摘要
目的探讨以双目失明为首发表现的分离转换性障碍(DCD)的临床特征、诊断与治疗要点,分析误诊原因及防范误诊策略。方法回顾性分析1例曾误诊青年男性创伤后以急性双目失明为主要症状的DCD患者的临床资料,结合文献复习进行分析。结果患者跌倒后突发双目失明,详细体格检查及辅助检查(头颅MRI、视觉诱发电位等)均未发现器质性病变依据。初步诊断为脑震荡后视觉损伤予对症处理并留观,进一步排查其他病因。经多学科会诊明确诊断为DCD(符合DSM-5 F44.5及ICD-116B60标准)。误诊时间约为42 h。确诊后采用催眠暗示疗法,视力恢复。结论应激环境下,青年人突发功能性失明需警惕DCD。诊断需在积极排除器质性疾病的同时,关注心理社会因素及特征性“软体征”。早期识别和针对性心理干预(如催眠暗示)效果显著。建立“心身双重筛查”机制和标准化评估流程有助于降低误诊率。
Objective To investigate the clinical characteristics,and key points in diagnosis and treatment of dissociative conversion disorder(DCD)presenting with bilateral blindness as the initial symptom,and to analyzing the causes of misdiagnosis and prevention strategies.Methods A retrospective analysis was conducted on the clinical data of a young male patient with post-traumatic acute bilateral blindness as the primary symptom,who was initially misdiagnosed but ultimately found to have DCD,followed by further discussion based on literature review.Results The patient developed sudden bilateral blindness after a fall.Comprehensive physical examination and auxiliary tests(including brain MRI,visual evoked potentials)revealed no organic lesions,The patient was initially diagnosed with post-concussion visual impairment.Symptomatic management and observation were administered,with further workup to rule out other etiologies.The diagnosis of DCD was subsequently confirmed through a multidisciplinary team consultation,in accordance with the DSM-5(F44.5)and ICD-11(6B60)diagnostic criteria.The duration of misdiagnosis was approximately 42 h.Hypnotic suggestion therapy was initiated immediately after diagnosis,resulting in restored vision.Conclusion Sudden functional blindness in young adults in stressful environments warrants vigilance for DCD.Diagnosis requires actively ruling out organic diseases while paying attention to psychosocial factors and characteristic"soft signs."Early identification and targeted psychological intervention(e.g.,hypnotic suggestion)are highly effective.Establishing a"dual psychosomatic screening"mechanism and standardized assessment procedures can help reduce misdiagnosis rates.
作者
闫迎鸽
王德军
祖生洲
韩敏娜
王莉
YAN Yingge;WANG Dejun;ZU Shengzhou;HAN Minna;WANG Li(Jingnan Medical District,Chinese PLA General Hospital,Beijing 100072,China;Department of Medical Psychology,the First Medical Center,Chinese PLA General Hospital,Beijing 100143,China)
出处
《临床误诊误治》
2025年第24期21-25,共5页
Clinical Misdiagnosis & Mistherapy
关键词
分离转换性障碍
误诊
脑震荡
失明
催眠疗法
心理暗示
dissociative conversion disorder
misdiagnosis
concussion
blindness
hypnotherapy
psychological suggestion
