Schmidt S, Wisser R, Heitmann R
Abteilung Neurologie, RLK Bonn.
Psychother Psychosom Med Psychol. 1994 Jul;44(7):247-50.
Dystonic movements and other dyskinesias often cause diagnostic difficulties due to their complex symptomatology. Namely focal dystonias are frequently misdiagnosed as conversion reactions. Idiopathic dystonias are generally considered a nonstructural (neurobiochemical) disorder of the basal ganglia. Many case reports, however, have dealt with patients presenting with "atypical" dystonia whose symptoms were relieved by psychotherapy or hypnosis. We present the histories of two young women exhibiting focal dystonia emerging for the first time under circumstances of profound emotional trouble. We discuss the general difficulties in the diagnosis of dystonic movement disorders and review the criteria for the diagnosis of "psychogenic dystonia". The basal ganglia integrate limbic, proprioceptive and sensorimotor inputs to create emotionally and functionally appropriate voluntary movements. Therefore, the traditional dichotomy "psychogenic-somatogenic" appears to be inappropriate when applied to extrapyramidal movement disorders. In a psychosomatic understanding, the assumption of a psychogenic "trigger" for a somatic movement disorder does not mean a contradiction.
肌张力障碍性运动和其他运动障碍因其复杂的症状表现常常导致诊断困难。具体而言，局灶性肌张力障碍常被误诊为转换反应。特发性肌张力障碍通常被认为是基底神经节的一种非结构性（神经生化）疾病。然而，许多病例报告涉及到表现为“非典型”肌张力障碍的患者，其症状通过心理治疗或催眠得到缓解。我们呈现两位年轻女性的病史，她们在严重情绪困扰的情况下首次出现局灶性肌张力障碍。我们讨论了肌张力障碍性运动障碍诊断中的一般困难，并回顾了“精神性肌张力障碍”的诊断标准。基底神经节整合边缘系统、本体感觉和感觉运动输入，以产生情绪和功能上适当的自主运动。因此，当应用于锥体外系运动障碍时，传统的“精神性 - 躯体性”二分法似乎并不合适。从心身医学的理解来看，认为躯体运动障碍有精神性“触发因素”的假设并不矛盾。
