Lorazepam Interview for Psychogenic Aphonia

靜脈注射Lorazepam會談於心因性失聲之臨床運用

蕭暉獻(Hui-Hsien Hsiao) ； 歐陽文貞(Wen-Chen Ouyang)

《台灣精神醫學》 26卷1期 (2012/03) Pp. 6+64-68

https://doi.org/10.29478/TJP.201203.0008

摘要

目的：過往對於轉化症執行藥物會談之成效並無太多證據，而執行lorazepam會談於心因性失聲個案之相關報告則更加缺乏。個案報告：一名40歲被先生懷疑不忠貞的失聲已婚婦女病人，住院期間安排身體檢查及腦部MRI以排除其他器質性原因，之後診斷為心因性失聲，在穩固醫病關係後，執行lorazapam藥物會談，於會談過程中並搭配觀看圖卡的方式來幫助發聲，當時可發單音循序漸進至片語，隔日她就能說話。結論：轉化症之心因性失聲病人，使用靜脈注射lorazapam來執行藥物會談搭配圖卡，為臨床上一可參考之治療方式。

關鍵字

心因性失聲 ； benzodiazepine治療 ； 身體型式疾患

並列摘要

Background: Conversion disorder is thought of using physical symptoms to symbolize unbearable psychological symptoms. The value of drug interview in treating conversion disorder is at present unknown and few studies exist in reporting lorazepam interview for psychogenic aphonia. Case report: A 40-year-old female patient suffered from aphonia suddenly after her husband mistrusted her infidelity. She received surgical treatment of pituitary gland tumor one month before her onset of aphonia. After visiting psychiatric outpatient clinic, she was carefully examined. She did not show any apparent MRI findings related to aphonia. She was diagnosed as psychogenic aphonia, and she started to phonate 1-2 syllables during lorazepam interview with cards of pictures and word messages, and she could speak several words 5-6 hours later. On the following day she could speak fluently. Conclusion: We suggest that lorazepam interview with proper use of cards with pictures and word messages could be one of treatments for patients with psychogenic aphonia.

並列關鍵字

psychogenic aphonia ； benzodiazepine interview ； somatoform disorder

參考文獻

Sadock, BJ(ed.),Sadock, VA(ed.),Kaplan, HI(ed.)(2005).Comprehensive Textbook of Psychiatry.Philadelphia:Lippincott Williams & Wilkins.

Schecker, N(1990).Childhood conversion reactions in the emergency department: part II-general and specific features.Pediatr Emerg Care.6,46-51.

Poole, NA,Wuerz, A,Agrawal, N(2010).Abreaction for conversion disorder: systematic review with meta-analysis.Br J Psychiatry.197,91-5.

Kim, JS,Cho, EJ,Park, LJ,O, JS(2010).Conversion phenomenon during the induction period of general anesthesia: case report.Korean Journal of Anesthesiology.59,210-3.

Sadock, BJ(ed.),Sadock, VA(ed.)(2000).Kaplan & Sadock's Comprehensive Textbook of Psychiatry.Baltimore:Lippincott Williams & Wilkins.