Cybulska E M
Thameslink Healthcare Services, Kent, United Kingdom.
Psychosom Med. 1997 Jan-Feb;59(1):67-9. doi: 10.1097/00006842-199701000-00009.
An association of "globus hystericus" with depressive illness has already been established. Successful treatment with antidepressants has been previously reported but this is the first report of globus symptom responding to electroconvulsive therapy (ECT) followed by long-term remission on maintenance dose with tricyclic antidepressant.
A detailed retrospective study of an elderly patient's General Practice medical notes revealed 45-year history of recurrent globus symptom, interspersed with other somatic complaints. Patient's frequency of consultations with her family physician was noted before treatment and during the 5-year follow-up period. Using DSM-III diagnostic categories, the patient was diagnosed as suffering from major depressive disorder with globus symptom. The notes were insufficient to ascertain whether past episodes of globus occurred in a setting of depressive disorder.
A prompt response of globus symptom to ECT was observed with 5-year symptom-free follow-up period as long as the patient remained on a maintenance dose of antidepressant. A marked reduction in frequency of medical consultations for other somatic complaints was noted.
The case illustrates a strong association of globus symptom with depressive disorder and other somatic concerns. Patients with recurrent globus symptom and family history of depressive illness should be screened for a possibility of depressive disorder. ECT and antidepressants may be successfully used in treatment of globus in a setting of depressive illness. Long-term maintenance with antidepressive medication may keep at least some of these patients symptom-free. It is suggested that globus hystericus could be more appropriately viewed as a somatic symptom of depression rather than a conversion disorder.
“癔球症”与抑郁症之间的关联已得到证实。此前已有使用抗抑郁药成功治疗的报道，但这是首例关于癔球症症状对电休克疗法（ECT）有反应且在使用三环类抗抑郁药维持剂量治疗后长期缓解的报告。
对一名老年患者全科医疗记录进行的详细回顾性研究显示，其有45年反复出现的癔球症症状病史，其间穿插着其他躯体不适主诉。记录了患者在治疗前及5年随访期间与家庭医生的就诊频率。根据《精神疾病诊断与统计手册》第三版（DSM - III）诊断标准，该患者被诊断为患有伴有癔球症症状的重度抑郁症。这些记录不足以确定过去癔球症发作是否发生在抑郁症背景下。
观察到癔球症症状对ECT迅速产生反应，只要患者持续使用抗抑郁药维持剂量，就有长达5年的无症状随访期。还注意到其他躯体不适主诉的就诊频率显著降低。
该病例表明癔球症症状与抑郁症及其他躯体问题之间存在密切关联。对于有反复癔球症症状且有抑郁症家族史的患者，应筛查是否存在抑郁症的可能性。ECT和抗抑郁药可成功用于治疗伴有抑郁症的癔球症。使用抗抑郁药物进行长期维持治疗可能使至少部分此类患者保持无症状状态。建议将癔球症更恰当地视为抑郁症的一种躯体症状，而非转换障碍。
