内囊前肢毁损术治疗妄想性障碍1例  

Lesioning to the forelimb axons of the internal capsule under guidance of stereotactic techniques for delusional disorder:a case report

作　　者：姜志锋 段蕾梅 黄鑫 任永英 许建强 JIANG Zhi-feng;DUAN Lei-mei;HUANG Xin;REN Yong-ying;XU Jian-qiang(Department of Neurosurgery,North China Medical and Health Group Fengfeng General Hospital,Handan 056200,China;Department of Neurosurgery,Handan Hospital of Integrated Traditional Chinese Medicine and Western Medicine,Handan 056005,China;Mental Health Center,North China Medical and Health Group Fengfeng General Hospital,Handan 056200,China)

机构地区：[1]华北医疗健康集团峰峰总医院神经外科,河北邯郸056200 [2]华北医疗健康集团峰峰总医院精神卫生中心,河北邯郸056200 [3]邯郸市中西医结合医院功能神经外科,河北056005

出　　处：《中国临床神经外科杂志》2024年第1期63-64,共2页Chinese Journal of Clinical Neurosurgery

基　　金：邯郸市科学技术研究与发展计划项目(19422083012-3)。

摘　　要：妄想性障碍临床相对少见。在妄想症状的影响下,病人常不认为自己有病,因此治疗依从性较差,成为临床治疗的难点。本文报道1例18年病史的34岁男性妄想性障碍,曾多次就诊于外院精神科,曾口服帕罗西汀、富马酸喹硫平、氯硝西泮等药物,均以“病人认为药物不对症、有副作用”等原因不能坚持服药,症状持续无缓解,社会功能严重受损致中学辍学,长期由家人照看。就诊我院后,经取得病人家属充分知情同意,行双侧内囊前肢毁损术,病人妄想、强迫症状完全消失,焦虑情绪及睡眠明显改善。Delusional disorder(DD)is relatively uncommon in clinic.Due to the influence of delusional symptoms,patients with DD often lack insight into their illness,resulting in poor treatment adherence and posing a challenge for clinicians.This paper presented a 34-year-old male patient with an 18-year history of DD.He has received multiple treatments at other psychiatric hospitals,including oral administration of paroxetine,quetiapine fumarate,clozapine,and other medications.However,he was unable to maintain medication compliance due to his belief that the drugs were ineffective for his symptoms and caused side effects.As a result,his symptoms persisted without relief and severely impaired his social functioning;consequently,he dropped out of middle school and relied on family care for long time.After admission to our hospital,we performed lesioning to the forelimb axons of the internal capsule under guidance of stereotactic techniques on the patient after obtaining full informed consent from the patient's family.The patient's delusions and obsessive-compulsive symptoms completely disappeared while experiencing significant improvements in anxiety levels and sleep quality after the operation.

关 键 词：妄想性障碍 立体定向技术 内囊前肢毁损术 

分 类 号：R749.8[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]