What is Conversion Disorder?

Dissociation symptoms, also known as hysteria psychiatric symptoms, refer to the partial or complete loss of self-identity and memory of the past, and the symptoms of conversion such as reduced consciousness, selective forgetting, or mental outbreak are also called hysteria. Symptoms refer to the unhappiness of patients when they encounter unsolvable problems and conflicts. They are manifested in a variety of physical symptoms. It can appear like any disease. Therefore, some people call hysteria a "great disease." "Or" disease mimics. " Mainly manifested as a variety of physical symptoms, the scope of consciousness is narrowed, suggestive, selective forgetting or emotional outbursts, but can not detect the corresponding organic damage as its pathological basis.

Switching disorder

Conversion disorder: Dissociative (conversion) disorder is a type of dissociation and conversion caused by obvious mental factors such as internal conflicts, emotional excitement, cues or self-cues of significant life events and acting on vulnerable individuals. Symptom-based mental illness.

Transitional disorder concept

Causes of switching disorders

The causes of separation (conversion) of mental and psychological factors are closely related to mental factors. Various unpleasant moods, such as anger, grievance, panic, shame, embarrassment, sadness, and other traumas are often the causes of the initial onset, especially the fear of stress is an important factor that causes the disease. The acute snoring reaction that occurs during combat is particularly pronounced, and traumatic childhood experiences, such as physical or psychological abuse, are one of the important reasons for conversion and separation disorders in adulthood. A small number of patients may have no obvious cause after repeated illnesses, and later may relapse due to association or re-experience of the first episode of emotions, and they are mostly caused by cues or self-cues. For example, a woman was insulted by the German fascist army during the Soviet Patriotic War In the future, every time I passed by a movie theater that was showing a war movie, a seizure occurred when I heard the sound of gunfire. Seizures help patients get out of trouble, vent their emotions, gain sympathy from others, or get support and compensation.

The incidence of somatization disorder of susceptible quality and mental factors are not obvious. Whether mental factors cause hysteria or what type of hysteria are related to the patient's physiological and psychological quality. Those with susceptible qualities are more likely to develop the disease when they are stimulated lightly. About 49.8% of the patients with hysteria characteristics of this disease, the main characteristics of their personality are: performing personality characteristics: about 20% of patients with this disease have a typical performing personality. The performance is as follows: sharp and emotional emotional fluctuations are excessive, emotional use, exaggerated expressions, naive and dramatic speech behaviors, poor emotional control, and shallow emotions. Low cultural level and superstitious beliefs. Self-centeredness: Constantly seeking stimulus to seek the attention of those around you. Highly suggestive: It is easy to be hinted by people and the surroundings, and it is also easy to hint at itself. Rich fantasy: rich imagination or even fantasy instead of reality, always play the role of fantasy intentionally or unintentionally, but there are fantasy lies. Adolescent or menopausal women are more likely to develop hysteria than the general population, but such personality traits are not a necessary condition for snoring. Hysteria is prone to occur when people with susceptible qualities experience psychological conflict or accept cues after frustration. Some people who do not belong to this type of personality can also develop snoring reactions under the influence of strong psychological factors.

Organic factors have been found in about 2/3 of the patients with brain disease or organic encephalopathy, 32% of patients have a history of neurological diseases, especially epilepsy.

Genetic factors The genetic research results of this disease are quite inconsistent. Some studies have found that some patients with the disease have genetic qualities. A family survey by Ljunberg (1957) found that the hysteria among fathers, siblings, and siblings was 1.7%, 2.7%, and 4.6%, respectively; It was 7.3%, 6.0%, and 6.9%. Overall, the prevalence of male first-degree relatives was 2.4%, and that of female first-degree relatives was 6.4%. Foreign data also show that the incidence of syphilis in the close relatives of snoring patients is 1.7% to 7.3%, and that of female first-degree relatives can reach 20%. In Fujian, China, 24% of patients reported a positive family history, which was higher than the normal population. It is suggested that genetic factors may play a role in the pathogenesis of the disease, but the 24 pairs of twins studied by Slater (1961) and the twins of twins and twins of twins each have 12 pairs. Of these 23 pairs, at least one person was diagnosed with hysteria in each pair, and one person was diagnosed with snoring personality in the other pair; regardless of whether there is a single egg or dizygotic twin, there is no pair of patients with snoring and the results are in sharp contrast with Ljunberg. . Arkonac and Guze (1963) conducted a family study of 25 female snoring patients and found that 5 of the first-degree relatives were all female; 9% of all first-degree relatives and 15% of female first-degree relatives; and the authors estimated that rickets The prevalence of women in the general population is only 1% to 2%. In addition, increased cases of antisocial personality disorder and alcoholism were reported among male first-degree relatives of snoring probands. The results of genetic studies are more consistent: Briquet syndrome Cloninger et al. (1986) reported that the prevalence of Briquet syndrome was 7.7% in the first-degree relatives of such probands, compared with 2.5% in the normal control group. Torgersen (1986) reported a group of twins with somatoform disorders, studying the same disease rate of 29% for twins and 10% for twins. At the same time, it also found that patients with siblings suffered from generalized anxiety disorder. Increased prevalence. Cloninger et al. (1975) suggested that this is a multifactorial genetic pattern that manifests as Briquet syndrome in women and antisocial personality disorder in men.

Social and cultural qualities such as customs, habits of religion, beliefs, and living habits also have a certain effect on the occurrence and onset of the disease and the symptoms and manifestations (II) Pathogenesis

There are two types of neurophysiological explanations for the pathogenesis of the disease: one is based on Janet's theory of consciousness separation, which states that the change in consciousness state is the neurophysiological basis for the onset of snoring; with the separation of patients' consciousness, there is attention to alertness, near memory, and information integration capabilities Cognitive impairment due to the inhibition of afferent stimuli by the cerebral cortex. Patients' self-consciousness is weakened and implied. At this time, when the individual is threatened by biopsychological or social factors, various instinct responses similar to those when animals are in danger appear. Another explanation, such as the fierce motor response false death reflex and the return to infancy, is based on Pavlov's advanced neural activity theory, which believes that the mechanism of rickets is: harmful factors acting on people with a weak nervous type Functional separation of the first and second signaling systems between the cerebral cortex and the lower cortex, or inconsistency in the function of the first signaling system and the lower cortex in patients. The function is relatively weakened under the influence of external stimuli. Of the cerebral cortex quickly enters the limit of inhibition and thus generates positive induction The enhanced activity of the department is clinically manifested as emotional outbreaks of seizures, as well as symptoms of instinctual activity and autonomic nerves. On the other hand, strong and lasting emotional tension can also generate excitatory foci in the cerebral cortex, thereby causing negative induction such inductive inhibition and the above-mentioned over-limit inhibition. Taken together, the spread to other parts of the cortex and the lower part of the cortex makes the cerebral cortex appear in a phased state, so clinical symptoms and signs such as sensory loss, limb paralysis, and hazy state appear.

Pavlov believes that the physiological mechanism of cues and self-suggestions in patients with rickets is: harmful stimuli acting on weak nerve types can lead to weakened cerebral cortex function and enhanced subcortical activity, which is called positively induced clinical manifestations as emotional outbreaks and convulsions. Instinctual activity and autonomic symptoms, as well as strong emotional tension, can cause cortical excitement to cause negative induction. The clinical manifestations are symptoms such as sensory loss, limb paralysis, and hazy state. In the case of weakened cerebral cortex, external realistic stimuli produce weaker negatively induced cerebral cortex The other parts of the body are in a state of inhibition. At this time, the language influence of the hinter is completely isolated from the activities of other parts of the cortex; therefore, it has absolute irresistible power.

The pathogenesis of this disease has a variety of pathopsychological explanations. Different clinical types have different pathopsychological mechanisms.

Somatization: The concept proposed by Stekel (1943) originally refers to a type of deep-seated neurosis that manifests as a physical disorder, which is the same as Freud's concept of "transition". The generalization refers to the pathological psychological process of expressing psychological pain through somatic symptoms. The occurrence of somatization is usually not realized by the patient, but the somatic symptoms described are not symbolic expressions that suppress the inner conflict in the unconscious area but are particularly related to the unpleasant emotional experience. It is that anxiety and depression are closely related; therefore, it is quite common in the community and the community to distinguish from "conversion" somatization. It is not limited to hysteria. So-called somatization disorder is just a type of somatization that is more serious. More prominent in the pathogenesis of somatization disorder than other snoring types

Transformation: The concept proposed by Freud early (1894). He believes that the sexual psychological development of snoring patients is fixed at an early stage, the stage of the Electra complex; their sexual impulses are suppressed and their mental energy is transformed into physical symptoms; this not only protects The patient makes him unaware of the existence of sexual impulses and these somatic symptoms are often a symbolic expression of inner conflict to save the patient from anxiety (primary benefit)

Patients with this type of snoring often show an indifferent attitude towards their physical dysfunction; a 19th-century French doctor called it "belle indifference". This attitude gives the impression that the patient does not care about the recovery of his physical function. Rather, they want to retain some social benefit from the symptoms (secondary benefit). Although patients are often unaware of the intrinsic link between symptoms and benefits, pathological psychologists believe that these patients have unconscious motivation to switch symptoms. Patients with such symptoms have a sick role and can enjoy the rights of the patient; their symptoms are sufficient to show that the failure to complete their work is not his fault or to claim compensation. Or the purpose of controlling others, so some people regard the switching symptoms as a kind of non-verbal communication between the patient and the outside world, but behavioralists believe that the switching symptoms are a way for patients to adapt to life experiences that have suffered frustration. Symptoms of intensive hysteria are treated as a learned response through operational conditioning Who once found such symptoms can alleviate the plight of the anxiety brought him and his dependency needs are met persistent symptoms will be strengthened; or when difficulties arise again later

Separation: The concept proposed by Janet (1889). He pointed out that in many mental disorders, some concepts and cognitive processes can be separated from the mainstream of consciousness and transformed into neurotic symptoms such as paralysis, forgetfulness, changes in consciousness state, and automatism. Re-integrate these concepts and processes to return to a normal state. He believes that these separated components are subconscious unconscious separations. The main obstacle to the integration of different conscious components is the basis of hypnosis and various hysteria. But Freud thinks separation is an obstacle. A variant of diarrhea is a positive defense process. Its role is to exclude painful emotions and thoughts from consciousness. Some modern scholars believe that separation is both a basic pathological and psychological mechanism of conversion disorder and separation disorder. Patients who are associated with acute mental stress or self-hypnosis often have a suggestive increase in the integration of mental functions such as sensory memory and identity recognition, which are manifested as various separation symptoms

Signs of switching disorder

The onset of this disease is mostly in young people over the age of 35. Rarely, acute onset is often stimulated by psychosocial factors. It can occur multiple times. It is more common in women. It is mainly dissociative (mental disorder) and conversion ( Physical disorders) Two types of disorders, because they can have both motor dysfunction, as well as autonomic nervous function consciousness and memory disorders or even psychiatric disorders, so it is easy to cause misdiagnosis. The clinical manifestations of this disease are very complex and diverse. They are divided into the following types: Types of

The clinical manifestations of separation disorder are consciousness and affective disorder. The consciousness is narrow and the dim state is more common. The range of consciousness is narrowed. Some dream-like states or state. Various defensive reflections are always present and related to strong emotional experience. Emotional outbreak symptoms such as crying, rolling, chest chesting, screaming, shouting, and so on are sometimes dramatic. The content of the speech is related to the inner experience, so it is easy to be understood. This type of mental factors are often obvious before the onset of the disease. Although the patient himself denies it, others see the onset of the disease It is often conducive to getting rid of distress, venting depressed emotions, gaining sympathy and attention from others, or getting support and compensation. Repeated authors often relapse through memories and associations of events or situations related to previous traumatic experiences. According to clinical characteristics, this type can be divided into the following The categories DSM- and are divided into dissociative forgetfulness, dissociative psychiatric multiple personality dissociation disorder and atypical dissociation disorder according to their clinical manifestations.

Dissociative amnesia: It belongs to psychogenic amnesia patients who suddenly lose memory of major events they have experienced without organic damage such as brain trauma; the forgotten events are often related to trauma or stressful events. I ca nt remember it because of accidental reasons. If the event is limited to a certain period of time, we cannot recall local form or selective forgetting. Those who have lost memory of all past lives are called generalized form forgetting.

Dissociative fugue: It is a special form of dissociative disorder. Patients often develop an illness under the influence of a sudden mental stimulus. They suddenly wander from one place to another. They often leave from unsatisfactory residences. Traveling from home or workplace to a field trip; the place of travel may be a place that was familiar and emotionally meaningful in the past. At this time, although the patient is awake, the scope of consciousness is reduced. Roaming lacks planned and purposeful but daily basic life (such as diet and living) Ability and simple social contact (such as buying tickets, driving directions, etc.) are still maintained; some patients forget their past experiences and appear in a new identity; others do not see obvious abnormalities in their words and appearances; which lasted for dozens of minutes Behaviors that are quite complete over a few days or longer are completely forgotten afterwards or can only be recalled from a typical mirage.

(3) Dissociative stupor: Deep consciousness appears after trauma or triggered by traumatic experience. Maintain a fixed posture for a long period of time lying on the back or sitting. No speech and random movements. No light and sound stimulation. At this time, the patient's muscle tone posture and breathing can be no obvious abnormalities. Opening his upper eyelid with his hand, he can see the eyeballs turn downward or close his eyes tightly; indicating that the patient is neither asleep nor in a coma, and can usually wake up by himself within tens of minutes. turn

Dissociative trance and possession: The state is manifested as a distinct range of consciousness, narrowing the parties in a self-closed state, and their attention and consciousness activities are limited to one or two aspects of the current environment, which only produce individual stimuli in the environment The typical tadpole response is found in the hypnotic witchcraft or superstitious activities when the caster interacts with the "ghost" and "god" and some people who are in the tadpole-induced state of fascination induced by qigong such as He Xiangzhu, if their status is Deities or dead people replace claiming to be a god or a dead person talking is called appendage state detached state and appendage state are involuntary undesired pathological processes; patient movement Many monotonous repeated gestures and speeches through others or self-suggestions to control the appearance or disappearance of such states are a kind of behavior related to specific culture or superstition; although the phenomenon of separation of consciousness should not be diagnosed as a separation disorder

DisDissociative identity disorder, also known as hysteria. Patients with dual or multiple personality suddenly lose all memories of their past. They cannot recognize their original identity and perform daily social activities in another identity; such as gods or undead. Isosomes replace the patient's awareness of the surrounding environment. Insufficient attention and perception are limited to certain aspects of the surrounding people and things and are linked to the patient's changed identity. The disorder is transient mental disorder without delusional hallucinations. Symptoms in which two types of personality appear alternately are more commonly referred to as double personality or alternate personality; one of them is often dominant

Other separation disorders: In addition to the above types of separation disorders, the following special types can be seen clinically:

Emotional outburst: Minor disturbance of consciousness, often when people are arguing with emotions, they burst into tears, yell on the ground, beat their chests, tear their clothes, tear their clothes, or bang their heads against the wall; their speech acts have the potential to vent their inner anger Features Occurs particularly violently on the occasion of crowds of people. It usually takes tens of minutes to quiet down and can be partially forgotten afterwards.

Hysterical pseudodementia (hysterical pseudodementia): A type of hysteria suggested by Wernicke after a trauma suddenly appears to have a severe intellectual disability. Even the simplest questions and their own conditions cannot give correct answers or give approximate answers. The simple questions are answered "don't know" or the excuses are obfuscated; on the contrary, the answers to the complex questions can be correct and give the impression of being sluggish; Depressive pseudodementia

Ganser syndrome: A group of mental symptoms described by Ganser (1898) are more common in detained criminal patients. They have mild confusion and can correctly understand questions but often give approximate answers such as "What is the number of" 2 2 "?" He answered. The "3" or "5" cow has five legs, etc .; ask the patient to light the match and turn the matchstick upside down; wipe the matchbox with the end without the medicine tip; ask him to open the door with the key, and turn the key upside down and insert it into the keyhole. Others use intentional impressions or joking images; in some behaviors, they do not show dementia and are often accompanied by weird behavior or excitement and recurrence of stupidity. They seem to be in a dream just now.

puerilism: It is more common to experience childish childish language expressions and movements after trauma; patients with children s own expressions, behaviors, speech, and other mental activities return to childhood with immature childhood and excessive performance. It pretends to be a two- or three-year-old ignorant child and calls the surrounding people "uncles" and "aunts". Some people think that this situation is just like the Ganser syndrome.

Hysterical psychosis (hysterical psychosis): Sudden onset after severe trauma mainly manifests as obvious behavioral disturbances. Crying and laughing. Transient hallucinations, delusions of thinking, and disintegration of personality. Such symptoms often occur in performing personality. Women rarely have a course of disease longer than 3 weeks, can suddenly return to normal without sequelae but can recur

Conversion disorders are mainly manifested as voluntary motor and sensory dysfunctions, suggesting that patients may have some type of nervous system or physical disease, but physical examination and neurological examination and laboratory examinations cannot find corresponding internal damage to their internal organs and nervous system. Symptoms and signs that do not conform to the anatomical and physiological characteristics of the nervous system and are considered to be a patient's inability to resolve inner conflicts and desires. Symbolic conversions can have the following common types

Dyskinesia: can be manifested as increased movement or abnormal movement

Paralysis: can show monoplegia paraplegia or hemiplegia examination can not find evidence of damage to the nervous system can be manifested as monoplegia hemiplegia paraplegia quadriplegia (common in the lower limbs) accompanied by increased muscle tension or relaxation muscle tension increased often fixed in a certain position There is obvious resistance during passive movement but it does not meet the anatomical characteristics. The joint is often used as the boundary. When paralyzed limbs are required to move, they can be found to antagonize muscle contraction and lift the paralyzed limbs. When the examiner suddenly lets go, the paralyzed limbs slowly fall without re-entering the central paralysis Proximal peripheral paralysis is consistent with the characteristics of the proximal end being more distal than the lower extremity. The paralyzed leg is dragged away instead of using the hip strength to throw the leg to the front. Although walking crooked, it will support the lower extremity. Freedom of movement but unable to stand and walk, such as assisted walking, is more difficult than true organic patients, but when the patient is confident that there is no one next to him, he walks well. Chronic cases may have limb contractures or present with atrophic muscle atrophy without prompting the body. Changes in muscle tone and tendon reflex or positive pathological changes

tremor tics and myoclonus: manifested as thick limb tremors or irregular twitching myoclonus is a rapid twitch of a group of muscles similar to a dance-like movement

astasia-abasia: Patients can move with both lower limbs but cannot stand and need to be supported or fall over to one side; neither can they walk or walk with their feet close to each other.

Mutism (aphonia): Patients do not use words to express opinions or answer questions, but can use writing or gestures to talk to people. They say that they want to speak but cannot speak or can only use whispers or hoarse voices. Aphonia is checked for absence of organic lesions in the nervous system and vocal organs and no other psychiatric symptoms

Convulsion: often occurs when you are emotional or implied, and suddenly fall slowly or lie on the bed. You should not stiffen your body, shake your body or roll on the bed, or breathe in an angled bow. There may be actions such as scratching clothes, scratching hair, chest, biting, etc. Some expressions are painful, tears in eyes, but no bite tongue or incontinence. Most of the symptoms take tens of minutes to relieve.

(3) Major seizures: There are often obvious psychological inducements before the onset of seizures. There is no regularity of seizures. There is no rigidity and clonic period. The wrist joint metacarpophalangeal flexion, interphalangeal joint extension, thumb adduction, lower limb extension, or whole body rigid paroxysmal. Seizures may be accompanied by crying, breathing may be paroxysmal, facial expression may be slightly flushed, urinary incontinence, tongue occlusion may be normal, pupil size may be normal; corneal reflexes may even be present, but sensitive consciousness may be unclear, but may be implied to cause seizures. It is not slack but mostly powerful to resist passive movements; no pathological reflexes, such as positive reflexes at the later stage of the attack, suggest that organic lesions usually occur for several minutes or hours. A leading cadre of a factory in a suburb of a city rides from the factory. On the way to the urban area, a car came on the way to avoid the unfortunate accident. Both of the patients were uninjured and also participated in on-site command rescue work. When he remembered the dangerous situation at that time, a whole-body convulsion suddenly occurred. He was sent to the hospital for treatment. Whenever he walked past the accident site, he had the same attack and had to take a detour.

(3) Various peculiar dystonias, muscle weakness, dance-like movements but no organic changes can be confirmed, such as a young man's weird movements often dancing after his son's death and grief, sometimes sent to the hospital several times a day to inject a calcium gluconate Immediately after the solution, he changed to sodium chloride injection and hinted that healed quickly.

Hearing impairment: mostly manifested as sudden hearing loss, electrical audiometry and auditory evoked potential examination, normal aphasia and aphasia, but no vocal cord, tongue and throat muscle paralysis, and normal whispering when coughing

Visual impairment: can be manifested as amblyopia and blindness (tunnel vision) concentric visual field reduction monocular diplopia often occurs suddenly or can be treated to suddenly return to normal. Hysteric blindness cases have normal visual evoked potentials.

Sensory Disorders: can be manifested as somatosensory allergy or abnormal or special sensory disorders

Loss of sensation: it is manifested as lack of sensation in local or whole body skin or half-body analgesia or sock-type sock-type sensation. Its range is inconsistent with the nerve distribution. The sensation of loss may be pain, tactile, temperature, cold.

Sensation of allergy: manifested as local skin is particularly sensitive to touch, slight strokes can cause severe pain

Paresthesia: If the patient often feels a foreign body sensation or obstruction in the throat, an abnormality cannot be found in the throat examination; it is called globulos hystericus, but it should be distinguished from styloid syndrome caused by styloid processes. The latter can be confirmed by a pharyngeal touch or radiograph

If there is switching pain, it can be diagnosed from the patient's exaggerated words and the diffuse expression of the facial lesions.

Most of the symptoms described in the so-called "silent silence", "qi jue" and "mei nu qi" in Chinese medicine belong to

Special manifestations

Mass hysteria: Also known as epidemic hysteria Hysteria symptoms can affect many people through social contact. Girls 11 to 15 years of age are most susceptible to diseases that often occur in groups that live together. At school, in a temple or in a public place, at first, a person had a snoring attack, and witnesses around him were affected. The similar symptoms occurred one after another. The lack of understanding of the nature of this disease often caused widespread tension and fear in this group; Under the influence of hysteria in a short-term outbreak, such snoring attacks are mostly short-lived and similar. Common symptoms include seizures, conviction, food poisoning, headache, sore throat, abdominal pain, vertigo, and fatigue. Nervous and fearful, when hysteria symptoms occur, the surrounding students witnessed the onset of the disease. Due to the lack of scientific knowledge of the vaccination, they were also affected. Fear of nervousness. On the basis of this, many students will have similar symptoms one after another. Sexual hysteria or hysteria set The main reason for the collective episode of rickets caused by physical attacks is various factors that can cause group members to develop fear and anxiety, such as unwelcome exams for teachers or leading cultural differences between home and school. Superstitions, disasters, social changes, and so on can often A collective episode of hysteria that directly triggers an individual is usually frail, neurotic, emotionally unstable, prone to negative emotional responses, and highly dependent, and more likely to show symptoms in the hysteria epidemic. Isolate patients, especially the first cases, and give symptomatic symptoms. Treatment of epidemics can quickly control patients. Most of them are young women. Stress, fatigue, lack of sleep, menstrual periods, and those with performing personality traits are more likely to develop. Prayer in the church to practice certain qigong (such as Hexiang pile) or panic epidemic. The mysterious atmosphere formed during the region or period often provides the conditions for the epidemic of hysteria

CompCompensation neurosis: In medical disputes involving work accidents and traffic accidents, victims often make claims for financial compensation. In the process of litigation, it shows that reservations and exaggerated symptoms are conducive to victims' claims for compensation. The symptoms of exaggeration or persistence are generally not affected by the will of the person. It is dominated by the unconscious mechanism. Some of the physical symptoms after family planning surgery are not the basis of organic damage. Most of these obstacles are such obstacles. For such cases involving claims for compensation, they should be handled as soon as possible, and a thorough settlement should be avoided. Elimination of the victim's symptoms After the problem of extremely adverse compensation is resolved, medical rehabilitation measures should be taken as soon as possible in conjunction with psychological treatment to promote the elimination of symptoms

(3) Occupational neurosis: This is a type of motor coordination disorder that is closely related to occupations. The fine coordinated movements of their fingers need to be used nervously for several hours each day; such as copying a piano or violin for a long time. Especially when tired or in a hurry, hand muscles gradually become tight and painful. If you don't listen, the finger movement will be slow and labor or bouncing. If you have severe muscle tremors or spasms, you ca nt use your forearm or even the entire upper limb to give up your hand or change to other. Hand movements are normal when finger movements return to normal. These symptoms occur when writing is called writer's spasm. They are more common in people who are anxious and anxious. They are tired of work or have a heavy mental burden. Most of them have a slow onset of the nervous system. Damage In addition to coordinated finger movements, these symptoms can also be manifested as stuttering after intense speech training. The patient should be in a state of mental relaxation and then undergo corresponding muscle coordination function training from simple to complex.

Visceral dysfunction

Vomiting: mostly stubborn vomiting after eating, that is, no nausea and vomiting can be eaten after long-term vomiting does not cause malnutrition. Digestive tract examinations have no corresponding positive findings. Various new diagnostic criteria are mostly classified into the body form. obstacle

Hiccups: Hiccups, stubborn, frequent, loud sounds are especially noticeable when others are not paying attention, but lessened when no one is watching

(3) Excessive ventilation: Although wheezing-like breathing is frequent and intense, there are no signs of cyanosis and hypoxia

Hysteria globules: Uncertain objects or masses are felt in the middle or slightly of the pharynx. This feeling is especially obvious when swallowing or want to swallow. Symptoms disappear during eating. There is no difficulty swallowing food and no weight loss occasionally. Patients experience throat pain or burning as if they were injured by a fishbone spur. Patients are mostly middle-aged women but can also occur with young men and men

Others: such as polydipsia, polydipsia, etc.

Separation symptoms and conversion symptoms can be seen in a variety of neuropsychiatric diseases and physical diseases. A large number of follow-up observations of this disease at home and abroad have shown that organic diseases of the nervous system, such as epilepsy, multiple sclerosis, hepatolenticular degeneration, intracranial space occupying lesions, etc .; Diseases such as schizophrenia, depression, personality disorders, etc .; physical diseases such as hematoporphyria, hepatic encephalopathy, tetanus, etc. are misdiagnosed as the disease. The reason is that the symptoms of the disease lack sufficient specificity. Symptoms are induced by psychogenic factors. No organic signs can be found. Acceptable language implies the diagnosis. The diagnosis is not very reliable. The correct clinical diagnosis should be based on the complete exclusion of various neuropsychiatric diseases and the body that may show symptoms of separation and conversion. Based on the disease, this not only requires the clinician to carefully understand whether the patient has a history of such organic diseases, but also to carefully observe the signs or suspicious clues of organic diseases, and then take more reliable modern inspection methods such as Electronic computer brain tomography and other technologies to confirm organic damage in the early stages of certain organic diseases If the evidence is not easy to find, a long enough clinical follow-up is required to finalize the diagnosis. During the follow-up process, the treatment has achieved significant results, and the complete elimination of symptoms can help confirm the diagnosis. Therefore, the diagnosis of snoring requires two pieces of evidence: one is exclusionary evidence; two Is the supporting evidence to have a sufficient basis to rule out mental disorders caused by organic diseases or independent substances? Hysteria symptoms can be seen in a variety of neuropsychiatric and physical diseases, so it is difficult to rely on clinical symptoms for diagnosis. Clinicians must not only carefully understand the patient's history of organic diseases, but also observe whether there are signs of organic diseases or similar symptoms. If necessary, CT MRI and other examination methods can be used to exclude evidence. Of course, it must be supportive. The evidence includes psychosocial factors, symptoms suggestive and secondary benefits. If the three of them are not diagnosed, there may be doubts. In particular, some patients deny that mental factors require patient inquiry to understand the main points of diagnosis:

Separate and physical dysfunction, especially neurological dysfunction, there is sufficient evidence to exclude organic lesions

Psychological stimulus related to psychological needs and psychological contradictions It has a temporary connection with the occurrence or deterioration of symptoms; there is a clear connection between the onset and stress events. The course is often repeated.

Symptoms impede social function

Expressions that can mimic symptoms and indifferent areas

Cannot explain or even contradict neuroanatomy with the pathophysiology of physical diseases

Not other mental illness

Transitional disorder preventive care

To reduce the occurrence of this disease, it is necessary to emphasize that the conditions for the formation of an individual's personality with a healthy and good personality are various aspects. The adverse factors in the acquired environment play a very important role in the development of children's personality disorders and behavioral disorders. The most common adverse factors It is childhood trauma. Improper parenting methods. Harmonious family life and harmful effects of the external environment. To prevent abnormal development of personality and other mental disorders, we must pay attention to the physical and mental health of children and adolescents. Childhood education begins. Given that early childhood character development often determines its subsequent personality characteristics, individual mental health should first start with childhood education and education. Childhood is also an important time to lay the foundation for physical and mental health. Cultivation of education must first pay attention to family education. The family is the main place for children's life and activities. Children are imitative and easy to accept the influence of people around them. The atmosphere of family life and the relationship between family members and their education methods for children's personality development and Physical and mental health All play an important role. For this reason, the family should cooperate with the school to educate the children about their moral qualities, cultivate their moral character and style of love of work, love of the collective, and develop an honest, candid, courageous, and cheerful personality. Early detection and timely correction of some nerves Mental disorders occur in childhood. Neuropsychiatric dysfunction often begins with individual symptoms. Childhood behavior disorders such as stuttering enuresis, neurovomiting, and sleep disorders are often manifested as lonely, impulsive, or ADHD. If the diagnosis is timely and properly handled, a considerable number of cases can be corrected and cured in time.

Medications for switching disorders

(A) treatment

Adequate early treatment is important to prevent recurrence of symptoms and chronicity of the disease. Emphasis should be emphasized. Reasonable explanations for the first onset of symptoms. The connection between symptoms and psychological causes and personality traits. Good treatment and verbal hints can often achieve good results. People with recurrent attacks should formulate an overall treatment plan that combines psychotherapy with drugs and physical therapy according to the condition. It should not be hastily adopted simple language to suggest that although the treatment was effective at the time, it is easy to relapse or new symptoms will replace the original symptoms.

Secondly, it should be noted that after the diagnosis is basically clear, repeated examinations should be avoided as much as possible. Unnecessary examinations will often complicate the condition. Improper prompting during the inquiry of the medical history or examination may make the patient appear new. Symptoms and signs

In the course of contacting the patient and avoiding the adverse environment in the treatment process, too many people are watching. Over-attention to symptoms. Strong nervousness about the development of the patient's condition will increase the patient's tendency to seek attention and worsen the condition.

Psychotherapy is the basic measure for the treatment of this type of disease, mainly including the following aspects:

Hint therapy: It is an effective measure to eliminate conversion disorders. It is particularly applicable to patients with acute onset. It can be divided into two types: imply awakening and hypnotic suggestion. The patient urgently requires the therapist to use language hints or cooperate with appropriate physical therapy acupuncture or massage in the awake state. Good results can be obtained. Longer course of cases with unclear etiology often require the use of drugs or speech hypnosis to eliminate the patient's psychological resistance in order to achieve better results.

Awakening implies: the doctor should explain the results of the examination to the patient at the beginning of the treatment; then explain to the patient in short and clear language that his disease is a transient neurological dysfunction; which treatment method is to be taken; with the help of treatment Lost function can completely return to normal; make patients have a high degree of confidence in treatment and urgent cure requirements. Patients with motor and sensory disorders can choose to use 10% calcium gluconate 10ml intravenous bolus or use induction electricity to stimulate the affected area at the same time. Speech massage and passive exercise encourage patients to use their functions; then use language reinforcement to convince patients that the functions that have been lost with the help of treatment are recovering ... have been fully restored; and further encourage patients to perform corresponding functional activities

Hypnosis suggestion: There are many methods to perform hypnotic susceptibility test before treatment starts. One or two of them can be selected to determine whether the patient is suitable for language hypnosis. For example, let the patient stand on both feet with his back to the doctor's head and lean the doctor's hand. The pillow then tells the patient that he should fall backwards after the hand is removed. If the patient falls back immediately after the doctor's hand is removed, it means that the patient has a certain hypnotic sensibility. The language hypnosis can be used to suggest treatment when the patient enters the hypnotic state. Patients with poor hypnosis or doctors who are inexperienced with language hypnosis can use 2.5% sodium pentothal or sodium amytal 10 ~ 20ml slow intravenous injection to make the patient enter a mild state of consciousness Then use the method suggested in the above awakening to suggest with words or use electrical stimulation to massage passive movements.

Hypnosis therapy: In addition to enhancing the suggestive sensory elimination and conversion symptoms, it can also be used to treat patients with separated amnesia, multiple personality mutism, stupefaction, and emotionally damaged or depressed patients. In hypnosis, it can make the forgotten traumatic experience heavy. The depressed emotion is released to achieve the purpose of eliminating symptoms. In hypnosis or awake state, guide patients to talk about their inner distress and release the hurt or depressed emotions. The treatment method is called catharsis to highlight the emotional disorder. Of patients receive good results

Interpretive Psychotherapy: The main purpose is to guide patients to correctly understand and treat the mental factors that cause disease. To understand the nature of the disease and help patients analyze the defects of personality and the ways and methods to overcome the defects of personality. Various types of

Analytic psychotherapy: focus on exploring the patient's unconscious motivation to guide the patient to understand the impact of unconscious motivation on health and eliminate it. It is mainly applicable to separate forgetfulness, multiple personality and various conversion disorders. Psychoanalytic techniques or insight therapy can be adopted.

Behavioral therapy: It mainly adopts a gradual and stepwise strengthening method to perform functional training for patients. It is suitable for chronic cases that imply treatment of invalid limbs or speech dysfunction.

Family therapy: When the family relationship of the patient is affected by the disease or the treatment requires the cooperation of family members, this treatment method should be used to improve the patient's treatment environment and obtain family support.

Medicine and physical therapy

Medicine treatment: It is difficult to accept formal psychology when snoring psychosis state or spastic seizure can use intramuscular injection of chlorpromazine hydrochloride 25 50mg; or intravenous injection of diazepam (diazepam) 10 20mg to promote patients to sleep. Symptoms disappear after waking up. Those who still have psychiatric symptoms after the acute phase can use chlorpromazine hydrochloride orally 1 to 3 times / d25-50mg / times. Those who are left with dizziness, headache, insomnia and other symptoms of brain weakness can be given aprazolam (aprazolam). ) 3 times / d 0.4 0.8mg / time or Laurazepam (cloxaphene) 3 times / d 0.5 1mg each time; or Hydroxazine (Antel) 3 times / d 25mg / time; or Ace Zolun (Sullenazol) 1 to 2 mg every night before going to bed; lasts 2 to 3 weeks

Stimulation of nasal mucosa by ammonia in patients who are drowsy can awaken patients but the stimulation time should not be too long to prevent nasal mucosal burns

Physical therapy: Acupuncture or electrical stimulation therapy can have a good effect on dysfunction such as conversion paralysis, deafness, blindness, or limb twitching; however, attention should be paid to the need for strong stimulation of acupuncture or Electrical excitement therapy can promote patients' consciousness to normal

This disease is a kind of easily recurring disease. Eliminating the cause in a timely manner enables patients to have a correct understanding of the nature of their disease, to face up to the existence of personality defects, to improve interpersonal relationships, to prevent recurrence, and to help with long-term hospitalization or home recuperation. Accommodation or inappropriate strengthening is not conducive to rehabilitation

The treatment of this disease should be established from the time of the examination. A good doctor-patient relationship is very important to the success of the treatment. Doctors should care about patients and help them find the cause of the disease. Guide them to treat the disease correctly. Build confidence to overcome the disease. The cure is the doctor and the patient. Result of joint efforts Hysteria treatment is mainly based on psychotherapy supplemented by drugs and other treatments

Psychotherapy

Interpretive psychotherapy:

Make patients and their families and colleagues have a correct understanding of the nature of the disease and tell them that hysteria is a functional disease that can be completely cured to eliminate its doubts and facilitate better cooperation with treatment.

Guide patients to understand the relationship between mental and personality factors and onset and treatment, give them comfort and encouragement, help them to rationally arrange life and work, adjust the environment, remove mental stimulation, and actively overcome personality defects.

Give patients the opportunity to indulge themselves in a timely manner and persuade them to deal with everything in a rational manner instead of being overly emotional.

At the same time, the doctor should also teach the patient's relatives how to do during and after the episode of snoring. For example, don't panic in the attitude of the patient. Over-concern or please the first. The doctor should comprehensively and objectively introduce the medical history to the relatives when implementing the treatment plan. Leave the treatment site with confidence to create a quiet and relaxed environment for the treatment. When relatives improve, relatives should cooperate with the doctor to continue to encourage or imply that family members such as patients can cooperate with doctors to do so will play an important role in improving symptoms and consolidating treatment to avoid recurrence.

Suggestive treatment:

Psychological suggestion: it is an effective method to eliminate the symptoms of hysteria, especially the conversion of symptoms. The following problems should be paid attention to when performing suggestive treatment. A. The treatment environment should be quiet to eliminate the various adverse effects of the environment on the patient. All unrelated personnel should leave the treatment site to avoid The panic attitude or excessive attention of family members or those around them makes the symptoms worse, which makes treatment difficult. B. The doctor should be enthusiastic and confident during the process of contacting the patient and conducting a comprehensive examination. Establish a good doctor-patient relationship with confidence in the treatment. Patients develop a sense of trust. Practice has proved that the patient's trust in the doctor is often the key to determining the success or failure of the treatment. C. While the cues are implied, other appropriate measures should be taken for the symptoms such as oxygen injection with water for injection or vitamin C injection intramuscular injection. Bolus calcium injection and electroacupuncture

Drug suggestion: For the dissociation symptoms, induction therapy can be used, that is, 0.5 ml of ether is injected intravenously with language hints to inform patients that when they smell a special odor (ether), the symptoms can occur and let the disease occur without any worries. The more thorough it is, the better it is. After the peak period of the seizure, use an appropriate amount of distilled water to subcutaneously inject the thorax and use language to indicate to the patient that the disease has been eradicated and then stop. For some conversion symptoms, you can also apply drugs to suggest that for patients with dyskinetic dyskinesia A calcium gluconate injection tells the patient that this is a specific medicine for this disease. After the intravenous injection, if the throat feels hot, the physical symptoms will improve immediately. Once the patient receives the verbal suggestion, the physical symptoms will be accompanied by the fever of the throat after the injection. May disappear dramatically

(3) Hypnosis therapy: People are more likely to accept language in the state of hypnosis, suggesting that the purpose of eliminating separation and switching symptoms can be achieved through therapeutic language "input" after hypnosis.

Behavioral therapy: functional training of patients is suitable for patients with motor or speech disorders that suggest that treatment is ineffective

Medication

For those with obvious mental symptoms, chlorpromazine or promethazine hydrochloride combined with 25-50 mg of intramuscular injection can be given.

For emotional outbreaks and convulsions, the author can immediately give diazepam (Diazepam) 10-20mg or clonazepam 1-2mg intramuscularly

(3) Those who still have obvious mental symptoms after the acute phase can take chlorpromazine 25 to 50 mg once orally three times a day orally; perphenazine 4 to 10 mg one to three times a day orally; or risperidone 1 to 2 mg once a day orally with headache. Insomnia can be given alprazolam 0.4mg or Laurazepam 0.5mg 1 to 3 times per day orally

Other treatments

Acupuncture treatment: acupuncture can be used to acupuncture acupuncture points in Zhonghe Valley Neiguan Yongquan Zusanli

Compression treatment: enable the supine patient to use his thumbs and thumbs to press the person's Zhongbaihui, Zhongqi, Haizhongchong, Neiguan, and other acupoints from light to slow and gently until the patient's symptoms are relieved.

(3) Electrical stimulation treatment: For patients with convulsive seizures, trembling states, and some switching symptoms, stronger electrical stimulation treatment can often receive better results.

Medicine treatment for hysterical hazy state psychosis or spastic seizures can use intramuscular injection of chlorpromazine hydrochloride 25 50mg; or intramuscular injection of perphenazine 5 10mg; or intravenous injection of diazepam (diazepam) 10 20mg prompts patients to fall asleep. After the period of time, those who still have obvious symptoms can use chlorpromazine orally 1 to 3 times / d 25 to 50 mg / times. Those who have leftover dizziness, headache, insomnia and other symptoms of brain weakness can be given alprazolam 0.4 to 0.8 mg 3 times / d. Or estazolam 1 to 2 mg every night before going to bed generally takes 2 to 3 weeks

Stimulate the nasal mucosa with ammonia when you are in a drowsy state, but the stimulation time should not be too long to avoid burns

Physical therapy Hysteria palsy, deafness, blindness, or dysfunction such as limb twitching or dysfunctional sclerosis, can be treated with strong acupuncture or electrical stimulation. Good attention to language and suggestive treatment

Psychotherapy

Suggestion therapy: It is suitable for patients with snoring physical disorders, especially acute onset patients, who need urgent treatment, can achieve good results through language and appropriate physical therapy acupuncture or massage. This suggestion is called arousal suggestive course The long-term cause of illness is not clear. Patients with motor and sensory disorders can choose a slow intravenous bolus of 10ml calcium gluconate, coupled with language massage or passive exercise. Encourage patients to use their functions. With multiple hints, make patients believe that their functions are recovering.

Another suggestion therapy is to perform hypnotic susceptibility before treatment in the hypnotic state. If the patient has a certain hypnotic sensation, use language hypnosis. If the patient is not sensitive, use 2.5% thiopental sodium or isoprene. Slow intravenous injection of barbituric acid 10 20ml puts the patient into a mild haze state and then hints according to the above hint method when awakening

Hypnosis therapy: In addition to enhancing the implied susceptibility to eliminate the physical symptoms of snoring hysteria, it can also be applied to patients with snoring amnesia, multiple personality stupor states, and patients with emotional impairment or depression.

In the state of hypnosis or awakening, the treatment method that guides the patient to talk about the inner distress and release the hurt or depressed emotions is called venting therapy

Interpretive Psychotherapy: Applicable to all types of hysteria except syphilis

Analytical psychotherapy: suitable for hysterical amnesia and multiple personality disorders

Behavioral therapy: suitable for chronic cases of limb or speech dysfunction that suggest that the therapy is ineffective

(B) the prognosis

Most of the onsets are usually triggered by obvious psychological factors and the symptoms can gradually increase. The first onset is usually in the early childhood and early adulthood before the age of 10 and after the age of 35. However, there are also reports of the first onset after the age of 80. (Weddington 1979) The first onset of illness in middle or old age should first consider whether it is a nervous system or other physical disease. The disease has two episodes of seizures and persistent disease. Separation of the aphrodisiac state, stiff state, appendage state, emotional outbreak, and switching spasm Disturbances such as episodic and separated amnesia, identity disorders, switching dyskinesias, and sensory disorders often have a persistent course

Most of the patients with acute onset to the emergency room of the general hospital recovered quickly for more than one year. According to Ljungberg (1957), about half of the patients still had symptoms after 10 years. Lewis (1966) tracked 98 syphilis patients at Maudsley Hospital 7-12 The results of this year were: 54 healthy workers, 12 unchanged workers, 10 worsened, 7 deaths, 7 deaths, 3 deaths from causes not related to psychiatry, 3 deaths from organic diseases of the nervous system, and 1 suicide. Most of the unrecovered cases had personality disorders and difficulty in adapting to society. 91 of the last diagnosed changes were 11: 8 were diagnosed with depression, 2 were schizophrenia, and 1 had dementia after a fall. The prognosis of patients depends on a variety of factors: clear etiology and timely and reasonable resolution of short course of treatment. Patients without obvious personality defects before the disease can get a good outcome. Patients are relieved of psychological conflict and no anxiety after illness. This type of benefit is called "primary gain", and the disease can make the patient get more benefits from the external environment, such as the care and care of relatives and friends. Heavy workloads and responsibilities are "secondary gains". Although these two types of "benefits" can provide immediate benefits to patients, they are not conducive to the elimination of symptoms, leading to a long-lasting disease course that is difficult to be seen. The length and relapse are closely related to the correct treatment after the disease. Improper treatment or verbal suggestion can often increase the persistence of the disease and prolong the course of the disease. Follow-up studies have shown that most of the patients with this disease have a good prognosis. Work and get rid of the symptoms. A few people, such as paralysis or visceral dysfunction, delay the residual symptoms and therefore seriously affect work and living ability. It can even affect lifespan due to complications. Patients with a long course or frequent recurrent episodes have difficulty in treatment People with performing personality are also more difficult to treat and are prone to relapse