Abstract:
Conversion disorder-called functional neurological symptom disorder in the DSM-5-has roots that trace back to antiquity. The term conversion, originating from psychoanalysis, signifies the appearance of physical symptoms as an effort to resolve or convey unconscious and distressing intrapsychic conflicts- \"converting\" them from manifesting in the mind to manifesting in the body. Despite efforts made in elucidating the neurobiological etiologies of functional neurological symptom disorder, a psychodynamic lens remains indispensable in understanding the patient. This article presents two patients who developed functional neurological symptom disorder, one after a COVID-19 vaccination and one in the context of long COVID. A discussion follows on the intrapersonal, interpersonal, and systemic etiological factors that predispose, precipitate, and perpetuate COVID-related functional neurological symptom disorder. We elaborate on psychodynamic psychological processes and conflicts that may unfold between patients with COVID-related functional neurological symptom disorder and their health care providers. We also share suggestions on how a consultation-liaison psychiatry team may offer support to the primary treating team to facilitate a therapeutic space within which patients with COVID-related functional neurological symptom disorder may recover.
摘要:
转换障碍-在DSM-5中称为功能性神经症状障碍-的根源可以追溯到古代。术语转换,源于精神分析,表示身体症状的出现是为了解决或传达无意识和令人痛苦的内在心理冲突-“将它们从表现在头脑中转变为表现在身体中。尽管努力阐明功能性神经症状障碍的神经生物学病因,心理动力学透镜在理解病人方面仍然是不可或缺的。本文介绍了两名出现功能性神经症状障碍的患者,一次是在COVID-19疫苗接种后,一次是在长期COVID的背景下。接下来是关于内部人的讨论,人际关系,和易感的全身病因,沉淀,并延续COVID相关的功能性神经症状障碍。我们详细阐述了与COVID相关的功能性神经症状障碍患者与其医疗保健提供者之间可能发生的心理动力学心理过程和冲突。我们还分享了有关咨询-联络精神病学团队如何为主要治疗团队提供支持的建议,以促进治疗空间,使患有COVID相关功能性神经症状障碍的患者可以康复。