Cassady Joslyn D, Kirschke David L, Jones Timothy F, Craig Allen S, Bermudez Ovidio B, Schaffner William
Epidemiology Program Office, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
J Am Acad Child Adolesc Psychiatry. 2005 Mar;44(3):291-7. doi: 10.1097/00004583-200503000-00014.
Outbreak investigations are challenging in a cross-cultural context, and outbreaks of psychiatric disease are rare in any community. We investigated a cluster of unexplained debilitating illness among Amish girls.
We reviewed the medical records of cases, consulted with health care providers, performed active case finding, administered open-ended and structured interviews, and met with Amish community members. A case-patient was defined as a resident of the county who was bedridden for more than 3 weeks with otherwise unexplained systemic weakness and anorexia from January 2000 to February 2002.
Five case-patients were identified. All were Amish girls aged 9 to 13 years. All five had debilitating voluntary motor deficits, anorexia, and weight loss. Four experienced neck weakness with inability to hold up their heads. Thorough medical evaluations failed to identify an organic etiology. All five patients met the diagnostic criteria for conversion disorder. Substantial social conflict within the Amish community preceded illness onset. Family behavioral interventions were recommended. Three months after the investigation, four of five patients demonstrated some improvement.
Clinicians should be aware of the potential for outbreaks of psychogenic illness and work to address the challenges of developing effective intervention strategies, particularly in the cross-cultural context.
在跨文化背景下进行疫情调查具有挑战性，而且精神疾病疫情在任何社区都很罕见。我们调查了一群阿米什女孩中出现的一系列不明原因的衰弱性疾病。
我们查阅了病例的医疗记录，咨询了医疗服务提供者，开展了主动病例搜索，进行了开放式和结构化访谈，并与阿米什社区成员会面。病例患者定义为2000年1月至2002年2月期间该县的居民，这些居民因不明原因的全身无力和厌食而卧床超过3周。
确定了5例病例患者。均为9至13岁的阿米什女孩。所有5例均有衰弱性随意运动功能障碍、厌食和体重减轻。4例出现颈部无力，无法抬头。全面的医学评估未能确定器质性病因。所有5例患者均符合转换障碍的诊断标准。阿米什社区内严重的社会冲突先于疾病发作。建议采取家庭行为干预措施。调查3个月后，5例患者中有4例有了一些改善。
临床医生应意识到心因性疾病爆发的可能性，并努力应对制定有效干预策略所面临的挑战，尤其是在跨文化背景下。
