Psychiatry and Medicine.ppt

1、Psychiatry and Medicine,Dr. Yang Yun Mental Health Centre West China Hospital Sichuan University Email: 12-Apr-2005,Structure of this lecture,Concept Classification Clinical features Treatment guideline Psychosomatic disorders,Prevalence of depression in somatic disorders,General popu Chronic diso I

2、n patient U In patient O Out p tumor In p tumor stroke MI Parkinson Di Hypertension,Prevalence,Adapted from: WPA/PTD Educational Program on Depressive Disorders. Gavard JA, et al. Diabetes Care.1993;16(8):1167-1178. (modified),Concept,Primary and secondary Functional and organical Symptom syndrome d

3、isorder unit Relationship between somatic disorders and mental disorders,Relationship between somatic disorders and mental disorders,Due to somatic disorders Co-mobility Psychotic aspect of a disorder Medications treating somatic disorders:,Medications reported to cause depression,Classification,Med

4、ical and surgical disorders Brain disorder Medication Emergency and traumatic experiences Psychosocial factors,Clinical features,Primary symptoms Acute encephalopathy syndrome Chronic encephalopathy syndrome Depression Anxiety,Acute encephalopathy syndrome,Delirium: A disorder characterized by CONFU

5、SION; inattantiveness; disorientation; ILLUSIONS; HALLUCINATIONS; agitation; and in some instances autonomic nervous system overactivity. It may result from toxic/metabolic conditions or structural brain lesions. (From Adams et al., Principles of Neurology, 6th ed, pp411-2),Chronic encephalopathy sy

6、ndrome,Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract

7、 thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. Personality changes Amnesia syndrome,Depression,Mood Self-evaluation Motor retardation Voice Movement Mind Attention Biological changes,Anxiety,Mental : anxiety,

8、 worry, concentration, tension Movement: restlessness, trembling, irritation, angry Automatic nerve controlled organs: palpitation, shortness or breath, sweating, chronic pain, chest discomfort,Treatment guideline,Aetiology treatment Symptom-targeted treatment Alternative treatment,Psychosomatic dis

9、orders,Psychosomatic disorders,Definition of psychosomatic disorders Current research/findings Diagnosis Differentiation diagnosis Treatment,What is psychosomatic disorder?,Definition: the onset of which are closely related to psychological factors, especially emotional factors. It mainly affects or

10、gans and tissue that are controlled by the automatic nerves and causes structural or functional changes. Also called psychophysiologic disorders when there is only functional damage.,How are psychosomatic disorders look like?,Definite organic or functional disorder of an organ. Somatic symptoms as t

11、he main clinical manifestation The change of the disorder is closely related to emotional factors,Which are psychosomatic disorders?,Cardiovascular disorders: coronary heart disease, primary hypertension Digestive system: peptic ulcer、ulcerative colitis Endocrine &Metabolic disease：hyperthyroidism、h

12、ypothyroidism, diabetes mellitus, simple obesity Respiratory system：asthma, hyperventilation syndrome Urogenital system：frigidity, impotence、premature ejaculation, nervous polyuria,Which are psychosomatic disorders?,Neuromuscular system：spasmodic torticollis (wryneck) Skin：neurodermatitis、pruritus O

13、ther：malignant tumor、SLE Early identified psychosomatic disorders: hyperthyroidism, hypothyroidism, peptic ulcer , primary hypertension, coronary heart disease,Etiological hypothesis,Psychophysiological,Etiological hypothesis,Special response：,Current research on psychosomatic disorders（1）,1994 UKs

14、research on CHD Americans research on relationship between psychological factors and tumor Relationship between DM and depression Suicide rate is 3-5 folds of normal population Depression and depressive symptoms is obviously higher in DM Causation：comorbidity, depression cause DM, DM and its complic

15、ations cause depression, same neurotransmitter changes,Current research on psychosomatic disorders （2）,There are changes of 5-HT, ACTH, IL-1 and IL-6 in DM patients, and they are correlate to anxiety, depression and glucose level. After anxiolytic and antidepressant treatment, the changes above retu

16、re to normal , and so is blood glucose level. There is characteristic change of personality in DM patients. The changes above in DM patients are somewhat same as depression patients.,Current research on psychosomatic disorders （3）,About peptic ulcer（2001）： 1、gastrointestinal tract: the biggest emoti

17、onal organ (1830s in Canada), 5-HT distribution 2、 ulcer patients normally have anxiety or depressive emotions. 3 “Alexithymia”of ulcer patients 4 、5-HT changes in CNS 5 、subtype of peptic ulcer 6 、correlates of lesion area and anxietic level,Current research on psychosomatic disorders （4）,Clinical

18、observation about chronic pain 1、relationship between chronic pain and emotion: chronic pain itself is a kind of emotion 2、effect of antidepressant on chronic pain,Diagnostic index,Definite lesion on organs and tissues controlled by autonomic nervous system The remission and deteriorate of disorders

19、 are closely relate to emotional changes Some have evidence of primary benefit Certain personality characteristic as background,Historical features suggesting a significant psychogenic component to chronic Pain,Multiple locations of pains at different times Pain problems dating from adolescent Pain

20、without obvious somatic cause, especially in the perineal or face region Physically abusive parents or spouse Multiple surgical procedures of an elective nature Alcohol or drug abuse (patient and/or spouse) Frequent failure in job and social life,Recognition of emotional disorder in the physically i

21、ll,Screening questions for psychiatric symptoms How about you been feeling in yourself? Have you been very worried about your health? How have you been sleeping? Screening questions about the psychiatric history Are you taking any sleeping tablets or tablets for your nerves? Have you ever suffered f

22、rom tension or nerves? Have you ever consulted a doctor about your nerves? Screening questions about social factors Any problems recently that have upset you? Any problems at home or at work? Observation of the patients Mood and behavior during the interview If emotional disorder is suspected Take a full psychiatric history See other informants,Diagnostic procedure,History taking Individual life events Physical exam Neuropsychological test Laboratory test,Diagnostic proc