Hyperemesis Gravidarum: A Psychosomatic A Psychosomatic?

妊娠劇吐：一種身心疾病？

10.29478/TJP.200712.0009

張勝傑(Shen-Chieh Chang)；葉英堃(Eng-Kung Yeh)

噁心 ； 嘔吐 ； 抗憂鬱劑 ； 激素 ； nausea ； vomiting ； antidepressant ； hormone

台灣精神醫學

21卷4期（2007 / 12 / 01）

304 - 311

英文

背景：自十九世紀末期起，就有學者將妊娠劇吐(hyperemesis gravidarum)視為心身疾病(psychosomatic disease)的一種，然而這種看法在台灣精神醫學界似乎並不廣為人知。個案：一位35歲的已婚婦女，在懷孕第11週的時候，因妊娠劇吐二度住進本院婦產科病房，我們被照會加以評估其精神狀態，並在本科每週定期舉行的會診個案討論會中，兩次提出此個案加以討論。討論：我們討論了文獻中關於妊娠劇吐為心因性或非心因性的各種看法、對待此類病人所應有的態度、及罹有妊娠劇吐甚或憂鬱症之懷孕婦女的治療選擇。結論：雖然妊娠劇吐在精神科臨床執業中並不常見，而且幾乎都由婦產科醫師轉介而來，我們必須提醒自己，妊娠劇吐是一種身心疾病的可能性。藉由文獻的回顧，及個案討論，我們發現及早的心理社會介入(psychosocial intervention)，將會同時給懷孕婦女及胎兒帶來益處。

Background: Having been long seen as a psychosomatic disease, hyperemesis gravidarum (HG) has, received little attention in Taiwan psychiatry. The Case: We are presenting a case of 35-year-old married woman with HG in her 11th week of gestation. Her obstetrician requested us to see this patient in a psychiatric consultation. The case was discussed in the weekly teaching consultation case conference twice consecutively in 2006. Discussion: We discussed the issues of psychogenic theory of HG, dissenting views against the HG psychogenesis, accepting the patient as she is, weighing the risk and benefit of the antidepressant therapy, and the limitation of this case presentation. Conclusion: HG is rarely seen in consultation psychiatry, but should be reminded as a psychosomatic disease. Based on the findings of this case and the literature, we conclude that HG patients could be better benefited from an earlier psychosocial intervention for the well-being of both mother and fetus.

1. American Psychiatric Association(2000).Diagnostic and Statistical Manual of Mental Disorders.Washington, DC:APA.
2. Bogen JT(1994).Neurosis: a Ms-diagnosis.Perspect Biol Med,37,263-274.
3. Busse EW(1955).Hyperemesis gravidarum: psychiatric principles for the therapeutic team.Dis Nerv Syst,16,47-50.
4. Caruso SM,el-Mallakh RS,Hale MS(1990).Systems dynamics in hyperemesis gravidarum.Fam Syst Med,8,91-95.
5. Dooley L(1920).Psychoanalysis of Charlotte Bronte, as a type of the woman of genius.Am J Psychol,31,221-272.
6. el-Mallakh RS,Liebowitz NR,Hale MS(1990).Hyperemesis gravidarum as conversion disorder.J Nerv Ment Dis,178,655-659.
7. Fairweather DV(1978).Nausea and vomiting during pregnancy.Obstet Gynecol Annu,7,91-105.
8. Fairweather DV(1968).Nausea and vomiting in pregnancy.Am J Obstet Gynecol,102,135-175.
9. Guclu S,Gol M,Dogan E,Saygili U(2005).Mirtazapine use in resistant hyperemesis gravidarum: report of three cases and review of the literature.Arch Gynecol Obstet,272,298-300.
10. Hamptom T(2006).Antidepressants and pregnancy: weighing risks and benefits no easy task.JAMA,295,1631-1633.
11. Harvey WA,Sherfey MJ(1954).Vomiting in pregnancy.Psychosom Med,16,1-9.
12. Iancu I,Kotler M,Spivak B,Radwan M,Weizman A(1994).Psychiatric aspects of hyremesis gravidarum.Psychother Psychosom,64,143-149.
13. Kallen B(1987).Hyperemesis during pregnancy and delivery outcome: a registry study.Eur J Obstet Gynecol Reprod Biol,26,291-302.
14. Karpel L,de Gemeline C(2004).Psychological approach of hyperemesis gravidarum.J Gynecol Obstet Biol Reprod,33,623-631.
15. Katon WJ,Ries RK,Bokan JA,Kleinman A(1980).Hyperemesis gravidarum: a biopsychosocial perspective.Int J Psychiatry Med,10,151-162.
16. Louik C,Hernandez-Diaz S,Werler MM,Mitchell AA(2006).Nausea and vomiting in pregnancy: maternal characteristics and risk factors.Paediatr Perinat Epidemiol,20,270-278.
17. Lub-Moss MM,Eurelings-Bontekoe EH(1997).Clinical experience with patients suffering from hyperemesis gravidarum (severe nausea and vomiting during pregnancy): thoughts about subtyping of patients, treatment and counseling models.Patient Educ Couns,31,65-75.
18. Munch SL(1998).Hyperemesis Gravidarum and Patient Satisfaction: Patients` Perceptions of the Patient-physician Relationship [a dissertation].East Lansing Michigan, USA:Michigan State University.
19. Munch SL(2002).Chicken or the egg? the biological-psychological controversy surrounding hyperemesis gravidarum.Soc Sci Med,55,1267-1278.
20. Munch SL,Schmitz MF(2006).Hyperemesis gravidarum and patient satisfaction: a path model of patients` perceptions of the patient-physician relationship.J Psychosom Obstet Gynaecol,27,49-57.
21. Nonacs R,Cohen LS(2002).Depression during pregnancy: diagnosis and treatment options.J Clin Psychiatry,63(suppl 7),24-30.
22. Schouenborg LO,Honnens de Lichtenberg M,Djursing H,Sorensen J.(1992).Hyperemesis gravidarum.Ugeskr Laeger,154,1015-1019.
23. Shen WW(2007).Clinical Psychopharmacology for the 21st Century.Taipei:Hochi Publishing Co..
24. Shen WW,Baig MS,Sata LS,Hofstatter L(1983).Dopamine receptor supersensitivity and the chemoreceptor trigger zone.Biol Psychiatry,18,917-921.
25. Simpson SW,Goodwin TM,Robins SB(2001).Psychological factors and hyperemesis gravidarum.J Womens Health Gend Based Med,10,471-477.
26. Soltani H,Tayloe GM(2003).Changing attitudes and perceptions to hyperemesis gravidarum.RCM Midwives,6,520-524.
27. Tsang IS,Katz VL,Wells SD(1996).Maternal and fetal outcomes in hyperemesis gravidarum.Int J Gynaecol Obstet,55,231-235.
28. Verberg MF,Gillott DJ,Al-Fardan N,Grudzinskas JG(2005).Hyperemesis gravidarum, a literature review.Hum Reprod Update,11,527-539.
29. Yeh EK(2005)."Knowledge" vs "wisdom": from "evidence-based" to "problem-solving", the roles of consultation psychiatry in general hospital.Formos J Med Humanit,6,77-86.