精神病学课件 5.22 应激障碍 生理心理障碍 上课课件.ppt

book 沈渔邨．精神病学（第四版）．北京：人民卫生出版社，2002 赵靖平. 精神药物治疗学. 北京：人民军医出版社，2005 中华医学会精神科分会.中国精神障碍分类与诊断标准(第三版). 济南：山东科学技术出版社，2001 Oxford Text Book of Psychiatry, 2006 Synopsis of Psychiatry, 2007 Psycho –Physiological Disorder Treatment Psychological treatments Cognitive–behaviour therapy Psychopharmacological treatment 她怎么了? 患者，女性，23岁。周末搭男友摩托郊游后返城，途中遭遇车祸，双双被送进医院急诊室。其男友不治身亡，而病人本人受轻伤。正在给病人包扎伤口时，病人突然大哭大叫，扯掉绑带，赤脚往诊室外冲，口中不停呼唤男友的名字，行为冲动，表情恐惧。经治疗后症状在数天内消失。半年后随访该病人，家人反映车祸后2月左右开始病人性格有改变，无故发脾气，不喜欢外出，沉默少语，常发呆出神，有时突然伴有恐惧神情，事后问其原因，称当时正在回忆车祸情景。睡眠差，常做噩梦，有几次听到病人从睡梦中惊醒。不敢坐摩托车，甚至听到汽车的喇叭声也表现恐惧害怕。 Posttraumatic stress disorder, PTSD A term that describes an anxiety disorder that was brought about by a very disturbing or frightening experience. * Many inner-city youths Many new immigrants from troubled countries More women than men Approx. 35% of returning military men women who were in active combat * Sleep disorders, persistent nightmares Persistent memory of the event Sudden flashbacks Spontaneous reaction to “cues” Irritability Lack of concentration/time management Emotional detachment * Clinical manifestation (1) Flashback (2) Fight (3) Flight (4) Freeze Diagnosis Symptom criteria: (1) The patients have the experience of unusually traumatic events or situation (e.g., natural and man-made calamities); (2) There is reappearance of traumatic experience (flash-backs) , with at least 1 of the following: ①involuntary recall of the experience of being attacked; ②repeated manifestation of nightmare with traumatic content; ③repeated manifestation of illusions, hallucinations; ④repeatedly feel affiliation when the scene retakes place in memories (e.g., revisiting a place). It may cause individual unusual affiliation and cause marked physiological reaction (e .g., palpitation, sweat, looking pale). (3) Sustained hyperviligance, with at least 1 of the following: ①difficulty of falling sleep, or unreality of sleep; ②irritability; ③difficulty