伴强迫症状的精神分裂症误诊原因分析  

Analysis of the Causes of Misdiagnosis of Schizophrenia with Obsessive-compulsive Symptoms

作　　者：高明秀 庄宁 王瑞超 付华斌 赵会懂 GAO Mingxiu;ZHUANG Ning;WANG Ruichao;FU Huabin;ZHAO Huidong(Department of Psychiatry,the 980th Hospital of Joint Logistic Support Force of the PLA,Shijiazhuang 050082,China;Department of Medical Information Data,the 980th Hospital of Joint Logistic Support Force of the PLA,Shijiazhuang 050082,China)

机构地区：[1]中国人民解放军联勤保障部队第九八〇医院精神心理科,石家庄050082 [2]中国人民解放军联勤保障部队第九八〇医院医学信息数据室,石家庄050082

出　　处：《临床误诊误治》2024年第13期19-22,34,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨伴强迫症状的精神分裂症的临床特点及误诊原因。方法回顾性分析2021年1月至2023年1月伴强迫症状的精神分裂症4例的临床资料。结果4例以强迫症状为主诉,病史10个月~9年,均以强迫为首发症状,均误诊为强迫障碍。2例为继发性强迫,属于精神病性症状的延续症状,2例为原发性强迫。误诊时间10个月~9年。依据国际疾病分类第十一次修订本相关标准修正诊断为精神分裂症,1例给予抗精神病及抗抑郁治疗,3例经抗精神病药物配合多参数无抽搐电休克治疗,2~3个月后好转,阳性精神病性症状及强迫症状基本消失,残存部分阴性症状。结论伴强迫症状的精神分裂症病情复杂、社会功能差、认知功能损害严重,误诊率高,预后较差。Objective To investigate the clinical characteristics and causes of misdiagnosis of schizophrenia with obsessive-compulsive symptoms.Methods The clinical data of 4 patients with schizophrenia complicated with obsessive-compulsive symptoms admitted from January 2021 to January 2023 were retrospectively analyzed.Results Four patients presented with obsessive-compulsive symptoms as the main complaint,with a history of 10 months to 9 years,and obsessive-compulsive symptoms as the initial symptom.All were misdiagnosed as obsessive-compulsive disorder.Among them,2 patients had secondary compulsion,which was a continuation of psychotic symptoms,and 2 patients had primary compulsion.The misdiagnosis lasted from 10 months to 9 years.According to the relevant criteria of the 11th revision of the International Classification of Diseases(ICD-11),the diagnosis of schizophrenia was revised.One case was given antipsychotic and antidepressant treatment,and 3 patients were treated with antipsychotic drugs combined with multi-parameter non-convulsive electroconvulsive therapy.After 2 to 3 months,the positive psychotic symptoms and compulsive symptoms basically disappeared,and some negative symptoms remained.Conclusion Schizophrenia with obsessive-compulsive symptoms is complex,with poor social function,severe cognitive impairment,high misdiagnosis rate,and poor prognosis.

关 键 词：伴强迫症状的精神分裂症 误诊 强迫障碍 强迫观念行为 反强迫 精神病性症状 治疗 预后 

分 类 号：R749.3[医药卫生—神经病学与精神病学]