정신신체의학 (Korean Journal of Psychosomatic Medicine)

한국정신신체의학회 (Korean Psychosomatic Society)
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히스테리아(전환장애)의 소실과 진화적 뇌신경 부조화 반응 가설

Disappearance of Hysteria(Conversion Disorder) and the Evolutionary Brain Discord Reaction Theory

  • 송지영 (경희대학교 의과대학 정신건강의학교실)
  • Song, Ji Young (Department Psychiatry, Kyung Hee University School of Medicine)
  • 투고 : 2016.01.13
  • 심사 : 2016.04.30
  • 발행 : 2016.06.30
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초록

연구목적 19세기말부터 근래까지 정신과 및 응급실에서 많이 볼 수 있었던 히스테리아(전환장애)환자를 이제는 더 이상 보기 어려워졌다. 이러한 현상의 원인을 규명해보고자 하였다. 방 법 정신과 외래 및 입원환자의 수가 지난 12년 동안 과연 얼마나 되는지 병록지를 조사하고 증상의 변화, 증상지속기간을 조사하였으며, 지난 2년간 응급실에서 정신과진료에서 본 전환장애 환자수를 조사하였다. 이 결과를 과거의 연구 결과와 비교해보았다. 이를 토대로 히스테리아(전환장애)의 소실 및 증상 변화의 원인을 찾아보았다. 결 과 히스테리아(전환장애)의 환자수가 현저히 줄어들었으며 그 증상도 변화된 것을 확인하였다. 그리고 이러한 변화는 불과 수십 년 사이에 일어났다. 그 간의 연구결과를 통하여 신경질환 진단법의 발달, 진단명과 증상기재 용어의 변화, 감정자극에 따른 뇌기능의 변환, 그리고 진화론적 관점 등이 이 병의 감소 내지는 증상의 변화를 설명할 수 있다. 결 론 히스테리아(전환장애)의 소실 및 증상의 변화가 불과 수십 년 동안에 일어날 수 있는 것은 진화적으로 변화하는 뇌와 환경 사이의 부조화에 따른 충격이 반응으로 나타난다는 가설을 통하여 이유의 많은 부분이 설명된다. 그리고 비록 과거의 히스테리아(전환장애) 환자수는 줄었으나 그 모습이 변화된 환자수는 결코 적지 않다. 정신과의사는 이들 환자에게 적절한 치료를 제공해 주기 위해서 일차 진료의사와 신경과의사와 협동해야 하며 주도적인 역할이 필요하다. 현재 사용하는 진단명이나 증상 기재 용어는 그 기본 내용이나 개념이 일부 변화했을 뿐, 뇌기능의 장애와 연관된 원인 불명의 신체증상이라는 점에서 달라진 바가 없다고 생각한다. 이에 저자는 과거의 용어인 히스테리아(전환장애)를 부활시키는 것이 타당하다는 점을 설명하였다.

Objectives : The author tried to find out reasons why and how hysteria(and conversion disorder) patient numbers, which were so prevalent even a few decades ago, have decreased and the phenotype of symptoms have changed. Methods : The number of visiting patients diagnosed with conversion disorder and their phenotype of symptoms were investigated through chart reviews in a psychiatric department of a University hospital for the last 12 years. Additionally, the characteristics of conversion disorder patients visiting the emergency room for last 2 years were also reviewed. Those results were compared with previous research results even if it seemed to be an indirect comparisons. The research relied on Briquet P. and Charcot JM's established factors of the vicissitudes of hysteria(and conversion disorder) which has been the framework for more than one hundred and fifty years since hysteria has been investigated. Results : The author found decreased numbers and changes of the phenotype of the hysteria patients(and conversion disorder) over the last several decades. The decreased numbers and changes of the symptoms of those seemed to be partly due to several issues. These issues include the development of the diagnostic techniques to identify organic causes of hysteria, repeated changes to the symptom descriptions and diagnostic classification, changes of the brain nervous functions in response to negative emotions, and the influence of human evolution. Conclusions : The author proposed that the evolutionary brain discord reaction theory explains the causes of disappearance of and changes to symptoms of hysteria(conversion disorder). Most patients with hysteria(conversion disorder) have been diagnosed in the neurological department. For providing more appropriate treatment and minimizing physical disabilities to those patients, psychiatrists should have a major role in cooperating not only with primary care physicians but with neurologists. The term 'hysteria' which had been used long ago should be revived and used as a term to describe diseases such as somatic symptom disorder, functional neurological symptoms, somatization, and somatoform disorders, all of which represent almost the same vague concept as hysteria.

키워드

참고문헌

  1. 송지영, 공재연, 장환일. 히스테리아의 추적 관찰. 신경정신의학 1989;28:841-848.
  2. 박재훈. 히스테리 신경증의 증상 양상변화. 신경정신의학 1982;21:603-610.
  3. 김시경, 신철진, 김재진, 이상익, 정인원. 응급실에 내원한 급성 히스테리반응의 진단특성. 정신병리학 1198;7:130-140.
  4. 정상근, 최명수, 정애자, 황익근. 전환장애환자의 정신생리적 반응. 전북의대논문집 2002;26:11-19.
  5. Akagi H, House A. The clinical epidemiology of hysteria: vanishingly rare, or just vanishing? Psychological Medicine 2002;32:191-194. https://doi.org/10.1017/S0033291701004962
  6. Shorter E. From paralysis to fatigue: A history of psychosomatic medicine in the Modern Era. New York: The Free Press; 1992.
  7. Stone J, Hewett R, Carson A, Warlow C, Sharpe M. The 'disappearance' of hysteria: historical mystery or illusion? J R Soc Med 2008;101:12-18. https://doi.org/10.1258/jrsm.2007.070129
  8. Kanaan R, Armstrong D, Barnes P, Wessely S. In the psychiatrist's chair: how neurologists understand conversion disorder. Brain 2009;132(Pt 10):2889-2896. https://doi.org/10.1093/brain/awp060
  9. Ballmaier M1, Schmidt R. Conversion disorder revisited. Funct Neurol 2005 ;20:105-113.
  10. Tschinkel S, Harris M, Le Noury J, Healy D. Postpartum psychosis: two cohorts compared, 1875-1924 and 1994-2005. Psychol Med 2007;37:529-536. https://doi.org/10.1017/S0033291706009202
  11. Healy D. Psychiatric 'diseases' in history. Hist Psychiatry 2014;25:450-458. https://doi.org/10.1177/0957154X14543980
  12. Slater E. Diagnosis of hysteria. BMJ 1965;1:1395-1399. https://doi.org/10.1136/bmj.1.5447.1395
  13. Stone J, Smyth R, Carson A, Lewis S, Prescott R, Warlow C, Sharpe M. Systematic review of misdiagnosis of conversion symptoms and "hysteria." BMJ 2005;331:989. https://doi.org/10.1136/bmj.38628.466898.55
  14. Stone J, Carson A, Duncan R, Coleman R, Roberts R, Warlow C, Hibberd C, Murray G, Cull R, Pelosi A, Cavanagh J, Matthews K, Goldbeck R, Smyth R, Walker J, Macmahon AD, Sharpe M. Symptoms 'unexplained by organic disease' in 1144 new neurology out-patients: how often does the diagnosis change at follow-up? Brain 2009;132(Pt 10):2878-2888. https://doi.org/10.1093/brain/awp220
  15. Mersky H. the importance of hysteria. Br J Psychiatry 1986; 149:23-28. https://doi.org/10.1192/bjp.149.1.23
  16. Crommelinck M. Neurophysiology of conversion disorders: a historical perspective. Neurophysiol Clin 2014;44:315-321. https://doi.org/10.1016/j.neucli.2013.10.126
  17. Bogousslavsky J, Walusinski O, Veyrunes D. Crime, hysteria and belle epoque hypnotism: the path traced by Jean-Martin Charcot and Georges Gilles de la Tourette. Eur Neurol 2009; 62:193-199. https://doi.org/10.1159/000228252
  18. Bogousslavsky J, Dieguez S. Sigmund Freud and hysteria: the etiology of psychoanalysis? Front Neurol Neurosci 2014; 35:109-125.
  19. Haller H, Cramer H, Lauche R, Dobos G. Somatoform disorders and medically unexplained symptoms in primary care. Dtsch Arztebl Int 2015;112:279-287.
  20. Tavel ME. Somatic symptom disorders without known physical causes: one disease with many names? Am J Med 2015;128: 1054-1058. https://doi.org/10.1016/j.amjmed.2015.04.041
  21. 5 Historical Manias That Gripped Societies, Then Disappeared. November 15, 2012. http://mentalfloss.com/article/ 13097/5-historical-manias-gripped-societies-then-disappeared
  22. Medeiros De Bustos E, Galli S, Haffen E, Moulin T. Clinical manifestations of hysteria: an epistemological perspective or how historical dynamics illuminate current practice. Front Neurol Neurosci 2014;35:28-43.
  23. American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders(5th ed.; DSM-5). New York: American Psychiatric Association;2013.
  24. Owens C, Dein S. Conversion disorder: The modern hysteria. Adv Psychiatr Treat 2006;12:152-157. https://doi.org/10.1192/apt.12.2.152
  25. Edwards MJ, Stone J, Lang AE. Functional/psychogenic movement disorders: Do we know what they are? Movement Disorders 2014;29:1696-1697.
  26. Halayem S, Bouden A, Hammami M, Hamza M, Halayem MB. Somatic manifestations among depressed children: the case of complains and conversion symptoms. Tunis Med 2014; 92:154-158.
  27. Kinetzsept E. Is Hysteria Real? Brain Images Say Yes. The New York Times. 2006; Sep. 26th.
  28. Kaplan MJ. A psychodynamic perspective on treatment of patients with conversion and other somatoform disorders. Psychodyn Psychiatry 2014;42:593-615. https://doi.org/10.1521/pdps.2014.42.4.593
  29. 조은이. 신체 증상 귀인과 감정표현불능증이 신체화에 미치는 영향에서 통합성의 조절효과(석사학위논문). 서울: 가톨릭대학교 대학원;2011.
  30. Spence SA, Crimlisk HL, Cope H, Ron MA, Grasby PM. Discrete neurophysiological correlates in prefrontal cortex during hysterical and feigned disorder of movement. Lancet 2000;355:1243-1244. https://doi.org/10.1016/S0140-6736(00)02096-1
  31. Anderson MC1, Ochsner KN, Kuhl B, Cooper J, Robertson E, Gabrieli SW, Glover GH, Gabrieli JD. Neural systems underlying the suppression of unwanted memories. Science 2004;303:232-235. https://doi.org/10.1126/science.1089504
  32. Northoff G1. What catatonia can tell us about " top-down modulation": a neuropsychiatric hypothesis. Behav Brain Sci 2002;25:555-577 discussion 578-604. https://doi.org/10.1017/S0140525X02000109
  33. Goldberg G, Bloom KK. The alien hand sign. Localization, lateralization and recovery. Am J Phys Med Rehabil 1990;69:228-238. https://doi.org/10.1097/00002060-199010000-00002
  34. Damasio AR. Descartes' error revisited. J Hist Neurosci 2001;10:192-194. https://doi.org/10.1076/jhin.10.2.192.7250
  35. Guerit JM. Neurophysiology of conversive disorders. Neurophysiol Clin 2014;44:301-304. https://doi.org/10.1016/j.neucli.2014.09.062
  36. Raj V, Rowe AA, Fleisch SB, Paranjape SY, Arain AM, Nicolson SE. Psychogenic pseudosyncope: diagnosis and management. Auton Neurosci 2014;184:66-72. https://doi.org/10.1016/j.autneu.2014.05.003
  37. Campbell A. T he evolutionary psychology of women's aggression. Philos Trans R Soc Lond B Biol Sci 2013;28:368(1631).
  38. Whittle S, Yucel M, Yap MB, Allen NB. Sex differences in the neural correlates of emotion: evidence from neuroimaging. Biol Psychol 2011;87:319-33. https://doi.org/10.1016/j.biopsycho.2011.05.003
  39. Dedora DJ. Carlson JM, Mujica-Parodi LR. Acute stress eliminates female advantage in detection of ambiguous negative affect. Evol Psychol 2011;9:532-542.
  40. Gardener EK, Carr AR, Macgregor A, Felmingham KL. Sex differences and emotion regulation: an event-related potential study. PLoS One 2013;8:e73475. https://doi.org/10.1371/journal.pone.0073475
  41. Campbell A. The evolutionary psychology of women's aggression. Philos Trans R Soc Lond B Biol Sci 2013;368(1631).
  42. Bracha HS. Human brain evolution and the “Neuroevolutionary Time-depth Principle:” Implications for the Reclassification of fear-circuitry-related traits in DSM-V and for studying resilience to warzone-related posttraumatic stress disorder. Prog Neuropsychopharmacol Biol Psychiatry 2006;30:827-853. https://doi.org/10.1016/j.pnpbp.2006.01.008
  43. Schmidt NB, Richey JA, Zvolensky MJ, Maner JK. Exploring human freeze responses to a threat stressor. J Behav Ther Exp Psychiatry 2008;39:292-304. https://doi.org/10.1016/j.jbtep.2007.08.002
  44. Blanc JJ, Alboni P, Benditt DG. Vasovagal syncope in humans and protective reactions in animals. Europace 2015;17:345-349. https://doi.org/10.1093/europace/euu367
  45. Micale MS. Charcot and the idea of hysteria in the male: gender, mental science, and medical diagnosis in late nineteenthcentury France. Med Hist 1990;34:363-411. https://doi.org/10.1017/S0025727300052777
  46. van Boxtel MP, Bosma H, Jolles J, Vreeling FW. Prevalence of primitive reflexes and the relationship with cognitive change in healthy adults: a report from the Maastricht Aging Study. J Neurol 2006;253:935-941. https://doi.org/10.1007/s00415-006-0138-7
  47. Developmental plasticity: Wikipedia, the free encyclopedia. http://en.wikipedia.org/
  48. Gould SJ. The Mismeasure of Man. New York: W. W. Norton & Company;1981. p.83.
  49. Slavich GM, Cole SW. The emerging field of human social genomics. Cli Psychol Sci 2013;1:331-348. https://doi.org/10.1177/2167702613478594
  50. Cole SW. Human social genomics. PLoS Genet 2014;10(8):e1004601. https://doi.org/10.1371/journal.pgen.1004601
  51. Gibson G. The environmental contribution to gene expression profiles. Nature Reviews Genetics 2008;9:575-581. https://doi.org/10.1038/nrg2383
  52. Slavich GM, Way BM, Eisenberger NI, Taylor SE. Neural sensitivity to social rejection is associated with inflammatory responses to social stress. Proc Natl Acad Sci USA 2010;107:14817-1422. https://doi.org/10.1073/pnas.1009164107
  53. Idaghdour Y, Czika W, Shianna KV, Lee SH, Visscher PM, Martin HC, Miclaus K, Jadallah SJ, Goldstein DB, Wolfinger RD, Gibson G. Geographical Genomics of Human Leukocyte Gene Expression Variation in Southern Morocco. Nat Genet 2010;42:62-67. https://doi.org/10.1038/ng.495
  54. Zimmer C. Parasite Rex. 기생충 제국. 이석인 역. 서울: 궁리출판;2004. p.258.
  55. Rief W, Isaac M. The future of somatoform disorders: somatic symptom disorder, bodily distress disorder or functional syndromes? Curr Opin Psychiatry 2014;27:315-319. https://doi.org/10.1097/YCO.0000000000000089
  56. Klaus K, Rief W, Brahler E, Martin A, Glaesmer H, Mewes R. The distinction between “medically unexplained” and “medically explained” in the context of somatoform disorders. Int J Behav Med 2013;20:161-171. https://doi.org/10.1007/s12529-012-9245-2
  57. Briquet P. Traite de Hysterie;1859.
  58. Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition. American Psychiatric Association;1987.
  59. Merkler AE, Parikh NS, Chaudhry S, Chait A, Allen NC, Navi BB, Kamel H. Hospital revisit rate after a diagnosis of conversion disorder. J Neurol Neurosurg Psychiatry 2016;87:363-366. https://doi.org/10.1136/jnnp-2014-310181
  60. Heruti RJ, Levy A, Adunski A, Ohry A. Conversion motor paralysis disorder: overview and rehabilitation model. Spinal Cord 2002;40:327-334. https://doi.org/10.1038/sj.sc.3101308
  61. Bracha HS, Yoshioka DT, Masukawa NK, Stockman DJ. Evolution of the human fear-circuitry and acute sociogenic pseudoneurological symptoms: the Neolithic balanced-polymorphism hypothesis. J Affect Disord 2005;88:119-129. https://doi.org/10.1016/j.jad.2005.05.013
  62. Wahlstrom L, Michelsen H, Schulman A, Backheden M, Keskinen-Rosenqvist R. Longitudinal course of physical and psychological symptoms after a natural disaster. Eur J Psychotraumatol 2013 Dec 27;4. doi: 10.3402/ejpt.v4i0.21892.
  63. Asadi-Pooya AA, Emami Y, Emami M. Psychogenic nonepileptic seizures in Iran. Seizure 2014;23:175-177. https://doi.org/10.1016/j.seizure.2013.11.005