精神障碍症状学(英文).ppt

精神障碍症状学(英文).ppt

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精神病学精神病学PsychiatricClinicalSignsandSymptomsLiuZheningMD&PhDGeneralintroductionnSignsnSymptomsnSyndromeDisordersofperception（one）nPerceptionistheprocessofbecomingawareofwhatispresentedthroughthesenseorgans.nImageryisanexperiencewithinthemind,usuallywithoutthesenseofrealitythatispartofperception.nIllusion.Disordersofperception（two）nAbnormalities:

nChangesintheintensityofthingsperceivednChangesinthequalityofperceptionnIllusions:

anillusionisamisperceptionofanexternalstimulusnHallucinations:

ahallucinationisaperceptionexperiencedintheabsenceofanexternalstimulustothecorrespondingsenseorgan.HallucinationnAhallucinationhastwospecialqualities:

nItisexperiencedasatrueperception,notaimaginary.nItseemstocomefromtheoutsidewould.nPseudohallucinationnExperiencesthatpossessoneofthesequalitiesarecalledpseudohallucination.TypesofhallucinationnAuditoryhallucinationmaybeexperiencedasvoices,noises,ormusicnVisualhallucinationmaybeexperiencedasflashesoflightorascompleximagessuchasthefigureofmannHallucinationofsmellortastenTactilehallucinationDisorderofthinkingnThoughtdisordersdenotefivekindsofabnormality:

nAbnormalityoftheamountandspeedofthought.（thestreamofthought）nAbnormalityofthewaysinwhichthoughtsarelinkedtogether.nDelusionsnOvervaluedideasnObsessionalandcompulsivesymptomsDisordersofthestreamofthoughtnPressureofthoughtnPovertyofthoughtnThoughtblockingDisordersoftheformofthoughtnFlightofideasnLooseningofassociationsnPerseverationDelusionsnAdelusionisabeliefthatisfirmlyheldoninadequategrounds,isnotaffectedbyrationalargumentorevidencetothecontrary,andisnotaconventionalbeliefthatthepersonmightbeexpectedtoholdgivenhiseducationalandculturalbackground.DelusionalthemesnPersecutorydelusionnDelusionofreferencenGrandioseandexpansivedelusionsnDelusionofguiltandworthlessnessnNihilisticdelusionsnHypochondriacaldelusionsnDelusionsofjealousynDelusionofcontrolChangesinthenatureofmoodnDepressionnElationnAnxietynAngerAbnormalfluctuationofmoodnBlunting,flattingnLabilitynIncontinencen（inconsistencybetweenmoodandthinking:

incongruityofaffect）DisorderofmemorynSensorystoresnShort-termmemorynLong-termmemoryAmnesicsyndromenTheamnesicsyndromeischaracterizedbyaprominentdisorderofrecentmemoryinabsenceofgeneralizedintellectualimpairment.nAetiologyandpathology:

alcoholabuseisthemostfrequentcauseandseemstoactbycausingadeficiencyofthiamine.ClinicalfeaturesofamnesicsyndromenRecentmemoryseverelyimpairednRemotememorysparednDisorientationintimenConfabulationnOthercognitivefunctionspreservedDisorderofconsciousnessnCloudingofconsciousnessnStupornConfusionDeliriumnDefinition:

deliriumischaracterizedbyimpairmentofconsciousness.nPrevalencen5%15%ingeneralmedicalorsurgicalwardsn20%30%insurgicalintensivecareunitsnPrognosis:

mostpatientsrecoverquicklyandonlyafewneedspecifictreatment.SymptomsofDeliriumnImpairedconsciousnessnDisorganization,poorconcentrationnPerceptionnIllusionnhallucinationnThinkingnConfusednIdeasofreferencenDelusionsnMoodnAnxious,irritable,depressednMemoryimpairednFluctuatecourse,worseineveningandatnight.“sundowneffective”SymptomsofDeliriumDementianPrevalence:

n5%for65;20%forpeople80formoderateandseveredementianInChina,4%for65yearsoldClinicalfeaturesofdementianUsuallydevelopsgraduallynmemorylossisthesalientfeaturenusuallymemorylossforrecenteventsmoreseverethanforremoteeventsnpresentingasforgetfulness,difficultyinlearningnewthingsnconfabulationmaybepresentnimpairedattentionandconcentrationndisorientationnjudgmentandgeneralknowledgeimpairedClinicalfeaturesofdementianLanguageproblemnWordfindingdifficultiesinitiallynMaytalknonsenseorincoherent（aphasia）orbecomemuteatlatestagenDelusionsandhallucinationsnSomepatientsmayhave:

nparanoidideasndelusionsoftheftnotherdelusionsandhallucinationsClinicalfeaturesofdementianBehaviourchangenImpairedactivitiesofdailylivingnInappropriatebehaviour,distractibilityandrestlessnessnChangeinpersonalitye.g.sexualdisinhibition,reductionofinterestsnMoodchangenAnxiety,irritability,depression,labilitynSleepandappetitedisturbancenDeliriumnAcuteonsetnFluctuatecoursenImpairedconsciousnessnThinkingdisorganizednPerceptualdisturbancecommonnAlertnessusuallyimpairedn“exceptmulti-infarctdementia”nDementianInsidiousonsetnStableorprogressivenNormalconsciousnessnThinkingimpoverishednPerceptualdisturbanceuncommonnNormallyalertInsightnAwarenessthattreatmentisrequirednRecognitionthatthesephenomenaareabnormalThankyouforyourattention