I. The past of hysteria Hysteria is also known as hysteria and dissociative conversion disorder, and all three terms refer to the same mental illness. Clinical psychology began with the study of hysteria. At the end of the 19th century Freud came into contact with Anna O., a patient of Blois, who is still today the most famous patient in the history of clinical psychology. Through his study of Anna O., Freud creatively developed the theory of psychoanalysis. After caring for her ailing father, Anna O developed the following symptoms: neurotic cough, strabismus, aphasia, different kinds of paralysis, visual disturbances and frightening hallucinations. Anna O. seemed to have two different but alternating “states of consciousness”: one was a normal state of consciousness; the other was what Blouillet called a “hypnotic-like state”. Later we called the second condition the hysterical state of seizure. In those days, hysteria was a common psychological disorder in women, usually caused by a major life event, internal conflict, etc., acting on a susceptible individual. Some patients would have seizures, shortness of breath, shouting, fainting, and others would hit themselves or even bump into walls and other self-injurious behaviors. If there are people around the symptoms will be more intense. Second, the onset of causes 1, personality traits hysteria attacks generally have a close relationship with personality traits. People with hysterical personality have a high degree of emotionality, strong and unstable emotional reactions, easily transferred from one emotion to another, they tend to deal with people emotionally, the entire mental activity is susceptible to the influence of emotions and tend to extremes. Emotions and behavior are easily implied by the words and behavior of others. They like to boast about themselves, show themselves, are happy to be the center of attention, and like to be praised by others. They give vivid fantasies, especially strong emotional reactions, and easily confuse imagination and reality together. 2.Psychological factors Stress, serious illness, panic, being insulted, aggravation, dissatisfaction and the distance of relatives and other stronger mental trauma are often the triggers for the first onset of hysteria. 3, childhood experience Some children in early childhood because of family break-up, improper parenting style, overindulgence and frustration in the process of growing up can also cause the onset of hysteria. 4.Environmental influence Hysteria patients are more sensitive to the environment than others. Sometimes the words and actions of people around them will make patients have a series of fantasies, and they will fall into the suggestion of themselves, which will lead to the onset of the disease. 5.Brain damage Brain trauma and brain diseases, family genetics are also important reasons for the onset of hysteria. III. Symptoms The most common symptoms of hysteria are emotional outbursts, including: excessive emotion, ventilatory crying, impulsive destruction of objects, wounding, self-injury and suicidal behavior. The clinical manifestations of dysthymia are complex and varied, i.e., there can be perceptual impairment or autonomic dysfunction symptoms, so the misdiagnosis rate is high, and primary care physicians need to pay extra attention when judging, and the following types are common: 1. Dissociative amnesia manifests as a sudden inability to recall important personal experiences. The amnesia is extensive, usually revolves around traumatic events, and cannot be explained using substances, neurological lesions, or other physiological causes. 2. Dissociative wandering Accompanied by amnesia of individual identity, manifested by sudden, unplanned trips. 3. Dissociative rigidity suddenly appears to maintain a fixed posture for a considerable period of time, lying or sitting on the back, without speech or random movements, and without response to light, sound or pain stimuli. At this time, the patient’s muscle tone, posture and whistling are not obviously abnormal. It is generally related to mental trauma. 4.Hysterical pseudo-dementia Sudden appearance of severe mental impairment after mental trauma, without organic brain lesions or other psychiatric disorders, different from organic or depressive pseudo-dementia. The content of hallucinations and delusions is less fixed, more variable and easily changed by suggestion. 5.Motor disorder Excessive increase, decrease or abnormal movement without neurological damage. For example, hysterical paralysis, limb tremor, twitching and myoclonus, inability to stand or walk, muteness or loss of voice, etc. 6, spasmodic disorder Suddenly occurs when emotionally excited or cued, slowly fall to the ground or lying on the bed, whistling, general rigidity, limb tremors, etc., without incontinence, most of which last for tens of minutes. 7. Convulsive grand mal seizures often have obvious psychological triggers, and the convulsions are irregular, without tonic and clonic phases. There are often wrist joints, metacarpophalangeal joints flexion, interphalangeal joints straightening, thumb inversion, lower limbs straightening or general rigidity, paroxysmal acceleration of whistling, slightly flushed face, no urinary incontinence and other symptoms. There is no tongue biting, pupil size is normal during seizures; corneal reflexes are present, consciousness can be cued to make the convulsions pause, limbs do not relax in the later stages of the seizure, and generally seizures can last from several minutes to several hours. There are also symptoms such as deafness, blindness and abnormal sensation without physiological reasons. In addition to a correct clinical diagnosis based on the full exclusion of possible various neuropsychiatric and somatic disorders, there must be supporting evidence, including three aspects of symptom suggestibility, psychosocial factors and secondary benefit, and if one is missing, the diagnosis may be doubtful. IV. Treatment The etiology of dysthymia is mainly nonorganic, so treatment should be actively used in the form of psychotherapy to help patients recover. Psychotherapy is the basic measure for treating this kind of disease, mainly including the following aspects: 1. Suggestion therapy The best treatment method for hysteria attacks is suggestion therapy, which is an effective measure for eliminating conversion disorder, especially for patients with acute onset. There is such a story in the Yingda TV series “Psychological Clinic”: a girl was suddenly paralyzed after a major car accident, but various tests proved that the girl’s physiology had completely healed and would not lead to paralysis. The doctor implied that she would next have a famous sea-going psychiatrist for the most effective treatment. And her parents were asked to help by pretending to prepare a large sum of money to ask this doctor and his team to inject the girl with a special drug for paralysis. A shot of vitamin B disguised as a special drug, the girl immediately miraculously stood up. 2. SSRI drugs Antidepressant and antipsychotic drugs are also often used for acute episodes of dysthymia. Some doctors may also take the treatment of acupuncture to treat episodes of dysthymia. The most effective treatment for dysthymia is still psychoanalysis. 3.Psychoanalytic therapy In psychotherapy, the psychiatrist guides him to recall his childhood experiences and discover his acute and chronic childhood traumas, complexes and problems in early parent-child relationships. This gives him the opportunity to grow up again in the early years of his life in the company of the psychiatrist. It should be noted, however, that this psychoanalytic treatment is not exclusively Freudian in its early stages, but may also include components of hypnosis, expressive therapy, etc. PS: In cases of hysteria with lethargy, hazy consciousness, hallucinatory delusions of psychosis, or convulsive episodes, psychotherapy is generally difficult, and treatment by pharmacological or physical methods should be administered at this time. Drug treatment is usually intramuscular or intravenous Valium 10-20ms; Clonidine 1 ~ Zmp; if necessary, you can also intramuscular injection of chlorpromazine 25-50mg, sometimes can also add isoprostanes 25-50mg. most patients soon after the injection of human sleep, the next day when you wake up the symptoms can disappear. The injection can be repeated for a few patients who are not well. If the patient is left with dizziness, headache, insomnia and other symptoms of brain weakness, he should continue to use some small amount of anti-anxiety drugs, such as alprazolam, sulezapine, clonidine, etc., and can also take Antares, glutamate. As a primary care physician, dysthymia can generally be judged well: its symptoms are more obvious and easily distinguished from other psychological and physical disorders. However, from the treatment point of view, dysthymia is more difficult to treat, and primary care physicians without professional training in this area should promptly refer patients to the psychiatry department of psychiatric hospitals or the psychology department of general hospitals.