Behavioral Treatment for Psychogenic Gagging Patient: A Case Report

心因性嘔吐患者之行為處理：病例報告

蘇若梅(Jo-Mei Su)

《臺灣兒童牙醫學雜誌》 2卷4期 (2002/12) Pp. 110-115

https://doi.org/10.6319/TJPD.2002.2(4).4

摘要

許多小朋友在看牙齒時會嘔吐，而其中很多的嘔吐乃是心理因素，做為逃避看牙齒的手段。本病例報告為一強烈嘔吐之患者，經查詢病史，診斷為心因性嘔吐。臨床上經由率統性的去敏感及行為處理，其可以完成全口的牙料診療而不再嘔吐，並可以刷其後牙而無嘔吐現象。(Taiwan J Pediatr Dent 2(4): 110-115,2002)

關鍵字

嘔吐反應 ； 心理性因素 ； 軀體性因素 ； 行為修形 ； 正向增強

並列摘要

Many dentists have faced children that display the gagging reflex during dental treatment, making any procedure difficult. This case presents the proposition that these gagging attacks may be of psychogenic origin. This is a boy showed extremely psychogenic gagging behavior. His past history showed that he experienced syncope and vomiting when facing unpleasant situations or when desiring parent's attention. Neurological exam showed that there was no sign of neurotic anomaly. Concluded from the medical history, it was supposed as psychogenic origin. Systemic desensitization and waking hypnosis (intensively emphasizing that he wouldn't vomit) were used from the first appointment. Also he was told that vomiting would keep mother away from the operating room. During the following appointments, the patient was less nervous and less gagging was exhibited. By the end of dental treatment course, the patient behaved well and no vomiting was noticed. After 2 years, he came back for follow-up and was doing well. Children frequently use gagging and vomiting as an excuse to avoid dental treatment. Differential diagnosis for somatogenic and psychogenic gagging is the key to manage the pediatric patients successfully. If it is diagnosed with psychogenic gagging problem, the dentists can utilize systemic desensitization and waking hypnosis to increase patients' confidence and successfully complete the dental treatment. (Taiwan J Pediatr Dent 2(4): 110-115, 2002)

並列關鍵字

Gag Reflex ； Psychogenic Factor ； Somatogenic Factor ； Shaping ； Positive Reinforcement