Universidade Federal de São Paulo, Departamento de Psicobiologia, São Paulo SP, Brazil.
Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.
Arq Neuropsiquiatr. 2022 May;80(5 Suppl 1):324-327. doi: 10.1590/0004-282X-ANP-2022-S120.
The diagnosis of functional neurological disorders is a major challenge in neurologist practice. Some clinical strategies can facilitate the recognition of functional disorders, but several pitfalls make their diagnosis difficult. Here we highlight the following points of attention during evaluation of patients with functional disorder: not all bizarre behavior is functional; not every event triggered by an emotional factor is a functional disorder; not every topographic incongruity is a functional disorder; patients may present functional and organic symptoms at the same time; psychiatric comorbid condition is not always evident in the history of a functional disorder; problematic communication at the time of diagnosis can compromise treatment and prognosis. In conclusion, we emphasize that special attention to these possible pitfalls facilitate the correct diagnosis and management of functional neurological disorders.
功能性神经障碍的诊断是神经科医生实践中的一个主要挑战。一些临床策略可以帮助识别功能性障碍，但有几个陷阱使得其诊断变得困难。在这里，我们在评估功能性障碍患者时强调以下注意点：并非所有奇异的行为都是功能性的；并非每个由情绪因素触发的事件都是功能性障碍；并非每个地形不协调都是功能性障碍；患者可能同时出现功能性和器质性症状；功能性障碍的病史中并不总是明显存在精神共病；诊断时的沟通问题可能会影响治疗和预后。总之，我们强调特别注意这些可能的陷阱有助于正确诊断和管理功能性神经障碍。
