Ding Juen Mei, Kanaan Richard A A
University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC 3084, Australia.
University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC 3084, Australia; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Denmark Hill, London SE5 9RJ, UK.
J Psychosom Res. 2016 Dec;91:55-60. doi: 10.1016/j.jpsychores.2016.10.012. Epub 2016 Nov 3.
Unexplained neurological symptoms (UNS) are common presentations in neurology but there is no consensus as to what they should be called. This is important, as patient acceptance is a predictor of outcome and there is evidence that patients are unhappy with the terms used. Patient understanding of these terms may be limited, however, and, once explained, the terms may seem more or less offensive. We sought to elicit patients' views of 7 frequently used terms for UNS, and whether these changed once definitions were provided.
185 participants were recruited from a medical outpatients' waiting area. They were given questionnaires outlining a hypothetical situation of leg weakness, with 7 possible labels. Participants were asked whether they endorsed 4 connotations for each label and the "number needed to offend" (NNO) calculated, before and after definitions were given.
It was found that "functional" was significantly less offensive than other terms used (NNO 17, compared with "Conversion Disorder" NNO 5, p<0.001). Reported understanding of the terms was generally low, however, and many terms became significantly more offensive once definitions were provided. Participants' reported understanding had a significant effect, with low understanding causing terms to be viewed as more offensive after explanation.
Much of the 'offence' in UNS lies not in the terminology but in the meaning those terms carry. This study replicated previous findings that "functional" was less offensive than other terms, even after explanation, but in common with most terms this was partly due to patients' limited understanding of its meaning.
不明原因的神经症状（UNS）是神经病学中常见的症状表现，但对于其该如何命名尚无共识。这一点很重要，因为患者的接受程度是预后的一个预测指标，而且有证据表明患者对所使用的术语不满意。然而，患者对这些术语的理解可能有限，而且一旦进行解释，这些术语可能或多或少会显得冒犯性。我们试图了解患者对7个常用于描述UNS的术语的看法，以及在给出定义后这些看法是否会改变。
从一个门诊候诊区招募了185名参与者。他们收到了一份问卷，问卷描述了一个腿部无力的假设情况，并给出了7个可能的标签。参与者被问及是否认可每个标签的4种内涵，并计算出给出定义前后的“冒犯阈值”（NNO）。
发现“功能性的”比其他使用的术语冒犯性明显更低（NNO为17，而“转换障碍”的NNO为5，p<0.001）。然而，报告的对这些术语的理解普遍较低，而且许多术语在给出定义后冒犯性显著增加。参与者报告的理解有显著影响，理解程度低会导致术语在解释后被视为更具冒犯性。
UNS中的许多“冒犯性”不在于术语本身，而在于这些术语所承载的含义。本研究重复了之前的发现，即“功能性的”比其他术语冒犯性更低，即使在解释之后也是如此，但与大多数术语一样，这部分是由于患者对其含义的理解有限。
