Feinstein Anthony
Continuum (Minneap Minn). 2018 Jun;24(3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY):861-872. doi: 10.1212/CON.0000000000000601.
This article provides a broad overview of conversion disorder, encompassing diagnostic criteria, epidemiology, etiologic theories, functional neuroimaging findings, outcome data, prognostic indicators, and treatment.
Two important changes have been made to the recent Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria: the criteria that conversion symptoms must be shown to be involuntary and occurring as the consequence of a recent stressor have been dropped. Outcome studies show that the rate of misdiagnosis has declined precipitously since the 1970s and is now around 4%. Functional neuroimaging has revealed a fairly consistent pattern of hypoactivation in brain regions linked to the specific conversion symptom, accompanied by ancillary activations in limbic, paralimbic, and basal ganglia structures. Cognitive-behavioral therapy looks promising as the psychological treatment of choice, although more definitive data are still awaited, while preliminary evidence indicates that repetitive transcranial magnetic stimulation could prove beneficial as well.
Symptoms of conversion are common in neurologic and psychiatric settings, affecting up to 20% of patients. The full syndrome of conversion disorder, while less prevalent, is associated with a guarded prognosis and a troubled psychosocial outcome. Much remains uncertain with respect to etiology, although advances in neuroscience and technology are providing reproducible findings and new insights. Given the confidence with which the diagnosis can be made, treatment should not be delayed, as symptom longevity can influence outcome.
本文全面概述了转换障碍，涵盖诊断标准、流行病学、病因理论、功能神经影像学发现、结局数据、预后指标及治疗方法。
《精神疾病诊断与统计手册》第五版（DSM - 5）的诊断标准有两项重要变化：转换症状必须被证明是不自主的且是近期应激源所致这一标准已被删除。结局研究表明，自20世纪70年代以来误诊率急剧下降，目前约为4%。功能神经影像学显示，与特定转换症状相关的脑区存在相当一致的激活不足模式，同时边缘系统、边缘旁系统和基底神经节结构有辅助激活。认知行为疗法作为首选心理治疗方法前景良好，尽管仍需更多确切数据，而初步证据表明重复经颅磁刺激也可能有益。
转换症状在神经科和精神科环境中很常见，影响多达20%的患者。转换障碍的完整综合征虽不太常见，但预后不佳且社会心理结局不良。病因方面仍有许多不确定因素，尽管神经科学和技术的进展提供了可重复的发现和新见解。鉴于可以做出诊断，不应延迟治疗，因为症状持续时间会影响结局。
