有抑郁或焦虑障碍，应咨询精神科医生。如果康复停滞不前，此类患者应转诊给在功能性神经症状患者认知行为疗法方面有经验的心理学家。
