Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
University of Cambridge. Addenbrookes Hospital, Level E4, Box 189, Cambridge, CB20QQ, United Kingdom.
J Psychiatr Res. 2021 Sep;141:353-357. doi: 10.1016/j.jpsychires.2021.07.013. Epub 2021 Jul 14.
Conversion disorder, also called Functional Neurological Symptom Disorder is poorly understood by many in the medical profession and is associated with considerable health care costs. Sigmund Freud, in an early, pre-psychoanalytic period paper, suggested that hysterical motor paralyses arose from a "functional or dynamic lesion" which was no different from an organic one, but rather an altered expression of it. He linked this functional brain disturbance to an excess of affect, a faulty conceptualization on the part of the symptomatic individual of how the affected organ works, and elements of dissociation and dual consciousness. One hundred and thirty years later converging functional imaging studies provide support for the excess affect component of his hypothesis. A small but growing fMRI literature has revealed bottom-up hyperactive neural activity in limbic regions and a potential failure of top-down regulation from prefrontal regions. Aberrant functional connectivity of limbic-motor regions now provides a mechanistic model that sheds light on an early Freudian theory explaining, in part, how symptoms of Conversion Disorder arise.
转换障碍，也称为功能性神经症状障碍，在医学领域中许多人对此了解甚少，并且与相当大的医疗保健费用有关。西格蒙德·弗洛伊德（Sigmund Freud）在早期的前精神分析时期的一篇论文中提出，歇斯底里的运动性瘫痪是由“功能性或动力性损伤”引起的，这种损伤与器质性损伤没有什么不同，而只是其表现形式不同。他将这种功能性大脑紊乱与过度的情感联系起来，即症状个体对受影响器官如何运作的概念化错误，以及分离和双重意识的元素。一百三十年后，功能影像学研究的融合为他的假说中的过度情感成分提供了支持。一小部分但不断增长的 fMRI 文献揭示了边缘区域的自上而下的过度活跃神经活动，以及来自前额叶区域的潜在调节失败。现在，边缘运动区域的异常功能连接提供了一个机制模型，部分解释了转换障碍症状的产生，这部分解释了早期弗洛伊德理论。
