Ogrizek Anais, Ros Thomas, Ludot Maude, Moro Marie-Rose, Hatchuel Yves, Gomez Nicolas Garofalo, Radjack Rahmeth, Felix Arthur
Department of Adult and Child Psychiatry, Martinique University Hospital, F-97200 Fort-de-France, France.
Department of Child Psychiatry, University of Paris, Hôpital Cochin, Maison de Solenn, F-75014 Paris, France.
Children (Basel). 2023 Sep 25;10(10):1601. doi: 10.3390/children10101601.
Functional neurological symptom disorder (FNSD) is a common diagnosis among adolescents. However, we feel it is a difficult diagnosis to assess because of the diversity of its clinical manifestations, the rapid changes in its nosography over the years, and its common imbrication with established somatic diagnoses. We would like to illustrate this hypothesis through a case presentation and the original diagnostic process that emerged from it.
We chose to present our diagnosis approach through the case of an 11-year-old boy who showed a progressive loss of motor and sensory function to the point of total dependency, and then suddenly switched between this state and a "normal" physical presentation, while deliriously claiming to be an angel.
All possible infectious, autoimmune, metabolic, and toxic disorders were ruled out. After the successive therapeutic failures of antidepressants and neuroleptics, FNSD was diagnosed.
The DSM-5-TR classification was insufficient to explain the full clinical picture and a complementary approach (biblical, psychoanalytical, and historical) was used to analyze the cause of this atypical presentation.
功能性神经症状障碍（FNSD）在青少年中是一种常见诊断。然而，我们认为由于其临床表现的多样性、多年来疾病分类学的快速变化以及它与既定躯体诊断的常见重叠，这是一种难以评估的诊断。我们想通过一个病例介绍及其产生的原始诊断过程来说明这一假设。
我们选择通过一个11岁男孩的病例来展示我们的诊断方法，该男孩表现出运动和感觉功能逐渐丧失直至完全依赖，然后在这种状态和“正常”身体表现之间突然切换，同时神志不清地声称自己是天使。
排除了所有可能的感染性、自身免疫性、代谢性和中毒性疾病。在抗抑郁药和抗精神病药相继治疗失败后，诊断为FNSD。
《精神疾病诊断与统计手册》第5版修订版（DSM-5-TR）分类不足以解释全部临床表现，因此采用了一种补充方法（圣经、精神分析和历史方法）来分析这种非典型表现的原因。
