精神科急诊服务中转换障碍的误诊
The misdiagnosis of conversion disorder in a psychiatric emergency service.
作者信息
Fishbain D A, Goldberg M
机构信息
University of Miami School of Medicine, Florida.
出版信息
Gen Hosp Psychiatry. 1991 May;13(3):177-81. doi: 10.1016/0163-8343(91)90140-r.
During a 1-year period, 8400 patient presentations to a psychiatric emergency service were screened for the conversion symptom of extremity paresis/paralysis. Of 4220 unduplicated presentations, three patients had this complaint. These cases were reviewed and followed up. All had received a DSM-III diagnosis of conversion disorder, but in each case the patient's conversion symptom was attributed to organic disease. This had medicolegal consequences in one case and threatened legal consequences in the others. Although the frequency of this alleged conversion symptom was 0.07%, in reality it was 0.0%. Guidelines for the management of the alleged conversion symptom of paresis/paralysis are discussed.
在为期1年的时间里，对8400例前往精神科急诊服务部门就诊的患者进行了检查，以筛查肢体轻瘫/瘫痪的转换症状。在4220例无重复的就诊病例中，有3例患者有此主诉。对这些病例进行了回顾和随访。所有患者最初都被诊断为符合《精神疾病诊断与统计手册》第三版（DSM-III）标准的转换障碍，但在每例中，患者的转换症状最终都被归因于器质性疾病。其中1例产生了法医学后果，其他病例则面临潜在法律后果。尽管这种所谓的转换症状出现频率为0.07%，但实际上其发生率为0.0%。本文还讨论了针对疑似肢体轻瘫/瘫痪转换症状的处理指南。
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