Lenart-Domka Ewa, Pelc-Dymon Marzena
Oddział Rehabilitacji Neurologicznej dla Dzieci i Młodzieży Regionalnego Ośrodka Rehabilitacyjno-Edukacyjnego dla Dzieci i Młodzieży, Kliniczny Szpital Wojewódzki Nr 2 w Rzeszowie.
Zakład Rehabilitacji, Wydział Medyczny Uniwersytetu Rzeszowskiego.
Psychiatr Pol. 2018 Aug 24;52(4):685-695. doi: 10.12740/PP/OnlineFirst/43145.
The most common motor deficits in patients with conversion disorder are tremors, weakness of limbsand gait disturbance. The proper diagnosis and treatment aswell as the patient and their family's cooperation during therapy are essential to achieve fast recovery. The aim of this paper is to provide an overview of multidisciplinary interventions successfully applied in the treatment of conversion disorders in children, illustrated with an example of a case study.
Case report: The 9 years old boy, with trembling of the limbs, trunk ataxia, impaired balance, and significant disability in self-locomotion, caused by conversion disorders, was admitted to stationary rehabilitation treatment because of the lack of progress in the current, four-month treatment, which consisted of hydroxyzin administration and irregular psychotherapy. Behavioural modifications in rehabilitation, individual psychotherapy, family counselling and psychoeducation, and sertralinepharmacologicaltreatmentwereimplemented at the same time. Particular attention was paid to obtain the parents'approval for multidisciplinary therapy, considering that the previous treatment was ineffective because of parents being unconvinced about psychogenic causes of symptoms. They were focused on over diagnosing the child's symptoms making it difficult to manage the proper treatment.
After a three-week period of comprehensive treatment the patient recovered completely and returned to independent mobility and social functioning relative to his age.
The simultaneous implementation of multi-profile treatment is an effective approach in children motor conversion disorders. In order to achieve therapeutic success it is necessary to convince the parents about the psychogenic ground of the symptoms and a need of multi-profile treatment.
转换障碍患者最常见的运动缺陷是震颤、肢体无力和步态障碍。正确的诊断和治疗以及患者及其家属在治疗过程中的配合对于快速康复至关重要。本文旨在概述成功应用于儿童转换障碍治疗的多学科干预措施，并以一个案例研究为例进行说明。
病例报告：一名9岁男孩因转换障碍导致肢体颤抖、躯干共济失调、平衡受损以及自主运动严重受限，由于当前为期四个月的治疗（包括服用羟嗪和不定期心理治疗）缺乏进展，故而入院接受住院康复治疗。同时实施了康复中的行为矫正、个体心理治疗、家庭咨询与心理教育以及舍曲林药物治疗。特别注意获得家长对多学科治疗的认可，因为之前的治疗无效是由于家长不相信症状的心理成因。他们过于关注对孩子症状的过度诊断，使得难以进行恰当的治疗。
经过为期三周的综合治疗，患者完全康复，恢复了与其年龄相符的独立活动能力和社交功能。
同时实施多方面治疗是治疗儿童运动性转换障碍的有效方法。为了取得治疗成功，有必要让家长相信症状的心理成因以及多方面治疗的必要性。
