Study ObjectivesThe main objectives of this case study are 1. Clinicians facing symptoms that are difficult to interpret should exercise caution in diagnosing conversion disorder. 2. Increasing awareness about rare neurological conditions may appear as psychogenic illnesses. 3. Clinicians be advocate for their patients.IntroductionConversion disorder is a mental condition in which a person present with one or more symptoms of altered voluntary motor or sensory function, or other neurologic symptoms that cannot be explained by medical evaluation. Stiff person syndrome (SPS) is a disabling autoimmune central nervous system disorder characterized by progressive muscle rigidity, gait impairment, with superimposed painful spasms. SPS is commonly associated with high anti-glutamic acid decarboxylase (GAD) antibody titers. The dominant antigen recognized by these antibodies is the GABA-synthesizing enzyme GAD.MethodPatient X, a 17-year-old Hispanic American female who presented to the Child and Adolescent Psychiatry Clinic with the complaint of ataxia & aphasia associated with anxiety. Patient was referred by the neurology clinic after they could not establish any organic cause of her ataxia or aphasia. After thorough evaluation at the child psychiatry clinic she was given the diagnosis of anxiety secondary to ataxia and aphasia and r/o Conversion Disorder. She was initiated treatment with sertraline for her anxiety. Her sertraline dose was increased gradually up to 100 mg daily. From the beginning the patient also received counseling & physical therapy. With these combination of treatments, patient’s symptoms did not get any better. Her symptoms actually got worse over time. At this point, the Child Psychiatry Clinic sent a message to the neurology clinic for further evaluation of patient due to her progressive gait and speech impairments.ResultsThe neurology clinic saw the patient again and did further testing. The patient was positive for high titers of anti-glutamic acid decarboxylase antibodies (Anti-GAD). At this point, the patient was given the diagnosis of Stiff Person Syndrome. Patient was admitted to the hospital for further management. She was treated with benzodiazepines, IV immune globulin, & steroid. Soon after discharge from the hospital, the patient was seen at the Child Psychiatric Clinic. The patient’s mother reported, after the in-patient treatment, the patient’s symptoms improved.DiscussionIt is essential for clinicians to look for neurologic & other general medical conditions while evaluating a patient with possible conversion disorder. A systematic review of 27 studies found that among 1466 patients initially diagnosed with conversion symptoms, the frequency of misdiagnosis was approximately 4 percent.References. BMJ. 2005;331(7523):989. Epub Oct 13. Childhood onset of stiff-man syndrome. JAMA Neurol. 2013;70(12):1531. J Neurol Neurosurg Psychiatry. 2015 Aug; 86(8):840–8. Epub 2014 Dec 15.

中文翻译：

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困境，转换障碍或僵人综合症，病例报告

研究目标 本案例研究的主要目标是 1. 面临难以解释的症状的临床医生在诊断转换障碍时应谨慎行事。2. 提高对罕见神经系统疾病的认识可能表现为心因性疾病。3. 临床医生应为他们的患者辩护。 简介转换障碍是一种精神疾病，其中一个人出现一种或多种自主运动或感觉功能改变的症状，或医学评估无法解释的其他神经系统症状。僵人综合征 (SPS) 是一种致残性自身免疫性中枢神经系统疾病，其特征是进行性肌肉强直、步态障碍和叠加的疼痛性痉挛。SPS 通常与高抗谷氨酸脱羧酶 (GAD) 抗体滴度相关。这些抗体识别的主要抗原是 GABA 合成酶 GAD。方法患者 X 是一名 17 岁的西班牙裔美国女性，她因与焦虑相关的共济失调和失语症就诊于儿童和青少年精神病学诊所。在无法确定她的共济失调或失语的任何器质性原因后，神经内科诊所转诊了患者。在儿童精神病学诊所进行全面评估后，她被诊断为继发于共济失调和失语症以及 r/o 转换障碍的焦虑症。她开始用舍曲林治疗她的焦虑。她的舍曲林剂量逐渐增加至每天 100 毫克。从一开始，患者还接受了咨询和物理治疗。通过这些治疗组合，患者的症状并没有得到任何改善。随着时间的推移，她的症状实际上变得更糟。至此，儿童精神科门诊因患者进行性步态和语言障碍向神经科门诊发送信息，对患者进行进一步评估。结果神经科门诊再次见到该患者并进行了进一步检查。该患者的高滴度抗谷氨酸脱羧酶抗体（Anti-GAD）呈阳性。此时，患者被诊断为僵人综合症。患者入院接受进一步治疗。她接受了苯二氮卓类药物、IV 免疫球蛋白和类固醇的治疗。出院后不久，患者在儿童精神科诊所就诊。患者母亲反映，经过住院治疗，患者症状有所好转。评估可能患有转换障碍的患者时的其他一般医疗状况。一项对 27 项研究的系统评价发现，在 1466 名最初诊断为转化症状的患者中，误诊率约为 4%。参考资料。英国医学杂志。2005；331（7523）：989。Epub 10 月 13 日。儿童期出现僵人综合症。JAMA 神经元。2013；70(12):1531。J Neurol Neurosurg 精神病学。2015年8月；86（8）：840-8。Epub 2014 年 12 月 15 日。J Neurol Neurosurg 精神病学。2015年8月；86（8）：840-8。Epub 2014 年 12 月 15 日。J Neurol Neurosurg 精神病学。2015年8月；86（8）：840-8。Epub 2014 年 12 月 15 日。