van Meerkerk-Aanen Petra J, de Vroege Lars, Khasho David, Foruz Aziza, van Asseldonk J Thies, van der Feltz-Cornelis Christina M
Clinical Center of Excellence for Body, Mind, and Health, GGz Breburg.
Department Tranzo, Tilburg School of Behavioral and Social Sciences, Tilburg University.
Neuropsychiatr Dis Treat. 2017 Aug 2;13:2057-2067. doi: 10.2147/NDT.S130475. eCollection 2017.
Since the advent of computed tomography and magnetic resonance imaging scans, neurological disorders have less often been falsely labeled as conversion disorder (CD). However, misdiagnosis of a neurological disorder as CD still occurs, especially in cases with insidious onset. Misinterpretation of la belle indifférence may contribute to such misdiagnosis. Here, we describe a case of progressive supranuclear palsy/Richardson's syndrome (PSPS) misdiagnosed as a case of CD.
A 62-year-old woman consulted two different neurologists in 2012 because of falling spells since 2009 and was diagnosed with CD. She was referred to the Clinical Center of Excellence for Body, Mind, and Health for treatment of CD. After neurological examination, blood tests, and psychiatric examination, in which la belle indifférence and a history of incest were found, CD was confirmed. However, despite treatment for CD, the patient's physical symptoms deteriorated over a year. After repeated physical and psychiatric examinations, neurocognitive assessment, and consultation with a third neurologist because of suspicion of neurological disease, the patient was diagnosed with PSPS.
La belle indifférence may be a psychological sign in the context of CD, but it may also be an expression of lack of mimic due to Parkinsonism or of eye movement disorder in the context of neurological illness. A diagnosis of CD should not be considered definitive if no improvement occurs in terms of physical, mental, and cognitive symptoms despite appropriate therapy. In case of deterioration, neurological reexamination and reinterpretation of la belle indifférence should be considered.
自从计算机断层扫描和磁共振成像扫描出现以来，神经系统疾病被误诊为转换障碍（CD）的情况已不常见。然而，将神经系统疾病误诊为CD的情况仍有发生，尤其是在起病隐匿的病例中。对“泰然漠视”的错误解读可能导致此类误诊。在此，我们描述一例被误诊为CD的进行性核上性麻痹/理查森综合征（PSPS）病例。
一名62岁女性因自2009年起出现跌倒发作，于2012年咨询了两位不同的神经科医生，被诊断为CD。她被转介至身心与健康卓越临床中心接受CD治疗。经过神经系统检查、血液检查和精神检查，发现了“泰然漠视”和乱伦史，CD得到确诊。然而，尽管接受了CD治疗，患者的身体症状在一年多的时间里仍不断恶化。由于怀疑患有神经系统疾病，在反复进行身体和精神检查、神经认知评估并咨询了第三位神经科医生后，患者被诊断为PSPS。
“泰然漠视”可能是CD背景下的一种心理体征，但也可能是帕金森病导致的表情缺乏或神经系统疾病背景下眼动障碍的一种表现。如果经过适当治疗后身体、精神和认知症状均无改善，则不应将CD诊断视为定论。若症状恶化，应考虑重新进行神经系统检查并重新解读“泰然漠视”。
