地塞米松诱发恐缩症1例

1病例患者男,57岁,因“双耳卡他性中耳炎”予地塞米松10mg加阿莫西林克拉维酸针2.0g静滴治疗,每日2次。第3日在局麻下行左侧耳膜切开引流术。第7日夜里开始出现盗汗,大汗淋漓、全身发冷,感阴茎变小正缩入腹中,极度恐惧不安,大声喊叫,持续约30min自行缓解。血常规、电解质均正常。随后2d又发作3次,症状同前。停用地塞米松后未再发作。该患者既往对磺胺药物过敏。精神检查:神智清,主动讲述发作时的体验,诉当时浑身发凉,看到阴茎变小正缩入腹中,非常恐惧,回想仍心有余悸,担心再发。给予阿普唑仑0.4mg,每日2次,心理认知治疗2次,1周后康复。2讨论…     

海南省恐缩症8例临床调查和干预报告

2011年5月1日至2011年6月13日期间,海南省出现了8恐缩症案例。为了提高广大医务人员对该病的认识,现将此次发病患者的临床表现和干预措施报告如下:     

恐人症发病危险因素的研究

运用病例对照调查的方法对恐人症发病因素进行了研究。共５７例，平均发病年龄为１５．６±２．７岁。恐人症的症状都带有性色彩含意。自我约束信条、家教不良、童年性不良经历、对性不良经历自责和性禁闭想法等因素是恐人症发病的主要原因。可能通过退行性防御机制、投射机制、自我实现的预言机制等而发病。     

以强迫、恐怖为首发症的精神分裂症

一、病历摘要 患者于××,H22403,女,22岁,未婚,莱阳市人,汉族、营业员。因精神失常7年,又话多,疑人迫害月余,于1993年5月5日第3次住院。家族成员无精神病及癫痫史。患者母孕期健康,足月顺产,在10个月时,头部有摔伤史,3岁前曾有抽搐史,后未再发作。幼年生长发育好,7岁上学,学习成绩中等,初中毕业后就业于现单位。病前性格开朗、活泼。     

恐缩症（附1例报道）

恐缩症是以恐惧生殖器缩人体内致死的以恐怖焦虑发作为特征的一种与化相关的综合征。多发生于广东海南一带,以男性青少年为多,女性较少。现将我们收治的一例报道如下。     

恐人症的病理心理本质和发病机制探讨

作者在给恐人症病人进行心理治疗的同时,对113例病人的症状、生活经历、个性特点及病中各时期的内心体验做了深入调查。发现病人个性大都孤僻、怕羞、重视别人对他的“生活作风”的评价,大多数承认其恐惧症状带有性的意味。在详细询问的78例中有67例承认在3～12岁期间,有过主动参与的儿童性经历。病人在青春期开始出现对异性的性意识和性幻想时,感到差耻、自责、怕被人看出来,出现恐人症状。幼年性经历的忆起和自责加剧了病情。阻碍了正常性心理的发展成熟。作者提出了对恐人症心理病理本质和发病机制的理论,同时分析了产生恐人症和社会文化背景及中国目前恐人症多见的原因。     

利培酮致男性乳房发育症1例

1病例患者,男性,42岁.因饮酒20年,成瘾2年,凭空见蛇,虫爬感,疑人害3d.于2011年4月24日首次住我院.既往无服用抗精神病药史.查体:双侧乳房正常,无压痛.精神检查:意识清,定向力正常,问答切题,引出言语性幻听、幻视、幻触,有被害妄想,情感不协调,无自知力,对酒渴求.诊断:酒精所致精神障碍.给予利培酮2 mg/d及保肝治疗;2周后幻觉妄想消失;治疗至第43天时患者诉双侧乳房肿大、疼痛.查体:双侧乳房增大,触及边界清晰的肿块约4 ×4 cm2,有触痛,无溢乳.患者心情烦躁,痛苦,情绪焦虑.考虑为利培酮致男性乳房发育症;即停用利培硐,改用阿立哌唑口崩片10 mg/d,并予心理疏导消除紧张焦虑情绪.25 d后双侧乳房疼痛减轻,肿块减小;3个月后痊愈出院.2个月后电话随访双侧乳房肿块消除,无疼痛,情绪平稳.     

以抽搐为首发症状的胰母细胞增殖症1例报告

婴儿持续性高胰岛素性低血糖症（persistent hyperinsu‐linemic hypoglycemia of infancy ,PHHI）是在临床表现、组织学、分子生物学、遗传病因和治疗反应等方面均较罕见的异质性疾病［1‐4］,亦称为先天性高胰岛素血症,家族性高胰岛素血症,胰岛母细胞增殖症,由Aynsley‐Green在1981年首次报道［5］。PHHI是引起新生儿和婴儿持续性低血糖中最常见的原因［6］,以胰岛β细胞自律性失常,在严重低血糖时仍持续不适当分泌胰岛素为特征。其临床特点为婴儿或儿童期出现低血糖伴高胰岛素血症、低酮体血症和低脂肪酸血症。其低血糖常常难以纠正,如果治疗不及时,长期持续性低血糖可导致不可逆的中枢神经系统损伤,故早期诊断和治疗有重要意义［7］。而国内以抽搐为首发症状的胰母细胞增殖症报导很少,现将2012年2月～2015年10月诊治的1例胰母细胞增殖症患儿的结果报告如下。     

伴强迫症状的神经棘红细胞增多症1例

<正>神经棘红细胞增多症(Neuroacanthocytosis,NA)是一类罕见的遗传性神经系统疾病,发病率约为1/5000000,通常分为三种类型:(1)以基底节变性为主的核心型NA,包括VPS13A基因突变所致的常染色体隐性遗传舞蹈病-棘红细胞增多症和Kell基因突变所致的X连锁遗传Mc Leod综合征;(2)伴血清脂蛋白减少的综合征,包括先天性无β-脂蛋白及低β-脂蛋白     

A case of obsessive-compulsive disorder by proxy

Obsessive-compulsive disorder is a frequent psychiatric disorder with a lifetime prevalence rate of 2%-3 % (Sadock, B.J. & Kaplan, H.I. (Eds.). Kaplan and Sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry, 9th ed. Lippincott, Williams & Wilkins. 2003). Patients almost always carry out compulsions to minimize their anxiety/distress associated with the obsessions. Repeated thoughts about contamination represent one of the most common obsessions (American Psychiatric Association. Obsessive-compulsive disorder. In: Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: American Psychiatric Association; 2000). In this report, we describe an interesting case of a 58-year-old lady who substituted her husband for her to perform the compulsive behaviors.     

Corticostriatal circuitry in regulating diseases characterized by intrusive thinking

Intrusive thinking triggers clinical symptoms in many neuropsychiatric disorders. Using drug addiction as an exemplar disorder sustained in part by intrusive thinking, we explore studies demonstrating that impairments in corticostriatal circuitry strongly contribute to intrusive thinking. Neuroimaging studies have long implicated this projection in cue-induced craving to use drugs, and preclinical models show that marked changes are produced at corticostriatal synapses in the nucleus accumbens during a relapse episode. We delineate an accumbens microcircuit that mediates cue-induced drug seeking becoming an intrusive event. This microcircuit harbors many potential therapeutic targets. We focus on preclinical and clinical studies, showing that administering N-acetylcysteine restores uptake of synaptic glutamate by astroglial glutamate transporters and thereby inhibits intrusive thinking. We posit that because intrusive thinking is a shared endophenotype in many disorders, N-acetylcysteine has positive effects in clinical trials for a variety of neuropsychiatric disorders, including drug addiction, gambling, trichotillomania, and depression.     

A case of mitochondrial encephalomyopathy characterized by repeated stroke-like episodes

We reported a case of mitochondrial encephalomyopathy with repeated stroke-like episodes. A 33-year-old single male was admitted to our hospital because of stroke-like episodes with visual field defect, hemiplegia and convulsion repeated seven times for the past seven years. There were no abnormalities on the physical examination. He was hallucinative and perseverative and had mental deficiency. Muscle weakness and atrophy were not prominent, and generalized hyporeflexia were present without pathological reflexes. Myoclonus was not observed. Serum CK and blood gas analysis were normal (pH 7.398). Although blood levels of lactate and pyruvate were almost within normal limit, lactate was elevated by 20WATT-15 minutes exercises. On the contrary, the CSF levels of lactate and pyruvate were elevated markedly. CT of the brain revealed the presence of the low density areas in the right occipital and the left frontal lobes. Cranial 4 vessels studies were unremarkable. EEG showed the diffuse slowness with spike and wave complex. CT of the muscles were normal. A specimen obtained from the left biceps brachii muscle showed ragged-red fibers without obvious myogenic or neurogenic changes, and accumulations of abnormal mitochondria with paracrystalline inclusion bodies were observed by electron microscopy. However, mitochondrial abnormalities were not seen in the vessel walls in the biopsied muscle. Activities of complex I + III, II + III, IV in mitochondria were normal. Clinical features of this case were consistent with MELAS. However, this case showed no muscle weakness, short stature and lactic acidosis which characterize MELAS, and the onset of this case was later than those cases that were reported before.     

A case of senile chorea

Senile chorea, a late-onset, slowly progressive disorder without mental changes, is a poorly characterized entity. It is often thought to represent late-onset Huntington's disease in which the chorea precedes the mental changes and the family history is absent due to parental death before symptoms. The following case differs pathologically from Huntington's disease and from previous reports of senile chorea.     

以性兴奋为特征的癫痫误诊为精神分裂症1例

<正>1病例患者,女性,53岁,以反复阴道电刺激感,伴被害、紧张、恐惧、出走3~+年,加重1+月入院。2013年5月与前男友分手后,渐出现阴部烧灼感,阴道中有电流刺激感,伴性兴奋体验。初认为性欲旺盛,后发作频繁,持续时间长,有时可达7~8小时,高潮后疲乏感,感觉像和鬼在交合,感到很痛苦。同期患者在网上看到一个人发表了很多评论,认为内容都在暗示和她有关,认为此人很了解她的过去和现在,便     

A case report of refractory obsessive-compulsive disorder improved by risperidone augmentation of clomipramine treatment

A male patient aged 43 years, suffering from symptoms of obsessive-compulsive disorder (OCD), such as washing hands and feet frequently and checking documents compulsively, had received intensive pharmacotherapeutic and behavior therapy. Although the administration of anxiolytic drugs and/or clomipramine did not show curative effects, a combination of clomipramine and risperidone showed much greater effect in improving these symptoms.