Schuster J-P, Mouchabac S, Le Strat Y, Limosin F
Service universitaire de psychiatrie, hôpital Corentin-Celton, assistance publique-hôpitaux de Paris, université Paris Descartes, France.
Encephale. 2011 Oct;37(5):339-44. doi: 10.1016/j.encep.2010.12.006. Epub 2011 Feb 2.
Conversion disorders comprise many clinical pictures, including hysterical mutism. Hysterical mutism has emerged as a clinical entity that remains difficult to diagnose, and whose treatment is poorly codified. Hysterical mutism is a disorder of the vocal function without changing the integrity of the body, resulting in loss of voice. Identified at all times, hysterical mutism entered the medical field in the late nineteenth century, under the direction of Jean-Martin Charcot (Salpêtrière School). Since then, although the disorder has emerged as a clinical entity, it remains little known.
A systematic review of the literature. We performed electronic literatures search of relevant studies using Medline, SUDOC, and BIUM. Search terms used were mutism, functional aphonia, conversion disorder, hysteria.
The epidemiology of hysterical mutism is difficult to assess. The first limitation is the lack of consensensual diagnostic criteria. An estimate of its frequency may be advanced through registries consultation of otolaryngology-head and neck surgery. Through a literature review, emerges a rare disorder, about 5% of functional dysphonia. The sex-ratio is in favour of women. Regarding age of onset of disorder, functional aphonia mainly concerns adults with an average around the age of 30-40 years. The onset of the disorder typically involves a sudden onset and a recent stressful event. The duration of the disorder is difficult to specify. It appears that this dysfunction is rapidly reversible and that the majority of patients are in remission of this disorder within three months. The recurrence of dysfunction seems to be frequent. The existence of psychiatric comorbidity did not appear to be the rule. The natural history of this disorder is not known making it tricky to evaluate the efficiency of therapeutic approaches.
Today the term hysterical mutism does not appear as an entity in either international classification. It belongs to the category of conversion disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Identified as a medical entity described by the school of the Salpêtrière, this disorder has raised little interest. The medicalization of the condition remains difficult because of the importance of stigma associated with it, which contributes to the rejection rather than support of patients with mutism. To better understand this disorder and improve the care of patients who suffer, renewed interest is warranted.
转换障碍包含多种临床表现，其中包括癔症性缄默。癔症性缄默已成为一种难以诊断且治疗方法缺乏规范的临床病症。癔症性缄默是一种不改变身体完整性的发声功能障碍，导致失音。癔症性缄默在19世纪末由让 - 马丁·夏科（萨尔佩特里埃学派）引入医学领域，此后一直存在，但鲜为人知。
对文献进行系统综述。我们使用Medline、SUDOC和BIUM对相关研究进行电子文献检索。使用的检索词为缄默、功能性失音、转换障碍、癔症。
癔症性缄默的流行病学情况难以评估。首要限制在于缺乏共识性的诊断标准。可通过耳鼻喉 - 头颈外科登记处咨询来预估其发病率。通过文献综述发现，这是一种罕见病症，约占功能性发声障碍的5%。男女比例倾向于女性。关于发病年龄，功能性失音主要涉及成年人，平均年龄在30 - 40岁左右。该病症通常突然发作，且发病前有近期的应激事件。病症持续时间难以确定。似乎这种功能障碍可迅速逆转，大多数患者在三个月内病情缓解。功能障碍的复发似乎较为常见。精神共病情况并非普遍存在。该病症的自然病程尚不清楚，这使得评估治疗方法的疗效变得棘手。
如今，癔症性缄默在国际分类中均未作为一个独立的实体出现。在《精神疾病诊断与统计手册》（DSM - IV - TR）中，它属于转换障碍类别。作为萨尔佩特里埃学派描述的一种医学病症，该病症关注度较低。由于与之相关的污名化问题严重，导致对这种病症的医学化处理仍然困难，这使得缄默患者遭到排斥而非得到支持。为了更好地理解这种病症并改善对患者的治疗，有必要重新关注。
