Heyer Geoffrey L
Department of Neurology, Dell Medical School, Austin, Texas.
J Nerv Ment Dis. 2019 Apr;207(4):255-263. doi: 10.1097/NMD.0000000000000952.
The conversion disorder that appears like syncope is common but poorly recognized. The study aimed to develop and validate a brief, clinician-administered screening tool to discriminate psychogenic nonsyncopal collapse (PNSC) among young patients referred for fainting. Consecutive patients with PNSC and with syncope (15.4 ± 2.2 years) completed a 92-item inventory highlighting features typical of PNSC and neurally mediated syncope (n = 35, each cohort). Fourteen items were retained and revised and then administered to new cohorts ultimately diagnosed with PNSC or syncope (n = 40, each cohort). Further revision led to a 10-item Fainting Assessment Inventory (FAI-10). Scoring the syncope ratings positively and the PNSC ratings negatively, median scores differed between cohorts with PNSC and with syncope (-6 vs. 7; p < 0.001). Diagnostic sensitivity (0.95), specificity (0.875), positive predictive value (0.889), negative predictive value (0.93), and area under the curve (0.973) were calculated. The FAI-10 furthers clinicians' ability to distinguish various forms of transient loss of consciousness.
表现类似晕厥的转换障碍很常见,但却未得到充分认识。该研究旨在开发并验证一种由临床医生使用的简短筛查工具,以鉴别因昏厥前来就诊的年轻患者中的精神性非晕厥性虚脱(PNSC)。连续纳入的PNSC患者和晕厥患者(年龄15.4±2.2岁)完成了一份包含92个条目的问卷,该问卷突出了PNSC和神经介导性晕厥的典型特征(每组35例)。保留并修订了14个条目,然后将其应用于最终诊断为PNSC或晕厥的新队列(每组40例)。进一步修订后形成了一个包含10个条目的昏厥评估问卷(FAI-10)。对晕厥评分取正值,对PNSC评分取负值,PNSC队列和晕厥队列的中位数得分有所不同(-6对7;p<0.001)。计算了诊断敏感性(0.95)、特异性(0.875)、阳性预测值(0.889)、阴性预测值(0.93)和曲线下面积(0.973)。FAI-10提高了临床医生区分各种形式短暂意识丧失的能力。