精神科との境界領域について:機能性神経障害を中心に

日本の神経学は諸外国と異なり精神神経学の精神科と神経科への分離から出発したのではなく,それが現在の脳神経内科のあり方に陰を落としている.機能性神経障害(functional neurological disorders,以下FNDと略記,ヒステリー)は脳神経内科と精神科をまさに繋ぐ疾患だが,古代から存在し,神経学の源流ともなったcommon diseaseである.FNDの診断は,除外診断によって行うのではなく,精神科的原因・心理学的特徴から診断するのでもなく,神経症候そのもの(=FNDの陽性徴候)を元に,検査は最低限としてなるべく早期に積極診断すべきである.この考えは最新の精神科の疾病分類DS...

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Published in臨床神経学 Vol. 63; no. 3; pp. 135 - 144
Main Author 園生, 雅弘
Format Journal Article
LanguageJapanese
Published 日本神経学会 2023
Subjects
Online AccessGet full text
ISSN0009-918X
1882-0654
DOI10.5692/clinicalneurol.cn-001817

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Abstract 日本の神経学は諸外国と異なり精神神経学の精神科と神経科への分離から出発したのではなく,それが現在の脳神経内科のあり方に陰を落としている.機能性神経障害(functional neurological disorders,以下FNDと略記,ヒステリー)は脳神経内科と精神科をまさに繋ぐ疾患だが,古代から存在し,神経学の源流ともなったcommon diseaseである.FNDの診断は,除外診断によって行うのではなく,精神科的原因・心理学的特徴から診断するのでもなく,神経症候そのもの(=FNDの陽性徴候)を元に,検査は最低限としてなるべく早期に積極診断すべきである.この考えは最新の精神科の疾病分類DSM-5においても支持された.様々な陽性徴候が記載されている.脳神経内科医の診療そのものが治療ともなる.
AbstractList 日本の神経学は諸外国と異なり精神神経学の精神科と神経科への分離から出発したのではなく,それが現在の脳神経内科のあり方に陰を落としている.機能性神経障害(functional neurological disorders,以下FNDと略記,ヒステリー)は脳神経内科と精神科をまさに繋ぐ疾患だが,古代から存在し,神経学の源流ともなったcommon diseaseである.FNDの診断は,除外診断によって行うのではなく,精神科的原因・心理学的特徴から診断するのでもなく,神経症候そのもの(=FNDの陽性徴候)を元に,検査は最低限としてなるべく早期に積極診断すべきである.この考えは最新の精神科の疾病分類DSM-5においても支持された.様々な陽性徴候が記載されている.脳神経内科医の診療そのものが治療ともなる.
Author 園生, 雅弘
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References 22) Stone J, LaFrance WC Jr, Brown R, et al. Conversion disorder: current problems and potential solutions for DSM-5. J Psychosom Res 2011;71:369-376.
3) Stone J, Carson A, Sharpe M. Wall between neurology and psychiatry. Some parts of the wall are thicker than others. BMJ 2002;325:778.
59) Fasano A, Valadas A, Bhatia KP, et al. Psychogenic facial ‍movement disorders: clinical features and associated conditions. Mov Disord 2012;27:1544-1551.
16) American Psychiatric Association: Diagnostic and statistical manual of mental disorders, 5th edition (DSM 5TM). Arlington, Virginia: American Psychiatric Press Inc; 2013.
17) Stone J. Functional neurological disorders: the neurological assessment as treatment. Neurophysiol Clin 2014;44:363-373.
2) Baker MG, Kale R, Menken M. The wall between neurology and psychiatry. BMJ 2002;324:1468-1469.
48) Keane JR. Wrong-way deviation of the tongue with hysterical hemiparesis. Neurology 1986;36:1406-1407.
1) Koehler PJ. Freud’s comparative study of hysterical and organic paralyses: how Charcot’s assignment turned out. Arch Neurol 2003;60:1646-1650.
9) 園生雅弘.ヒステリー患者の神経症状と診察.神経内科 2017;87:307-311.
36) Roos DB, Owens JC. Thoracic outlet syndrome. Arch Surg 1966;93:71-74.
44) Schwingenschuh P, Deuschl G. Functional tremor. Handb Clin Neurol 2016;139:229-233.
25) Hallett M. Physiology of psychogenic movement disorders. J Clin Neurosci 2010;17:959-965.
51) Tinazzi M, Simonetto S, Franco L, et al. Abduction finger sign: a new sign to detect unilateral functional paralysis of the upper limb. Mov Disord 2008;23:2415-2419.
60) Rolak LA. Psychogenic sensory loss. J Nerv Ment Dis 1988;176:686-687.
33) Magee KR. Hysterical hemiplegia and hemianesthesia. Postgrad Med 1962;31:339-345.
45) Baker JH, Silver JR. Hysterical paraplegia. J Neurol Neurosurg Psychiatry 1987;50:375-382.
54) Keane JR. Hysterical gait disorders: 60 cases. Neurology 1989;39:586-589.
23) Slater E. Diagnosis of “Hysteria”. Br Med J 1965;1:1395-1399.
40) 園生雅弘.MMT・針筋電図ガイドブック.東京:中外医学社;2018.
58) Schrag A, Trimble M, Quinn N, et al. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 2004;127:2360-2372.
34) Archibald KC, Wiechec F. A reappraisal of Hoover’s test. Arch Phys Med Rehabil 1970;51:234-238.
14) 園生雅弘.機能性筋力低下の電気診断.臨床神経生理 2022;50:482-486.
18) Stone J, Carson A, Duncan R, et al. Who is referred to neurology clinics?—the diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010;112:747-751.
43) Chen CS, Lee AW, Karagiannis A, et al. Practical clinical approaches to functional visual loss. J Clin Neurosci 2007;14:1-7.
53) 園生雅弘.脊椎脊髄の冠名徴候・症候群 Raimiste徴候,Str mpell徴候.脊椎脊髄ジャーナル 2015;28:264-265.
55) Okun MS, Rodriguez RL, Foote KD, et al. The “chair test” to aid in the diagnosis of psychogenic gait disorders. Neurologist 2007;13:87-91.
12) 園生雅弘.機能性神経障害(ヒステリー).Peripheral Nerve 2021;32:190-198.
32) 園生雅弘.脊椎脊髄の冠名徴候・症候群 Babinski屈股現象,Hoover徴候,Sonoo外転試験.脊椎脊髄ジャーナル 2015;28:328-334.
26) Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures?. J Neurol Neurosurg Psychiatry 2010;81:719-725.
52) Raimiste J. Deux signes d’hemiplegie organique du membre inferieur. Rev Neurol 1909;17:125-129.
24) Stone J, Carson A, Duncan R, et al. Symptoms ‘unexplained by organic disease’ in 1144 new neurology out-patients: how often does the diagnosis change at follow-up?. Brain 2009;132:2878-2888.
39) Sonoo M. Paradoxical wrist flexion: a new test to detect functional weakness of the upper limb. eNeurologicalSci 2020;22:100302.
15) Weintraub MI. Hysterical conversion reactions: a clinical guide to diagnosis and treatment. Jamaica: Spectrum Publications; 1983.
41) Lempert T, Brandt T, Dieterich M, et al. How to identify psychogenic disorders of stance and gait. A video study in 37 patients. J Neurol 1991;238:140-146.
50) Sethi NK, Sethi PK, Torgovnick J. Supine catch sign—a simple clinical test to differentiate between true and false (pseudo) radial nerve palsy. Clin Neurol Neurosurg 2010;112:441-442.
56) Baik JS, Lang AE. Gait abnormalities in psychogenic movement disorders. Mov Disord 2007;22:395-399.
47) Yugué I, Shiba K, Ueta T, et al. A new clinical evaluation for hysterical paralysis. Spine 2004;29:1910-1913.
20) Hallett M. Quantifying and understanding deficits in nonorganic neuromuscular and movement disorders. In: American Association of Neuromuscular & Electrodiagnostic Medicine editor. Pleanary II: How do we measure up? Quantitation in EDX and Clinical Practice. Rochester: American Association of Neuromuscular & Electrodiagnostic Medicine; 2012. p. ‍15-19.
8) 園生雅弘.ヒステリー(転換性障害)の神経学.Brain Nerve 2014;66:863-871.
30) Sonoo M. Abductor sign: a new reliable sign to detect unilateral nonorganic paresis of the lower limb. J Neurol Neurosurg Psychiatry 2004;75:121-125.
49) Horn D, Galli S, Berney A, et al. Testing head rotation and flexion is useful in functional limb weakness. Mov Disord Clin Pract 2017;4:597-602.
38) 曽我恭一.胸郭出口症候群.臨床整形外科 1989;24:1429-1433.
28) Daum C, Hubschmid M, Aybek S. The value of ‘positive’ clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry 2014;85:180-190.
29) Hoover CF. A new sign for the detection of malingering and functional paresis of the lower extremities. JAMA 1908;51:746-747.
35) Ziv I, Djaldetti R, Zoldan Y, et al. Diagnosis of “non-organic” limb paresis by a novel objective motor assessment: the quantitative Hoover’s test. J Neurol 1998;245:797-802.
10) 園生雅弘.ヒステリー性筋力低下(機能性筋力低下)の診断.脊椎脊髄ジャーナル 2020;33:183-189.
11) 園生雅弘.機能性神経障害(機能性神経症状症;ヒステリー).園生雅弘,北川一夫,青木正志編.脳神経疾患最新の治療2021-2023.東京:南江堂;2021. p. 304-306.
21) Hallett M. Functional (psychogenic) movement disorders—Clinical presentations. Parkinsonism Relat Disord 2016;22:S149-S152.
31) Adams RD, Victor M. Principle of Neurology. 4th ed. New York: McGraw-Hill; 1989. p. 52.
46) Wilson SAK. The approach to the study of hysteria. J Neurol Psychopath 1931;11:193-206.
37) 立石昭夫.胸郭出口症候群の診断と治療.日本整形外科学会雑誌 1980;54:817-827.
57) Zeuner KE, Shoge RO, Goldstein SR, et al. Accelerometry to distinguish psychogenic from essential or parkinsonian tremor. Neurology 2003;61:548-550.
42) Stone J, Vermeulen M. Functional sensory symptoms. Handb Clin Neurol 2016;139:271-281.
19) Babinski J.萬年甫訳.器質性片麻痺とヒステリー性片麻痺の鑑別診断:1900年.神経進歩 1967;11:664-674.
5) 葛原茂樹.日本經學會創立(1902)から116年:歴史に学び教訓を未来に活かす.臨床神経 2020;60:1-19.
27) Devinsky O, Gazzola D, LaFrance WC Jr. Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol 2011;7:210-220.
61) Bowlus WE, Currier RD. A test for hysterical hemianalgesia. N ‍Engl J Med 1963;269:1253-1254.
4) 高橋昭.日本神経学会 誕生と発展.臨床神経 2009;49:724-730.
6) 日本神経学会神経内科専門医課題検討委員会.日本神経学会神経内科専門医課題検討委員会答申書概要[Internet].東京:日本神経学会;2017 Jul 15. [cited 2022 Dec 11]. Available from https://www.kktcs.co.jp/jsnmypage/ProxyServlet/toshin/gaiyo.html(神経学会会員限定サイト)
7) 園生雅弘.器質性麻痺と心因性麻痺の鑑別診断:運動麻痺の鑑別診断.脊椎脊髄ジャーナル 2006;19:1037-1045.
13) 園生雅弘.脳神経内科医から見た機能性神経障害(転換性障害).臨床精神医学 2022;51:519-524.
References_xml – reference: 42) Stone J, Vermeulen M. Functional sensory symptoms. Handb Clin Neurol 2016;139:271-281.
– reference: 50) Sethi NK, Sethi PK, Torgovnick J. Supine catch sign—a simple clinical test to differentiate between true and false (pseudo) radial nerve palsy. Clin Neurol Neurosurg 2010;112:441-442.
– reference: 10) 園生雅弘.ヒステリー性筋力低下(機能性筋力低下)の診断.脊椎脊髄ジャーナル 2020;33:183-189.
– reference: 24) Stone J, Carson A, Duncan R, et al. Symptoms ‘unexplained by organic disease’ in 1144 new neurology out-patients: how often does the diagnosis change at follow-up?. Brain 2009;132:2878-2888.
– reference: 44) Schwingenschuh P, Deuschl G. Functional tremor. Handb Clin Neurol 2016;139:229-233.
– reference: 52) Raimiste J. Deux signes d’hemiplegie organique du membre inferieur. Rev Neurol 1909;17:125-129.
– reference: 1) Koehler PJ. Freud’s comparative study of hysterical and organic paralyses: how Charcot’s assignment turned out. Arch Neurol 2003;60:1646-1650.
– reference: 11) 園生雅弘.機能性神経障害(機能性神経症状症;ヒステリー).園生雅弘,北川一夫,青木正志編.脳神経疾患最新の治療2021-2023.東京:南江堂;2021. p. 304-306.
– reference: 3) Stone J, Carson A, Sharpe M. Wall between neurology and psychiatry. Some parts of the wall are thicker than others. BMJ 2002;325:778.
– reference: 6) 日本神経学会神経内科専門医課題検討委員会.日本神経学会神経内科専門医課題検討委員会答申書概要[Internet].東京:日本神経学会;2017 Jul 15. [cited 2022 Dec 11]. Available from https://www.kktcs.co.jp/jsnmypage/ProxyServlet/toshin/gaiyo.html(神経学会会員限定サイト).
– reference: 51) Tinazzi M, Simonetto S, Franco L, et al. Abduction finger sign: a new sign to detect unilateral functional paralysis of the upper limb. Mov Disord 2008;23:2415-2419.
– reference: 12) 園生雅弘.機能性神経障害(ヒステリー).Peripheral Nerve 2021;32:190-198.
– reference: 36) Roos DB, Owens JC. Thoracic outlet syndrome. Arch Surg 1966;93:71-74.
– reference: 26) Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures?. J Neurol Neurosurg Psychiatry 2010;81:719-725.
– reference: 16) American Psychiatric Association: Diagnostic and statistical manual of mental disorders, 5th edition (DSM 5TM). Arlington, Virginia: American Psychiatric Press Inc; 2013.
– reference: 21) Hallett M. Functional (psychogenic) movement disorders—Clinical presentations. Parkinsonism Relat Disord 2016;22:S149-S152.
– reference: 54) Keane JR. Hysterical gait disorders: 60 cases. Neurology 1989;39:586-589.
– reference: 46) Wilson SAK. The approach to the study of hysteria. J Neurol Psychopath 1931;11:193-206.
– reference: 47) Yugué I, Shiba K, Ueta T, et al. A new clinical evaluation for hysterical paralysis. Spine 2004;29:1910-1913.
– reference: 59) Fasano A, Valadas A, Bhatia KP, et al. Psychogenic facial ‍movement disorders: clinical features and associated conditions. Mov Disord 2012;27:1544-1551.
– reference: 25) Hallett M. Physiology of psychogenic movement disorders. J Clin Neurosci 2010;17:959-965.
– reference: 28) Daum C, Hubschmid M, Aybek S. The value of ‘positive’ clinical signs for weakness, sensory and gait disorders in conversion disorder: a systematic and narrative review. J Neurol Neurosurg Psychiatry 2014;85:180-190.
– reference: 31) Adams RD, Victor M. Principle of Neurology. 4th ed. New York: McGraw-Hill; 1989. p. 52.
– reference: 13) 園生雅弘.脳神経内科医から見た機能性神経障害(転換性障害).臨床精神医学 2022;51:519-524.
– reference: 60) Rolak LA. Psychogenic sensory loss. J Nerv Ment Dis 1988;176:686-687.
– reference: 20) Hallett M. Quantifying and understanding deficits in nonorganic neuromuscular and movement disorders. In: American Association of Neuromuscular & Electrodiagnostic Medicine editor. Pleanary II: How do we measure up? Quantitation in EDX and Clinical Practice. Rochester: American Association of Neuromuscular & Electrodiagnostic Medicine; 2012. p. ‍15-19.
– reference: 38) 曽我恭一.胸郭出口症候群.臨床整形外科 1989;24:1429-1433.
– reference: 22) Stone J, LaFrance WC Jr, Brown R, et al. Conversion disorder: current problems and potential solutions for DSM-5. J Psychosom Res 2011;71:369-376.
– reference: 23) Slater E. Diagnosis of “Hysteria”. Br Med J 1965;1:1395-1399.
– reference: 29) Hoover CF. A new sign for the detection of malingering and functional paresis of the lower extremities. JAMA 1908;51:746-747.
– reference: 53) 園生雅弘.脊椎脊髄の冠名徴候・症候群 Raimiste徴候,Str mpell徴候.脊椎脊髄ジャーナル 2015;28:264-265.
– reference: 61) Bowlus WE, Currier RD. A test for hysterical hemianalgesia. N ‍Engl J Med 1963;269:1253-1254.
– reference: 33) Magee KR. Hysterical hemiplegia and hemianesthesia. Postgrad Med 1962;31:339-345.
– reference: 2) Baker MG, Kale R, Menken M. The wall between neurology and psychiatry. BMJ 2002;324:1468-1469.
– reference: 49) Horn D, Galli S, Berney A, et al. Testing head rotation and flexion is useful in functional limb weakness. Mov Disord Clin Pract 2017;4:597-602.
– reference: 58) Schrag A, Trimble M, Quinn N, et al. The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 2004;127:2360-2372.
– reference: 40) 園生雅弘.MMT・針筋電図ガイドブック.東京:中外医学社;2018.
– reference: 18) Stone J, Carson A, Duncan R, et al. Who is referred to neurology clinics?—the diagnoses made in 3781 new patients. Clin Neurol Neurosurg 2010;112:747-751.
– reference: 14) 園生雅弘.機能性筋力低下の電気診断.臨床神経生理 2022;50:482-486.
– reference: 17) Stone J. Functional neurological disorders: the neurological assessment as treatment. Neurophysiol Clin 2014;44:363-373.
– reference: 30) Sonoo M. Abductor sign: a new reliable sign to detect unilateral nonorganic paresis of the lower limb. J Neurol Neurosurg Psychiatry 2004;75:121-125.
– reference: 5) 葛原茂樹.日本經學會創立(1902)から116年:歴史に学び教訓を未来に活かす.臨床神経 2020;60:1-19.
– reference: 56) Baik JS, Lang AE. Gait abnormalities in psychogenic movement disorders. Mov Disord 2007;22:395-399.
– reference: 45) Baker JH, Silver JR. Hysterical paraplegia. J Neurol Neurosurg Psychiatry 1987;50:375-382.
– reference: 15) Weintraub MI. Hysterical conversion reactions: a clinical guide to diagnosis and treatment. Jamaica: Spectrum Publications; 1983.
– reference: 19) Babinski J.萬年甫訳.器質性片麻痺とヒステリー性片麻痺の鑑別診断:1900年.神経進歩 1967;11:664-674.
– reference: 55) Okun MS, Rodriguez RL, Foote KD, et al. The “chair test” to aid in the diagnosis of psychogenic gait disorders. Neurologist 2007;13:87-91.
– reference: 37) 立石昭夫.胸郭出口症候群の診断と治療.日本整形外科学会雑誌 1980;54:817-827.
– reference: 8) 園生雅弘.ヒステリー(転換性障害)の神経学.Brain Nerve 2014;66:863-871.
– reference: 4) 高橋昭.日本神経学会 誕生と発展.臨床神経 2009;49:724-730.
– reference: 57) Zeuner KE, Shoge RO, Goldstein SR, et al. Accelerometry to distinguish psychogenic from essential or parkinsonian tremor. Neurology 2003;61:548-550.
– reference: 27) Devinsky O, Gazzola D, LaFrance WC Jr. Differentiating between nonepileptic and epileptic seizures. Nat Rev Neurol 2011;7:210-220.
– reference: 34) Archibald KC, Wiechec F. A reappraisal of Hoover’s test. Arch Phys Med Rehabil 1970;51:234-238.
– reference: 41) Lempert T, Brandt T, Dieterich M, et al. How to identify psychogenic disorders of stance and gait. A video study in 37 patients. J Neurol 1991;238:140-146.
– reference: 43) Chen CS, Lee AW, Karagiannis A, et al. Practical clinical approaches to functional visual loss. J Clin Neurosci 2007;14:1-7.
– reference: 39) Sonoo M. Paradoxical wrist flexion: a new test to detect functional weakness of the upper limb. eNeurologicalSci 2020;22:100302.
– reference: 48) Keane JR. Wrong-way deviation of the tongue with hysterical hemiparesis. Neurology 1986;36:1406-1407.
– reference: 35) Ziv I, Djaldetti R, Zoldan Y, et al. Diagnosis of “non-organic” limb paresis by a novel objective motor assessment: the quantitative Hoover’s test. J Neurol 1998;245:797-802.
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Snippet 日本の神経学は諸外国と異なり精神神経学の精神科と神経科への分離から出発したのではなく,それが現在の脳神経内科のあり方に陰を落としている.機能性神経障...
SourceID jstage
SourceType Publisher
StartPage 135
SubjectTerms ヒステリー
機能性神経障害
機能性筋力低下
認知行動療法
陽性徴候
Title 精神科との境界領域について:機能性神経障害を中心に
URI https://www.jstage.jst.go.jp/article/clinicalneurol/63/3/63_cn-001817/_article/-char/ja
Volume 63
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