躯体疾病误诊为癔症的临床分析  

A Clinical Analysis of Somatic Diseases Misdiagnosed as Hysteria

作　　者：蔡占魁 阎同军 陈方斌 汪莉 丁松柏 欧阳晖 CAI Zhan-kui;YAN Tong-jun;CHEN Fang-bin;WANG Li;DING Song-bai;OUYANG Hui(Department of Psychiatry,the 904th Hospital of PLA Joint Logistics Support Forces,Changzhou,Jiangsu 213003,China)

机构地区：[1]解放军联勤保障部队第九〇四医院精神科,江苏常州213003

出　　处：《临床误诊误治》2022年第4期13-16,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨躯体疾病误诊为癔症的原因,并总结防范误诊措施。方法回顾性分析2007年5月—2020年6月收治4例躯体疾病误诊为癔症的临床资料。结果4例均有前期心理刺激因素,伴有精神症状,因早期躯体疾病症状不典型,误诊为癔症。入院后经连续观察病情变化,结合各项检查,确诊为病毒性脑炎、抗N-甲基-D-天冬氨酸(NMDA)受体脑炎、Guillain-Barre综合征、脊髓亚急性联合变性各1例。3例转入神经内科并给予相应治疗后痊愈出院,1例抗NMDA受体脑炎转外院治疗。结论癔症诊断要慎重,需全面询问病史、严格体格检查、动态观察病情变化,以及行必要的专科检查,以避免误诊。Objective To explore causes of somatic diseases misdiagnosis as hysteria and to summarize the preventive measures.Methods Clinical data of 4 patients with somatic diseases misdiagnosed as having hysteria between May 2007 and June 2020 was retrospectively analyzed.Results All the 4 patients had early psychological stimulation factors accompanied by psychiatric symptoms,while their early symptoms of somatic diseases were atypical.Thus they were misdiagnosed as having hysteria.After admission,the diagnosis of viral encephalitis was confirmed in 1 patient,anti-N-methyl-D-aspartate(NMDA)receptor encephalitis in 1 patient,Guillain-Barre syndrome in 1 patient and subacute combined degeneration of spinal cord in 1 patient by continuous observations on condition changes combined with examination results.Among the 4 patients,except for 1 patient with anti-NMDA receptor encephalitis who was transferred to another hospital for treatment,the other 3 patients were transferred to the department of neurology,recovered after relevant treatments,and discharged eventually.Conclusion Hysteria should be carefully diagnosed.It is necessary to inquire relevant medical history comprehensively,perform physical examinations carefully,observe the changes of conditions dynamically and complete specific examinations so as to avoid misdiagnosis.

关 键 词：癔症 误诊 GUILLAIN-BARRE综合征 脊髓亚急性联合变性 脑炎 病毒性 抗NMDA受体脑炎 

分 类 号：R749.73[医药卫生—神经病学与精神病学]