Vietnam J o u m a l of PhysiolOfly 20(3), 9/2016 I S S N : 1869 - 2376 BAG OlfiM NHAN CACH VA SANG C H A N T A M L t <t BENH N H A N
R 6 | L O A N PHAN LY LI>A T U 6 | VI T H A N H N I E N
N g u y i n Van T u a n ' ' , Tran Thi Thu Ha'
, 2 . • , ^ _ ? ^ ^ ' ^ " ' ' " " = " * "^ ' " * " ' f^^"" " « " h> 1 f din 19 tuii duKTC chin aoin
To. khia: nhdn cich, sang chin tSm ly. ril loan phSn ly L D A T V A N D E
Theo T l chftc Y t l T h i glftl (1992) R l i loan phan ly (RLPL) la tlnh trang m i l mot p h i n hay hoan loan s u hop n h i t blnh thuftng giua tri nhft, qua khft, y thfte v l d^c tlnh ca nhan vfti nhu'ng cam giac tryc t i l p va s u k i l m soat vSn dftng cfla oo t h i . a cac q u i c gla, tJ Ift r i l loan phan ly cft su thay d i i do chiu anh huftng cfla cftc n l n van hfta khac nhau. Theo nghiftn cftu ft mftt s l nuftc vftng Bac Au nhu Hft Lan Thgy Sy ty 10 r l i loan phan iy chilm tft 4- 8% bOnh nhan tam t h i n d i l u tri nfti tnj, trong khi dft ty 10 nay ft T h i NhT Ky la 10%, ft B i c My la 15%.
R i l loan phan ly gap ft nhilu Ifta t u i i , song cft nhilu truftng hop ft ifta l u l l vj thanh niOn [ g . T u i i v| thftnh niftn la gial doan boat dOng tOm sinh ly n i i bat, boat dOng nhan thuc cQng phat tnIn khftng
Dai iioc Y Ha NOi
• Tac gia chiu trach nhi$m chinh:
Nguyin VSn T u i n Email: nvtuannimhvnOiimi i art,, „„
Ngdy nhan bai; 1/8;2016 Ngay nhfln bai phdn bian: 11/9/2016 Ngdy chip nhan dSng: 23/9/2016
ngung. Hon nua, dfti song e l m xflc Ifta l u l l nay phong phft va da dang.
Tnrftc nhftng anh hudng cua mfti tnrftng khOng thuSn loi, nhung ngufti ft lua t u i l nay thuftng phSi d i i mat vfti nhilu ftp luc tnjng cuftc s i n g , d l d i n d i n nhftng cam xflc hanh vi khOng phil hop, trong dft cft roi loan phan ly [3J.
Trong r i l loan phan ly, nhan each va sang c h i n tam ly dftng val trft quan trpng.
S u k i t hop hal y l u t i nfty dftng val trft chfl y l u hong co c h i bOnh sinh cfla r i i loan phan ly.
Mgc tieu: MO ta dOc d l l m nhan each va sang c h i n tam ly ft bOnh nhan r l i loan phOn ly lua t u i i v| thanh nian.
2. B 6 | T U V N G V A PHI/ONG PHAp NGHI£N CChl
2.3. D i l tu^mg n g h i i n ci>u 45 bOnh nhan ft ifta l u l l vj thftnh niSn tft 11 d i n 19 t u i i duoc c h i n doan xac dlnh r i i loan phan iy theo ICD-10 nhOp ViOn SU'C khfte Tam t h i n - BOnh viftn Bach Mai trong thfti gian 9/2014 d i n 8/2015. Loai Iru: Cft bOnh ly thuc I h l nang v l nfti khoa, t h i n kinh; B|nh nhan khftng d i n g y tham gia nghiin cuu- va Bftnh nhan b i d i l u tri.
Vietnam J o u m a l of Physiology 20(3), 9/2016 I S S N : 1 8 5 9 - 2 3 7 6 2.4. Phuxmg phap nghien ci>u
Si> dyng phifong phap nghien ci>u m6 ta cat ngang. CSc Ijenh nhan nghifin ci>u deu du'oc hoi va kham, ghi chep chi ti^t phfi kin cac bi4n s6 nghien CLPU theo mpt m l u b?nh an tii6ng nh^t. Danh gia nhan c i c h dya tren mang MMPI, lu-p'ng g i i diem so do nha tam ly thyc hi$n danh gia.
So li^u du-oc tinh % theo dgc d i l m lam sang. So sanh m6i lien quan bang cac test X2, t vd gia tn p. Xi> ly s6 lifiu bang p h i n mem SPSS 16.0. Nghi&n cu-u thirc hipn khi 6iK?c sy dSng y cGa ngu-oi bfinh v^
dam b i o tinh b i o mat thong tin theo quy djnh hi$n hSnh.
3. K^TQUANGHieNCO-U
3.1. D$c diem chung n h 6 m b$nh nhdn nghien ci>u
Bfinh nhan b nhdm tufii ti> 17-19 chiem ty ip cao nhiit 53,3%. b§nh nhSn b nhdm tu6i tilp 11-13 chi^m t? Ifi thSp nh4t id 8.9%. Tu6i trung blnh cua nghifin ci>u la 16 3, nhu-ng tu6i kh*i p h i t c i c tri§u chiing s6m hon l i 15.9. TT Ifi nif/nam I i 3.5/1. Bfinh n h i n d i n tie n6ng thfin chilm da s6 66,7%. bpnh n h i n s6ng 6- thj t r l n chilm ty Ifi thap n h i t 8,9%. B^nh n h i n c6 trinh dp trung hoc co s * 62,2% chilm tJ lp cao nhat, b#nh n h i n co trinh d$ tmng hpc ph6 thfing ft g i p n h i t 15,6%.
3.2. D^c d i l m m6i tru'd'ng gia d'rnh nhdm b^nh nhSn nghien cii-u B i n g 3.1. Phan bo d l i tu-p-ng nghien ci>u theo mpt s6 dgc d i l m gia dlnh
Ogc diem MU'C d$ quan tfim
trong gia dinh
Chilu chuQng Blnh thuang Moi quan hfi trong gia
dinh
Ngu-p-c dai
33,3 Cd m i u t h u i n
Khfing m i u thuin
17,8 82.2
T i l n si> bfinh t i m than Khong 97.8
2,2 3.3. O^c diem n h i n c i c h nhdm bpnh n h i n nghfen cO-u
B i n g 3.2. Phin b l d l i tt/p-ng nghifin cO-u theo d i l n d l n h i n c i c h MMPI D|c dilm
Hy- hysteria
Ranh gi6l
n (%)
D-trlm c i m Hd-nghi bfinh
11(24,4%)
Bfinh ly 11(24.4%)
12(26,7%) 11(24,4%)
LoSu
8(17.8%) 21(46.7%)
Sc-phin li
11(24,4%) 15(33,3%)
L-thinh th$t
10(22.2%) 18(40%)
HifiuslF-K<12 (cd dO tin cgy)
12(26,7%) 3(6.7%)
c6 dO tin cgy 24 (53,3%)
Khdng c6 dfi fin c^y 9 (20%)
^ ° ' - ^ ' " • ' " " m a l of Physiology 20(3), 9/2016 ISSN: 1859 - 3.4, D t e d l l m sang c h i n tam ly ft. nhftm benh nhan nghien c m i
Bang 3,6. Phan b l d i l hrpng nghien cftu Iheo sang c h i n tam ly (SCTL)
^
4. BAN LUAN
Quan hO trong gla dlnh va r i i loan phan ly
NghiOn cftu cfla Faul va Nicol (1986) bOnh nhan ft t u i i vi thanh n i i n m i c r l i loan phan ly s i n g trong gia dinh cft nhieu b i t hOa hon gia dlnh khSc. S u xlch mich Irang gia dlnh, s u chia ly, m i t mat ngufti than la nhung y l u t i tam ly nang n l cft t h i la nhan t i t h u i n loi cho sg. phat sinh r i l loan phan iy Iheo Kate Zona 2014 [6].
Theo Campo 6 gia dlnh cfla bOnh nhSn tre em va vi Ihanh niftn bi r i l loan phan ly cft it s u h i tro. It g i n k i t hon cac gia dinh khac. Trong gia dlnh, mpl ngufti It cft s u glao t i l p tuong tac vfti nhau thi b i l u hiftn trIOu chftng co t h i nhu mftt hinh thflc giao BIp cfla bOnh nhan vfti mpl ngufti, nfi duoc xem nhu ngftn ngu khftng iftl b i l u dat nhung khft khan d l thu hut s u chfl y, tim k i l m s u giflp dft tft xung quanh [3],
NhOn dinh cfla Sutaja Sethi khi nghien cftu r i l loan phan ly (chuyin di) ft lift em va vi thanh nIOn cft 66% bOnh nhan la tnjng tam cfta gia dinh, i u i n n h j n duoc so quan tam t u ngufti than [8]. Nghiin cuu cua Vu Thy d m v l dac d i i m iam
sang va mot s l d i e d i l m nhan each r l i loan v | n dOng vO cam giac phan ly cft 68,7% bOnh nhan s i n g trang m i l tnrftng gla dlnh nuOng chilu, mgi ngufti trong gia dlnh luOn bao bpc con cai, dap ftng a l y dfl tfl^c thfti nhftng nhu d u cfla con, mpi hanh dftng cfta con d i u duoc tan duong va banh vuc. Bay la d i i u kiOn gftp p h i n hinh thanh va phat triln nhan each y l u d u l l , khftng cft kha nang t u IOp, thilu t u chfl, k i m thich nghi vfti s u Ihay d l i mOi tnrftng s i n g , luftn mong m u i n minh la tmng tam cfla s u chfl y, thu hflt s u quan tam cfla moi nguoi xung quanh - la y l u t l thuOn loi thuc d i y s u phat sinh r i i loan phan iy [6].
Bac d l l m nhan each
K i t qua nghiSn cftu cfla chflng tfti phft hop vfti nghian cftu cfla VQ Thy d m khi sft dung thang dftnh gia nhan each MMPI cft 15,2% cft Ihang Hy cao mftc bOnh ly 37,8% cft Ihang Hd cao mftc bftnh iy 111' Nhilu tac gia cung nhOn dinh r i l loan phan ly thuftng xuit hiftn ft bOnh nhan cft k h i u [2]. Theo Folks (1985) r i l loan nhan each iiOn quan d i n r i i loan phan ly ehilm
Vietnam J o u m a l of Physiology 20(3), 9/2016 ISSN: 1 8 5 9 - 2 3 7 6 ty Ifi ti> 16-46% [4]. Roi logn p h i n fy b tuoi
vj ^ a n h nien cung gi6ng d' cac lira tu6i khic. hau h^t xay ra a nhirng doi t u ^ n g c6 nhan c i c h phan ly.
Thang L d i n h g i i mirc dfi t h i n h thgt cua bfinh nhan 33,4% co ket qua khong d i n g tin cgy. Dieu nay cd tfie giai thich bfinh n h i n c6 n h i n c i c h phan ly, co tinh tra loi l i m sai Ipch so lieu. Thang t r i m c i m (D) v i thang io i u c6 ket qua d- mirc bpnh ly b mpt s6 bpnh nhan (24,4% . 33,3%) th^ hipn net n h i n c a d i tr^m cam v i Io i u phdi hop. C i c nfit nhan each trfin l i di^u kipn thugn Ip-i dh roi logn p h i n ly phit sinh v i cung gop p h i n iy giai s y xuSt hi$n cac i^i logn tam tfiln kdt hop nhu- lo i u v i t r i m cam,
D$c didm sang chdn t i m ly Kdt q u i nghifin cuu cxia chOng tfii tusDng ddng vbi Bema Pehlivantu nghien ciJu trfin 40 bfinh nhgn tre em v i vj thinh nifin mdc rdi logn chuydn di trong 4 n i m da ghi nh§n 90% b$nh nhin cd sang chdn t i m 1^ xudt hi§n cdp didn trong idn khd'i phit b$nh ddu tifin [5]. Theo Kate khi nghifin a X i rdi logn phin ly & nO vj thinh nien nh^n thdy moi quan h§ mfit thidt gi&a sang chdn t i m ly v i bidu hipn tri0u cht>ng bfinh ly [6]. VO Thy Cdm nghifin ciju mdi quan hfi tri$u chiing rdi logn phin ly v i sang chdn t i m ly cho thdy ty Ifi n i y chidm 75.6% [1J. Ket q u i n i y cung phil hp-p vdi nhidu t i c gia trfin thd gi6i:
sang chdn tSm i'y ddng vai trd quan trong trong si/ phit tndn tripu chimg p h i n ly (chuydn di) (miu thuSn gia dlnh, si^ mdt m i t ngu^i thin...) [7],
So s i n h v6i kdt q u i nghien cu-u cua c i c t i c g i i k h i c trfin thd gidri ve sang chdn t i m ly b bfinh n h i n rdi logn phan Iy ChOng tfii nh§n thdy c6 s v k h i c bifit: Cf Vidt Nam. c i c sang chdn tam ly hdu hdt xudt p h i t tip m i u thudn gia dlnh v i cfing vi$c, cdn b c i c n\tbc trfin thd g\b\ SCTL dirng ddu l i Igm dgng co thd. Igm dgng tlnh dye ho|c bj ngiporc dai {9],
Nhidu hon mfit nhdm sang chdn t i m iy % xay ra cQng thd-i didm nhir s y cOng J hu'dng nh&ng m i u thudn gSy khd k h i n cho trfi vj thanh nifin trong vi^c ddi phd vol chdng, gop phdn thiic ddy bidu hifin bfinh ly ciia rdi logn ph5n ly. Trifiu chirng rdt logn phan ly ( c h u y ^ di) l i s y d i p ipng cua CO thd tru'd'c nh&ng sang c^dn t i m ly giiJp ngu'd'i bfinh giam thidu lo au. trd- Igi trgng t h i i can bdng mfit c i c h nhanh chdng [7],
5. K t T LUAN
Roi logn p h i n iy thu'd'ng xudt hi$n b bpnh n h i n c6 n h i n c i c h Hysteria v6i didm tren thang Hy trong trdc nghipm n h i n c i c h MMPI cao b m&c ranh gid'i (61). Rdi logn p h i n ly co mdi lifin quan m§t thiet vd'i sang chdn tSm ly (95.6%).
Ndi dung chu ydu sang chdn tSm ly cd ngudn gdc t& gia dinh, cfing vific.
TAl L i e u THAM K H A O 1. VQ Thy Cam (2015). NghiSn cuu ddc diim Idm sdng vd mdt s6 d$c diim nhdn cdch cua b$nh nhdn rdi lo^n phdn ly vdn d0ng vd cdm gidc, Lu§n i n tidn sy.
Tru'd'ng Dgi hpc Y H i Nfii.
2. M. Kuloglu, M. Atmaca, E. Tezcan et al. (2003). Sociodemographic and clinical characteristics of patients with conversion disorder in Eastern Turi^ey.
Soc Psychiatry Psychiatr Epidemiol. 38, 88-93.
3. John V. Campo and Sandraa L.
Fritsch (1994). Somatization in Children and Adolescents. J. am . Acad. Child Adolesc Psychiatry. 33:9.1223-1235.
4. Charles V. Ford and David G.
Follfs (1985). Conversion disorders An oven/iew. PSYCHOSOMATICS, 26 No 5.
371-383.
5. Berna Pehlfvantu"rfc and Fatih Unal (2002). Conversion disorder in children and adolescents A 4-year follow- up study. Joumal of Psychosomatic Research, 52, 187-191.
Vietnam Joumal of Physiology 20(3), 9/2016 ISSN: 1 8 5 9 - 2 3 7 6
SvmnH:'^ 'n^T ' ' ° " ' " ' ^ ^ " ^ " ^ ^ 8- Sujate Sethi and Raghu Gandhi S S l n T ? « T ' " ' * • """'"^^ ' ^ " ' '^'^' Features and Outcome of
^ r t s f ^ " ° M ' ° " ' " ' ™ " - ' ^ " « = ' ^ " " ° ' » ' ^ ^ ' ^ " Children and Doctora^ Dissertations, University of Adolescents. J Indian Assoc Child ConnectieutGraduateSchooi /<do/esc. Men,. Health. 6 , 4 9 - ^
Syniptomatology and Course in Childhood Childhood Abus? in Patients W h
Zio7^z":rs5-reo."" "'^""^ s,"srigr"'- ^-^ •' "-^'^'^
PERSONALITY AND STRESSORS AMONG ADOLESCENT DISOCIATIVE DISORDER PATIENTS
Nguyen Van Tuan', Tran Thi Thu Ha'
^ Hanoi Medical Unhmrslty DIsociatlve disorders are common among adolescence. C o m t o a f e n hetaeer, andTZi ™ ' T " " " ' * ' " ™'^ '' " ' * ^ ' ^ ' ° - " " " - TO descnb^pet^onaZ and shessor among adofescen, dissociative disorder patients. Subjects « SsZialve disorder patients according to ICD-10 at the s o e , nf m o „ . . , 1 t °«sccianre A/al/ona, ,ns«„,e of Men'al Heallh ttom Z l 4 o s ^ ' l . Method-'cTT "', o t l T r - r ° = ' ^ ' " ^ "'voider patienls haL l S c , e r „ X ^ X " C a f e InsTstt^Zt^' ' " " " T - r ® " ' " " " " ™ " * " * * ^ ^ (S5.e%7en^ ouan act (77.3%). stressors come trom family and study/work. Conclusions: Dlssoclath/e disorder panenls have a hysteric personally, within Hy scale of MMPI Is highly boZ'neandTh nsk lectors from family and study/work. I'lmnme ana mgn
Keyvrords. personality, stressor, dissociative disorder
