Conversion disorder

Introduction to conversion disorders Dissociative (conversion) disorder is a type of dissociation and transformation caused by obvious mental factors such as major life events, inner conflicts, emotional agitation, suggestive or self-suggestion, and acting on susceptible individuals. Symptoms of mental illness. Dissociation symptoms, also known as hysteria psychosis, refers to the partial or complete loss of the patient's identification of self-identity and memory of the past, but manifested as narrowing of consciousness, selective forgetting or mental outbreaks, etc. Sexual physical symptoms refer to the unsatisfactory problems encountered by patients and the unpleasantness caused by conflicts. They are manifested in various physical symptoms. It can manifest symptoms similar to any disease, so some people refer to snoring as " Great disease" or "disease imitator." Mainly manifested in a variety of physical symptoms, reduced range of consciousness, suggestive, selective forgetting or emotional outburst and other mental symptoms, but can not find the corresponding organic damage as its pathological basis. basic knowledge The proportion of illness: the incidence rate is about 0.0001% - 0.0004% Susceptible people: no specific population Mode of infection: non-infectious Complications: depression

Causes of conversion disorders

(1) Causes of the disease

1. Separation of mental and psychological factors The causes of sexual disorders are closely related to mental factors. Various unpleasant moods, anger, grievances, panic, shame, embarrassment, sadness and other traumas are often the cause of initial illness, especially the spirit. Tension, fear is an important factor in triggering this disease. This is especially true in acute snoring reactions in combat; while traumatic experiences in childhood, such as mental abuse, physical or sexual devastation, are conversions in adulthood. And one of the important reasons for separation disorders, a small number of patients can have no obvious incentives after multiple episodes, and later because of association or re-experience of the initial episodes of emotional recurrence, and more caused by hints or self-suggestion, such as the former Soviet Union In the national war, a woman was insulted by the German fascist army. Later, when passing through a movie theater that was showing a war movie, she heard the sound of guns, that is, a seizure occurred, which was conducive to the patient getting out of trouble, venting emotions, and getting others. Sympathy or support and compensation.

2. The relationship between the onset of somatic disorder and the mental factors is not obvious. Whether the mental factors cause snoring, or what type of snoring is related to the physiological and psychological quality of the patients, those with susceptibility are less likely to be motivated. Disease, the patient with snoring personality characteristics accounted for about 49.8%, the main characteristics of his personality are:

1 Performing personality characteristics: About 20% of the patients have typical performance personality, as follows: distinct emotional emotions, excessive emotions, exaggerated expressions, naive speech, drama, poor emotional control, emotions shallow.

2 The level of culture is low and the concept of superstition is heavy.

3 Self-centeredness: Constantly pursuing excitement to seek the attention of the people around you.

4 Highly suggestive: It is easy to be hinted by people and the environment around, and it is easy to suggest yourself.

5 rich fantasy: imagination is rich, even with fantasy instead of reality, always intentionally or unintentionally playing the role of fantasy, can have fantasy lies.

6 Women in adolescence or menopause are more prone to snoring than the average person, but such personality traits are not necessary for snoring. When people with susceptibility are frustrated, psychological conflicts or acceptance of suggestion are prone to snoring, some People who do not belong to this type of personality can also suffer from snoring reactions under the influence of strong mental factors.

3. Organic factors Some studies have found that about 2 / 3 of the patients with brain disease or organic brain disease, 32% of patients have had neurological diseases, especially the history of epilepsy.

4. Genetic factors The genetic research results of this disease are quite inconsistent. Some studies have found that some patients have genetic quality. The family survey of Ljunberg (1957) found that the father, brother and son of the snoring proband had sputum 1.7. %, 2.7% and 4.6%; the prevalence rates of mothers, sisters and daughters were 7.3%, 6.0%, and 6.9%, respectively. In general, the prevalence of male first-degree relatives was 2.4%, and the female first-degree relatives suffered. The disease rate is 6.4%. Foreign data also show that the incidence of this disease in the close relatives of snoring patients is 1.7%~7.3%, and the incidence rate of female first-degree relatives can reach 20%. The report of patients with positive family history in Fujian area in China 24%, higher than the normal population, suggesting that genetic factors may play a role in the pathogenesis of the disease, but Slater (1961) studied 24 pairs of twins, monozygotic twins and twin twins each with 12 pairs, 23 of which At least one person in each pair was diagnosed with snoring, and one in the other pair was diagnosed as snoring personality; no single or double ovarian twins had a pair of snoring, in stark contrast to Ljunberg's results, Arkonac And Guze (1963) research on the family of 25 female snoring patients The first-degree relatives have 5 cases of snoring patients, all women; 9% of all first-degree relatives, accounting for 15% of female first-degree relatives; and the authors estimate that the prevalence of snoring in women of the general population is only 1% to 2 %, in addition to the increase in cases of anti-social personality disorder and alcoholism among male first-degree relatives of snoring probands, the results of genetic studies are more consistent with Briquet syndrome, Cloninger et al. (1986) reported that such probands The prevalence of Briquet syndrome in first-degree relatives was 7.7%, compared with 2.5% in the normal control group. Torgersen (1986) reported a group of somatoform disorders in twin studies, with a single-female twin co-morbidity rate of 29 %, and the twin-child twins have a prevalence rate of 10%; at the same time, the prevalence of generalized anxiety disorder is also found in patients with siblings. Cloninger et al. (1975) considered this to be a multi-factor genetic model, and the performance in women is Briquet synthesis. In men, it is an antisocial personality disorder.

5. Social and cultural qualities such as customs, religious beliefs, living habits, etc., also have an impact on the occurrence and form of the disease and the symptoms.

(two) pathogenesis

There are two neurophysiological explanations for the pathogenesis of this disease: one is based on Janet's theory of consciousness separation. It is believed that the change of consciousness state is the neurophysiological basis of the onset of snoring. With the separation of patient consciousness, attention, alertness, and near memory And the impairment of cognitive functions such as information integration ability, because the cerebral cortex inhibits the afferent stimulation, the patient's self-awareness is weakened, and there is a suggestive increase. At this time, when the individual is threatened by biological, psychological or social factors, There are various instinctive reactions like animals at risk, such as intense motor response, false death reflexes, and regression to the naive period. Another explanation is based on Pavlov's advanced neurological activity theory, which considers the onset of snoring. The mechanism is: harmful factors act on people with weak neurological types, causing separation or inconsistency between the first and second signaling systems of the high-level neural activity, between the cerebral cortex and the lower cortex, the patient's first signaling system And the function of the lower part of the cortex is relatively dominant, and under the influence of external stimuli, it is already in a weak state. The cortex rapidly enters the over-limit inhibition, resulting in positive induction, which enhances the activity in the lower part of the cortex. It is clinically characterized by emotional outbursts, seizures, and instinctual activity and autonomic symptoms. On the other hand, strong and persistent emotional stress can be Excitatory foci are generated in the cerebral cortex, causing negative induction. This induced inhibition is combined with the above-mentioned over-limit inhibition, and spreads to other parts of the cortex and the lower part of the cortex, causing the cerebral cortex to be in a phase state, so that the sensory loss occurs in the clinic. Symptoms and signs such as sputum, sputum status.

Pavlov believes that the physiological mechanism of suggestive and self-imposed increase in snoring patients is: harmful stimuli affect the weak neurological type, which can cause cerebral cortical function weakening, enhanced subcortical activity, called positive induction, clinical manifestations Emotional outbreaks, seizures, instinctual activity and autonomic symptoms. In addition, strong emotional stress can excite the cortex, causing negative induction, clinical manifestations of sensory loss, limb paralysis, paralysis and other symptoms and signs, weakening in the cerebral cortex In the case of external real-world stimuli, a weak negative induction is induced, and other parts of the cerebral cortex are in a state of inhibition. At this time, the linguistic influence of the suggestive is completely isolated from the activities of other parts of the cortex; thus, it is absolutely irresistible. power.

The pathogenesis of this disease has a variety of pathological psychological explanations, different clinical types, and different pathological psychological mechanisms.

Somatization: The concept proposed by Steckel (1943), originally referred to as a deep-seated neurosis of physical disorders, identical to Freud's concept of "conversion", and thereafter The meaning of the term evolved to refer to the pathological psychological process of expressing psychological pain through physical symptoms. The occurrence of somatization is usually not recognized by the patient, but the physical symptoms of the complaint are not the symbolic expression of the inner conflict in the unconscious area. It is closely related to unpleasant emotional experiences, especially anxiety and depression; therefore, unlike conversion, somatization is a fairly common phenomenon in the clinic and in the community. It is not limited to hysteria. The so-called somatization disorder is nothing but a body. A type with more serious effects, somatization is more prominent in the pathogenesis of somatization disorders than other types of snoring.

Conversion: The concept put forward by Freud early (1894), he believes that the sexual psychological development of snoring patients is fixed in the early stage, that is, the stage of the love complex; its sexual impulse is suppressed, so its mental energy is transformed into physical symptoms; Not only does the patient protect him from being aware of the existence of sexual impulses, but these physical symptoms are often a symbolic expression of inner conflict, thereby protecting the patient from anxiety (primary benefit).

Such snoring patients often show an indifferent attitude towards their physical dysfunction; the 19th-century French doctor called it "belle indifference", which gives the impression that patients do not care about their physical functions. Recovery, but want to retain the symptoms to obtain a certain social benefit (secondary benefit), although the patient himself is usually not aware of the intrinsic link between symptoms and benefits, but pathological psychologists believe that such patients exist Unconscious motivation, the conversion symptoms are caused by the unawareness of the patient. With such symptoms, the patient has a sick role and can enjoy the patient's rights; the symptoms themselves are sufficient to indicate that his work task is not completed. My fault, or the purpose of claiming compensation or controlling others, therefore, some people regard the conversion symptoms as a non-verbal communication between the patient and the outside world, but the behavioralist believes that the conversion symptoms are patients suffering from setbacks. An adaptation of life experience, and the benefits of illness are strengthened by operational conditioning, and the symptoms of snoring are seen. It is a learned response. Once a patient finds such symptoms, he can alleviate the anxiety caused by the difficult situation, and his dependence needs will be satisfied, the symptoms will be strengthened, persistence; or encounter difficulties later. It appears again.

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 neurological symptoms such as paralysis, forgetting, state of consciousness change and autonomic disorder. Etc. But through hypnosis, these concepts and processes can be reintegrated and returned to normal. He believes that these separated components are subconscious. Separation of consciousness is mainly an obstacle to the integration of different conscious components, which is hypnosis and various snoring. Foundation, but Freud believes that separation is a variant of repression, a positive defense process, its role is to make painful emotions and thoughts excluded from consciousness, some modern scholars believe that separation It is not only a conversion disorder but also a basic pathological psychological mechanism of separation disorders. Its occurrence is related to acute mental stress or self-hypnosis. Such patients often have suggestive increases, and the integration of psychological functions such as perception, memory and identification is suppressed. It manifests itself as a variety of separation symptoms.

Conversion disorder prevention

To reduce the occurrence of this disease, we must emphasize the development of healthy and good personality. The conditions for the formation of individual personality are various. Among them, the undesirable factors in the acquired environment are very important in the development of children's personality disorder and behavioral disorder. Status, the most common adverse factors are childhood trauma, improper parenting methods, disharmonious family life, and the harmful effects of the external environment. To this end, to prevent abnormal personality development and other mental abnormalities, it is necessary Pay attention to the physical and mental health of children and adolescents.

1. Emphasis on mental health must begin with the education of childhood. Since the early childhood development of personality determines its subsequent personality characteristics, the individual's mental health should first be started from the training of childhood, and the childhood is also An important moment in the foundation of physical and mental health.

2. Childhood education should first pay attention to family education. Family is the main place for children's life and activities. Children are imitative and easy to accept the influence of people around them. Therefore, the atmosphere of family life, the relationship of family members and their relationship Children's educational methods play an important role in children's personality development and physical and mental health. To this end, families should cooperate with schools, educate children about moral quality, cultivate their love of labor, love the collective morality and style, and raise Be honest, honest, strong, brave and cheerful.

3. Early detection and timely correction of some neuropsychiatric disorders, neuropsychiatric disorders occurring in childhood, often starting from individual symptoms, such as stuttering, enuresis, tics, neurological vomiting and sleep disorders, behavioral disorders in childhood , often manifested as solitude, dullness, impulsive behavior or ADHD, etc., such as timely diagnosis and timely diagnosis, if handled properly, there are quite a few cases that can be corrected and cured in time.

Conversion disorder complications Complications depression

Generally no complications.

Symptoms of Conversion Disorders Common Symptoms Separate Identity Disorders Sensory Disorders Separated Deafness Status... Mop-independent substances... Weak emotions, outbursts, and nausea

The disease is mostly in the adolescent period. It is rare for those who are over 35 years old. They are often stimulated by psychosocial factors. They can have multiple onsets, especially in women. The clinical manifestations are dissociation (spirit). Obstacle) and conversion (somatic disorder) are two kinds of obstacles. Because it can have exercise, sensory disturbance, and can be expressed as autonomic function, consciousness, memory disorder, and even psychotic disorder, it is easy to cause misdiagnosis in clinic. The clinical manifestations of the disease are very complex and diverse, and are now classified into the following types.

1. The clinical manifestations of separation disorders are consciousness and affective disorder. The consciousness disorder is narrow in consciousness, the state of paralysis is more common, the scope of consciousness is narrowed, some are in a state of dream or paralysis, and various defensive reflexes always exist in the disturbance of consciousness, and Related to a strong emotional experience, there can be emotional bursting symptoms such as crying and laughing, screaming, screaming and screaming, sometimes dramatic, and the content of the speech is related to the inner experience, so it is easy to be understood, this type of mental factor before the onset Often it is obvious that although the patient himself denies, others seem to think that the onset of the disease is often conducive to getting out of trouble, venting repressed emotions, gaining sympathy and attention from others, or receiving support and compensation, repeatedly sending authors, often through memories and associations. According to the clinical characteristics, this type can be divided into the following categories according to the clinical characteristics. DSM-III and IV are divided into separate forgetting, segregation, multiple personality, personality disintegration according to their clinical manifestations. Obstacles and atypical separation disorders.

(1) Dissociative amnesia (dissociative amnesia): belongs to psychogenic forgetting, patients have no physical damage such as head and brain trauma, and suddenly lose memory of major events they have experienced; forgotten events are often associated with trauma or It is related to stressful events. It is not because of accidental reasons. If it is limited to events that occur within a certain period of time, it cannot be recalled. It is called local form or selective forgetting. A generalized form is forgotten.

(2) Dissociative fugue: a special form of dissociative disorder. Patients often develop under the influence of acute mental stimulation. Suddenly wandering from one place to another, often it is never If you are away from home, you can leave the home or work place and travel to other places. The place of travel may be a place that is familiar and emotional in the past. At this time, although the patient is in an awakening state, the scope of consciousness is narrowed, and roaming lacks planning and purpose. However, the daily basic life (such as eating and drinking) ability and simple social contact (such as purchasing tickets, riding a car, asking for directions, etc.) remain; some patients forget their past experiences and appear in a new identity, others I can't see the abnormal behavior of his words and deeds and appearances; it lasts for a few tens of minutes to a few days or longer, and the behavior during the period is quite complete. After a complete forgetting or only a piece of recall, the typical tour is extremely rare.

(3) Dissociative stupor: triggered by trauma or traumatic experience, with deep disturbance of consciousness, maintaining a fixed posture for a long time, lying on his back or sitting, without words and random movements, No response to light, sound and pain stimuli. At this time, the patient's muscle tension, posture and breathing may be no abnormality. The upper eyelid is opened by hand, and the eyeball is turned downward or closed, indicating that the patient is not sleeping. It is not in a coma, and it usually takes a few dozen minutes to wake up on its own.

(4) Dissociative trance and possession: The state of paralysis is characterized by a conspicuous narrowing of consciousness, and the parties are in a state of self-enclosement. Their attention and consciousness activities are limited to one or two aspects of the current environment. Responding to individual stimuli in the environment, the typical sputum state is seen in hypnosis, witchcraft or superstitious activities, when the surgeon interacts with the "ghost" and "god", and some qigong, such as Hexiang pile, induces In a state of fascination, a person in a state of paralysis, if his identity is replaced by a deity or a dead person, claiming that he is a god or someone who has died is talking, it is called a state of attachment, a state of separation, and a state of attachment. The body state is an involuntary, unintended pathological process; the patient's movements, postures, and speech are monotonous, repetitive, and can be controlled by others or self-sugges, and can be controlled at will. Cultural or superstitious behavior; although it is a separation of consciousness, it should not be diagnosed as a separation disorder.

(5) Dissociative identity disorder, also known as snoring dual or multiple personality, the patient suddenly loses all memories of his past events, does not recognize his original identity, and conducts daily social activities in another identity; Such as the devil or the undead, replacing the patient's identity, the perception of the surrounding environment is not sufficient, its attention and perception are limited to certain aspects of the surrounding people and things, and associated with the patient's changed identity, the disease is one Psychiatric symptoms such as dysphoria, delusions, hallucinations, etc., are more common in two personality types, called double personality or alternating personality; one of them is often dominant.

(6) Other separation disorders: In addition to the above types of separation disorders, the following special types are also clinically visible:

1 emotional outburst (emotional outburst): lighter consciousness disorder, often quarreling with people, sudden onset when emotional, crying, yelling, rolling on the ground, rubbing the chest, tearing clothes, destroying things, pulling hair or head against the wall; its words The behavior has the characteristics of venting inner anger and anger. In many occasions, the attack is particularly intense. Generally, it can be quiet for dozens of minutes, and some can be forgotten afterwards.

2 hysterical pseudodementia (hysterical pseudodementia): a type of hysteria proposed by Wernicke, patients suddenly have severe mental retardation after trauma, can not make a correct answer to even the simplest problem and its own situation, or give approximation The answer, to ask them a simple question, answer "I don't know", or excuse the congestion; on the contrary, the answer to the complex question can be correct and give a dull impression; but no brain organic disease or other Mental illness exists, unlike organic or depressive pseudo-dementia.

3Ganser syndrome: A group of psychiatric symptoms described by Ganser (1898), more common in detained criminals, patients with mild confusion, can correctly understand the question, but often give an approximate answer, such as "'2 2' equals How many?", he answered "3" or "5", the cow has five legs, etc.; when the patient burns a match, he turns the matchstick over, wipes the matchbox with the end without the medicine; and asks him to open the door with the key. Then turn the key upside down and insert it into the keyhole, giving the other person an impression of intentional or joking; but in some behaviors, it can not show dementia, and often accompanied by strange behavior, or excitement and chaos alternately, after relief, It is just like a dream.

4 puerilism (puerilism): more common, after the trauma, suddenly appeared as a child-like childish language, expressions and movements; patients with their own children, their expressions, behaviors, speech and other spiritual activities are back to childhood, childish Excessive performance, I can see that it is a color, pretend to be a child of two or three years old, and called the people around as "uncle" and "auntie". Some people think that this situation is the same as Ganser syndrome. A special category in sexual dementia.

5 hysterical psychosis: sudden onset of illness after severe trauma, mainly manifested as obvious behavioral disorders, impermanence, short-lived hallucinations, delusions and thinking disorders, and personality disintegration, etc. Most of the women who perform in the performance personality, the course of the disease rarely exceeds 3 weeks, can suddenly return to normal, without any symptoms, but can be re-issued.

2. The conversion disorder is mainly characterized by voluntary movement and sensory dysfunction, suggesting that the patient may have some kind of nervous system or physical disease, but physical examination, neurological examination and laboratory examination can not find that the internal organs and nervous system have corresponding Organic damage, whose symptoms and signs do not conform to the anatomical and physiological characteristics of the nervous system, is considered to be a symbolic conversion of inner conflicts and desires that cannot be resolved by patients, and may have the following common types.

(1) Movement disorders: can be expressed as reduced movement, increased or abnormal movement.

1: It can show single sputum, paraplegia or hemiplegia. The evidence of neurological damage can not be found. It can be manifested as single sputum, hemiplegia, paraplegia, quadriplegia (more common in lower limbs), accompanied by muscle tension enhancement or relaxation, muscle tension The enhancer is often fixed in a certain position, and there is obvious resistance during passive activities, but it does not conform to the anatomical features, often with the joint as the boundary; when the limb movement is required, it can be found that the muscle contraction is antagonized, the limb is lifted up, and the examiner suddenly let go. At the time, the limbs slowly fall, not to the proximal end of the central iliac crest, and the proximal iliac crest is more important than the distal end. The lower extremities are paralyzed and the legs are dragged away, instead of using the hip force first. Legs squat to the front, although walking is skewed, but it will support, rarely fall, lower limbs move freely when the lower limbs move, but can not stand walking, such as walking, it is more difficult than real organic patients, but when When the patient is convinced that there is no one, he walks very well. Chronic cases may have limb contracture or disuse muscle atrophy, but there is no change in muscle tone and tendon reflex or yang. Pathological response.

2 tremor, tics and myoclonus: manifested as gross fibrillation, or irregular twitching, myoclonus is a rapid twitch of a group of muscles, similar to dance-like movements.

3 can not stand, can not walk (astasia-abasia): patients can move lower limbs, but can not stand, support people need support, or dump to one side; can not walk, or walk together when the feet are together, is a bird-like Jumping.

4 mutism, aphonia: patients do not use words to express opinions or answer questions, but can use writing or gestures to talk to people, called mutism, want to talk, but can't make a sound, or can only use whispers or When talking in a hoarse voice, it is called aphasia, examining the nervous system and vocal organs, no organic lesions, and no other psychotic symptoms.

(2) convulsion: often occurs when emotions are excited or implied, slowly fall to the ground or lying on the bed, should not be called, the body is stiff, the limbs are shaking, or rolling on the bed, or angle bow In the anti-tension posture, when you breathe, you can stop, you can have clothes, scratch your hair, chest, bite, etc. Some expressions are painful, your eyes are tears, but you dont bite your tongue or incontinence, most of them last for tens of minutes. The symptoms are relieved.

(3) large seizures: there are obvious psychological incentives before onset, convulsions have no regularity, no rigidity and clonic period, often wrist joints, metacarpophalangeal joint flexion, phalanx joints straight, thumb adduction, lower limbs Straight or full body tough, limb paroxysmal turbulence, turbulence, seizures can be accompanied by crying, breathing is paroxysmal, face flushing, no urinary incontinence, no biting tongue, normal pupil size when attack; corneal reflex exists, It is even sensitive, but the consciousness is unclear, but it can be implicated to suspend convulsions. The limbs are not slack at the end of the attack, but most of them are powerful resistance to passive movement; no pathological reflexes, such as positive sputum reflexes in the later stages of the attack, suggesting organicity. Diseases, the general attack can last for a few minutes or a few hours, a leading cadre of a factory on the outskirts of a city, from the factory to the city by car, on the way to a car coming in on the way, in order to avoid each other, unfortunately both overturned, the sick He was not injured, but also participated in the on-site command and rescue work. When he once again remembered the dangerous situation at that time, he suddenly developed body convulsions, and his mind was unclear. He was sent to the hospital for treatment, and he went out every time. Locations have the same attack, they had to take a detour.

(4) All kinds of strange muscle tension disorders, muscle weakness, dance-like movements, but can not confirm organic changes, such as a young man, because his son died, sad, and often there are strange movements of dancing, sometimes hair Several times, after being sent to the hospital for injection of a calcium gluconate solution, it was healed. Later, it was injected with sodium chloride injection and implied, and it was quickly cured.

(5) Hearing impairment: more manifested as sudden hearing loss, electrical audiometry and auditory evoked potential examination normal, loss of voice, aphasia, but no vocal cords, tongue, throat muscle paralysis, coughing normal pronunciation, but also softly whisper.

(6) visual impairment: can be expressed as amblyopia, blindness, tunnel vision, concentric vision reduction, monocular diplopia, often sudden, can also be treated, suddenly returned to normal, hysteria blindness, visual evoked potential normal .

(7) Sensory disturbance: It can be expressed as somatosensory loss, allergy or abnormality, or special sensory disturbance.

1 sensation loss: manifested as local or whole body skin lack of sensation, or for half body analgesia, or glove, sock-type sensation loss, its range is not consistent with nerve distribution, the missing feeling can be pain, touch, temperature, cold feel.

2 feeling allergies: the performance of the skin is particularly sensitive to touch, a slight touch can cause severe pain.

3 paresthesia: If the patient often feels foreign body sensation or obstruction in the pharynx, no abnormalities can be found in the throat examination; it is called globulos hystericus, but attention should be paid to styloid syndrome caused by excessive styloid process. Identification, the latter can be confirmed by pharyngeal touch or radiograph.

(8) If there is a conversion pain, it can be exaggerated words and expressions from the patient, the diffuse part of the lesion, the meaning of the words is unknown, the partial closure treatment does not work, and the diagnosis is based on past medical history and psychological factors.

(9) Most of the symptoms described by Chinese medicine practitioners such as death without sound, qi qi and mei nuclear gas belong to it.

3. Special expressions

(1) Mass hysteria of snoring (also known as epidemic hysteria), snoring symptoms can affect many people through social contact, girls aged 11 to 15 are most susceptible to illness, mostly occur together In the group of life, such as schools, churches, monasteries or in public places, there is a person with snoring at first, and the minds of the surrounding witnesses are induced, and similar symptoms occur successively. Due to the lack of understanding of the nature of such diseases, they are often in this group. Causes a wide range of tensions and fears; under the influence of mutual suggestion and self-suggestion, the outbreaks of snoring are short-lived. Most of these snoring episodes are short-lived and have similar manifestations. Common symptoms include seizures, conviction of food poisoning, headache, and throat. Pain, abdominal pain, dizziness and fatigue, for example, in the school, for the collective injection of preventive vaccine for students, when a student is nervous, afraid of other symptoms of snoring, the surrounding students witness the incidence, due to lack of scientific understanding of the vaccine And thus also affected, generating fear and nervousness, on the basis of this, due to hints and self-darkness The role of many students will appear similar symptoms, called epidemic snoring or snoring group seizures, the main cause of seizures of snoring is a variety of factors that can cause group members to produce fear, anxiety, such as exams, unwelcome teachers or Leadership, cultural differences between families and schools, and superstitions, disasters, wars, social changes, etc. can often directly lead to seizures. For individuals, they are usually weak, nervous, emotionally unstable, and prone to Negative emotions, poor coping ability and strong dependence are more likely to show symptoms in the snoring epidemic. Patients, especially the initial cases, are isolated and given symptomatic treatment. The epidemic can be quickly controlled. Most of the patients are young women. Mental stress, fatigue, lack of sleep, menstrual period, and performance personality characteristics are more likely to occur, pray in the church, collectively practice some qigong (such as Hexiang pile), or in areas where panic disorder is prevalent or during The mysterious atmosphere formed often provides conditions for the epidemic of hysteria.

(2) Compensation neurosis: In work-related injuries, traffic accidents, and medical disputes, the victim often asks for financial compensation. In the course of the lawsuit, it shows, retains and exaggerates the symptoms, which is beneficial to the victim to claim compensation. Appearance, exaggeration or persistence is generally not governed by the will of the person, but by the unconscious mechanism. Some of the physical symptoms after the family planning operation, and the basis of no organic damage, are mostly such obstacles. Cases should be dealt with as soon as possible, and strive to solve them thoroughly and avoid delays. The protracted litigation process is extremely detrimental to the elimination of the symptoms of the victims. After the compensation is resolved, medical rehabilitation measures should be taken as soon as possible to cope with psychological treatment to promote the elimination of symptoms.

(3) occupational neurosis (occupational neurosis): This is a kind of motor coordination disorder that is closely related to occupation. Patients need to use their fingers' fine coordination actions for hours every day; such as copying, typing, piano or violin The performance lasts for a long time, especially when you are tired or catching up with the task, gradually the muscles of the hand are tense, painful, not listening, so that the finger activity is slow and strenuous, or bouncing; in severe cases, it can not be used due to muscle tremor or paralysis. Fingers, forearms, and even the entire upper limbs, giving up their hands, or changing to other manual activities, the finger movements return to normal, such symptoms appear in writing, called writer's spasm, more common in tension, anxiety, work People who are bored or have a heavy mental burden, the onset is mostly slow, neurological examination can not find organic damage, in addition to finger coordination, these symptoms can also be expressed as stuttering after intense speech training, treatment should make patients In a state of mental relaxation, and then carry out the corresponding muscle coordination function training, from simple to complex, step by step.

4. Visceral dysfunction

(1) vomiting: mostly refractory vomiting, vomiting after eating, no nausea before vomiting, can still eat after vomiting, although long-term vomiting does not cause malnutrition, no corresponding positive findings in digestive tract examination, various new Most of the diagnostic criteria are classified as physical form disorders.

(2) Hiccups: Hiccups are stubborn, frequent, and loud, especially when others notice, and are relieved when no one is there.

(3) Excessive ventilation: breathe-like breathing, although frequent and intense, but no signs of bun and hypoxia.

(4) snoring ball: In the middle or slight deviation of the pharynx, an indeterminate object or mass is felt. This is especially obvious when swallowing or when you want to swallow. The symptoms disappear during eating and there is no food to swallow. Difficulties, no weight loss, occasionally patients experience throat pain or burning that seems to be stabbed by fish bones. Most of the patients are middle-aged women, but young people and men can also occur.

(5) Others: such as drinking more urine, drums and so on.

Examination of conversion disorders

There is no specific laboratory test for this disease. When complications such as infections occur, laboratory tests show positive results of complications.

There is currently no specific laboratory support for this disease.

Diagnostic identification of conversion disorders

diagnosis

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 indicate that neurological organic diseases such as epilepsy, multiple sclerosis, hepatolenticular degeneration, intracranial Occupational lesions, etc.; mental illness, such as schizophrenia, depression, personality disorder, etc.; physical diseases, such as hematoporphyria, pre-hepatic encephalopathy, tetanus, etc., all misdiagnosed as the disease, the reason is this The symptoms of the disease lack sufficient specificity. The clinician only makes the diagnosis of the disease based on the patient's symptoms, induced by the heart, can not find organic symptoms, and can accept the language suggestion. It is not very reliable.

The correct clinical diagnosis should be based on the full exclusion of various neuropsychiatric and physical diseases that may cause separation and conversion symptoms. This requires not only the clinician to seriously understand the patient's medical history of such organic diseases, Also carefully observe the signs or suspicious cues of organic diseases, and then take more reliable modern examination methods, such as computerized tomography, magnetic resonance and other techniques to confirm, in the early stages of some organic diseases, If the evidence of qualitative damage is not easy to find, it is necessary to conduct clinical follow-up for a long time to finalize the diagnosis. During the follow-up process, the treatment has achieved remarkable results, and the symptoms are completely eliminated, which is helpful for affirmative diagnosis. Therefore, the diagnosis of hysteria needs There are two kinds of evidence: one is exclusionary evidence; the other is supporting evidence, which must be based on the exclusion of organic diseases or non-dependent substances, because snoring symptoms can be seen in a variety of neuropsychiatric diseases and Physical illness, so the diagnosis based on clinical symptoms is difficult to be very reliable, requiring clinicians not only to recognize Really understand the patient's medical history of organic diseases, but also to observe the signs or symptoms of organic diseases, if necessary, CT, nuclear magnetic resonance and other means of detection, exclusionary evidence is important, must also support Sexual evidence, including psychosocial factors, symptom suggestive and secondary benefits, if the three are missing, the diagnosis may be questionable, especially some patients deny mental factors, need patient inquiries, in-depth understanding, diagnosis points:

1. There are separation disorders and physical dysfunction, especially neurological dysfunction, there is sufficient evidence to rule out organic lesions.

2. Psychological stimulation related to psychological needs and psychological contradictions. It has a temporary relationship with the occurrence or deterioration of symptoms; there is a clear connection between onset and stress events, and the course of disease is repeated.

3. Symptoms impede social function.

4. There can be expressions that simulate symptoms and indifference.

5. Can not be explained by the pathophysiological mechanism of physical diseases, and even contradictory with neuroanatomy and physiology.

6. Not other mental illnesses.

Differential diagnosis

Common diseases that need special identification in clinical practice are: epilepsy, patients with epilepsy can also have a conversion episode of seizures, so-called hystero-epilepsy; seizures and conversion episodes coexist. At this time, you should be careful not to take the alternative method. In order to avoid missed diagnosis.

The symptoms of this disease can be seen in schizophrenia and affective disorder. If there are symptoms of the latter two, the diagnosis of the latter two should be considered first.

The identification of hysteria and reactive psychosis is that snoring psychosis is common in performance-type personality disorder, and its psychiatric symptoms can be performance, dramatic or exaggerated; it can be repeated, and there is an intermittent period of complete symptom relief.

The main point of identification of this disease and factitious disorders is that the symptoms of the latter are intentionally forged, but there is no clear motivation. Such patients often endure various pains in order to obtain the diagnosis of the disease and obtain the patient's identity. Examination and unpleasant treatment, including repeated surgery, the patient does not pursue special interests, nor evade any legal liability, and thus is different from prescribing, and the symptoms of the disease are dominated by unconscious mechanisms, and primary or Related to secondary benefits, it is not intentional forgery, so it is different from predatory disease and different from pretending to be sick.

1. Epilepsy is especially psychomotor epilepsy. The mental and psychological stimulating factors before the attack are not obvious. There are many auras such as abdominal discomfort. Sudden loss of consciousness can occur after screaming, falling everywhere, first stiff, then clonic, then recovering, attacking1

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