Functional neurological symptoms: welcome to the new normal.
Functional neurological symptoms: welcome to the new normal.
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功能性神经系统症状：欢迎来到新常态。
DOI：
10.1136/practneurol-2015-001310
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发表时间：
2016
影响因子：
2.8
通讯作者：
Edwards MJ
中科院分区：
文献类型：
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作者：
Edwards MJ
什么是神经科医生的“正常”？我们知道刻板印象：一个偶尔出现在医院里的冷漠而不可接触的人，他的兴趣只会被罕见和深奥的事物所引起;一个在诊断结果被大肆披露后就消失的人。神经病学正在发生变化，这种只在一定程度上正确的刻板印象正在逐渐消失在历史中。该专业已经认识到，它需要负责常见的神经系统疾病：中风，偏头痛，脑损伤，帕金森氏病，并这样做，神经学家需要可见，访问和直接提供护理的参与。乔恩斯通和同事1 2指出，神经科的“正常”的患者功能性神经症状是停留在过去。他们建议，神经科医生在与有功能性神经症状的患者进行会诊时，应该做与他们在其他神经科实践中所做的完全相同的事情。但是，对于一个神经科医生来说，看到一个有功能性神经症状的病人，什么是正常的行为呢？做病史？check.进行有针对性的检查？check.做一些相关的测试。check.解释问题是什么以及如何解决？嗯......这就是我们对功能性症状患者的管理中可能出现的问题，如果在这一步出错，咨询本身的治疗益处就会丧失，后续治疗就会更加困难。如果病人被诊断解释疏远了，并且没有出现接受它，那么任何治疗都不可能成功。正如斯通博士指出的，我们对诊断解释的"正常"是给问题一个名字，解释我们是如何做出诊断的，我们对症状是如何引起的所知道的，我们将如何提供帮助以及未来可能会发生什么。当有人问一个明智的问题，"为什么我得了多发性硬化症？"我们
What is ‘normal’for a neurologist? We know the stereotype: an aloof uncontactable individual who occasionally appears in the hospital, whose interest is only raised by the rare and esoteric; someone who, after the diagnosis is revealed in a flourish, disappears. Neurology is changing, and this stereotype, which was only ever partly true, is fading into history. The specialty has recognised that it needs to be responsible for common neurological disorders: stroke, migraine, brain injury, Parkinson’s disease, and to do so neurologists need to be visible, accessible and involved in the direct provision of care.Jon Stone and colleagues 1 2 point out that neurology’s “normal” for patients with functional neurological symptoms is stuck in the past. They suggest that neurologists should do exactly the same things in their consultations with patients with functional neurological symptoms as they do in the rest of their neurological practice. But what would be normal behaviour for a neurologist seeing a patient with functional neurological symptoms? Take a history? Check. Perform a targeted examination? Check. Organise some relevant tests? Check. Explain what the problem is and what to do about it? Ummm… This is where things can break down in our management of patients with functional symptoms, and if it goes wrong at this step, the therapeutic benefit of the consultation itself is lost and subsequent treatment is much more difficult. No treatment can succeed if the patient has been alienated by the diagnostic explanation and does not turn up to receive it. As Dr Stone points out, our ‘normal’for diagnostic explanations is to give the problem a name, explain how we made the diagnosis, what we know about how symptoms are caused, how we are going to help and what the future may hold. When someone asks the sensible question,‘Why do I have MS?’, we are