Alexander P J, Joseph S, Das A
Department of Psychiatry, Kasturba Medical College, Manipal, India.
Acta Psychiatr Scand. 1997 Mar;95(3):177-82. doi: 10.1111/j.1600-0447.1997.tb09617.x.
Studies of psychiatric out-patients from India have found that diagnosis of some of the subcategories of the dissociative and conversion disorders of the ICD and DSM classificatory systems are rarely made in this setting. Moreover, it was found that a significant percentage of patients seen in psychiatric practice may not fit into the defined subcategories of dissociative (conversion) disorders of these systems of classification. We studied the prevalence of various ICD-10 and DSM-IV categories of dissociative (conversion) disorders and our own proposed category of 'brief dissociative stupor' (BDS), among all the in-patients of a psychiatric unit in a general teaching hospital, over a 2-year period. There were 18 patients who fulfilled our criteria for BDS and 18 patients in the second group which included all of the remaining subjects with a diagnosis of any other subcategory of dissociative disorder according to ICD-10. Our analysis revealed that there were no patients with a diagnosis of dissociative amnesia, fugue, stupor, trance and possession disorders or identity disorders. There were significantly more female patients in the BDS group, and they also had significantly more comorbid Axis-I diagnoses and panic attacks. Since 50% of our patients fulfilled the criteria for BDS, there is clearly a need for further studies to establish the prevalence of this subcategory in patients from other centres. The classification of these patients with this phenomenology is problematic. Inclusion of a subcategory of dissociative non-epileptic seizures, instead of dissociative convulsions, should improve the classification of dissociative (conversion) disorders.
对印度精神科门诊患者的研究发现，在这种情况下，国际疾病分类（ICD）和精神疾病诊断与统计手册（DSM）分类系统中某些分离性障碍和转换性障碍子类别的诊断很少做出。此外，研究发现，在精神科实践中就诊的相当一部分患者可能不符合这些分类系统中分离性（转换性）障碍的既定子类别。我们对一家综合教学医院精神科病房的所有住院患者进行了为期两年的研究，调查了各种ICD - 10和DSM - IV分离性（转换性）障碍类别以及我们自己提出的“短暂分离性木僵”（BDS）类别的患病率。有18名患者符合我们的BDS标准，第二组有18名患者，其中包括根据ICD - 10诊断为任何其他分离性障碍子类别的所有其余受试者。我们的分析显示，没有诊断为分离性遗忘症、神游症、木僵、恍惚和附体障碍或身份障碍的患者。BDS组女性患者明显更多，并且她们还伴有更多的共病轴I诊断和惊恐发作。由于我们50%的患者符合BDS标准，显然需要进一步研究以确定该子类别在其他中心患者中的患病率。对具有这种现象学特征的这些患者进行分类存在问题。纳入分离性非癫痫性发作子类别而非分离性抽搐，应能改善分离性（转换性）障碍的分类。
