恐惧症(恐怖症)是一种以过分和不合理地惧怕外界客体或课件.ppt

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1、Chapter 9：Neurosis(2)PhobiaZhai Jin-guoJining Medical CollegePhobiaThis disorder is a kind of neurosis predominated by excessive,unreasonable panic of external objects or situationsThe patients are fully aware of unnecessary but cannot prevent panic attacks Panic attacks are usually accompanied by p

2、rominent anxiety and autonomic symptomsThe patient tries to avoid phobic objects or situations,or endures with dread.Whats phobia?恐惧症（恐怖症）是一种以过分和不合理地惧怕外界客体或处境为主的神经症。病人明知没有必要，但仍不能防止恐惧发作，恐惧发作时往往伴有显著的焦虑和自主神经症状。病人极力回避所害怕的客体或处境，或是带着畏惧去忍受。Whats phobia?Prevalence 0.59（1982 China）First onset age：25-44 year

3、Female MaleLife time prevalence：Agoraphobia 6.7%，Social phobia 13.3%，Special phobia 11.3%。First onset age:29,16,15 respectively（US 1996）Epidemiology of phobiaClassification of phobiaAgoraphobiaSocial phobiaSpecific phobiaDiagnostic criteria:(1)The patients conditions meeting the diagnostic criteria

4、of phobia;(2)The main phobic objects are some particular circumstances,such as heights,square,closed room,dark places,crowd places,traveling;one of the key features is excessive fear of lack of an immediately available exit in above status;(3)Excluding other phobic disorder.Agoraphobia Social Phobia

5、sSocial phobias-fear of failing or being embarrassed in publicpublic speaking(stage fright 怯场)fear of crowds,strangersmeeting new peopleeating in publicEqually often in males and femalesSpecific phobiaSpecific phobias-fear of specific objectAnimals(e.g.,snakes)Substances(e.g.,blood)Situations(e.g.,h

6、eights)More often in females than malesSocial phobiaSpecific phobiaAgoraphobiaAnxiety neurosisDysthymic disorderAlcohol dependenceDrug dependence Obsessive-compulsive disordercomorbidityGenetic factors familial inheritanceCourse and mechanism of phobia Biochemical factors Social phobia:higher norepi

7、nephrine in plasma Absence of growth hormone lead to decreasing social interact skill Psychosocial factors 恐惧症状的扩展和持续是由于症状的反复出现使焦虑情绪条件化，回避行为则阻碍了条件化的消退DiagnosisDifferential diagnosis Normal fear,anxietyTreatment Drugs therapy Antianxiety drugs：alprazolam Antidepressants:SSRIs paroxetine-adrenergic re

8、ceptor blockers：inderal(propranolol)Diagnosis and treatmentlAntidepressants TCAs:doxepine SSRIs:fluoxetine,paroxetine,sertraline,fluvoxamine,citalopram New antidepressantsl-adrenergic receptor blocker:inderal lNew antianxiety drugs:buspirone1.大叶性（肺泡性）肺炎 为肺实质炎症，通常累及肺大叶的全部或大部，并不累及支气管。病原体现在肺泡引起炎症，继之导致部

9、分或整个肺段、肺叶发生炎症改变，致病菌多为肺炎链球菌。本病多见于青壮年，临床起病急，主要症状为寒颤高热、咳嗽、胸痛、呼吸困难和咳铁锈色痰。2.小叶性（支气管）肺炎 指病原体经支气管入侵，引起细支气管、终末细支气管和肺泡的炎症。病原体有肺炎链球菌、葡萄球菌、病毒、肺炎支原体以及军团菌等。常继发于支气管炎、支气管扩张、上呼吸道病毒感染以及长期卧床的危重病人。3.间质性肺炎 以肺间质炎症为主，病变累及支气管壁及其周围组织，有肺泡壁增生及间质水肿。可由细菌、支原体、衣原体、病毒或卡氏肺囊虫等引起。病因学分类1.细菌性肺炎 如肺炎链球菌（即肺炎球菌）、金黄色葡萄球菌、甲型溶血性链球菌、肺炎克雷白杆菌、流感嗜血杆菌、铜绿假单胞菌、埃希大肠杆菌、绿脓杆菌等。2.非典型病原体所致的肺炎 如军团菌、支原体和衣原体等。