de Schipper Laura J, Vermeulen Marinus, Eeckhout Augustinus M, Foncke Elisabeth M J
Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands.
Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Clin Neurol Neurosurg. 2014 Jul;122:106-12. doi: 10.1016/j.clineuro.2014.04.020. Epub 2014 May 1.
Functional neurological symptoms (FNS) were considered as a psychiatric disorder at the beginning of the 20th century (conversion disorder). Psychiatrists performed diagnosis and treatment throughout most of the past century in the Netherlands, but in the latest decades patients were usually firstly referred to neurologists. The aim of this study was to investigate the opinions of today's neurologists, psychiatrists and rehabilitation physicians in the Netherlands, regarding pathogenesis, diagnosis and treatment of FNS.
An electronic questionnaire was sent to all neurologists registered with the Dutch Society for Neurology and to the members of the Department for Consultation-liaison and General Hospital Psychiatry.
343 of 780 neurologists, 64 of 197 psychiatrists and 47 of 750 rehabilitation physicians completed the questionnaire. 60% of neurologists and 67% of psychiatrists considered disordered brain functioning together with psychogenic factors responsible for FNS. 29% of neurologists and 88% of psychiatrists felt a psychiatrist was needed for diagnosis. 55% of neurologists and 88% of psychiatrists preferred combined treatment consisting of explaining FNS to patients, psychotherapy and physiotherapy provided by a therapist trained in FNS. 15% of neurologists preferred only physiotherapy.
Most neurologists and psychiatrists did not consider FNS as a mere psychiatric disorder, but counted disordered brain functioning together with psychogenic factors responsible for FNS. Subsequently, according to the majority of neurologists and psychiatrists FNS should not be solely diagnosed and treated by psychiatrists. These results can help to formulate treatment strategies.
功能性神经症状（FNS）在20世纪初被视为一种精神障碍（转换障碍）。在过去的大部分时间里，荷兰的精神科医生负责诊断和治疗，但在最近几十年，患者通常首先被转诊给神经科医生。本研究的目的是调查荷兰当今神经科医生、精神科医生和康复医生对FNS的发病机制、诊断和治疗的看法。
向荷兰神经学会注册的所有神经科医生以及会诊联络与综合医院精神病科的成员发送了一份电子问卷。
780名神经科医生中的343名、197名精神科医生中的64名和750名康复医生中的47名完成了问卷。60%的神经科医生和67%的精神科医生认为大脑功能紊乱与心理因素共同导致了FNS。29%的神经科医生和88%的精神科医生认为诊断需要精神科医生。55%的神经科医生和88%的精神科医生倾向于联合治疗，包括向患者解释FNS、心理治疗以及由接受过FNS培训的治疗师提供的物理治疗。15%的神经科医生仅倾向于物理治疗。
大多数神经科医生和精神科医生并不认为FNS仅仅是一种精神障碍，而是认为大脑功能紊乱与心理因素共同导致了FNS。因此，根据大多数神经科医生和精神科医生的观点，FNS不应仅由精神科医生进行诊断和治疗。这些结果有助于制定治疗策略。
