Mai F M
Department of Psychiatry, University of Ottawa, Ontario, Canada.
Can J Neurol Sci. 1995 May;22(2):101-10. doi: 10.1017/s0317167100040166.
Hysteria is an ancient word for a common clinical condition. Although it no longer appears in official diagnostic classifications, "hysteria" is used here as a generic term to cover both "somatoform" and "dissociative" disorders as these are related psychopathological states. This paper reviews the clinical features of four hysterical syndromes known to occur in a neurologist's practice, viz conversion, somatization and pain disorders, and psychogenic amnesia. The presence in the clinical history of a multiplicity of symptoms, prodromal stress, a "model" for the symptom(s), and secondary reinforcement all suggest the diagnosis, and minimise the need for extensive investigations to rule out organic disease. Psychodynamic, behavioral, psychophysiologic and genetic factors have been proffered to explain etiology. Appropriate treatment involves psychotherapeutic, behavioral and pharmacological techniques. A basic requirement is to avoid errors of commission such as multiple specialist referrals and invasive diagnostic and treatment procedures. Hysteria is a remediable condition if identified early and managed appropriately.
癔症是一种常见临床病症的古老称谓。尽管它已不再出现在官方诊断分类中，但在此处“癔症”用作通用术语，涵盖“躯体形式”和“分离性”障碍，因为这些是相关的精神病理状态。本文回顾了在神经科医生临床实践中已知会出现的四种癔症综合征的临床特征，即转换障碍、躯体化障碍和疼痛障碍以及心因性遗忘症。临床病史中存在多种症状、前驱应激、症状的“范例”以及继发性强化，这些都提示了诊断，并减少了为排除器质性疾病而进行广泛检查的必要性。心理动力学、行为学、心理生理学和遗传学因素已被提出用以解释病因。恰当的治疗涉及心理治疗、行为治疗和药物治疗技术。一个基本要求是避免诸如多次专科转诊以及侵入性诊断和治疗程序等医疗差错。如果早期识别并妥善处理，癔症是一种可治愈的病症。
