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[一位患有不明原因神经症状的患者]

[A patient with unexplained neurological symptoms].

作者信息

Maris-Boes Ester S, Ramdhani-Joosten Anneke A J, Scholte-Stalenhoef Anne Neeltje

机构信息

ZiekenhuisGroep Twente, afd. Psychiatrie, Almelo.

Contact: E.S. Maris-Boes (

出版信息

Ned Tijdschr Geneeskd. 2019 Aug 29;163:D3580.

PMID:31483585
Abstract

In this case of a 54-year-old woman, severe impairment of motor and sensory function - that could not be assigned to any neurological disease - was diagnosed as a probable conversion disorder or functional neurological disorder (FND). Several psychological stressors, which occurred in the year that preceded the first development of symptoms, were linked to the disorder. Nerve conduction values had not shown any abnormalities at the onset of the disease. However, as the condition progressed, cerebrospinal fluid and nerve conduction study proved an underlying polyneuropathy. In this article we discuss the diagnostic process followed in this case. General lack of evidence for psychological conflict being related to symptoms of conversion disorder/FND led to elimination of this criterion in DSM 5. Instead, the diagnostic process of conversion disorder/FND requires not only exclusion of neurological causes for the symptoms, but also active examination of neurological findings that are discrepant with known neurological diseases; taken together this can positively support a diagnosis of conversion disorder/FND.

摘要

在这位54岁女性的病例中,运动和感觉功能的严重受损(无法归因于任何神经系统疾病)被诊断为可能的转换障碍或功能性神经障碍(FND)。在首次出现症状前一年发生的几种心理应激源与该障碍有关。疾病发作时神经传导值未显示任何异常。然而,随着病情进展,脑脊液和神经传导研究证实存在潜在的多发性神经病。在本文中,我们讨论了该病例的诊断过程。由于普遍缺乏心理冲突与转换障碍/FND症状相关的证据,DSM 5中取消了这一标准。相反,转换障碍/FND的诊断过程不仅需要排除症状的神经学原因,还需要积极检查与已知神经系统疾病不符的神经学发现;综合起来,这可以有力地支持转换障碍/FND的诊断。

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