Załuska Maria, Zurko Renata, Kuroń Michał, Jakiel Grzegorz, Dudel Aneta
Kliniczny Oddział Psychiatryczny, IV Klinika Psychiatrii IPiN w Szpitalu Bielańskim w Warszawie.
Psychiatr Pol. 2011 Jul-Aug;45(4):599-609.
To pay attention to the role of stress connected with delivery, obstetric history, as to the pathologies in the infant as predictors of dissociative disturbances in the patient of the maternity ward.
The case analysis.
The thirty-year-old woman with secondary education, married and employed had left the maternity ward with her baby unnoticed on the fourth day after giving birth. The patient didn't remember this fact after finding her and the infant by the police. The patient had no genetic predisposition in her history and had suffered head injury in her childhood. Her mother lost two of her siblings (miscarriage and early death of infant). The patient miscarried her first pregnancy, and then she had waited several years for the baby. The second pregnancy was at risk, the labor was premature and the infant was born with palatoschisis. In the maternity ward, the patient had difficulties with feeding the baby. She experienced fear about the baby's life, as well as the feeling of being neglected by the staff. In the psychiatry ward, the patient did not reveal any symptoms of mental illness. A memory gap covered the period of her flight. She had shown interest in her child and was motivated to nurse him by herself. The tendency to use immature defence mechanisms (denial and suppression), as well as mild cognitive dysfunctions were observed in psychological testing. Dissociative fugue was diagnosed.
The interaction of past and present traumatic experiences with cognitive dysfunctions and immature defence mechanisms could influence the patient's ability to cope with fear about the child negatively. It led consequently to dissociative loss of memory with disintegration of perception, identity, and conscious control over the behaviour in the fugue. The case shows a need for early diagnosing and providing psychological support to patients of the maternity ward, especially those laden with multiple stress factors.
关注与分娩、产科病史相关的压力在婴儿病理状况方面作为产科病房患者分离性障碍预测因素的作用。
病例分析。
一名30岁女性，受过中等教育，已婚且有工作，产后第四天带着婴儿悄然离开了产科病房。警方找到她和婴儿后，她不记得这件事了。患者既往无遗传易感性，童年时曾头部受伤。她的母亲失去过两个兄弟姐妹（流产和婴儿早夭）。患者第一次怀孕时流产，之后等了几年才生下这个孩子。第二次怀孕有风险，分娩早产，婴儿患有腭裂。在产科病房，患者给婴儿喂奶有困难。她担心婴儿的生命，同时感觉被医护人员忽视。在精神科病房，患者未表现出任何精神疾病症状。一段记忆空白涵盖了她逃跑的那段时间。她对自己的孩子表现出兴趣，并有亲自哺乳的意愿。心理测试中观察到其有使用不成熟防御机制（否认和压抑）的倾向以及轻度认知功能障碍。诊断为分离性神游症。
过去和现在的创伤经历与认知功能障碍及不成熟防御机制的相互作用可能会对患者应对对孩子的恐惧的能力产生负面影响。这进而导致分离性记忆丧失，同时在神游症中出现感知、身份认同及对行为的意识控制的瓦解。该病例表明有必要对产科病房的患者，尤其是那些承受多重压力因素的患者进行早期诊断并提供心理支持。
