Cathébras Pascal, Régny Pauline
Service de médecine interne, hôpital Nord, CHU de Saint-Etienne, 42055 Saint-Etienne Cedex 2, France.
Rev Prat. 2012 Oct;62(8):1119-25, 1127-30.
"Hysterical" conversion hasn't vanished, and remains a diagnostic, therapeutic and relational challenge for the clinician. Conversion may be associated with organic disease. From the clinical point of view, two subtypes of conversion symptoms, namely psychogenic nonepileptic seizures and functional movement disorders, have been individualized. Physical signs of neurological inconsistency, and classical arguments in favor of a psychological etiology have been recently reevaluated, which allows, along with the progress of neurological investigations, to minimize the rate of misdiagnosis. Functional neuroimaging has shed light on the brain mechanisms involved in conversion phenomena. From a nosological point of view, there is a tension between the whish to "banalize" the conversion symptoms as mere "functional neurological symptoms", which makes easier to communicate the diagnosis to the patient and may remove the stigma from the diagnosis; and the wish of certain authors to "revive" hysteria, emphasizing the core phenomenon of dissociation and its close relationship with trauma. Proposed treatment of conversion disorder are numerous, although poorly evaluated and often insatisfactory, but recent publications insist on the importance of communicating the diagnosis to the patient in a honest, nonjudmental and understandable way, at the earliest phase of the disorder.
“癔症性”转换并未消失，对临床医生而言，它在诊断、治疗及医患关系方面仍是一项挑战。转换可能与器质性疾病相关。从临床角度来看，转换症状已被细分为两种亚型，即精神性非癫痫性发作和功能性运动障碍。神经学检查结果不一致的体征以及支持心理病因的经典论据最近已被重新评估，这使得随着神经学检查的进展，误诊率得以降低。功能性神经影像学揭示了转换现象所涉及的大脑机制。从疾病分类学角度来看，在将转换症状“普通化”为单纯的“功能性神经症状”（这便于向患者传达诊断结果并可能消除诊断带来的污名）的愿望，与某些作者“复兴”癔症的愿望（强调解离的核心现象及其与创伤的密切关系）之间存在矛盾。尽管对转换障碍的治疗方法众多，但评估不足且往往不尽人意，不过近期的出版物强调在疾病的最早阶段以诚实、无偏见且易懂的方式向患者传达诊断结果的重要性。
