【摘要】 目的探讨癔症首发患者的临床特征及有关诊断问题。方法收集108例首发癔症住院患者发病前各项资料及连续3年进行随访,分析患者病前性格及发病后症状变化特征。结果对108例首发癔症患者3年随访,维持癔症诊断80例(74.1%),改诊为双相情感障碍9例(8.3%),精神分裂症7例(6.5%),应激相关障碍5例(4.6%),癫、内分泌所致精神障碍和多发性硬化症各2例,病毒性脑炎1例;误诊率为25.9%。误诊主要见于癔症性精神障碍(36.7%)。维持癔症诊断和改诊患者在主要临床症状表现频度、病前癔症人格、临床症状易受暗示性、受教育程度等方面有显著差异(P<0.05～0.001);但改诊患者在早期以类癔症样发作时,临床上很难与癔症相鉴别,故对诊断为癔症的病人应进行随访,以免误诊。结论癔症以情感爆发、类抽搐样发作、意识朦胧、附体体验、身份障碍、症状易受暗示、多变等为临床表现特征。多发于女性、低文化程度、有一定的性格缺陷者,发病均有心理应激。癔症的症状虽然变化多端,缺乏特异性,误诊率较高,但癔症是一个疾病单元,CCMD3仍保留癔症作为一种精神疾病是适合我国情况的。更多还原

【Abstract】 Objective To explore the clinical features and the related diagnoses of first onset hysteria patients.Methods Various pre-onset data of 108 first onset hysteria patients were collected and followed up for three years continuously; the patients’ character before onsets and their changed features of symptoms after onsets were analyzed.Results After three years follow up, among the 108 first onset hysteria patients, 80 (74.1%) were maintained the diagnoses as hysteria, others were changed their diagnoses to be following: 9 (8.3%) were diagnosed as bipolar disorder; 7 (6.5%) as schizophrenia; 5 (4.6%) as stress-related disorders; each 2 as epilepsy, endocrine psychological disorder and cerebral sclerosis; and the other one as viral encephalitis. The misdiagnosis rate is 25.9%, mainly on the ones of hysterical psychological disorders(36.7%). The patients who were maintained the diagnoses as hysteria differed significantly (P<0.05～0.001) from those who were changed their diagnoses with respect to their behaviour frequency and features of primary clinical symptoms, hysterical personality before onsets, easiness of clinic symptom being suggested, and education accepted. Nevertheless, it is hard to clinically distinguish the later from hysteria during their prematurely hysterical paroxysm. As a result, the patients who are diagnosed as hysteria should be followed up to prevent misdiagnoses.Conclusions Hysteria is featured by the clinical behaviors of outburst of emotion, somatic seizure, twilight, possession state, identity disorder, as well as the easiness of symptom behaviours being suggested and varied. It is cardinally discovered amongst females with certain defective character who are poorly educated, and all onsets are accompanied by psychological irritability. Although hysteria has various symptoms without specificity as well as high misdiagnosis rate, this disease diagnosis of hysteria is tenable, and thus hysteria ,as a kind of mental disease, is reserved in the CCMD-3 is reasonable in China.更多还原