Psychogenic Visual Disturbance Research Articles

心因性視覚障害の診断と治療(押さえておきたい!心身医学の臨床の知41)

心因性視覚障害の診断と治療(押さえておきたい!心身医学の臨床の知41)

Usefulness of Stereopsis Test in Psychogenic Visual Disturbance with Optic Neuritis

Usefulness of Stereopsis Test in Psychogenic Visual Disturbance with Optic Neuritis

片眼性の調節痙攣が疑われた心因性視覚障害の一例

調節痙攣は毛様体筋の不随意的な持続的収縮により過剰な近視を呈する病態であり、その多くは心因性である。調節は通常両眼対称性に生じる反応であることから、心因性の調節痙攣も一般的には両眼性で生じ、片眼性での報告は希である。今回我々は、片眼性の調節痙攣と心因性視覚障害が合併した特異な症例を経験したので報告する。 症例は14歳女性。左眼の視力低下を自覚し近医を受診、他覚的にあきらかな異常が認められなかったため精査目的で当院を紹介され受診した。左眼は通常の視力検査では視力が出ず、トリック法を用いると良好な矯正視力が得られた。また視野検査では求心性視野狭窄を認めた。細隙灯検査や眼底検査などの他覚的検査で異常は見られなかったことなどから、心因性視覚障害と診断された。また、右眼に比べ左眼のみ過度の近視化が認められたが、調節麻痺下では屈折値に左右差はなく、眼軸長も左右差がなかったことから、左眼の片眼性調節痙攣が疑われた。 その後、経過観察中に矯正視力の変動を繰り返し、トリック法を用いても良好な視力が得られなくなり、自覚的視力は無光覚まで低下するようになった。それと同時期に輻輳痙攣も見られるようになった。 調節痙攣に対する治療として、累進屈折力レンズや調節麻痺剤の点眼を使用したが、十分な改善は得られず、輻輳痙攣が若干軽減した程度であった。片眼性の調節痙攣と心因性視覚障害という特異な所見を呈し、各種治療にも抵抗性であったが、その後の生活環境の変化で心理的ストレスが軽減された様子があり、発症1年後には自覚症状は改善し、調節痙攣などの所見は自然消失した。

めまいや歩行・起立障害を訴えた小児の転換性障害の2例

We report herein on 2 cases of pediatric psychogenic gait disturbance. Both patients (boys) were aged 10 years. Patient 1 had psychogenic fever and psychogenic visual disturbance. His symptoms improved after 4 months. Patient 2 had headache and general fatigue and was subfebrile. His symptoms disappeared after 5 months. Pediatric psychogenic gait disturbance is rare, and it is important to understand the clinical characteristics of the affected patients. In most cases, treatment can be time-consuming. To treat these patients, it is important to rule out organic disorders. A diagnosis of psychogenic gait disturbance should be made on the basis of the clinical characteristics of the disorder, such as (1) momentary fluctuations of stance and gait, often in response to suggestions; (2) excessive slowness or hesitation of locomotion incompatible with neurological disease; and (3) uneconomic postures with wastage of muscle energy. These symptoms typically improve in 4-5 months.

他科との連携が必要であった心因性視覚障害

他科との連携が必要であった心因性視覚障害

鳥取大学における小児の心因性視覚障害の統計的研究

鳥取大学における小児の心因性視覚障害の統計的研究

Occipital hypoperfusion in a patient with psychogenic visual disturbance

A patient with bilateral diminished visual acuity and blurred vision was given the diagnosis of psychogenic visual disturbance after extensive psychiatric and ophthalmological examinations. Single photon emission computed tomography with Tc-99m-ethylcysteinate dimer demonstrated remarkably reduced regional cerebral blood flow (rCBF) in the bilateral occipital lobes. More specifically, rCBF was reduced in the visual association areas, but not in the primary visual areas. These findings suggest that functional suppression of the visual association area is associated with the development of psychogenic visual disturbance.

The Characteristics of Static Visual Fields in Children with Psychogenic Visual Disturbances

Purpose It is well-known that patients with psychogenic visual disturbances (PVD) exhibit characteristic kinetic visual fields. Even when the kinetic fields are normalized, the static fields of PVD children frequently remain abnormal. To verify this finding, we performed static perimetry on those children whose kinetic fields were initially normal or which normalized during the follow-up period, and compared the results with those of children with psychosomatic disorders (PSD) and normal children. Methods We examined 9 PVD children (17 eyes), 16 PSD children (32 eyes), and 16 normal children (16 eyes). Program 30-2 or 24-2 of the Humphrey Field Analyzer was used in the examinations on all subjects. Results The average mean deviation (MD) of the PVD group was significantly lower than that of the other groups ( P < .01). False negative errors and short-term fluctuations were significantly higher in the PVD group than in the other groups ( P < .05). Conclusion Although PVD and PSD children possess a similar underlying psychological dysfunction, their performances in visual field testing proved to be quite different. In the PVD group, even when kinetic fields were normal, functional visual field loss in the static fields was common and had characteristic response properties.

耳痛を主訴とした心因性難聴の２例

Two cases of psychogenic hearing loss accompanied by otalgia are reported. Case one was a 10 year-old female. She had been treated with anticonvulsant for epileptic seizures since two years of age. She complained of right otalgia immediately after a ball struck her temporal region. The otological examination revealed right profound hearing loss without inflammatory changes in the ear, nose and throat. Because of a normal auditory brain-stem response (ABR) threshold, functional hearing loss caused by a psychogenic disorder was suspected. Three weeks later she again complained of severe right otalgia and visited our hospital at midnight, but no abnormal findings which would cause otalgia were evident. A subsequent psychological examination revealed that her symptoms occurred as a psychogenic reaction to anxiety about the unexpected occurrence of epileptic seizures. The ophthalmological examination also showed psychogenic visual disturbances with ocular pain.Case two was a 9 year-old female who complained of sudden left otalgia with bilateral hearing loss. Otorhinolaryngological examination revealed no organic changes which might cause otalgia and ABR revealed non-organic hearing loss.In both cases, the otalgia was accompanied by psychogenic hearing loss. If acute otalgia with acute hearing loss is not accompanied by organic changes, the change in hearing threshold can be considered psychogenic and further examination especially ABR is useful.

Accommodation power determined with visual evoked cortical potentials in psychogenic visual disturbances.

Accommodation power was measured with pattern visual evoked potentials in 12 normal subjects and three patients suffering from psychogenic visual disturbances and accommodation failure. Steady-state visual evoked cortical potentials recorded by increasing a minus-power lens in front of the eye in 1 diopter steps. The regression line was established from the visual evoked cortical potential amplitudes vs accommodation stimulus plot, and the objective accommodation power was determined by extrapolating the line to zero amplitude. The accommodation power measured by visual evoked cortical potentials was larger by approximately 2 diopters than that obtained subjectively by near-point rule in normal subjects. The subjective accommodation power was remarkably low for their age in each patient but the objective power was normal. These results suggest that the decrease of accommodation in these patients was caused by psychogenic mechanisms, and visual evoked cortical potential measurements of accommodation could provide helpful information for diagnosis.

心因性視力障害の視野

心因性視力障害の視野

A Case of Psychogenic Visual Disturbance Who Showed Marked Improvement by Sand Play Therapy

A Case of Psychogenic Visual Disturbance Who Showed Marked Improvement by Sand Play Therapy

心因性視力障害と調節について

Studies on 26 individuals associated with psychogenic visual disturbances were carried out with special emphasis on their living environment as a causative factors.When first seen, all patients compained of decreased visual acuity, in addition in some cases abnormalities of visual field and accommodation were observed. During the period of follow up from six months to 27 months, all cases showed the improvement in both visual acuity and visual field. As to the state of accommodation, 12 patients (46%) showed either hyper- or hypo- accommodation. Four patients showed siginificant decrease in the refraction after instillation of mydriacye. From these results, it is possible to assume that psychogenic visual disturbances may have a certain relation to the abnormalities of accommodation. We considered it was caused by an imbalance in the autonomic nervous of difficultes in adapting to the surrounding environment such as in school or in family.From these results, we stress the importance of the examination of accommodation in the diagnosis and treatment of the psychogenic visual disturbances.

On scierneuropsia, a previously unnamed psychogenic visual disturbance.

On scierneuropsia, a previously unnamed psychogenic visual disturbance.