Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders.
Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders.
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DOI：
10.1001/jamaneurol.2018.1264
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发表时间：
2018-09-01
期刊：
影响因子：
29
通讯作者：
Morgante F
中科院分区：
文献类型：
--
作者：
Espay AJ;Aybek S;Carson A;Edwards MJ;Goldstein LH;Hallett M;LaFaver K;LaFrance WC Jr;Lang AE;Nicholson T;Nielsen G;Reuber M;Voon V;Stone J;Morgante F
功能性神经障碍(FND)是医学上常见的残疾来源。患者经常被误诊，在长时间延误后被正确诊断，和/或诊断结果不佳，阻碍了对诊断的理解，导致不适当的治疗、医源性伤害、不必要和昂贵的评估，以及糟糕的结果。第五版《精神障碍诊断和统计手册》通过了功能性神经症状障碍/转换障碍，用功能性取代了心因性一词，并取消了作为FND先决条件的心理应激标准。现在可以通过识别FND特有的神经体征，而不依赖于是否存在心理应激源或提示性历史线索，以包容的方式做出诊断。新的模型强调了更广泛的过去敏感事件，如身体创伤、医疗疾病或生理/心理生理学事件。在这个模型中，对这些事件的强烈想法和期望与对感觉数据的异常预测和对身体的关注相关。神经生物学异常包括辅助运动区活动不足，以及与选择或抑制运动的区域相对断开，并与代理感相关。对于单独或联合进行具体的身体康复和心理干预，已经积累了有希望的证据，但临床试验证据仍然有限。功能性神经障碍是一种被忽视但可能是可逆的残疾来源。需要进一步的研究来确定各种干预措施的剂量和持续时间，联合治疗和多学科治疗的价值，以及最适合每个患者的治疗方式。
Functional neurological disorders (FND) are common sources of disability in medicine. Patients have often been misdiagnosed, correctly diagnosed after lengthy delays, and/or subjected to poorly delivered diagnoses that prevent diagnostic understanding and lead to inappropriate treatments, iatrogenic harm, unnecessary and costly evaluations, and poor outcomes. Functional Neurological Symptom Disorder/Conversion Disorder was adopted by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, replacing the term psychogenic with functional and removing the criterion of psychological stress as a prerequisite for FND. A diagnosis can now be made in an inclusionary manner by identifying neurological signs that are specific to FNDs without reliance on presence or absence of psychological stressors or suggestive historical clues. The new model highlights a wider range of past sensitizing events, such as physical trauma, medical illness, or physiological/psychophysiological events. In this model, strong ideas and expectations about these events correlate with abnormal predictions of sensory data and body-focused attention. Neurobiological abnormalities include hypoactivation of the supplementary motor area and relative disconnection with areas that select or inhibit movements and are associated with a sense of agency. Promising evidence has accumulated for the benefit of specific physical rehabilitation and psychological interventions alone or in combination, but clinical trial evidence remains limited. Functional neurological disorders are a neglected but potentially reversible source of disability. Further research is needed to determine the dose and duration of various interventions, the value of combination treatments and multidisciplinary therapy, and the therapeutic modality best suited for each patient.
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影响因子：
3.7
作者：
Aybek S;Nicholson TR;O'Daly O;Zelaya F;Kanaan RA;David AS
通讯作者：
David AS
影响因子：
2.6
作者：
Daum, Corinna;Aybek, Selma
通讯作者：
Aybek, Selma
DOI：
10.1016/b978-0-12-801772-2.00005-9
发表时间：
2016-01-01
期刊：
FUNCTIONAL NEUROLOGIC DISORDERS
影响因子：
--
作者：
Carson, A.;Lehn, A.
通讯作者：
Lehn, A.
DOI：
10.1016/b978-0-12-801772-2.00017-5
发表时间：
2016-01-01
期刊：
FUNCTIONAL NEUROLOGIC DISORDERS
影响因子：
--
作者：
Gasca-Salas, C.;Lang, A. E.
通讯作者：
Lang, A. E.
DOI：
10.1016/b978-0-12-801772-2.00043-6
发表时间：
2016-01-01
期刊：
FUNCTIONAL NEUROLOGIC DISORDERS
影响因子：
--
作者：
Gelauff, J.;Stone, J.
通讯作者：
Stone, J.