Lockhart Joseph, Satya-Murti Saty
Department of State Hospitals (JL), State of California; and Health Policy Consultant (SS-M), Santa Maria, CA.
Neurol Clin Pract. 2015 Feb;5(1):17-24. doi: 10.1212/CPJ.0000000000000092.
Neurologists often evaluate patients whose symptoms cannot be readily explained even after thorough clinical and diagnostic testing. Such medically unexplained symptoms are common, occurring at a rate of 10%-30% among several specialties. These patients are frequently diagnosed as having somatoform, functional, factitious, or conversion disorders. Features of these disorders may include symptom exaggeration and inadequate effort. Symptom validity tests (SVTs) used by psychologists when assessing the validity of symptoms and impairments are structured, validated, and objectively scored. They could detect poor effort, underperformance, and exaggeration. In settings with appropriate prior probabilities, detection rates for symptom exaggeration have diagnostic utility. SVTs may help in moderating expensive diagnostic testing and redirecting treatment plans. This article familiarizes practicing neurologists with their merits, shortcomings, utility, and applicability in practice.
神经科医生经常会评估一些患者，即便经过全面的临床和诊断检查，其症状仍难以轻易解释。这类医学上无法解释的症状很常见，在多个专科中出现的比例为10%至30%。这些患者常被诊断为患有躯体形式障碍、功能性障碍、做作性障碍或转换障碍。这些障碍的特征可能包括症状夸大和努力程度不足。心理学家在评估症状和损伤的有效性时使用的症状效度测试（SVT）是结构化的、经过验证的且有客观评分。它们能够检测出努力程度不佳、表现不佳和夸大情况。在具有适当先验概率的情况下，症状夸大的检测率具有诊断效用。SVT可能有助于减少昂贵的诊断检查，并重新调整治疗计划。本文使执业神经科医生熟悉其优点、缺点、效用以及在实践中的适用性。
