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Yıl:2008; Cilt: 45; Sayı: 3>> Özet
TAM METİN
Nöropsikiyatri Arşivi; 2008;45(3):97-99
"Konversiyonu Atlamak" Ayıp mı?
S Gülöksüz, ET Oral, LR Alpkan
Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, Alkol ve Madde Bağımlılığı Araştırma Tedavi ve Eğitim Merkezi, İstanbul
Konversiyon bozukluğu (KB) fiziksel bir hastalıktan kaynaklandığı düşünülen, ancak aslında psikolojik çatışma veya gereksinimin ifadesi olarak ortaya çıkan bir fiziksel işlev bozukluğudur. Konversif belirtilerin hatalı olarak KB tanısı alması, bu hastalarda var olan/altta yatan diğer tıbbi hastalıkları örtebilir. Bu olgu bildiriminde, belirtileri, babasını kalp krizi geçirirken gördükten sonra başlayan, dizartrisi, sol tarafında yüzü de içeren hemianestezisi, sağ taraf extremitelerinde hafif güçsüzlüğü, solda pitozisi, uykuya dalmak güçlüğü ve irritabilitesi olan 39 yaşında bir kadın hasta tartışılmaktadır. Başlangıçta psikiyatri ayaktan tedavi merkezinde KB tanısı almış ve altı ay boyunca antidepresan tedavi ile izlenmiştir. Altı ay boyunca yukarıda söz edilen belirtilerle göz hastalıkları, ortopedi ve nöroloji uzmanları tarafından değerlendirilmiş, migren tanısıyla nörolojide de takip edilmişti. İkinci basamak ayakta tedavi birimindeki psikiyatrik değerlendirmesinde major depresyon tanısı konulan ve daha öncesinde ayrıntılı görüntüleme tetkikleri uygulanmamış olan hastada BT ve MR ile sol pons yarısında infarkt saptandı. Konversiyon bozukluğu hatalı tanısı tüm takip ve tedavi sürecini etkiler, bu yüzden KB tanısı tam bir değerlendirmenin ve konversif belirtilerle ilişkili olabilecek diğer tüm hastalıkların dışlanması sonrası konulmalıdır.
Is it a Shame "To Miss the Diagnosis of Conversion Disorder"?
Conversion disorder (CD) is defined as “alteration in physical functioning that suggests physical disease but is apparently an expression of a psychological conflict or need”. Misdiagnosis of conversion symptoms as CD, may hide the existing and/or underlying medical illness in these patients. In this case report, a 39 [year] old female patient with dysarthria, left sided hemianesthesia including the face, slight weakness on the right side of the body, left sided ptosis, irritability, and difficulty in falling asleep was presented . These symptoms had appeared after witnessing her father’s heart attack. She was initially diagnosed as CD in the psychiatry outpatient unit and followed up for six [month]s with antidepressant treatment. Previously, she had also been examined by an ophthalmalogist, an orthopedist and a neurologist and followed up by the neurology department for her migraine. She was diagnosed with major depressive disorder according to DSM-IV-TR in her psychiatric evaluation in this unit. It was then realized that no computerized tomography (CT) and/or EEG had been ordered previously. Both CT and brain magnetic resonance imaging revealed left side pontine infarction. As misdiagnosis of CD may affect the wholemanagement and treatment procedure, CD ought to be diagnosed after a complete evaluation and by excluding all other possible underlying illnesses.

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