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Yıl:2009; Cilt: 46; Sayı: 1>> Özet
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Nöropsikiyatri Arşivi; 2009;46(1):30-33
Hastane Yatışı ve Girişimsel Tıbbi İşlemler Sonrasında Gelişen Disosiyatif Bozukluk: Bir Pediatrik Olgu Sunumu
M Coşkun, SS Zoroğlu
İstanbul Üniversitesi İstanbul Tıp Fakültesi, Çocuk ve Ergen Psikiyatrisi Anabilim Dalı, İstanbul, Turkey
Psikosomatik semptomlar çocuklarda klinik başvurunun sık nedenlerinden birisidir. Bu semptomların psikolojik kökenli olduğunun farkedilmesi bazen zor olabilmekte ve gereksiz hastane yatışı ve girişimsel tanısal işlemlere yol açabilmektedir. Diğer taraftan hastane yatışı ve girişimsel tıbbi işlemler çocuk psikolojisi üzerinde travmatik etkiler oluşturabilir ve patolojik disosiyasyona yol açabilir. Bu yazıda bacaklarında ani gelişen motor kayıp ve yürüyememe şikayeti nedeniyle hayatında ilk kez hastaneye yatırılan ve girişimsel tanısal işlemlere maruz kalan bir erkek çocuğu sunulmaktadır. Detaylı incelemeler sonrasında hastanın durumunu açıklayacak tıbbi bir neden saptanmadı ve psikiyatri konsultasyonu sonucu hastaya konversiyon bozukluğu tanısı konuldu. İki gün sonra hastanın durumu kendiliğinden düzeldi ve 17 gün süren yatış sonrası çıkışı yapıldı. Bununla birlikte hastaneden çıktıktan bir hafta sonra disosiyatif bir krizle başlayan disosiyatif bozukluk geliştirdi. Vakanın klinik özelliklerinin yanı sıra çocuklarda psikosomatik semptomların erken tanınmasının önemi ve hastane yatışının ve girişimsel tıbbi işlemlerin çocuk psikolojisi üzerindeki travmatik etkilerinin tartışılması planlanmaktadır.
Dissociative Disorder Following Hospitalization and Invasive Medical Procedures: A Pediatric Case Report
Psychosomatic symptoms in children may be frequent reasons for referral in pediatric practice. Recognition of these symptoms as psychosomatic may sometimes be difficult, leading to unnecessary hospitalization and invasive diagnostic procedures. Meanwhile hospitalization and invasive diagnostic procedures may themselves have a traumatic impact on child psychology and cause pathological dissociation. In this paper we report a 12- [year]-old boy who was admitted to hospital following a sudden onset of motor loss in his legs which led to his undergoing several invasive diagnostic procedures for the first time in his life. After comprehensive investigations no medical conditions were detected and he was eventually diagnosed with conversion disorder following psychiatric consultation. His condition returned almost to normal spontaneously after two days and he was discharged from hospital after 17 days of hospitalization. He then developed dissociative disorder following his discharge from hospital. We aim to discuss the clinical picture and the child's perception of the traumatic nature of invasive medical procedures in this particular case, the traumatic impact of hospitalization and invasive medical procedures on child mental health, and the importance of early recognition of symptoms of conversion or dissociative disorders in children.

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