新疆维吾尔族分离转换性障碍(癔症) 87例临床现象分析

Analysis on Clinical Phenomena of 87 Patients with Dissociative-Conversion Disorder for the Uygur Ethnic Group in Xinjiang

摘要: 目的：了解维吾尔族分离转换性障碍的临床表现及其特点、转归和治疗措施。方法：本文收集了符合CCMD-3有关癔症和DSM-5标准的分离转换性障碍标准的维吾尔族患者87例，采用临床观察、分类和归纳的方法得出总体临床概貌。结果：87例患者均在起病前面临心理社会负性刺激或自我的不良暗示，绝大多数在0~5小时内起病(69例，79.31%)，小部分在5~24小时内发病(11例，12.64%)，个别在1天以上时间内发病(7例，8.05%)。参照CCMD-3标准，本组患者的临床分型为癔症性精神病52例(59.8%)，癔症性抽动发作19例(21.8%)，多重人格表现为7例(8.0%)；癔症性双侧肢体瘫痪4例(4.6%)，癔症性过度换气3例(3.4%)，癔症性单侧肢体瘫痪2例(2.3%)。治疗方法采用适当隔离、安全防护、言语和行为暗示，同时给予清晰表达的理解和包容语言，有限使用生物医疗措施，缓解后给予2个月随访。结论：本组患者符合分离转换性障碍的一般临床演变规律。治疗方法中尤其需要注意适度隔离、安全防护以及言语和行为暗示治疗的技巧掌握。还需要注意随访中的宣传教育以预防复发。

Abstract: Objective: To understand the clinical manifestations, outcome and treatment of Uygur separation-conversion disorder. Methods: 87 patients with separation-conversion disorder were analyzed in this study and these patients were Uygur ethnic and the diagnosis accords with CCMD -3 and DSM-5 standard. We used the techniques of clinical observation, classification and inductive method, then obtained the clinical profile. Results: 87 patients were faced with negative psychosocial stimulation events or harmful self-suggestion before onset, most of them attacked in 0~5 hours (69 cases, 79.31%), a small part of them started within 5~25 hours (11 cases, 12.64%), and the individual patients were ill for more than one day (7 cases, 8.05%). According to CCMD-3 diagnosis standard, the clinical types of the patients were hysterical psychosis (52 cases, 59.8%), hysterical tic attack (19 cases, 21.8%), multiple personality (7 cases, 8.0%), hysterical bilateral paralysis (4 cases, 4.6%), hysterical hyperventilation (3 cases, 3.4%), and hysterical unilateral paralysis (2 cases, 2.3%). Appropriate isolation, medical safety, verbal and behavior suggestive therapy were used in treatment methods, and at the same time, they were given clear expression of understanding and tolerance language, limited use of biomedical measures, and a 2-month follow-up after remission. Conclusion: This group of patients is in accordance with the general clinical pattern of dissociative-conversion disorder. Special attention should be paid to appropriate isolation, safety precautions and suggestive treatment techniques, and also to follow-up and disease education.