误诊为功能性精神障碍的麻痹性痴呆10例临床分析

目的：探讨被误诊为功能性精神障碍的麻痹性痴呆患者的临床特点和诊治要点。方法：回顾性分析10例被误诊为功能性精神障碍的麻痹性痴呆患者的临床资料。结果：被误诊为功能性精神障碍的麻痹性痴呆均以精神症状为首发,多表现为精神病性症状、类躁狂、抑郁、类神经症、人格的改变及进行性痴呆等不典型症状群,本研究显示误诊率高达71．4％,误诊例次率以精神分裂症最高（47．3％）,其次为躁狂症或躁狂状态（37．5％）。抗精神病药物能有效改善精神症状,青霉素驱梅能阻止病情进展使病情得到缓解,两者缺一不可。结论：被误诊为功能性精神障碍的麻痹性痴呆均以精神症状为首发且症状不典型而易被误诊,早期鉴别诊断十分重要,抗精神病药物和青霉素治疗可以有效控制症状。

Clinical Analysis of 10 Cases with Paralytic Dementia Misdiagnosed as Functional Mental Disorders

Objective：To explore the clinical characteristics and key factors in diagnoses of paralytic dementia patients misdiagnosed as being afflicted with functional mental disorder. Methods： retrospectively analyzed the clinical data of 10 cases with paralytic dementia being misdiagnosed as functional mental disorder. Results：paralytic dementia patients being misdiagnosed as functional mental disorder inevitably manifest mental symptoms initially; these symptoms are mainly psychotic symptoms, quasi mania, depression, mattoid, change of personality and progressive dementia as well as other atypical syndromes. The analysis showed that 71.4 % were misdiagnosed, among these misdiagnosed cases, the highest ratio came from those of split personality （47.3 % ）, and the second, mania or manic state （37.5 %）. Anti-psychotic drugs should be applied together with the anti-syphilitic treatment of penicillin;anti-psychotic drugs can effectively improve the above-mentioned mental symptoms while the latter can prevent the disease from worsening and relieve the illness. Con clusion：all paralytic dementia misdiagnosed as functional mental disorder first attacks with atypical mental symptoms, thus they should be discerned and diagnosed as early as possible while treatment with anti-psychotic drugs and penicillin can effectively control these symptoms.