类似帕金森病的功能性运动障碍:病例报告。

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Journal of Medical Case Reports Pub Date : 2024-10-01 DOI:10.1186/s13256-024-04767-x
Sarah Goudarzzadeh, Shayan Shekarabi, Mahnaz Abdi
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引用次数: 0

摘要

简介功能性神经紊乱挑战了传统医学的认识,它表现出的神经症状无法用器质性病变来解释。本报告深入探讨了心理和生理表现之间错综复杂的相互作用,强调了及时诊断和干预的重要性及其对患者心理健康和生活质量的影响:一名 40 岁的伊朗单身男子因情绪症状加重(包括抑郁、易怒、攻击性、自杀念头以及运动和感官障碍)第三次入院。患者的症状始于心理压力和家庭冲突,导致左手肌肉无力和震颤。一年后,肌无力症状逐渐加重,导致行动迟缓、下肢运动障碍和依靠拐杖行走。患者仍表现出面具样面容、弯腰驼背的走路姿势等症状,但症状会周期性地相对改善。起初,患者被怀疑患有帕金森病,并开始服用左旋多巴和金刚烷胺。然而,由于疗效不理想,而且在频繁的检查和复查中也没有有力的证据证明患者存在神经系统问题,因此停止了用药。尽管多次住院治疗,但患者的症状仍然没有得到缓解。最后,经过多年的调查,根据专家的建议,他住进了精神病房进行诊断评估,并被诊断为功能性神经紊乱(精神性帕金森病)。他接受了药物治疗、电休克治疗和心理治疗。出院时,他的症状得到了部分改善,但在随后的几年里,症状时而复发,时而缓解:本病例研究揭示了功能性神经紊乱的复杂性,强调了综合诊断方法的必要性。包括心理支持在内的及时干预可以减轻症状、降低医疗成本并改善整体预后。该报告有助于精神病学和神经病学对功能性神经障碍性疾病的认识不断发展。报告强调早期识别,提倡采取综合干预措施,包括精神支持、认知行为疗法和患者心理教育。
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Functional movement disorder similar to Parkinson's disease: a case report.

Introduction: Functional neurological disorder challenges conventional medical understanding, presenting neurological symptoms without organic explanations. This report delves into the intricate interplay between psychological and physical manifestations, emphasizing the importance of timely diagnosis and intervention and its impact on a patient's mental health and quality of life.

Case presentation: A 40-year-old single Iranian man was admitted for the third time owing to exacerbation of mood symptoms, including depression, irritability, aggression, suicidal ideation, and movement and sensory problems. The patient's symptoms began with psychological stressors and family conflict, leading to muscle weakness and tremors in the left hand. Over a year, muscle weakness escalated, leading to slow movement, motor impairment in the lower limbs, and reliance on a cane for walking. The patient still exhibited symptoms, such as a mask-like face, stooped walking posture, and a relative improvement of symptoms periodically. At first, the patient was suspected of Parkinson's disease and was placed on levodopa and amantadine. However, the medication was discontinued owing to an unsatisfactory response and the lack of strong evidence in favor of neurological problems on frequent examinations and reviews. Despite multiple hospitalizations, the patient's symptoms remained unresolved. Finally, after years of investigations, based on specialists' recommendations, he was admitted to the psychosomatic ward for diagnostic evaluationele, and he was diagnosed with functional neurological disorder (psychogenic parkinsonism). He underwent pharmacotherapy, electroconvulsive therapy, and psychotherapy. He was discharged with partial improvement of symptoms, but showed periods of relapse and remission during the following years.

Conclusion: This case study illuminates functional neurological disorder complexities, emphasizing the need for a holistic diagnostic approach. Timely interventions, including psychological support, can alleviate symptoms, reduce healthcare costs, and improve the overall prognosis. The report contributes to evolving functional neurological disorder understanding in psychiatry and neurology. The report underscores early recognition, advocating for comprehensive interventions involving psychiatric support, cognitive-behavioral therapy, and patient psychoeducation.

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来源期刊
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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