Validity of the clinical examination in the diagnosis of Functional Neurological Symptoms ( Conversion Disorder ) 4 / 2014 PSYCHIATRIE & NEUROLOGIE 20 Deepa
نویسنده
چکیده
1. Historical Perspective 1. 1 Functional Neurological Symptoms: a debated Terminology In medicine it is not rare to encounter patients who have a medical complaint or symptom for which no disease is found, even after thorough examination. This situation is both distressing for the doctor and the patient because the diagnosis of «medically unexplained symptom» is unsatisfactory. If the symptom persists more than 6 months, it is classified as Somatic Symptom Disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) (1)(see Table 1). If the symptom is neurological in nature (sensory or motor), it is classified as Conversion Disorder (Functional Neurological Symptom disorder), regardless of its duration. Because of the peculiar clinical presentation of neurological symptoms, these have been recognized as early as the Greek Antiquity when Hippocrates (460 BC) suggested the term Hysteria (in Greek hyster = uterus). He indeed observed that the symptoms occurred most often in women and linked the causal mechanism to a dysfunctioning wandering uterus. Over the years, several synonyms have then been employed to designate these neurological symptoms: hysterical, conversive, psychogenic, psychosomatic, dissociative or somatoform. This variety of terms, unfortunately, induces confusion in the medical community even though they do refer to the same clinical entity. There is now a need to use a common unified term and experts have recently advocated for the use of the term «functional» (2) as it is descriptive, non judgmental (3) or stigmatizing and is well accepted by the patients (4).
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Differentiating cerebral ischemia from functional neurological symptom disorder: a psychosomatic perspective
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