Pawełczyk Tomasz, Pawełczyk Agnieszka, Rabe-Jabłońska Jolanta
Klinika Zaburzeń Afektywnych i Psychotycznych UM w Łodzi.
Psychiatr Pol. 2012 May-Jun;46(3):483-92.
Dissociative and conversion disorders are classified together according to ICD-10 as states that are not confirmed by the presence of somatic diseases, which they suggest. According to the DSM-IV, both disorders are classified separately. Conversion disorders are a group of psychiatric disorders whose symptoms mimic the presence of malfunction or loss of motor or sensory function, whereas the nature and dynamics of the observed symptoms is not fully explained by the results of objective assessments and consultations, nor is the direct effect of a psychoactive substance. Impaired mental integration of different functions which normally interact simultaneously in the perception of reality and inner experience of the individual is found in dissociative disorders.
The article describes the case of 25-year old man, in whom after initial suspicion of myasthenia gravis and its exclusion, a diagnosis of conversion disorder was made on the basis of the clinical picture and treatment with an SSRI antidepressant and individual psychotherapy were recommended. No improvement in mental and neurological status after six month therapy resulted in an in-depth diagnostics in a clinical setting and diagnosis of brain stem tumor (aastrocytoma fibrillare).
(a) Neuroimaging is a source of important clinical data and in many cases should constitute an inherent element of a psychiatric diagnosis. (b) Diagnosis of conversion (dissociative) disorders requires a precise differential diagnosis, excluding the somatic causes of observed neurological ailments. (c) A late diagnosis of neurological or somatic causes of symptoms which arouse a suspicion of conversion (dissociative) disorders may make a radical treatment impossible or may considerably aggravate the remote prognosis and quality of the patients' life.
根据国际疾病分类第十版（ICD - 10），分离性障碍和转换性障碍被归为一类，其表现为提示存在躯体疾病但未得到躯体疾病证实的状态。而根据《精神疾病诊断与统计手册》第四版（DSM - IV），这两种障碍是分别分类的。转换性障碍是一组精神障碍，其症状类似于运动或感觉功能出现故障或丧失，但客观评估和会诊结果以及精神活性物质的直接影响均无法完全解释所观察到症状的性质和动态变化。分离性障碍则表现为个体在对现实的感知和内心体验中，不同功能之间的心理整合受损，这些功能通常在正常情况下同时相互作用。
本文描述了一名25岁男性的病例。该患者最初被怀疑患有重症肌无力，在排除该疾病后，根据临床表现诊断为转换性障碍，并建议使用选择性5 - 羟色胺再摄取抑制剂（SSRI）进行抗抑郁治疗以及接受个体心理治疗。然而，经过六个月的治疗，其精神和神经状态并未改善，随后在临床环境中进行了深入诊断，最终确诊为脑干肿瘤（纤维型星形细胞瘤）。
（a）神经影像学检查是重要临床数据的来源，在许多情况下应成为精神科诊断的固有组成部分。（b）转换性（分离性）障碍的诊断需要进行精确的鉴别诊断，以排除所观察到的神经疾病的躯体原因。（c）对于引发转换性（分离性）障碍怀疑的症状，若对其神经或躯体原因诊断过晚，可能会使根治性治疗无法进行，或者可能会严重恶化远期预后及患者的生活质量。
