神经症和癔症患者的护理.ppt

神经症和癔症患者的护理社区护理学教研室李静芝概述定义：神经症又称神经官能症，是一组精神障碍的总称共同特征：与心理社会因素有关有一定的个性基础均不伴有器质性病变有自知力社会功能较完整病程大多持续迁延绪论其他恐惧症焦虑症躯体形式障碍强迫症AddTitle神经衰弱神经症分类（CCMD-Ⅲ)焦虑症：广泛性焦虑(generalizedanxietydisorder)惊恐障碍(panicdisorder)强迫症(obsessive-compulsiveneurosis)恐惧症(phobia)场所恐惧症(agoraphobia)社交恐惧症(socialphobia)单一恐惧症(simple/specificphobia)DSM-ⅣAnxietydisorderPanicdisorderPhobiasAgoraphobiaSocialphobiaSpecificphobiaGeneralizedanxietydisorderObsessive-compulsivedisorder神经症发病情况神经症发病率起病年龄惊恐障碍1-3.5%2030广泛性焦虑4-5%20场所恐惧症2.8-5.3%20-40社交恐惧症7.9-13%15-20强迫症2-2.5%25-30各型神经症的临床表现广泛性焦虑精神焦虑－对未来可能发生的某种危险经常担心，自知而无法自控，有大祸临头之感躯体焦虑－搓手顿足、肌肉紧张、气短、心悸、出汗、口干等Lucyisa49-year-oldlegalsecretary.shecomestotheclinicandtellsthenurse,“itwasprobablyfoolishtocomehere.Nobodyunderstandme.”sheisshakyanddiaphoretic（出汗的）.Heronlydaughterisexpectingherfirstchild.Althoughthepregnancyisgoingwell.Lucyworriesthatsomethingiswrongwiththebaby.Lucydescribesherselfastenseandirritable.Shehasdifficultyinitiatingsleepandcannotconcentrateatwork.Sheworriesaboutmakingmistakesatwork,aboutbeingfiredfromherposition,andaboutthefinancialproblemsthecouldresult.AB特点：无特殊的恐惧性处境，突然感到一种突如其来的惊恐体验，伴濒死感或失控感及自主神经紊乱起病急，终止快（5-20min），再发惊恐障碍各型神经症的临床表现Dora,a30-year-oldpharmacist,livesathomeandcaresforhermother.Afterhermother’sdeathfromheartdisease,Dorabeginstoexperiencetension,irritability,andsleepdisturbance.Onseveraloccasions,Doraawakensgaspingforbreath.Herheartpounds,andshefeelsatightsensation,likeabandaroundherchest,herpulsetypicallyincreasetomorethan110beatsperminute,andsheexperiencesdizziness.Shefearsthatsheisgoingtodie.强迫观念，伴强迫行为22%不确定、不安全感、不完美感40%自我强迫与反强迫并存38%强迫症各型神经症的临床表现各型神经症的临床表现场所恐惧症e.g.Jimisa28-year-oldman.Heoncelivedaveryactivelife.Jim’sfather,whohadsev