Mace C J, Trimble M R
Department of Psychology, University of Warwick, Coventry.
Br J Psychiatry. 1996 Sep;169(3):282-8. doi: 10.1192/bjp.169.3.282.
Previous work suggests neurological disease commonly supervenes in cases of conversion disorder but has not identified clear predisposing factors. Patients' subsequent use of services has been neglected.
Clinical outcomes for 73 patients investigated for pseudoneurological symptoms at a neurological hospital 10 years earlier were compared with findings on presentation. Fifty-six patients complied with a structured interview concerning use of services.
Thirty patients had no relief from their original symptom at follow-up. They had been older, with more chronic symptoms, and different auxiliary psychiatric diagnoses. In 11 patients a clear neurological diagnosis was subsequently made for the original symptom. Provisional neurological diagnoses at presentation had been disproportionately common among these 11. Small numbers of patients with poor outcomes made most use of hospital and community services. High attenders met screening criteria for somatisation disorder at follow-up.
The prognosis for chronic symptoms remains poor, but subsequent rediagnosis of neurological disease is less frequent than commonly supposed. Somatisation disorder may develop if hospital contact does not lead to diagnosis of another disease.
先前的研究表明，神经系统疾病在转换障碍病例中通常会随后出现，但尚未确定明确的诱发因素。患者后续的服务使用情况一直被忽视。
将10年前在一家神经科医院因疑似神经系统症状接受调查的73例患者的临床结果与就诊时的检查结果进行比较。56例患者接受了关于服务使用情况的结构化访谈。
30例患者在随访时原有症状未缓解。他们年龄较大，症状更具慢性，且有不同的辅助精神科诊断。11例患者后来针对原有症状明确了神经系统诊断。这11例患者中，就诊时临时的神经系统诊断比例过高。少数预后较差的患者使用医院和社区服务的频率最高。频繁就诊者在随访时符合躯体化障碍的筛查标准。
慢性症状的预后仍然很差，但随后对神经系统疾病的重新诊断比通常认为的要少。如果住院检查未导致诊断出其他疾病，可能会发展为躯体化障碍。
