Fritzsche K, Baumann K, Schulze-Bonhage A
Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 8, 79104 Freiburg, Deutschland.
Nervenarzt. 2013 Jan;84(1):7-13. doi: 10.1007/s00115-011-3455-8.
The great physical resemblance between epileptic and dissociative seizures and a diagnosis of epilepsy that had been made years ago and usually had been treated unsuccessfully makes it difficult for both physician and patient to communicate the diagnosis of dissociative seizures. A direct referral to psychotherapy treatment is rarely accepted by patients. Intermediate steps, which are based on cooperation between neurologists and psychotherapists, are necessary. The approach that we use to communicate diagnosis and motivation for psychotherapeutic treatment includes eight steps: 1. Welcome and introduction; 2. Jointly watching a video of documented seizures; 3. The message that the seizures are not of epileptic origin, 4. Development of an alternative disease concept; 5. Motivation for a conversation with a representative from psychosomatics; 6. Responding to the fear of "going crazy"; 7. If necessary, briefly touching on the subject of sexual violence; 8. More recommendations and conclusion of the conversation. The manual was discussed and practiced with the attending neurologist in two sessions and is now being regularly used by two neurologists with concomitant supervision.
癫痫发作与分离性发作在体征上极为相似，且多年前已确诊为癫痫且治疗通常未成功，这使得医生和患者都难以传达分离性发作的诊断。直接转诊至心理治疗很少被患者接受。基于神经科医生和心理治疗师合作的中间步骤是必要的。我们用于传达心理治疗诊断和动机的方法包括八个步骤：1. 欢迎与介绍；2. 共同观看有记录的发作视频；3. 告知发作并非癫痫起源；4. 形成替代疾病概念；5. 激发与身心医学代表交谈的动机；6. 回应“发疯”的恐惧；7. 如有必要，简要提及性暴力主题；8. 更多建议及谈话总结。该手册在两次会议上与主治神经科医生进行了讨论和实践，现在两名神经科医生在监督下定期使用。
