概述

功能性神经障碍是一个较新且较广泛的术语,也称为转换障碍,具有神经系统(神经病学)的症状,但无法由神经疾病或其他医疗状况解释。然而,症状真切存在,并会导致严重不适或功能问题。

体征和症状根据功能性神经障碍的类型而异,可能包括特定模式。这些障碍通常会影响运动或感官,比如行走、吞咽及视力或听力。症状的严重程度各不相同,可能时有时无,也可能持续存在。但症状无法有意制造或控制。

目前尚不清楚导致功能性神经障碍的原因。这种疾病可能由神经系统疾病或对压力、心理或生理创伤的反应而引起,但并非总是如此。功能性神经障碍与大脑如何运作有关,而并不会对大脑结构造成伤害(如卒中、多发性硬化症、感染或损伤导致的伤害)。

早期诊断和治疗(尤其是疾病相关教育)有助于恢复。

症状

不同的功能性神经障碍的症状有所不同,这取决于功能性神经障碍的类型,而且这些症状严重到足以导致损害,需要医疗评估。这些症状会影响身体运动、功能和感官。

影响身体运动和功能的体征和症状包括:

  • 无力或瘫痪
  • 震颤或行走困难等异常运动
  • 失衡
  • 吞咽困难或感觉“喉咙里有块东西”
  • 癫痫发作或发抖、明显失去意识(非痫性发作)
  • 反应迟钝

影响感知的体征和症状包括:

  • 麻木或失去触觉
  • 无法说话或言语不清等言语问题
  • 复视或失明等视力问题
  • 听力问题或耳聋

何时就诊

如出现上列体征和症状,请就医。如果基本病因是神经疾病或其他病况,务必及时诊断并治疗。如诊断为功能性神经障碍,治疗会改善症状,帮助预防其他问题。

When to see a doctor

Seek medical attention for signs and symptoms that concern you or interfere with your ability to function. If the underlying cause is a neurological disease or another medical condition, quick diagnosis and treatment may be important. If the diagnosis is functional neurologic disorder, treatment may improve the symptoms and help prevent future problems.

病因

目前尚不清楚导致功能性神经障碍的确切原因。关于导致症状的脑部原因的理论十分复杂,涉及多种机制,取决于功能性神经障碍的类型。

即使不存在疾病或异常,大脑中控制肌肉和感官功能的部位也基本参与其中。

功能性神经障碍的症状可能在压力事件后突然出现,或伴随情感或身体创伤出现。其他诱因可能包括大脑在结构、细胞或代谢水平上的功能改变或中断。但症状的引发因素并不总能确定。

风险因素

增加患功能性神经障碍风险的因素包括:

  • 患有神经系统疾病或障碍,比如癫痫、偏头痛或运动障碍
  • 近期有重大压力,或者情感或身体创伤
  • 患有心理健康疾病,如心境障碍或焦虑障碍、分离性障碍或某些人格障碍
  • 家庭成员患有功能性神经障碍
  • 可能在童年遭受过身体或性虐待或忽视的经历

女性比男性更容易患功能性神经障碍。

并发症

功能性神经障碍(尤其未治疗时)的一些症状可能导致明显失能和生活质量不良,类似于医学病状或疾病所致症状。

June 23, 2022
  1. Conversion disorder (functional neurological symptom disorder). In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Oct. 4, 2016.
  2. Stone J, et al. Conversion disorder in adults: Treatment. https://www.uptodate.com/home. Accessed Oct. 4, 2016.
  3. Conversion disorder. Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/conversion-disorder. Accessed Oct. 4, 2016.
  4. Stone J, et al. Conversion disorder in adults: Clinical features, assessment, and comorbidity. https://www.uptodate.com/home. Accessed Oct. 4, 2016.
  5. Stone J, et al. Conversion disorder in adults: Terminology, diagnosis, and differential diagnosis. https://www.uptodate.com/home. Accessed Oct. 4, 2016.
  6. Stone J, et al. Conversion disorder in adults: Epidemiology, pathogenesis, and prognosis. https://www.uptodate.com/home. Accessed Oct. 4, 2016.
  7. Ali S, et al. Conversion disorder — Mind versus body: A review. Innovations in Clinical Neuroscience. 2015;12:27.
  8. Vandenberg JM, et al. The modified gait abnormality rating scale in patients with a conversion disorder: A reliability and responsiveness study. Gait & Posture. 2015;41:125.
  9. Staab JP (expert opinion). Mayo Clinic, Rochester, Minn. March 22, 2017.
  10. Edwards M. Mechanism of functional neurological symptoms. Advances in Clinical Neurosciences and Rehabilitation. http://www.acnr.co.uk/2013/06/mechanism-of-functional-neurological-symptoms/. Accessed Oct. 25, 2016.
  11. Voon V, et al. Functional neuroanatomy and neurophysiology of functional neurological disorders (conversion disorder). Journal of Neuropsychiatry and Clinical Neuroscience. 2016;28:168.
  12. Stone J. Functional neurological symptoms. Journal of the Royal College of Physicians Edinburgh. 2011;41:38.
  13. Stone J. Functional neurological disorders: The neurological assessment as treatment. Practical Neurology. 2016;16:7.
  14. Carson A, et al. Epidemiology. Handbook of Clinical Neurology. 2016;139:47.
  15. Gelauff J, et al. Prognosis of functional neurologic disorders. Handbook of Clinical Neurology. 2016;139:523.
  16. Stone J, et al. Explanation as treatment for functional neurologic disorders. Handbook of Clinical Neurology. 2016;139:543.
  17. Nielsen G. Physical treatment of functional neurologic disorders. Handbook of Clinical Neurology. 2016;139:555.
  18. Goldstein LH, et al. Psychologic treatment of functional neurologic disorders. Handbook of Clinical Neurology. 2016;139:572.
  19. Deeley Q. Hypnosis as therapy for functional neurologic disorders. Handbook of Clinical Neurology. 2016;139:585.

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Associated Procedures

功能性神经障碍/转换障碍