背景和动机:这是一个30多岁的男性审前囚犯由于自残和缺乏自我照顾而进入精神病院的案例。他在试图切除大块头皮时受了重伤。在诸如此类的固定躯体妄想中，患者往往对一系列抗抑郁和抗精神病药物没有反应。本病例报告提出了一个实例，在分裂情感性患者与固定的躯体妄想是无反应的传统治疗。还讨论了在这个特殊的患者群体中装病和治疗障碍的警告信号。方法:我在患者住院期间采访了他，并查看了患者的记录，包括之前的入院记录，以获得足够的信息，将一套合理的解释和鉴别诊断组合在一起。结果:病人认为有人在他在牢房里睡觉的时候把强力胶放在了他头皮的皮肤下，唯一的方法就是把它抠出来。至于是谁给他换了头皮，他的解释似乎各不相同;在不同的时候，他说好莱坞的电影明星、狱友和一个朋友的远亲都做过。在住院期间，他的头皮受到严重的擦伤，肉眼可以清楚地看到鲜红的皮肉。 Discussion: Review of the literature suggests numerous reasons for why people may present with somatic delusions. One hypothesis is that it serves as a defense mechanism to cope with trauma and other stressors. In the case of this patient, prior to his admission he had numerous financial and environmental stressors, such as being unemployed and divorced, as well as a history of physical and emotional trauma. Conclusions: Somatic delusions are still poorly understood, and a wider range of research is still needed to explain the pathophysiology behind delusional symptoms and their association to other psychiatric disorders. Extensive research is also needed to understand how to better treat fixed somatic delusions, as the current treatment protocol seems to be ineffective in patients such as this one.
