頁籤選單縮合
題名 | Functional Visual Disturbance due to Hysteria=歇斯底里症之功能性視覺障礙 |
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作者 | 賴慧群; 林耕國; 楊孟玲; 陳賢立; Lai, Hui-chun; Lin, Ken-kuo; Yang, Meng-ling; Chen, Henry Shen-lih; |
期刊 | 長庚醫學 |
出版日期 | 20070100、20070200 |
卷期 | 30:1 2007.01-02[民96.01-02] |
頁次 | 頁87-91 |
分類號 | 415.8732 |
語文 | eng |
關鍵詞 | 歇斯底里症; Goldmann視野計; Tangent screen視野檢查; 管狀視野; Hysteria; Goldmann perimetry; Tangent screen; Constricted tubular visual field; |
中文摘要 | 23歲男性,主訴已有三年之久完全無法看到周邊景物,及所見事物均呈紫色。檢查病患結果為:兩眼視力正常,皆為1.0。眼壓、瞳孔對光反射、眼前葉及眼底都正常,兩眼辨色力正常,無斜視。病患亦否認有眼痛、頭部外傷、癲癇、高血壓及糖尿病等病史,無特殊家族史。Goldmann視野計檢查結果呈現:只有中央10度的縮小視野。作Tangent screen檢查,在變換各種大小及顏色不同的視標,結果顯現為縮小的管狀視野,其形狀為柱狀體而非椎狀體。觀察病人對其病情及預後並不特別關心,且病患的工作壓力頗大。綜合上述,此為功能性而非器質性之視野障礙,我們診斷是歇斯底里症。歇斯底里症又稱為轉化症,是因個人心理不安之衝動和慾望,經轉化作用表現在身體的障礙。在使用視野檢查以診斷歇斯底里症時,需預先排除器質性疾病,並與詐病作鑑別診斷。而Tangent screen視野檢查,在鑑別器質性及精神性病因方面,扮演重要角色。歇斯底里症這類病人的視野障礙為縮小的管狀視野,通常病人在其所能見的視野之內視力正常,超過此範圍之外則全盲。到目前為止,仍無合理及肯定之學說證據來解釋,歇斯底里症為什麼會產生周圍全盲的管狀視野。醫師在面對這些病人時,需要給予支持、信心,治療上以溫和地建議方式,耐心地對待病人。 |
英文摘要 | A 23-year-old male complained of loss of peripheral visual field and everything having purple shadows in the afternoon. This had lasted for 3 years but he had paid little attention to the symptoms. Investigations, including visual acuity, intra-ocular pressure, pupil reflex, and anterior and posterior segment of the eyes, were normal. He denied ocular pain, history of head injury, epilepsy or related family history. The Goldmann perimeter and tangent screen examinations showed a bilateral constricted tubular visual field defect within the central 10° and steep margins. Tracing his past social history, he had been in jail for 3 months. He also complained his work was hard and caused him tension. The visual symptoms were a functional disturbance, not an organic disorder. We diagnosed him with hysterical functional visual disturbance. Hysteria, or conversion disorder, has long been a puzzling and fascinating problem in psychology and ophthalmology. The mechanism and reasons for hysteria are still not clear. The tangent screen is useful in diagnosis. The constricted tubular, spiral or star-shaped visual fields with steep slopes are specific findings in hysteria. We suggest that ophthalmologists should treat patients with psychogenic symptoms, using suggestion, patience and reassurance. |
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