精神病学英文ppt课件：08--神经症性障碍.pptx

《精神病学英文ppt课件：08--神经症性障碍.pptx》由会员分享，可在线阅读，更多相关《精神病学英文ppt课件：08--神经症性障碍.pptx（70页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、神经症性障碍神经症性障碍NeuroticDisorderDepartmentofPsychiatry,ShanghaiMentalHealthCenterShanghaiJiaoTongUniversitySchoolofMedicine2016/10/25RenjiHospitalDefinitionNeuroticdisorderisatermgenerallyusedtodescribeanonpsychoticmentalillnesswhichtriggersfeelingsofdistressandanxietyandimpairsfunctioning.2016/10/25 Re

2、nji Hospital3Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalwithpsychologicalcausationgeneticpredispositionandpersonalitytraitchronicandrecurrentcoursebeintouchwithrealityunusualfearandanxietytoescapecertainsituationsmixturesofsymptoms,especiallyanxietyanddepressiveonesarecommonunderstan

3、dthenatureoftheirproblemsbutcantresolvewiththeexceptionofsocialphobiatheirfrequencyishigherinwomenthaninmenCommonfeatures2016/10/25 Renji Hospital4Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalReclassificationinDSM-5Theconditionsformerlyreferredtoasneuroticarenowdescribedwithmanyotherte

4、rms,suchas:Anxietydisorder（Phobia）Obsessive-CompulsiveandrelatedDisorderSomaticsymptomandrelateddisordersDissociativeDisorders2016/10/25 Renji Hospital5Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalICD-10Neurotic,Stress-RelatedandSomatoformDisorders(F40-F48)F40PhobicanxietydisordersF41O

5、theranxietydisordersF42Obsessive-compulsivedisorderF43Reactiontoseverestress,andadjustmentdisordersF44DissociativeconversiondisordersF45SomatoformdisordersF48Otherneuroticdisorders2016/10/25 Renji Hospital6Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalEtiologyandpathogenesisEnvironmenta

6、l Stress,PsychosocialfactorsTemperamental Genetic multiplegenesconfervulnerabilitytoneuroticdisorder.however,theexactgenes,geneproducts,orfunctionsrelatedtothegeneticregionsimplicatedremainunknownPhysiological neuro-anatomyneurologicalbiochemistry2016/10/25 Renji Hospital7Xu,Yeqing,ShanghaiMentalHea

7、lthCenter2016/10/25RenjiHospitalPhobicAnxietydisorders2016/10/25RenjiHospitalPhobicAnxietydisordersTheTheICD-10ClassificationICD-10ClassificationrF40.0 AgoraphobiarF40.1 SocialphobiasrF40.2 Specific(isolated)phobiasrF40.8 OtherphobicanxietydisordersrF40.9 Phobicanxietydisorder,unspecified2016/10/25

8、Renji Hospital9Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalAgoraphobiaClinicalmanifestationsClinicalmanifestationsmarked,orintense,fearoranxietytriggeredbytherealoranticipatedexposuretoawiderangeofsituationsindividualstypicallyexperiencethoughtsthatsomethingterriblemighthappenfearoran

9、xietyisevokednearlyeverytimetheindividualcomesintocontactwiththefearedsituationactivelyavoidsthesituationor,ifheorsheeitherisunableordecidesnottoavoidit,thesituationevokesintensefearoranxietythefear,anxiety,oravoidancemustbeoutofproportiontotheactualdangerposedbytheagoraphobicsituationsandtothesocio

10、culturalcontext2016/10/25 Renji Hospital10Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalICD-10DiagnosticCriterion:ICD-10DiagnosticCriterion:Allofthefollowingcriteriashouldbefulfilledforadefinitediagnosis:a.thepsychologicalorautonomicsymptomsmustbeprimarilymanifestationsofanxietyandnotse

11、condarytoothersymptoms,suchasdelusionsorobsessionalthoughts;b.theanxietymustberestrictedto(oroccurmainlyin)atleasttwoofthefollowingsituations:crowds,publicplaces,travellingawayfromhome,andtravellingalone;andc.avoidanceofthephobicsituationmustbe,orhavebeen,aprominentfeature.Agoraphobia2016/10/25 Renj

12、i Hospital11Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalSocialPhobiaClinicalClinicalmanifestationsmanifestationsoftenstartinadolescencearecentredaroundafearofscrutinybyotherpeopleincomparativelysmallgroups(asopposedtocrowds),usuallyleadingtoavoidanceofsocialsituationsUnlikemostotherph

13、obias,socialphobiasareequallycommoninmenandwomen.Theymaybediscrete(i.e.restrictedtoeatinginpublic,topublicspeaking,ortoencounterswiththeoppositesex)ordiffuse,involvingalmostallsocialsituationsoutsidethefamilycircle.Afearofvomitinginpublicmaybeimportant.2016/10/25 Renji Hospital12Xu,Yeqing,ShanghaiMe

14、ntalHealthCenter2016/10/25RenjiHospitalSocialPhobiaClinicalmanifestationsClinicalmanifestationsDirecteye-to-eyeconfrontationmaybeparticularlystressfulinsomecultures.Socialphobiasareusuallyassociatedwithlowself-esteemandfearofcriticism.Theymaypresentasacomplaintofblushing,handtremor,nausea,orurgencyo

15、fmicturition,theindividualsometimesbeingconvincedthatoneofthesesecondarymanifestationsofanxietyistheprimaryproblem;symptomsmayprogresstopanicattacks.Avoidanceisoftenmarked,andinextremecasesmayresultinalmostcompletesocialisolation.2016/10/25 Renji Hospital13Xu,Yeqing,ShanghaiMentalHealthCenter2016/10

16、/25RenjiHospitalICD-10DiagnosticCriterionICD-10DiagnosticCriterion:Allofthefollowingcriteriashouldbefulfilledforadefinitediagnosis:a.thepsychological,behavioural,orautonomicsymptomsmustbeprimarilymanifestationsofanxietyandnotsecondarytoothersymptomssuchasdelusionsorobsessionalthoughts;b.theanxietymu

17、stberestrictedtoorpredominateinparticularsocialsituations;andc.thephobicsituationisavoidedwheneverpossible.SocialPhobia2016/10/25 Renji Hospital14Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalSpecific(isolated)phobiasClinicalClinicalmanifestationsmanifestationsThesearephobiasrestrictedt

18、ohighlyspecificsituationssuchasproximitytoparticularanimals,heights,thunder,darkness,flying,closedspaces,urinatingordefecatinginpublictoilets,eatingcertainfoods,dentistry,thesightofbloodorinjury,andthefearofexposuretospecificdiseases.Althoughthetriggeringsituationisdiscrete,contactwithitcanevokepani

19、casinagoraphobiaorsocialphobias.Specificphobiasusuallyariseinchildhoodorearlyadultlifeandcanpersistfordecadesiftheyremainuntreated.2016/10/25 Renji Hospital15Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalSpecific(isolated)phobiasClinicalmanifestationsClinicalmanifestationsTheseriousness

20、oftheresultinghandicapdependsonhoweasyitisforthesufferertoavoidthephobicsituation.Fearofthephobicsituationtendsnottofluctuate,incontrasttoagoraphobia.Radiationsicknessandvenerealinfectionsand,morerecently,AIDSarecommonsubjectsofdiseasephobias.2016/10/25 Renji Hospital16Xu,Yeqing,ShanghaiMentalHealth

21、Center2016/10/25RenjiHospitalICD-10DiagnosticCriterionICD-10DiagnosticCriterion:Allofthefollowingcriteriashouldbefulfilledforadefinitediagnosis:a.thepsychological,behavioural,orautonomicsymptomsmustbeprimarilymanifestationsofanxietyandnotsecondarytoothersymptomssuchasdelusionsorobsessionalthoughts;b

22、.theanxietymustberestrictedtoorpredominateinparticularsocialsituations;andc.thephobicsituationisavoidedwheneverpossible.Specific(isolated)phobias2016/10/25 Renji Hospital17Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalAnxietydisordersdifferfromdevelopmentallynormativefearoranxietybybein

23、gexcessiveorpersistingbeyonddevelopmentallyappropriateperiods.sharefeaturesofexcessivefearandanxietyandrelatedbehavioraldisturbances.AnxietyDisorder:Fearistheemotionalresponsetorealorperceivedimminentthreat,whereasanxietyisanticipationoffuturethreat.rOCD:Theyare,however,recognizedastheindividualsown

24、thoughts,eventhoughtheyareinvoluntaryandoftenrepugnant.Differentialdiagnosis2016/10/25 Renji Hospital18Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalrHypochondriasis:Thesomaticsymptomsofanxietyaresometimesinterpretedassignsofseriousphysicalillness,butinthesedisordersthepatientsareusuall

25、yreassuredbyphysiologicalexplanations,andconvictionsaboutthepresenceofphysicalillnessdonotdevelop.rTemporalLobeEpilepsy,TLE:derealisationLossofawarenessEEGNeurologicalsignsDifferentialdiagnosis2016/10/25 Renji Hospital19Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalClinicalManagementCog

26、nitive-Behaviouraltherapy(CBT)psychopharmacotherapyTricyclicantidepressantsMOAIs(tranylcypromifle)SSRIs(clomipramine,citalopram,fluoxetine,fluvoxamine,paroxetitle,sertraline)SNRI(venlafaxine);welltolerated,noabusepotentialBenzodiazepines:alprazolam,clonazepam)-forseveralweeks(potentialforabuse,devel

27、opmentoftoleranceandaddictionbeta-blockingdrugs-fortheshorttreatmentofperformanceanxiety,especiallysomaticsymptomsliketremor2016/10/25 Renji Hospital20Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalAnxietydisorders2016/10/25RenjiHospitalGeneralizedanxietydisorderClinicalmanifestationsCli

28、nicalmanifestationsTheessentialfeatureisanxiety,whichisgeneralizedandpersistentbutnotrestrictedto,orevenstronglypredominatingin,anyparticularenvironmentalcircumstances(i.e.itisfree-floating).Asinotheranxietydisordersthedominantsymptomsarehighlyvariable,butcomplaintsofcontinuousfeelingsofnervousness,

29、trembling,musculartension,sweating,lightheadedness,palpitations,dizziness,andepigastricdiscomfortarecommon.2016/10/25 Renji Hospital22Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalGeneralizedanxietydisorderClinicalClinicalmanifestationsmanifestationsFearsthatthesuffererorarelativewillsh

30、ortlybecomeillorhaveanaccidentareoftenexpressed,togetherwithavarietyofotherworriesandforebodings.Thisdisorderismorecommoninwomen,andoftenrelatedtochronicenvironmentalstress.Itscourseisvariablebuttendstobefluctuatingandchronic.2016/10/25 Renji Hospital23Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25R

31、enjiHospitalICD-10DiagnosticCriterionICD-10DiagnosticCriterion:Thesufferermusthaveprimarysymptomsofanxietymostdaysforatleastseveralweeksatatime,andusuallyforseveralmonths.Thesesymptomsshouldusuallyinvolveelementsof:a.apprehension(worriesaboutfuturemisfortunes,feelingonedge,difficultyinconcentrating,

32、etc.);b.motortension(restlessfidgeting,tensionheadaches,trembling,inabilitytorelax);andc.autonomicoveractivity(lightheadedness,sweating,tachycardiaortachypnoea,epigastricdiscomfort,dizziness,drymouth,etc.).Generalizedanxietydisorder2016/10/25 Renji Hospital24Xu,Yeqing,ShanghaiMentalHealthCenter2016/

33、10/25RenjiHospitalPanicdisorderClinicalClinicalmanifestationsmanifestationsrTheessentialfeaturesarerecurrentattacksofsevereanxiety(panic)whicharenotrestrictedtoanyparticularsituationorsetofcircumstances,andwhicharethereforeunpredictable.rAsinotheranxietydisorders,thedominantsymptomsvaryfrompersontop

34、erson,butsuddenonsetofpalpitations,chestpain,chokingsensations,dizziness,andfeelingsofunreality(depersonalizationorderealization)arecommon.rThereisalso,almostinvariably,asecondaryfearofdying,losingcontrol,orgoingmad.Individualattacksusuallylastforminutesonly,thoughsometimeslonger;theirfrequencyandth

35、ecourseofthedisorderarebothrathervariable.2016/10/25 Renji Hospital25Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalPanicdisorderClinicalmanifestationsClinicalmanifestationsrAnindividualinapanicattackoftenexperiencesacrescendooffearandautonomicsymptomswhichresultsinanexit,usuallyhurried,

36、fromwhereverheorshemaybe.rIfthisoccursinaspecificsituation,suchasonabusorinacrowd,thepatientmaysubsequentlyavoidthatsituation.Similarly,frequentandunpredictablepanicattacksproducefearofbeingaloneorgoingintopublicplaces.Apanicattackisoftenfollowedbyapersistentfearofhavinganotherattack.2016/10/25 Renj

37、i Hospital26Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalICD-10DiagnosticCriterionICD-10DiagnosticCriterion:Inthisclassification,apanicattackthatoccursinanestablishedphobicsituationisregardedasanexpressionoftheseverityofthephobia,whichshouldbegivendiagnosticprecedence.Panicdisordershou

38、ldbethemaindiagnosisonlyintheabsenceofanyofthephobiasinF40.-.Foradefinitediagnosis,severalsevereattacksofautonomicanxietyshouldhaveoccurredwithinaperiodofabout1month:a.incircumstanceswherethereisnoobjectivedanger;b.withoutbeingconfinedtoknownorpredictablesituations;andc.withcomparativefreedomfromanx

39、ietysymptomsbetweenattacks(althoughanticipatoryanxietyiscommon).Panicdisorder2016/10/25 Renji Hospital27Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalrAnxiety disorder due to another medical condition Thediagnosisofanxietydisorderassociatedwithanothermedicalconditionshouldbeassignedifth

40、eindividualsanxietyandworryarejudged,basedonhistory,laboratoryfindings,orphysicalexamination,tobeaphysiologicaleffectofanotherspecificmedicalcondition(e.g.,pheochromocytoma,hyperthyroidism).rSubstance/medication-induced anxiety disorder Asubstance/medication-inducedanxietydisorderisdistinguishedfrom

41、generalizedanxietydisorderbythefactthatasubstanceormedication(e.g.,adrugofabuse,exposuretoatoxin)isjudgedtobeetiologicallyrelatedtotheanxiety.Forexample,severeanxietythatoccursonlyinthecontextofheavycoffeeconsumptionwouldbediagnosedascaffeine-inducedanxietydisorder.Differentialdiagnosis2016/10/25 Re

42、nji Hospital28Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalrDepressive,bipolar,and psychotic disorders Generalizedanxiety/worryisacommonassociatedfeatureofdepressive,bipolar,andpsychoticdisordersandshouldnotbediagnosedseparatelyiftheexcessiveworryhasoccurredonlyduringthecourseoftheseco

43、nditions.Differentialdiagnosis2016/10/25 Renji Hospital29Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalClinicalManagementPsychotherapy:e.g.,CBTPsychopharmacotherapyBenzodiazepines:alprazolam,clonazepam)-forseveralweeks(potentialforabuse,developmentoftoleranceandaddictionSSRIs(clomiprami

44、ne,citalopram,fluoxetine,fluvoxamine,paroxetitle,sertraline)SNRI(venlafaxine);welltolerated,noabusepotentialTricyclicantidepressantsMOAIs(tranylcypromifle)beta-blockingdrugs-fortheshorttreatmentofperformanceanxiety,especiallysomaticsymptomsliketremor2016/10/25 Renji Hospital30Xu,Yeqing,ShanghaiMenta

45、lHealthCenter2016/10/25RenjiHospitalObsessive-Compulsivedisorder2016/10/25RenjiHospitalPredominantlyobsessionalthoughtsorruminationsrThesemaytaketheformofideas,mentalimages,orimpulsestoact.Theyareveryvariableincontentbutnearlyalwaysdistressingtotheindividual.Awomanmaybetormented,forexample,byafearth

46、atshemighteventuallybeunabletoresistanimpulsetokillthechildsheloves,orbytheobsceneorblasphemousandego-alienqualityofarecurrentmentalimage.rSometimestheideasaremerelyfutile,involvinganendlessandquasi-philosophicalconsiderationofimponderablealternatives.Thisindecisiveconsiderationofalternativesisanimp

47、ortantelementinmanyotherobsessionalruminationsandisoftenassociatedwithaninabilitytomaketrivialbutnecessarydecisionsinday-to-dayliving.Obsessive-Compulsivedisorder2016/10/25 Renji Hospital32Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalObsessive-CompulsivedisorderPredominantlycompulsivea

48、ctsobsessionalritualsrThemajorityofcompulsiveactsareconcernedwithcleaning(particularlyhand-washing),repeatedcheckingtoensurethatapotentiallydangeroussituationhasnotbeenallowedtodevelop,ororderlinessandtidiness.Underlyingtheovertbehaviourisafear,usuallyofdangereithertoorcausedbythepatient,andtheritua

49、lactisanineffectualorsymbolicattempttoavertthatdanger.rCompulsiveritualactsmayoccupymanyhourseverydayandaresometimesassociatedwithmarkedindecisivenessandslowness.Overall,theyareequallycommoninthetwosexesbuthand-washingritualsaremorecommoninwomenandslownesswithoutrepetitionismorecommoninmen.2016/10/2

50、5 Renji Hospital33Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalObsessive-Compulsivedisorder2016/10/25 Renji Hospital34Xu,Yeqing,ShanghaiMentalHealthCenter2016/10/25RenjiHospitalICD-10DiagnosticCriterionICD-10DiagnosticCriterion:Foradefinitediagnosis,obsessionalsymptomsorcompulsiveacts,