医学英语-Psychiatry-精神病学教材课件

HandiZhangPSYCHIATRYHandiZhangPSYCHIATRY2MentalHealthCenter,ShantouUniversityZhang_handi@Zhang_handi@2MentalHealthCenter,ShantouOutlineRootsforpsychiatryIntroductiontopsychiatryBasicdefinitionsCommonpsychiatricsymptomsandsignsThecategories类别

ofpsychiatricdisordersMajorpsychiatricdisorders3OutlineRootsforpsychiatry3ObjectivesRootsVocabularyHavingageneralideaaboutpsychiatry

4ObjectivesRoots45psychiatrymentmneanxineurophrenschizmemorynervemindtreatmindUneasyanxiousspiltmind5psychiatrymentmneanxineurophrRootsforpsychiatryROOTMEANINGEXAMPLEPsych/omindpsychosomaticPsycho-somat-icIatrymedicalspecialtyPsychiatryPsych-iatrymentmindmentalment-almnememoryamnesiaa-mnes-iaanxiuneasy,anxiousanxietyAnxi-etySchiz/osplitschizophreniaSchizo-phren-iaphrenmindschizophrenianeuronerveneurosisneuro-sis6RootsforpsychiatryROOTMEANINPsychiatricdisorder/mentaldisorderWiththeactingof

theexternalandinternalfactorsonthebrainthefunctionofbrainbecomedisturbedongoing不间断的patternsofcognition,emotion,andbehaviorgodeviant不正常的,distressfuland/ordysfunctionalforaperiodoftime.7Psychiatricdisorder/mentaldi8psychiatristpsychologist8psychiatristpsychologistCommonclinicalsignsandsymptomsNormalmentalactivityCognition(Sensationandperception,thought/thinking,attention,memory,intelligence,insight,orientation方向)Emotion(mood,affect)Volition意志力andbehaviorConsciousness9CommonclinicalsignsandsympIllusion错觉Itisafalseperception曲解duetomisinterpretationofthestimuliarisingfromanobject.10Illusion错觉10Hallucination幻觉Itisafalseperceptionofsomethingthatisnotreallythere.Hallucinationmaybevisual,auditory,tactile,gustatory,orolfactory.Createbythemind.Itisasignofschizophrenia精神分裂11Hallucination幻觉11AuditoryhallucinationNonverbalauditoryhallucination幻听VerbalauditoryhallucinationCommenting评论Ordering命令

12Auditoryhallucination12Delusion妄想Anabnormalityincontentofthought.Itisanirrationallyheldastrong

beliefwithconviction

thatcannotbealteredbyrational合理的

argument.

Itisthesignsofschizophreniaandbipolardisorder.13Delusion妄想13Delusions妄想

ofpersecution/persecutory迫害

delusionsDelusionsofreference/ideasofreference牵连观念Delusionsofbeingcontrolled/delusionsofpassivityGrandiose

delusion夸大妄想

/delusions

ofgrandeur庄严

Delusionsofguilt14Delusions妄想ofpersecution/perObsession强迫症，痴迷unwanted、uncontrolledItisarecurrent周期性的

thoughtthatisunpleasantandprovokes煽动驱使

anxietybutcannotbegotridof.ObsessivethoughtObsessiveruminations沉思ObsessivedoubtsObsessiveimpulseObsessivereminiscence回忆怀旧15Obsession强迫症，痴迷unwanted、unconCompulsion

强迫症，强制Thepatientsknowthattheirbehaviorsarenotnormalbutcannotinhibitit.Itisrepetitivebehaviorsormentalactspreformedoverandoverinresponsetoanobsessivethoughtandusuallyleadingtoanxiety.CompulsivecheckingCompulsivewashingCompulsivecountingCompulsiverituals固定程序Obsessive-compulsivedisorder强迫性精神障碍16Compulsion强迫症，强制16Amnesia健忘症Itisalossofmemory.Anterograde顺行性couldnotremembereventsevenafterafewsecondsorminutes.Retrograde

逆行性couldnotrecallpre-existingmemories.17Amnesia健忘症17Dementia痴呆Itisachronicorpersistentdisorderofthementalprocessescharacterizedbylossofintellectualabilities,memorydisordersandchangesinpersonality,deterioration恶化

ofpersonalcare,impairedreasoningability,anddisorientation.Mentalretardation智力迟钝ItisanabnormallackofintelligenceasdeterminedbyIQtesting.18Dementia痴呆18Seniledementia(Alzheimers’disease)老年痴呆

isanexampleofchronicbrainsyndrome,inwhichthebrainatrophies萎缩,resultinginthelossofmemoryandintellectualfunctions,alteredpersonalityandothersymptoms.19/voase/3647.htmSeniledementia(Alzheimers’dMania躁狂症Itisastateofmindcharacterizedbyexcessivecheerfulnessandhyperactivity,disorganizationofbehavior,andelevationofmood.Core核心

symptom:theelevationofmood(feelgoodevenhigh)Easilychanged,irritability过敏性的易怒的Inflated膨胀的

self-esteemIncreasepsychomotoractivity(rapidthinkingandspeech,distractibility注意力分散)Decreasedsocialinhibitionwithapparentdisregardforpotentiallyharmfulconsequences(sexualover-activity,reckless鲁莽的

spending,dangerousdriving,inappropriatebusiness)20Mania躁狂症20DepressionItisamentalstatecharacterizedbyexcessivesadness.Coresymptom:depressedmoodLossofinterestAnhedoniaNegative,pessimisticthoughtsabouttheself(lowself-esteem),theworldandthefutureGuiltandworthlessnessordeathorsuicide21Depression21Apathy冷漠Itislossofinterestoremotionalinvolvement.22Apathy冷漠22AnxietyItisanabnormalandoverwhelmingsenseofapprehensionandfear.Involvingsubjectivefear,bodilydiscomfortandphysicalsymptomsPathologicalanxietyPresentindiscreteattackswithnoexternalstimulus(panicdisorder)Presentindiscreteattackswithfearedstimuli(phobias)Presentingeneralized,persistentstate(generalizedanxietydisorder)23Anxiety23PhobiaItisanexaggerated夸张的,usuallyunreasonable,fearofsomeoneorsomething.AgoraphobiaSocialphobiaSimplephobia/specificphobia24Phobia24Summany25IllusionHallucinationDelusionObsessionCompulsionAmnesiaDementiaMentalretardationManiaDepressionApathyAnxietyPhobiaSummany25IllusionManiaCasestudy1An84-year-oldwomanisadmittedtoanacutemedicalward.Shelivesalone.Accordingtoherneighboursheremainedactiveuntilafewdaysago.Herecallsshewasinhospitalwithachestinfectionlastyear,buthasnevernoticedherhavinganyproblemswithhermemoryoranyabnormalthoughts.Shewasadmittedwithconfusion,afterbeingfoundonthefloorbyparamedics.Thepatienttellsyoushewasbeatenupbythesecretservicewhotookhertoapolicestation.Shebelievesthesecretpolicefollowedherhomeduetoconnectionsthatherdeadhusbandhadwithaforeignpoliceforce.26Casestudy1An84-year-oldwomSheisirritableandhasattimesaskedtogohomeasshebelievessheisstillinthepolicestationandhasspentenoughtimethere.Shedescribesseeingmanypoliceofficerssittingarounddrinkingtea.Herspeechisdifficulttofollow.27SheisirritableandhasattiCasestudy2A25-year-oldwomanliveswithhermother.ShewasreferredbyherGPaftershetoldhimataroutineappointmentthatsheoftenhasanoverwhelmingimpulsetojumpinfrontofatrainwhensheisstandingatastation.Thishasalarmedherasshedoesnotwanttodie.Shehasneverharmedherselfandhasneverwantedto.Shehasrecentlylostherjobduetoconsistentpoortime-keeping.Althoughshewakesseveralhoursbeforesheneedstoleavethehouse,shecannotbeartoleaveuntilshehaswashedherselfatleastfivetimes.28Casestudy2A25-year-oldwomaIfshetouchesthefloorwithherbarefeetafterhershowershehastostartagain.Ifshedoesnotdothisthethoughtsofbeingcontaminatedwithdirtbecomeunbearable.Shecommnetsthatsheknowsherthoughtsare“notlogical”andfeelsfrustratedthatshecannotstopherexcessivewashing.29IfshetouchesthefloorwithDiagnosisICD-10(InternationalClassificationofDiseases)DSM-5(DiagnosticandStatisticalManualofMentalDisorders)CCMD-3(ChineseClassificationandDiagnosticCriteriaofMentalDisorders)30DiagnosisICD-10(InternationaThecategoriesofmentaldisordersinDSM-Ⅳ31ThecategoriesofmentaldisorSchizophreniaSchizophreniaisaseverementaldisordercharacterizedbywithdrawalfromreality,delusions,hallucinations,andchangesinbothbehaviorandmood.Schizophreniaismainlydividedintosimpletype,hebephrenictype,catatonictype,paranoidtypeandundifferentiatedtype.Life-timeprevalence1%Onsetage18-25yearsformenand21-30yearsforwomen32SchizophreniaSchizophreniaisSubtypesofschizophreniaSchizophreniahasalsobeensubdividedonthebasisofpsychopathology,course,andresponsetotreatmentHebephrenicschizophrenia/disorganizedschizophreniaParanoidschizophreniaCatatonicschizophreniaSimpleschizophreniaUndifferentiatedschizophrenia33SubtypesofschizophreniaSchizParanoidschizophreniaThistypeisthemostcommonformoftheillness.Ischaracterizedbyprominent突出的

paranoiddelusion,thoughtprocessesandmoodarerelativelysparedThepatientmayappearnormaluntilhisabnormalbeliefsareuncovered揭露.34ParanoidschizophreniaThistypCatatonicschizophreniaThistypeismuchlessfrequentlynowthaninpreviousyearsMotordisturbanceisthedominantfeatureStupor昏迷

(psychomotorinhibition),waxyflexibility蜡样屈曲,mutism缄默症,negativism否定论

andstereotyped陈旧的

actorspeechAgitatedhyperactivity(catatonicexcitment)35CatatonicschizophreniaThistyHebephrenicschizophreniaAbout11%ofpatientscanbediagnosedthistypeIscharacterizedbytheabsenceofsystematizeddelusionsandthepresenceofincoherenceandinappropriateaffectSillyandchildishbehavior36HebephrenicschizophreniaAboutSimpleschizophreniaAbout2%ofpatientscanbediagnosedthistype.Ischaracterizedbytheinsidious隐忧的

developmentofoddbehavior,socialwithdrawal,anddecliningperformanceatworkClearsymptomsareabsentDifficulttoidentifyreliablyPooroutcome37SimpleschizophreniaAbout2%oUndifferentiatedschizophreniaThistypeisthenextmostfrequentformDelusionsandhallucinationsofanytypeareprominentandareaccompaniedbyincoherenceandgrosslyofdisorganizedbehavior.38UndifferentiatedschizophreniaMood/affectivedisordersMoodisasustained持续的

emotionaltone情绪基调

perceivedalonganormalcontinuumofsadtohappy.Mooddisordersarecharacterizedbyabnormalfeelingsofdepressionoreuphoria精神欢快

withassociatedpsychoticfeaturesinsomeseverecases.39Mood/affectivedisordersMoodiTheclassification40Manicepisode/maniaDepression(unipolar)DysthymiaBipolardisordersCyclothymiaTheclassification40ManicepiClinicalpresentationsManicepisode躁狂发作Majordepressiveepisode抑郁发作41ClinicalpresentationsManicepManicepisodeThree“high”

symptomsEuphoricmood/elationAcceleratedthoughtprocessandspeech(flightofideas)Increaseinactivity42ManicepisodeThree“high”sympMajordepressiveepisodeThree“low”symptomsDepressedmood情感低落

(coresymptom)DiminishedabilitytothinkorconcentratePsychomotorretardation精神运动性障碍43MajordepressiveepisodeThreeNeurosisPsychosisNeurosisisamentalillnessinwhichinsightisretainedbutthereisamaladaptive不适应的

wayofbehavingorthinkingthatcausessuffering.1,absenceoforganiccauses2,relativelygoodsocialfunction3,considerableinsight44NeurosisPsychosis44NeurosesAnxietyPhobiaObsessive-compulsivedisorderSomatoformdisorders躯体病样精神障碍Neurasthenia神经衰弱症45NeurosesAnxiety45AnxietyNotattributable引起

torealdangerPersist

state

generalizedanxietydisorderUnexpectedattackpanicdisorder46AnxietyNotattributable引起toGADCLINICALFEATURESPsychologicalsymptomsPhysicalsymptoms

Sleepdisturbance47GADCLINICALFEATURES47PsychologicalsymptomsFree-floatinganxietyAnticipatoryanxietyWorryingthoughtRestlessnessIrritablePoorconcentration48PsychologicalsymptomsFree-floPhysicalsymptomsCardiovascularPalpitation,discomfortinchest,painovertheheartRespiratoryConstrictioninthechest,difficultyinhaling,overbreathingGastrointestinalDrymouth,difficultyinswallowing,epigastricdiscomfortNeuromuscularHeadache,tremor,tinnitus,dizziness,achingmuscles49PhysicalsymptomsCardiovasculaSleepdisturbanceDifficultyfallingasleepWakingupinthemiddleofsleepingEarlymorningawakening50SleepdisturbanceDifficultyfaPanicdisorderPanicdisorderischaracterizedbyrecurrentepisodicseverepanic(anxiety)attacks,whichoccurunpredictablyandarenotrestrictedtoanyparticularsituationorsetofcircumstances.51PanicdisorderPanicdisorderiPanicattacksarediscreteperiodsofintensefear,impendingdoomordiscomfort,accompaniedbycharacteristicsymptoms:palpitations,tachycardia,sweating,trembling,breathlessness,feelingofchoking,chestpain/discomfort,nausea/abdominaldiscomfort,dizziness,paraethesias,chillsandhotflushes,derealization,depersonalizationandfearoflosingcontrol,“goingcrazy”ordying.Notinrealdanger5-20min,<1hWithoutimpairmentofconsciousnessAbsenceoforganiccauses52PanicattacksarediscreteperObsessive-compulsivedisorderObsessions

ThoughtsruminationsdoubtsImpulseCompulsionsCheckingWashingCountingRituals53Obsessive-compulsivedisorderOPhobiaProvokedbyparticularobjectsorcircumstancesAcuteattackAvoidanceClassificationAgoraphobiaSocialphobiaSimplephobia54PhobiaProvokedbyparticularAgoraphobiaCommonthemesCrowdingConfinement

OpenspacesSocialsituationPublictransportationCrowdedshopsEmptystreetsCinemas,theatres55AgoraphobiaCommonthemes55SocialphobiaCommonthemeBeingobservedandopentocriticismCommittees,seminarsSocialgatheringsWritingorperforminginfrontofothersEatingordrinkinginpublicEyetoeye56SocialphobiaCommontheme56SimplephobiaCommontheme(Inappropriateanxiety)Animals,insectsBloodSharpobjectsNaturalphenomenon57SimplephobiaCommontheme(InaHysteria/dissociative(conversion)disorderHysteria

isapsychoneurosismarkedbyemotionalexcitabilityanddisturbancesofthepsychic,sensory,vasomotor,andvisceralfunctionswithoutanorganicbasis.58Hysteria/dissociative(conversStress-relateddisordersStress-relateddisordersaretemporarymentaldisorderscausedbystressingevents(traumaticevents)thatthreaten,harmorchallengeanindividual.Stress-relateddisordersincludeacutestressdisorderoracutestressreaction,andpost-traumaticstressdisorder.59Stress-relateddisordersStressOrganicPsychoses(organicmentaldisorders)Organicpsychoses(singular:psychosis)refertothementalillnessescausedbyaninjurytothebrainorbysomeinterferencewithnormalbrainfunction.Oneformoforganicpsychos