医学英语新教材下册unit4翻译.docx

1、医学英语新教材下册unit4翻译Section B ReadingsPassage 1Hyperactivity Disorder多动症Symptoms and Signs1 For over 50 years physicians have been evaluating and treating children who show various combinations of motoric overactivity, impulsivity, distractibility, and inattentiveness. During that time, the terminology

2、describing these children has changed, reflecting the shifting ideas about etiology and about the relationship of the symptoms of overactivity to the symptoms of inattentiveness. Called at different times minimal brain damage, minimal brain dysfunction, hyperactive child syndrome, hyperactive reacti

3、on of childhood, and attention-deficit disorder with or without hyperactivity, the syndrome is now known as attention-deficit/hyperactivity disorder (ADHD). In DSM-IV, ADHD is divided into three subtypes：a combined type (most frequent), a pre- dominantly inattentive type, and a predominantly hyperac

4、tive-impulsive type. This most recent diagnostic terminology reflects current thinking about the possible heterogeneity of this disorder.症状和体征1 内科医生们一直在进行着对一类孩子长达五十多年的诊断和治疗，这些孩子都体现出了一种或几种如下特点，即：肢体运动过于活跃， 性格易冲动，注意力涣散，和粗心大意。在那段时间里，用来描述这一类孩子的医学术语发生了改变，反映出了对于这一现象的病因学研究以及对于过于活跃和疏忽大意这些症状之间关系研究的观点的的不断转换。在不

5、同的时期曾经被叫做轻微脑功能损伤，轻度脑障碍， 儿童多动综合症，儿童多动反应症和伴有或不伴有多动症的注意力缺陷障碍的这一综合症，如今被叫做注意力缺陷多动症（简称ADHD）。在第四版的精神疾病诊断准则手册中，ADHD被分为三个小的类型：组合类型（注意力缺失合并过动型，这也是最常见的类型），注意力缺失型，以及过动型。这种最新的诊断术语反映了当前对这种疾病可能存在的异质性的观点。2 Clinically, these children are brought to the doctor when their parents or teachers complain that they are har

6、d to discipline, do not follow directions, seem to dawdle over the simplest tasks, leave projects and chores incomplete, forget to bring homework assignments back and school notices home, and then forget to bring homework to class. They may impulsively touch or bump into other children, dash into th

7、e street, or be unable to wait for their turn in a game. When motoric overactivity is present the child will fidget, squirm, and be “all over the place”. Often social problems with peers, negative relations with family members, poor school achievement, and diminished self-esteem are the result of th

8、e core problems in attention, distractibility, impulsivity, and overactivity.2 在临床表现上， 当这些孩子的父母或者老师抱怨孩子不遵守纪律，不听从教导，做最简单的任务也磨磨蹭蹭，不完成任务，总是忘记把家庭作业和学校通知带回家，以及忘记把作业带回学校的时候，他们会带孩子去看医生。这些孩子可能会冲动的去拍打或者冲撞其他的孩子，冲到街道中间，或者做游戏的时候不能够安分的等待自己的次序。当肢体运动过于活跃的时候，儿童会变得坐立不安，身体来回扭动，并且“无处不在”。粗心大意，注意力不集中，易冲动和过于活跃的核心问题往往会导致这

9、类儿童与同龄人之间产生的各种社会问题，和家人关系不融洽，学习成绩差，以及自尊心削弱等问题。3 Although the symptoms must have been present before age 7 for the diagnosis to be made, the disorder is frequently not noticed until the child enters school, perhaps because school requires more controlled, directed behavior and because teachers observe

10、 the child acting differently from other same-age peers. However, with increased media focus on ADHD, and with more children being in school-like settings at an earlier age, some clinicians are seeing an increase in referrals of younger children for evaluation of ADHD-like symptoms. For severely aff

11、ected preschoolers, the diagnosis may not be difficult, but in less obvious cases, parents may resist believing the child has any problems or may be convinced the child will grow out of it. Conversely, some referrals may be the result of parental intolerance for normative preschool exuberance.3 尽管对于

12、将要做出的诊断来说，这一疾病一定是在7岁之前出现，但是通常只有儿童进入学校之后这些症状才会引起注意。或许是因为学校要求学生的行为更加可受控制的，可以被指导，并且因为老师们观察到某个儿童的行为和其他同龄儿童的不同。然而，随着媒体对于ADHD的日益关注和许多儿童在很小的年龄就处在一个类似学校的环境中。一些临床医生要接待不断增加的年幼的转诊病人，对类似ADHD 的症状进行诊断。对于症状明显的学龄前儿童，诊断可能不难，但是在一些稍微不明显的病例中，父母可能不愿相信孩子出现了任何问题或者认为随着孩子的长大，这些现象会自动消失。相反，一些转诊病人可能正是父母对规范的学前教育繁荣不够宽容的结果。4 In t

13、he evaluating physicians office, the child may or may not appear squirmy, noisy, distractible, or inattentive. Because a medical examining room is usually quiet, with few distractions, the child is less apt to exhibit the problem behaviors there than in a noisy classroom surrounded by other children

14、.4 在内科医生的办公室里，儿童可能会也可能不会出现坐立不安，爱喧闹，注意力不集中或者是粗心大意等症状，因为医学检测室一般是安静的，几乎没有引起注意力分散的事物。和处于一个挤满了儿童的喧闹的房间里相比，在检测室的儿童不易于表现出那些问题行为。Differential Diagnosis5 Attention-deficit/hyperactivity disorder is a clinical diagnosis based on the familys description of the childs behavior, the school report, the clinicians

15、 observation, and, at times, comprehensive testing. There are no specific tests for ADHD. However, Conners parent Questionnaire and Teacher Rating Scale can help elicit a quantitative assessment of the specific ways the behaviors may show up.鉴别诊断5 ADHD是基于对儿童行为的家庭描述，学校报告，内科医生观察和间或全面检测的一种临床诊断。目前还没有对于A

16、DHD的具体的测试方法。但是，Conners父母调查问卷和教师评定量表能够帮助导出对这些行为可能表现出的具体方式的一种定量评估。6 Various types of continuous performance tests (CPTs) assess the childs ability to pay attention to routine, uninteresting stimuli, and components of many psychological tests (e.g., trail making mazes) assess attentional abilities.6 各种

17、类型的连续的性能测试(CPTS)对儿童把注意力集中在常规事务和乏味的刺激上的能力进行评估，许多心理测试的一些组成部分（例如，走迷宫）也能对注意力进行评估。7 Differential diagnosis includes hearing problem, impaired vision, poor nutrition, language-processing problems, thyroid dysfunction, pinworms, and adjustment disorder; ADHD must also be differentiated from several conditi

18、ons that can be present concurrently, such as learning disorder, conduct disorder, oppositional defiant disorder, anxiety disorder and mood disorder.7 鉴别诊断包括听力问题，视力受损，营养不良，语言处理问题，甲状腺功能障碍，蛲虫和适应障碍; ADHD 也要和一些能够同时出现的状况区别开来，例如学习障碍，品行障碍，对立违抗性障碍，焦虑症和情绪障碍。Epidemiology8 This disorder is more common in boys

19、than in girls, can be found in all socioeconomic groups, and has a prevalence of around 3%5% in school-aged children. Concurrent problems are frequent, and around two-thirds of ADHD children have another psychiatric diagnosis. These include conduct disorder (most common), learning disorder, oppositi

20、onal defiant disorder, and mood and anxiety disorders. The etiology is not clear, although there appears to be an increased family incidence in first-degree relatives. Some other causative factors that have been considered include prenatal or perinatal insult, prenatal drug and alcohol exposure, and

21、 lead poisoning. Contrary to a recent popular theory, food additives and sugar are not found to cause ADHD in most children.流行病学8 这一症状在男孩中间比在女孩中间更加常见，并且在所有社会经济群体当中都能被发现，而且在学龄儿童当中的发病率为大约百分之三到百分之五。通常还会伴有并发症，大约三分之二的患有ADHD的儿童有其他的精神病诊断，包括：品行障碍（最常见）， 学习障碍， 对立违抗性障碍，以及焦虑症和情绪障碍。尽管看上去似乎ADHD在一级亲属中的发病率有所提高，这一疾病

22、的病因还不清晰。一些被列入考虑的其他诱因包括产前或产后损伤，产前药物和酒精危害和铅中毒。和最近流行的一种理论相反，在对许多儿童的研究当中，食物添加剂和糖没有被发现会导致ADHD。Etiology9 Investigations into the biological factors involved in ADHD have focused on dopamine and noradrenergic systems, and when aggression coexists, on serotonin as well. Findings from brain-imaging studies h

23、ave been variable. In a study that examined parents of children with ADHD who self-reported ADHD symptoms when they (the parents) were children, positron-emission tomographic scans administered during attention-requiring tasks revealed decreased glucose metabolism in the frontal and prefrontal corte

24、x. 病因学9 对于ADHD的生物学因素的研究集中在多巴胺和去甲肾上腺素系统上，当攻击性行为同时存在时，也会涉及羟色胺。脑成像研究的结果是易变的。在一项对自己承认小时候也患有ADHD的ADHD患童父母的的研究中，在完成需要注意力的任务过程中进行的正电子放射断层扫描显示额叶和前额 皮层的葡萄糖代谢作用减少了。Treatment & Prognosis10 Treating the child with ADHD requires a multimodal approach. Psychopharmacological treatment with psychostimulants (methyl

25、phenidate, dextroamphetamine, and pemoline) is widely used and is effective in up to 90% of ADHD children. Other medications used in clinical practice include some antidepressants (imipramine, desipramine, and bupropion) and clonidine. The purpose of medication should be explained to both parent and

26、 child, and its effectiveness should be monitored by home and school reports. Medication alone is rarely sufficient, since parents will need counseling on methods of managing their childs behaviors and breaking the frequent patterns of dysfunctional interactions that have evolved over the years. A v

27、ariety of behavioral management techniques have been used with success, such as contingent reinforcement, time-outs, and daily reports from school to parents. Teachers and parents may need information about optimizing nondistracting environments for schoolwork and homework. Children also benefit fro

28、m counseling to address issues of decreased self-esteem, poor peer relations, and expectation of failure. Presently multicenter studies are in progress to assess the efficacy of various combinations of therapeutic modalities.治疗和预后诊断10 对于患有ADHD的儿童的治疗需要一种多模式的方法。运用精神药理疗法并搭配一些精神兴奋剂药物（如哌啶醋酸甲酯，右旋安非他命和匹莫林）

29、的方法是被广泛应用并且在高达百分之九十的患ADHD儿童当中是有效的。其他一些用在临床实践上的药物还包括抗抑郁剂（如米帕明， 地昔帕明和安非他酮）和可乐定。药物治疗的目的应该向患病儿童及其父母说明，治疗的效果应该有家庭和学校共同监督。单纯的药物治疗并不够，因为父母需要对控制他们孩子行为的方法以及打破未能得到治疗的患病儿童多年来演变而形成的功能失调性互动的常规模式的建议。多种行为管理技术已经成功的得到运用，例如，后效强化，暂停法，和学校给父母的日常报告。老师和父母们也需要能够优化儿童们完成学校和家庭作业的不容易导致注意力分散的各种环境的信息。儿童也能够从哪些应对自尊心下降，与同龄人关系恶劣和期望失

30、败的建议中获益。目前多中心的研究正在进行当中以对治疗方法的各种组合方式的功效进行评估。11 The prognosis for children with ADHD is controversial. It was previously thought that children outgrew their symptoms in adolescence, and it was possible to stop medications as the child got older. Recently there has been increasing focus on adolescents

31、and adults treated as children who continue to show some or all of the symptoms of ADHD on follow-up. In addition, adults are being identified who were untreated as children but manifest symptoms of impulsivity and poor attention, sometimes with coexistent antisocial personality disorder and substan

32、ce abuse.11 对于ADHD儿童的预后诊断是有争议的。以前认为儿童的症状会在青春期消失，并且当儿童长大的时候可以停止药物治疗。近来越来越多的注意力集中在了一些青年和成年人身上，他们小时候接受过治疗，但是在后续过程中依然表现出一些或者所有的ADHD症状。除此之外，一些小时候显示出性格易冲动和注意力不集中的症状但未接受治疗的成年人被发现有时候会伴有反社会人格障和滥用药物的症状。Illustrative Case: ADHD-Hyperactive-Impulsive Type12 A 7-year-old boy was referred by his first grade teache

33、r because of behavioral problems in the classroom. Her note said “Hes up when all the other kids are up, but hes up all the rest of the time too.” In a phone conference she described him as a “wiggle worm” who was either squirming in his seat or running around the classroom during assignments. She also descr