Chaudhary Pradhyuman, Banwari Girish, Parikh Nimesh, Gandhi Hitendra
Department of Psychiatry, Smt. Nathiba Hargovandas Lakhmichand Municipal Medical College and Sheth Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India.
Ind Psychiatry J. 2015 Jan-Jun;24(1):79-81. doi: 10.4103/0972-6748.160941.
An otherwise serious and potentially fatal organic condition may present with a co-existing strong functional component. We encountered a female patient who presented with bouts of severe headache over the occipital region, associated with blurring of vision. Initially, non-contrast computed tomography (CT) scan (Brain) showed normal study, and she was deemed as having functional symptoms. Later, magnetic resonance imaging (MRI) (Brain) showed filling defect in right sigmoid sinus and magnetic resonance (MR) venography confirmed right sigmoid sinus thrombosis. On adequate anticoagulation, she did not improve and still had bouts of severe headache, although no longer associated with impaired vision. The treating neurophysician concluded that symptoms could no longer be accounted for by the organic condition. Overt and covert psychosocial stressors were found to be present in a detailed psychological exploration. Psychological intervention effectively controlled the headache. Thus, functional overlay can complicate the clinical picture in a severe organic condition and may require active psychiatric intervention over and above medical treatment.
一种原本严重且可能致命的器质性疾病可能同时伴有强烈的功能性成分。我们遇到一位女性患者，她出现枕部严重头痛发作，并伴有视力模糊。最初，脑部非增强计算机断层扫描（CT）显示检查结果正常，她被认为有功能性症状。后来，脑部磁共振成像（MRI）显示右侧乙状窦有充盈缺损，磁共振静脉造影（MRV）证实右侧乙状窦血栓形成。在进行充分抗凝治疗后，她没有改善，仍然有严重头痛发作，尽管不再伴有视力受损。主治神经科医生得出结论，症状不能再用器质性疾病来解释。在详细的心理探索中发现存在明显和隐蔽的心理社会压力源。心理干预有效地控制了头痛。因此，功能性叠加可能会使严重器质性疾病的临床情况复杂化，可能需要在药物治疗之外进行积极的精神科干预。
