Validity of the "Drift without pronation" sign in conversion disorder
Validity of the "Drift without pronation" sign in conversion disorder
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DOI：
10.1186/1471-2377-13-31
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发表时间：
2013-04-01
期刊：
影响因子：
2.6
通讯作者：
Aybek, Selma
中科院分区：
文献类型：
--
作者：
Daum, Corinna;Aybek, Selma
背景：转换障碍（CD）是一种精神障碍，但诊断不能建立没有神经科医生的专业知识，因为区分功能和器质性症状依赖于仔细的床边检查。Joseph Babinski认为没有旋前肌漂移是歇斯底里性麻痹的“积极信号”，但这一信号的有效性从未被评估过。本研究的目的是检查“无内旋移位”征的敏感性和特异性。方法：选取诊断为CD的单侧功能性上肢轻瘫患者26例（DSM-IV），并将28例伴有器质性神经系统疾病的患者作为对照组。手臂稳定性测试是在手臂完全旋后伸展，手指内收，眼睛闭上10秒的情况下进行的。阳性的“无旋前移位”标志是指存在向下的无旋前移位。结果：所有CD受试者（100%）显示阳性信号，而只有7.1%的有机受试者显示阳性信号（Fisher’sp < 0.001）。该征象的敏感性为100% (95% CI: 84%-100%)，特异性为93% （95% CI: 76%-98%）。结论：观察“漂移无旋前”体征是转换障碍的特异性症状，有助于在床边快速区分器质性和功能性轻瘫。
Background: Conversion disorder (CD) is a psychiatric disorder, yet the diagnosis cannot be established without the expertise of a neurologist, as distinguishing a functional from an organic symptom relies on careful bedside examination. Joseph Babinski considered the absence of pronator drift as a 'positive sign' for hysterical paresis but the validity of this sign has never been evaluated. The aim of this study was to examine the sensitivity and specificity of the "drift without pronation" sign.Methods: Twenty-six patients with unilateral functional upper limb paresis diagnosed with CD (DSM-IV) and a control group of 28 patients with an organic neurological condition were consecutively included. The arm stabilisation test was performed with arms stretched out in full supination, fingers adducted, eyes closed for 10 seconds. A positive "drift without pronation" sign was defined by the presence of a downward drift without pronation.Results: All CD subjects (100%) displayed a positive sign when only 7.1% of organic subjects did (Fisher's p < 0.001). The sign yielded a sensitivity of 100% (95% CI: 84%-100%) and a specificity of 93% (95% CI: 76%-98%).Conclusion: The observation of a "drift without pronation" sign is specific for Conversion Disorder and can be of help in making a quick distinction between organic and functional paresis at the bedside.