Neurotic disorders - PowerPoint PPT Presentation

Loading...

PPT – Neurotic disorders PowerPoint presentation | free to view - id: bf322-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Neurotic disorders

Description:

????????????????? (relaxation training) ???????????? (exposure) ... (muscle relaxation) ??????????????????????????????????? (relaxing situation) ????? ... – PowerPoint PPT presentation

Number of Views:1456
Avg rating:3.0/5.0
Slides: 155
Provided by: medicin71
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Neurotic disorders


1
Neurotic disorders
  • vudhichai boonyanaruthee, MD

2
PSYCHOSIS VS NEUROSIS
3
PSYCHOSIS
  • OUT OF REALITY
  • DISORGANIZED BEHAVIOR
  • DISORGANIZED SPEECH
  • THOUGHT DISORDER
  • IMPAIRED INSIGHT JUDGMENT

4
NEUROSIS
  • INTRAPSYCHIC CONFLICTS SEX AGGRESSION
    DEPENDENCY NEED
  • DEFENSE MECHANISM

5
NEUROSIS
  • ANXIETY NEUROSIS
  • PHOBIC NEUROSIS
  • OBSESSIVE-COMPULSIVE NEUROSIS
  • HYSTERICAL NEUROSIS CONVERSION TYPE,
    DISSOCIATIVE TYPE
  • DEPRESSIVE NEUROSIS
  • etc.

6
NEUROSES V DSM - IV
  • ANXIETY NEUROSIS V GENERALIZED ANXIETY DISORDER
  • PHOBIC NEUROSIS V PHOBIC DISORDER
  • OBSESSIVE-COMPULSIVE NEUROSIS V OCD
  • HYSTERICAL NEUROSIS V CONVERSION DISORDER,
  • DISSOCIATIVE DISORDER
  • DEPRESSIVE NEUROSIS V DYSTHYMIC DISORDER
  • etc.

7
NEUROTIC DISORDERS
  • ANXIETY DISORDERS
  • SOMATOFORM DISORDERS
  • DISSOCIATIVE DISORDERS

8
ANXIETY DISORDERS
  • ANXIETY ???????????(anticipation)???
  • ???????????(danger)???? ??????????????? ?????????
  • ?????????????(feeling of dysphoria) ????
  • ???????????(somatic symptoms)

9
ANXIETY V FEAR
  • UNKNOWN
  • INTERNAL
  • VAGUE
  • KNOWN
  • EXTERNAL
  • DEFINITE

10
ANXIETY DISORDERS
  • LIFETIME PREVERENCE 24.9
  • MCM SOCIAL PHOBIA, SIMPLE PHOBIA AGORAPHOBIA
    WITHOUT PANIC DISORDER, GEBERALIZED ANXIETY
    DISORDER AND PANIC DISORDER
  • ( SUBSTANCE USE DISORDERS 26.6, MOOD DISORDERS
    19.3)

11
DSM IV Classification of Anxiety Disorders
  • Panic disorder without agoraphobia
  • Panic disorder with agoraphobia
  • Agoraphobia without history of panic disorder
  • Specific phobia
  • Social phobia
  • Obsessive-compulsive disorder

12
  • Posttraumatic stress disorder
  • Acute stress disorder
  • Generalized anxiety disorder
  • Anxiety due to a general medical condition
  • Substance-induced anxiety disorder
  • Anxiety disorder NOS

13
Panic disorder and Agoraphobia
  • Panic disorder without agoraphobia
  • Panic disorder with agoraphobia
  • Agoraphobia without history of panic disorder

14
Panic disorder
  • A. 12
  • 1. recurrent unexpected panic attacks
  • 2. ????????? 1 panic attack ????? ?????????
    1????????????? ?????????????????????? 1 ?????
  • a. ???????????? panic attack ???
  • b. ??????????????????? ????????????????
  • c. ?????????????????????????????????????? PA

15
Panic attack sudden intense fear or discomfort,
at least 4 S/S, peak in 10 min
  • a. palpitation, pounding or accelerated heart
  • b. sweating
  • c. trembling or shaking
  • d. shortness of breath or smothering
  • e. feeling of choking
  • f. chest pain or discomfort

16
Panic attack
  • g. nuasea or abdominal distress
  • h. feeling dizzy, unsteady, lightheaded or faint
  • I. derealization or depersonalization
  • j. fear of losing control or going crazy
  • k. fear of dying
  • l. paresthesia
  • m. chills or hotflushes

17
Panic disorder
  • B. ?? agoraphobia????????? ?? PD with AP ???? PD
    without AP

18
Agoraphobia
  • A. ??????????????????????? ???????????????????????
    ??????? ???? ???????????????????????? ?????????
    ?????????????????? ????????panic
    attack??????????????????????????panic ????
    ????????????????? ??????????? ??????? ???????
    ????????
  • B. ?????????? ???? ?????? ?????????????????
    ?????????????????????????????

19
Agoraphobia
  • C. anxiety and phobic avoidance
    ?????????????????????????????????????? ????
    social phobia, OCD, PTSD, separation anxiety
    disorder

20
Panic disorder
  • C. panic attacks ????????????? substance or
    general medical condition
  • D. ????????????????????????????? ???? major
    depressive disorder, schizophrenia, paranoid
    personality disorder, avoidance personality
    disorder, dependent personality disorder etc.

21
Treatment of Panic disorder
  • ?????????????? (Drug Treatment)
  • ???? Imipramine ??? Alprazolam
  • ?????? clonazepam, fluoxetine, fluvoxamine,
    clomipramine

22
Impramine(Troflanil, Minapine 10, 25, 50 mg)
  • - 1.5 mg/kg/d ?? panic disorder without
    agoraphobia
  • - 2.25 mg/kg/d ?? panic disorder with
    agoraphobia
  • - ???????????????????????? (???? 10 mg/d) ???????
  • - ??????????? ?????? ? ???????????????????????????
    7-10 ??? ( ???????????????????????????
    ? 4-6 ???????????????????????)
  • - ??????????????????????????????????????????????
    8-12 ?????
  • - ????????????? ? ??????

23
Alprazolam
  • - ???????????????? 0.25-0.5 mg ????? 4 ????? (2-6
    mg/day)
  • - ????????????????? 8-12 ?????
  • - ???? ? ?????? ???????? ? (25/week)

24
??????????????????? (Psychosocial Treatment)
  • ??????????????? ???
  • cognitive therapy
  • ????????????????? (relaxation training)
  • ???????????? (exposure)
  • ???? ? ???? ?????????????? (respiratory
    training), ????????????? (family therapy),
    ???????????????????????????? (insight-oriented
    psychotherapy) ???????

25
Cognitive therapy??????????


????????????????????????????? (fears of physical
symptoms) ???????? 3 ??????? ???
  • a. identify the fears ?????????????
  • b. explain ?????????????????????????????
  • c. demonstration ??????????????????? appearance
    of the symptoms, fearful response ??????????
    panic attack

26
c. demonstration
  • - ????????????????????????????????????????????????
    ??? ?????????????????????????? panic attack
    ?????????????????????????
  • - ??????????????????????????????????????????????
    ???????????????????????????????????? panic attack
    ???????????????

27
Relaxation training?????????????????????????????
? panic attacks
  • ?????????????????????? (muscle relaxation)
  • ??????????????????????????????????? (relaxing
    situation) ???????????????????????
  • ???????????????????????????????

28
???????????? (Exposure)
  • ??????????????????????????????????????????????????
    ????????????? (phobic targets) ???????????????????
    ???????? 2 ???????

29
???? ?
  • ?????????????? (respiratory training)
  • ????????????? (family therapy)
  • ???????????????????????????? (insight-oriented
    psychotherapy)
  • ??????????????????????????????? ????
    ??????????????????????????????????????????????????
    ? panic attack ???? ????, ???? ???????????????????
    ??????????????????? ???? ?????????????????????????
    ? ???????

30
Specific Phobia ??? Social Phobia
  • Social phobia ?????????????????????? ???
    ??????????????????????????????????????????????????
    ??????????????????????????????????????????????????
    (social or performance situations)
    ???????????????????????????????????????
    (avoidance) ?????

31
  • Specific phobia ?????????????????????? ???
    ??????????????????????????????????????????????????
    ??????????????????????????????????????????????????
    (specific feared object or situation)
    ???????????????????????????????????????
    (avoidance) ?????

32
??????????????????? Social Phobia
  • A. ???? (fear) ???????????????????????????????????
    ?????????????????????? (social or performance
    situations) ??????????????????????????????????????
    ?????????????? ??????????????????????????????????
    (??????????????????????) ?????????????????????????
    (humiliating or embarrassing)
  • B. ??????????????????????????????? (feared
    social situation) ?????????????????????????????
    (anxiety) ????????????? panic attack
  • C. ?????????????????????????????? (excessive)
    ????????????????? (unreasonable)

33
??????????????????? Social Phobia
  • D. ?????????? ???????????????????????????????????
    ??????????????????????????? (anxiety)
    ??????????????????????? (distress) ???????????
  • E. ??????????????????, ????????????????????
    ??????????????????????????????????????????????????
    ??????????????????????????????????????????,
    ?????? (????????), ???????????????,
    ?????????????????????? ???????????????????????????
    ???????????????????????????????????
  • F. ?????????????????????????? 18 ??,
    ???????????????? 6 ?????

34
??????????????????? Social Phobia
  • G. ???????? (fear) ????????????????? (avoidance)
    ??????????????????????????????????????????????????
    ??????????? ??????????????????????????????????????
    ??? ? ???? panic disorder with or without
    agoraphobia, separation anxiety disorder, body
    dysmorphic disorder, a pervasive developmental
    disorder, schizoid personality disorder ???????
  • H. ?????????????????????????????????????????????
    ? ?????????????? 1 ???????????????????????????????
    ???????

35
??????????????????? Specific Phobia
  • A. ???? (fear) ??????????????????????????????????
    ????????? (excessive) ???????????????
    (unreasonable) ???????????????????????????????????
    ??????? (object) ????????????? (situation)
    ??????????????????????? ???? ?????????????????
    (flying), ??????? (heights), ????? (animals),
    ??????????? (receiving an injection),
    ???????????? (seeing blood)
  • B. ??????????????????????????????????????????????
    ??????????? (anxiety) ????????????????????????????
    panic attack
  • C. ?????????????????????????????? (excessive)
    ????????????????? (unreasonable)

36
??????????????????? Specific Phobia
  • D. ??????????????????????????????????????????????
    ?????? (anxiety) ???????????????????????
    (distress) ???????????
  • E. ??????????????????, ????????????????????
    ??????????????????????????????????????????????????
    ????????????????????, ?????? (????????),
    ???????????????, ??????????????????????
    ??????????????????????????????????????????????????
    ????????????
  • F. ?????????????????????? 18 ??,
    ???????????????????? 6 ?????

37
??????????????????? Specific Phobia
  • G. ????????????? (anxiety), panic attack,
    ????????????????????????????????? (phobic
    avoidance) ???????????????? (object)
    ????????????? (situation) ???????????????????????
    ????????????????????????????? ? ????
    obsessive-compulsive disorder, posttraumatic
    stress disorder, separation anxiety disorder,
    social phobia, panic disorder with agoraphobia,
    agoraphobia without panic disorder ???????

38
?????????????? (Drug Treatment)
  • ?? specific phobia ???????????????????????
    (adjuctive treatment) ?????? adrenergic
    antagonists ???? propanolol ??????????????????????
    ?????? autonomic hyperactivity
  • social phobia monoamine oxidase inhibitors
    (????????????????????????????), reversible
    inhibitors of MAO-A (RIMAs), benzodiazepines
    (???? clonazepam, alprazolam) ??? beta-blockers
    (???? atenolol, propanolol)

39
??????????????????? (Psychosocial Treatment)
  • specific phobia exposure therapy
    ???????????????????????? (desensitization)
    ???????????????????? ? ???????????????????????????
    ???????????(hierarchy) ???????????????????????????
    ????????????????????????????????????????????
    relaxation ???? breathing control
    ??????????????????????????????????????????????????
    ?????????????????????? ? (????????????????????????
    ??) Systematic Desensitization
  • social phobia cognitive therapy, behavioral
    therapy ??? exposure therapy

40
Obsessive-Compulsive Disorder
  • ???????????????????? (obsessions)
    (?????????????????????????????????????????????????
    ?????????????????)
  • ???/???????????? (compulsions)
    (?????????????????????????????????????) ???????
    OCD ??????????????????????????????????????????????
    ???????????????????

41
??????????????????? Obsessive-Compulsive Disorder
  • A. ??????????? (obsessions) ????????????
    (compulsions)
  • ????????? (obsessions) ????????????????????
    a., b., c. ??? d.
  • a. ??????? (thoughts), ?????????? (impulses)
    ???????????? (imaging) ???????? ??? ? ???????
    ??????????????????????????? (intrusive)
    ??????????????????????????? (inappropriate)
    ???????????????????????? (anxiety)
    ??????????????????????? (distress)

42
b. ???????, ?????????? ???????????????? ?
????????????????????????????????????????????
(excessive worries) ??????????????????????????????
??? (real-life problems)
c. ???????????????????? (ignore)
?????????? (suppress) ???????, ??????????
???????????????? ? ???????????????????????????????
??????? (thoughts) ???????????? (actions) ????d.
?????????????????????, ??????????
???????????????????????????????????????????
(mind) ?????
43
???????? (compulsions) ????????????????????????
a. ??? b.
  • a. ??????????? ? (repetitive behavior)
    (??????????????, ?????????, ??????????) ????
    ????????????????????????? (mental actions) (????
    ??????????, ??????, ??????????? ? ??? ?)
    ??????????????????????????????????????????????????
    ??????????? ???? ?????????????????????????????

44
???????? (compulsions)
  • b. ??????????????????????????????????????????????
    ????????????????????????????????????????
    (distress) ???? ??????????????????????????????????
    ???????????????? ?????????????????????????????????
    ??????????????????????????????????????????????????
    ?????????????????????, ????????????
    ??????????????????????????

45
??????????????????? Obsessive-Compulsive Disorder
  • B. ??????????????????????????????????????????????
    ????? (excessive) ??????????????? (unreasonable)
    (??????????????)
  • C. ????????? (obsessions) ????????????
    (compulsions) ????????????????????????????????????
    ??????? (marked distress), ????????,
    ????????????????????????, ??????????????,
    ???????????????????? ????????????????????????????

46
??????????????????? Obsessive-Compulsive Disorder
  • D. ??????????????????????? 1 (Axis I) ????????
    ??????????????????? (obsessions) ????????????
    (compulsions) ????????????????????????????????????
    ????? ? ???? eating disorder, trichotillomania,
    body dysmorphic disorder, hypochrondriasis,
    paraphilia, major depressive disorder)
  • E. ??????????????????????????????????????????????
    ?????????????????????????????????????

47
???????? OCD ????????????????????????????
  • 1. ?????????????????????????????? (Obsession of
    contamination) ??????????????????????????? ?,
    ??????????????????? ???? ???????, ???????, ????,
    ???????? ???????
  • 2. ?????????????????????????? (Obsession of
    doubt) ??????????????????????????? ?
    ?????????????????????????? ???? ???????????,
    ???????????? ???????

48
???????? OCD ????????????????????????????
  • 3. ?????????????????????????????????????
    (Obsessional thoughts without a compulsion)
    ??????????????????????????????????????????????????
    ???????????????????? (sexual or aggressive act)
  • 4. ????????????????????????????????????? (Need
    for symmetry or precision) ???????????????????????
    ??????????? (compulsion of slowness) ????
    ????????????????????????????????????????

49
??????????????????? OCD ???? poor prognosis ???
  • 1. ???????????????????????????? (compulsions)
  • 2. ????????????????????????
  • 3. ????????????????? ?
  • 4. ?????????????????????????????
  • 5. ?? overvalued ideas ??? ????????????????? ?
    ????????????????????????? (delusions)
  • 6. ??????????? (delusions) ????????
  • 7. ?? personality disorder ???????? ????
    schizotypal personality disorder ???????

50
?????????????? (Drug Treatment)
  • clomipramine 25-50 mg. ???????
    ??????????????????????????????? 25 mg/d ??? 2-3
    ??? ?????????????????? 250 mg/d
    ???????????????????????? (side effects) ??????
  • SSRIs 80 mg/d ??? fluoxetine, 300 mg/d ???
    fluvoxamine ???? 60 mg/d ??? paroxetine
  • ???????????? 10 ??????????????????????????????????
    ????????????????? ?????????????????????? SSRIs
    ?????????????????? ??? clonazepam, pimozide ????
    buspirone ????????????????????????????????????????
    ???????????????????????????? cingulotomy

51
??????????????????? (Psychosocial Treatment)
  • behavioral therapy ??????????????????????????????
    ?????????????????????????????????????????
    exposure, response prevention ????????????
    desensitization, thought stopping ??? flooding
  • ???????????????? ? ???????????????????????????????
    ???????????????????? ??? ?????????????????????????
    ??? (insight-oriented therapy),
    ???????????????????????? (supportive
    psychotherapy), ????????????? (family therapy)
    ???????????????? (group psychotherapy)

52
Posttraumatic Stress Disorder Acute Stress
Disorder
  • Posttraumatic stress disorder (PTSD) ???
    ???????????????????????? ??? ?????????????????????
    ?????????????????????????????????????????????????
    (extremely traumatic event) ?????????????????
    (reexperiencing) ?????????????????????????????????
    ??? (increased arousal) ??????????????????????????
    ???? (stimuli) ?????????????????????
  • Acute stress disorder (ASD) ??????????????????????
    ??? ??????????????????????????? posttraumatic
    stress disorder ??????????????????????????????????
    ?????????????? (extremely traumatic event)

53
??????????????????? Posttraumatic Ttress Disorder
(PTSD)
  • A. ???????????????????????????????? (traumatic
    event) ????????????????????????????????
  • a. ????? (experienced), ?????????????
    (witnessed) ????????? (confronted)
    ???????????????????????????????? (actual death),
    ??????????? (threatened death), ?????????????
    (serious injury) ???????????????????????????
    (threat to the physical integrity)
    ????????????????
  • b. ??????????????????????????????????? (intense
    fear), ??????????????????????????????
    (helplessness), ??????????????? (horror)

54
??????????????????? Posttraumatic Ttress Disorder
  • B. ????????????? (reexperienced)
    ?????????????????? (traumatic event)
    ?????????????????????????????????????????
  • a. ???????????????? (recollections)
    ????????????? ? ??????????????????????????????????
    ???????? (distressing) ??????????????????????
    (images), ??????? (thoughts) ???????????????
    (perceptions)
  • b. ??????????????????????????????? (distressing
    dreams) ???? ?
  • c. ???????????? (acting) ?????????? (feeling)
    ???????????????????????????????????????????

55
??????????????????? Posttraumatic Ttress Disorder
  • d. ???????????????????????????? (intense
    psychological distress) ??????????????????????????
    ??????????????????????????????????????????????????
    ????????????? (symbolize) ????????? (resemble)
    ?????????????????????
  • e. ?????????????????????? (physiological
    reactivity) ??????????????????????????????????????
    ??????????????????????????????????????????????????
    ? (symbolize) ????????? (resemble)
    ?????????????????????

56
??????????????????? Posttraumatic Ttress Disorder
  • C. ??????????????? (avoidance) ????????
    (stimuli) ???????????????????????????? (trauma)
    ??? ???????????????????????? (general
    responsiveness) ??????????????????? 3
    ?????????????????
  • a. ?????????????????????????, ??????
    ??????????????????????????? (trauma)
  • b. ???????????????????????, ???????
    ?????????????????????????????????????????????
    (trauma)
  • c. ????????????? (recall) ???????????????????????
    ?????? (trauma)

57
??????????????????? Posttraumatic Ttress Disorder
  • d. ?????????? (interest) ????????????????
    (participation) ??????????????????????
  • e. ?????????????? ( feeling of detachment)
    ????????????????? (enstrangement) ??????????
  • f. ??????????????????? (restricted range of
    affect) ????????????????????????
  • g. ??????????????????? (foreshortened future)
    ???? ????????????????? ? ????????????????,
    ???????, ???? ???? ?????????????????

58
??????????????????? Posttraumatic Ttress Disorder
  • D. ????????????????????????????????????????
    (symptoms of increased arousal)
    (?????????????????????????????????)
    ???????????????????? 2 ????????????
  • a. ???????????????????????????? (difficulty
    falling or staying sleep)
  • b. ???????????????????? (irritability)
    ???????????????????? (outbursts of anger)
  • c. ?????????? (difficulty concentrating)
  • d. ?????????? (hypervigilance)
  • e. ???????????????? (exaggerated startle
    response)

59
??????????????????? Posttraumatic Ttress Disorder
  • E. ??????????????????? (????? 2, 3 ??? 4)
    ????????????? 1 ?????
  • F. ??????????????????????????????????????????????
    ??????? (significant distress) ???????????????????
    ????????????????????? (functioning) ????????,
    ?????????????? ?????????? ????????? ?

60
???????????????? Acute Stress Disorder (ASD)
  • ???????? PTSD ???????????????????????? ???
  • ???????????????????????? ASD ??????????????? 4
    ??????? ????????????????????????? (traumatic
    events)
  • ????????????????????????????????? 2
    ????????????? 4 ???????
  • ????????????????????? 4 ????????????????????????
    ?????????? ASD ???? PTSD

61
?????????????? (Drug Treatment)
  • ?????????????? ???????????????????????????????
    ??? imipramine ??? amitriptyline 50-300 mg/d
    ?????????????????? (intrusion) ????????????????
    (avoidance) ??? ??????????????????????????????? 8
    ??????? ??????????????????????????????????????????
    ??????????? 1 ??
  • ?????????? ? ?????????????????????? ?
    ?????????????????????? (aggression)
    ?????????????? (agitation) ??? SSRIs, MAOIs,
    anticonvulsants, clonidine, propanolol.
    alprazolam ??????????????? (antipsychotics)

62
??????????????????? (Psychosocial Treatment)
  • ??????????????????? ??? ??????????????????? PTSD
    ??????????????????????????? (traumatic events)
    ??????????????????????????????????????????????????
    ? (crisis intervention)
  • Gelder ?????? (1994) ????????????????? ???

63
  • 1. ??????????????????????????????????????????????
    ??????????????????????(sympathetic)
    ????????????????????????????? ?
    ??????????????????????
  • 2. ??????????????????????????????????????????????
    ??? (working through) ????????????????????????????
    ????????? (avoidance) ?????????? (denial)
    ?????????????????????????????????????????
  • 3. ???????????????????????????? (coping)
    ???????????? ? ???????????????
  • 4. ???????????????????????? ???? ?????????????,
    ???????????? ???????

64
?????????????????????????? PTSD
??????????????????????????????????????????????????
?????
  • ??????????????????????????? (exposure)
    ????????????????????????????????? (systemic
    desensitization) ?????????????????????????????????
    ?? (relaxation technique) ?????????????????????
    (cognitive therapy)
  • ?????????????????? ? ???????????? ???
    ????????????? (group psychotherapy),
    ????????????? (family therapy)

65
Generalized Anxiety Disorder(GAD)
  • ???????????????????? ??? ?????????????????????
    ??? (anxiety) ???????????? (worry)
    ?????????????????????????????????? 6 ?????

66
??????????????????? generalized anxiety disorder
(GAD)
  • A. ??????????????? (anxiety) ?????????????
    (worry) ?????????????????????????? (events)
    ??????????? (activities) ????????? ????
    ???????????????????? ????????????????????
    ????????????????? 6 ?????
  • B. ??????????????????????????????? (worry)
    ?????????????????

67
  • C. ????????????? (anxiety) ????????????? (worry)
    ????????????????????????? 3 ?? 6
    ?????????????????
  • a. ??????????? (restlessness) ???????????????????
    (feeling keyed up) ????????????? (on edge)
  • b. ????????????? (being easily fatigued)
  • c. ?????????? (difficulty concentrating)
    ????????? (mind going blank)
  • d. ???????? (irritability)
  • e. ??????????????????? (muscle tension)
  • f. ????????????? (sleep disturbance) ??????????,
    ??????????????????? ??????????????????

68
  • D. ??????????????????????????????????????????????
    ??????????????????????????? 1 (Axis I)
  • E. ?????????????, ?????????????
    ??????????????????????????????????????????????????
    ??????? (significant distress) ???????????????????
    ?????????????????????, ??????????????
    ?????????????? ? ????????
  • F. ??????????????????????????????????????????????
    ????????????? (substances) ???????????????????
    (general medical condition) ??????????????????????
    ????????????? mood disorders, psychotic disorder
    ???? pervasive developmental disorder

69
?????????????? (Drug Treatment)
  • benzodiazepines ??? buspirone
  • ????????????????????????????????????????????????
    ??? ?????????????? (diagnosis), ?????????????
    (target symptoms) ????????????????????? (duration
    of treatment) ????????????????????????????????????
    ?????? 2-6 ????????????????? ???1-2
    ???????????????? ? ??????

70
Benzodiazepines
  • intermediate half-life, 8-15 hrs???? lorazepam,
    alprazolam ???????????????????????????????????????
    ???????????????????????????????????????
    benzodiazepines ????????????????????? (long
    half-life, gt100 hrs) ?????????????????????????????
    ??
  • ?????????????????????????????? 25-30
    ???????????????????????????? (tolerance)
    ????????????? (dependence) ??? benzodiazepines ???

71
Buspirone
  • ????????????????????????? GAD ???????????????????
    60-80 ????????????????? ????????
    ???????????????, ????????????????????????????????,
    ??????????????????????????????????????
    ???????????????????? alcohol ???????
    ?????????????? 2-3 ???????????????????????????????
    ??????????????????????????????????????
    benzodiazepines ?????????????????????????????????
  • ?????????????????? ??? ??????????????
    (antidepressants) ??? B-adrenergic antagonist

72
??????????????????? (Psychosocial Treatment)
  • 1. ???????????????????????? (Supportive
    psychotherapy) ???????????????????????????????????
    ????????????????
  • 2. ????????????????????????????
    (Insight-oriented psychotherapy)
    ????????????????????????????????????????????
    (unconscious conflict)
  • 3. ???????????????????? (Cognitive
    psychotherapy) ???????????????????????????????????
    ????????
  • 4. ???????????????????? (Behavioral
    psychotherapy) ???????????????????????????????????
    ? GAD

73
Anxiety Disorder due to a General Medical
Condition
and

Substance-Induced Anxiety
Disorder
74
Anxiety Disorder due to a General Medical
Condition
  • Endocrine conditions hyperthyroidism,
    hypothyroidism, pheochromocytoma, hypoglycemia,
    hyperadrenocorticism
  • Cardiovascular conditions congestive heart
    failure, pulmonary embolism, arrhythmia
  • Respiratory conditions chronic obstructive
    pulmonary disease, pneumonia, hyperventilation
  • Metabolic conditions vitamin B12 deficiency,
    porphyria
  • Neurological conditions neoplasms, vestibular
    dysfunction, encephalitis

75
Substance-Induced Anxiety Disorder
  • intoxication alcohol, amphetamine
    ?????????????????, caffeine, cannabis, cocaine,
    hallucinogens, inhalants, phencyclidine
    ????????????????? ???????
  • withdrawal ???? alcohol, cocaine, sedatives,
    hypnotics ??? anxiolytics

76
?????????????????????
  • analgesics, sympathomimetics ????
    bronchodilators, anticholinergics, insulin,
    thyroid preparations, oral contraceptives,
    antihistamines, antiparkinsonian medications,
    corticosteroids, antihypertensives ???
    cardiovascular medications, anticonvulsants,
    lithium carbonate, antipsychotic medications,
    antidepressant medications ???????

77
???????? (Treatment)
  • ???????????????????????????????
  • ??????????????? ???? ????????????????????????????
    ????????????????
  • ??????????????????????????????????????????????????
    ???????????????????????????????????????????? ????
    ?????? anxiolytics, serotonergic antidepressants,
    behavioral therapy ???????


78
Somatoform Disorders
  • ??????????????????????????????????????????????????
    ???????????? ?????????????????????????????????????
    ???????? ??????????????????????????????
  • 1) ???????????????????????????????????????????????
    ???????????????????????????????????
  • 2) ??????????????????? ??? ???????????(conflicts)
    ????????????????????????(initiating),?????????????
    ???????????????????????(exacerbation) ???
    ?????????????(maintenance)

79
Somatoform Disorders
V

Psychological Factors affecting medical
conditions
  • Asthma
  • Migraine
  • Tension Headace
  • Rheumatoid Arthritis
  • Ulcerative Colitis
  • etc.

80
Somatoform Disorders
  • 1. Somatization Disorder
  • 2. Conversion Disorder
  • 3. Hypochondriasis
  • 4. Body Dysmorphic Disorder
  • 5. Pain Disorder
  • 6. Residual diagnostic categories ????
    Undifferentiated Somatoform Disorder, Somatoform
    Disorder NOS

81
Somatization Disorder
  • monosymptomatic syndrome - conversion disorder
    polysymptomatic syndrome -
    somatization disorder
  • ????????? 17 Thomas Sydenham ?????? psychological
    disturbance??????????? Antecedent
    sorrow(??????????????????????????)
    ????????????????????????? hysteria
    Sydenham????????????????? hysteria????????

82
  • 1970 ????? multisymptomatic hysteria ???
    Briquets syndrome ???? Briquets disease
  • ?? DSM-III ?????? Briquets syndrome??????????????
    ????????????????? somatoform disorder

83
??????????????????? Somatization Disorder
  • A. ???????????????????????????????? ????????????
    30 ???????????????????????????????????????????????
    ??????????????????????? ?????? ???????????????????
    ????????

84
  • B. ??????????????????????????????????????????
  • . 4 pain symptoms ?????????? ???????????????????
    ??? ???????????( ??????? ?????, ????, ????, ???,
    ?????, ??, ???????? ???????
    ???????????????????, ??????????????,
    ??????????????)

85
  • . 2 gastrointestinal symptoms
    ?????????????????????????? ???????????????????
    ??? ???? ????????, ???????, ????????????????????
    ??????????????????, ???????? ????
    ???????????????????????????????????????????
  • . 1 sexual symptoms ??????????????? ????
    ??????????????????? ??????????????????? ???
    ???? ??????????????????????????????
    ????????????????????,?????????????????,
    ?????????????????????, ????????????????????????,
    ???????????????????????????????

86
  • . 1 pseudoneurological symptoms ????????? ????
    ???????????(deficit)??????????????????????????????
    ??????????????????????????? ??? ???? ????
    coordination ???? balance, paralysis ????
    localized weakness, ???????? ???? ?????????,
    ??????????, urinary retention , hallucination,
    ?????????????????????????? ??????????,
    ???????????, ???????, ???, dissociative symptoms
    ???? ????????(amnesia), ??????????????????????????
    ????????????????????(loss of consciousness other
    than fainting)

87
  • C. ???????????? 1. ???? 2.
  • 1. ????????????????????? ??????? B.
    ????????????????????????????????????? ????
    ????????(???????? ???? ??)
  • 2. ????????????????????? ??????????
    ?????????????????? ??????????????????????????????
    ???????, ?????????????? ???? Lab
  • D. ?????????????????????????????(???? ??
    factitious disorder ???? malingering)

88
???????? (Treatment)
  • ???????????(management)??????????????
  • ????????(treatment)
  • ????????????????????????????????(doctor-patient
    relationship)?????????????????????????????

89
Helpful management strategies for Somatoform
Disorder
  • - ????????????????(primary care
    doctor)??????????????????(????????????)
    ???????????????????????????????????
  • - ??????????????????????????????? ??? ??? ??? ??
    ???????
  • - ?????????????????????????????????????
  • - ???????????????????????? ??????????????????????
    ??????????????????????????????????????????

90
  • - ????????????????????????????????????????????????
    ??? ????????????????????????????
  • - ???????????(signs)?????? ???????????????????????
    ???????
  • - ?????????????????????????????????(diagnosis
    test) ????????????????????????(laboratory
    evaluations) ???? ?????????(operative procedure)
    ??????????????????????????
  • - ???????????????????????????????????????????????
    ?????????????????????????

91
  • ??????????????????????????????????????????????????
    ?????????????? ? ?????????
  • ???????? ???????????????????????????????????
    Somatization Disorder ???????????? ???
    ????????????????????????????????? ?
    ??????????????????????????? ??????????????????????
    ????????????
  • ??????????????????????????????????????????????????
    ??????????drug abuse

92
Conversion Disorder
  • ?????? ????????????? Conversion Disorder ???
    Somatization Disorder ??????????? hysteria ,
    conversion reaction ???? dissociative reaction
  • ???????????? Briquet ??? Jean-Martin Charcot
    ????????????? conversion ??????????????????????
    ????????????????????????????????????????????
    (traumatic event)
  • Sigmund Freud ??????????????????? ?????
    conversion ???????????????????????????????
    (unconscious conflict)

93
??????????????????? Conversion Disorder
  • A. ?? 1 ???? ??????? 1????????????????????(symptom
    s or deficit) ??? voluntary motor ???? sensory
    function ?????????????? ????????????????
    ???????????????
  • B. ?????????????????????????????????????????
    ????????????(initiation) ??????????????????????(ex
    acerbation)???????? ??????????????????????(conflic
    ts) ???? ??????????(stressors)
  • C. ?????????????????????????????(????
    ??factitious disorders ???? malingering)

94
  • D.????????????????????? ??????????????????????????
    ???????????????? ???? ?????????????? ????
    ???????????????????????????????????????????????(cu
    lturally sanctioned behavior or experience)
  • E. ??????????????????? ???????????????????????????
    ????????????????????
  • F. ??????????????????????? ????????
    ????????????????????? ????????????????????????????
    ???? Somatization Disorder ???????????????????????
    ?????????

95
  • ???? ??????????????????????????
  • . with motor symptom or deficit
  • . with sensory symptom or deficit
  • . with seizure or convulsion
  • . with mixed presentation

96
  • ??????????????????????? ?????? ????? ?????????
  • ???????????????????????????????????? ??? passive
    aggressive , dependent , antisocial ???
    histrionic
  • ?????????????????????????????????????????????
    Depressive ??? Anxiety disorders ???????

97
???????????????????????????????????????????? ???
  • 1. Sensory symptoms ????????????????????????????
    ? ???? stocking and glove anethesia
    ????????????????????????????????????????????
    ??????????? ????? Tunnel vision
    ???????????????????? ???????
  • 2. Motor symptoms ????????? ???
    ???????????????????????????, ??????????
    ???????????????? ????????? ? ???????????? ????
    tremor, choreiform, tics, jerk ???????

98
  • 3. ???????? (Seizure symptom)
    ??????????????????? (pseudoseizure) ?????????
    (seizure) ??????????????????? ????????????????????
    1 ?? 3 ????????????????????????????????????????
  • 4. ?????????? ? ????????????? (Other associated
    features)
  • 4.1 Primary gain
  • 4.2 Secondary gain
  • 4.3 La belle indifference
  • 4.4 Identification

99
???????? (Treatment)
  • ?????????????????????????????????
  • ??????????????????????????????????????????????????
    ????????????

100
Hypochondriasis
  • ?????????????????????????????????????????????
    ?????? ???????????????????????????????????
  • ?????????????????????????????????????????????
    ? ???????????????????? ?
  • ?????????????????????????????????
    ????????????????????????????????????? ?
    ??????????????

101
??????????????????? Hypochondriasis
  • A. ???????(preoccupation)?????????????????????????
    ???????????????????? ?????????????????????????????
    ??????????
  • B. ??????????????????????? ???????????????????????
    ??????????????????????????
  • C. ?????????????? A. ???????????????? (???? ??
    Delusional Disorder, Somatic Type)
    ?????????????????????????????????????????????(????
    ?? Body Dysmorphic Disorder)

102
  • D. ??????????????????????? ????? ????
    ?????????????????
  • E. ???????????????? 6 ?????
  • F. ????????????? generalized anxiety disorder,
    obsessive compulsive disorder, panic disorder,
    major depressive episode, separation anxiety ????
    somatoform disorder ????
  • ???? ???
  • with poor insight ??????????????????????
    ??????????????????????????????????????????????????
    ???????????????????????? ???? ???????????

103
????????(Treatment)
  • ??????????????????????????????????
    ????????????????????????????????????????????????
  • ??????????????????????????????????????
    ??????????????????????????????????????
  • ????????????????????????? ????????????????????????
    ??? ????? Social support ??? Interaction
    ??????????????????????
  • ????????? Insight - oriented psychotherapy
    ???????????????

104
  • ??????????????????????????? ??????????????????????
    ?????????????? ???????????????????????????????????
    ?????????
  • ??????? ??? ???????????????????????????????????
    ?????? ???????????????????????

105
  • ??????????????????????????????????????????????????
    ????????????????????????????????? Underlying
    ???????? Major depressive disorder ???? Anxiety
    disorder
  • ??????????????????????? Hypochodriacal
    ???????????????????????????????????????? (
    Transient situational reactoin )
    ??????????????????????????????????????????????????
    ????????????? ?????????????????????????????

106
Body Dysmorphic Disorder
  • ???????????????? Body Dysmorphic Disorder
  • A. ??????????????????????????????????????(imagined
    defect)??????????(appearance) ???????????????????
    ????????? ???????????????????????????????????????
  • B. ??????????????????????? ????? ????
    ??????????????????????
  • C. ???????????????????????????????????????????????
    ? ???? Anorexia Nervosa

107
????????
  • ???????????????????????????????????????
    ??????????? ??????? ????????? ????????
    ????????????????????????????
  • ?????? Serotonergic drug ???? Fluoxetine ????
    Clomipramine??????????? 50
  • ???????????????????????????????????????

108
Pain Disorder
  • ???????????????????????????????????????????????
    ???????????????????????????????????????
  • ???????????????????????????????????????????????
    ???????????

109
??????????????????? Pain Disorder
  • A. ????????????????? 1 ????????????????????????
    ?????????????????????????????????? ???
    ??????????????????????????????????????????
  • B. ????????????? ???? ?????????
    ??????????????????????
  • C. ????????????????? ????????????
    ??????????????(onset) ??????????(severity)
    ??????????(exacerbation) ???? ?????????(maintenanc
    e) ???????????

110
  • D. ????????????? ???????????( ?????? Factitious
    Disorder ???? Malingering)
  • E. ????????????????????? Mood, Anxiety ????
    Psychotic Disorder ??? ??????????? ????????
    Dyspareunia
  • ???? Pain Disorder Associated with Psychological
    Factors
  • Pain Disorder Associated with Both
    Psychological Factors and a General Medical
    Condition
  • Pain Disorder Associated with a General
    Medical Condition
  • ???? Acute ??????????????? 6 ?????
  • Chronic ?????????????? 6 ?????

111
????????(Treatment)
  • Pharmacotherapy
  • ?????????????????? ???? Psychotropic medication
    ??????????????????????????????????????????????????
    ???
  • Antidepressant ???? Amitriptylline , Imipramine
    ???? Doxipine ????????????? ???? Serotonergic -
    antidepressant ???? Clomipramine ???? Fluoxetine
    ????????????????? ???????????????????????????
    Serotonin ????????????????????????

112
  • Behavioral therapy
  • Biofeedback ???????????? Migraine ,
    Myofacial pain ???? Muscle tension
  • Psychothehrapy
  • ????? Psychodynamic psychotherapy ?????
    ??????????????????????????????????????????????????
    ?? ???????????????????????????????????????????????
    ???? ? ????????????????????????????????
    ??????????????????????????????????????????????????
    ?????( Physical) ??? ????????(Psychological)
    ???????????????????????????????

113
  • Pain control program
  • ????????????????????????????????????????????
    ?????????????????????? ??????????????????? Pain
    unit ???????????????????????????? ???? Cognitive
    - Behavioral therapy , Group psychotherapy ,
    Physical ??? Rehabilitation ???
    ????????????????????????????

114
Undifferentiated Somatoform Disorder
  • ???????????????????
  • A. ???????????????????? 1 ???????????(????
    ?????????, ??????????, ???????????????????????????
    ???????????????
  • B. ??1) ???? 2)
  • 1)????????????????????? ??????????????????????
    ??????????????????????? ????????????????????
  • 2)????????????????????? ??????????????????????
    ???????????????????????????????
    ??????????,?????????????? ?????Lab

115
  • C. ??????????????????? ???? ??????????????????????
  • D. ??????????? 6 ?????
  • E. ??????????????????????????????????(????
    Somatoform Disorder????, Sexual Dysfunction, Mood
    Disorder, Sleep Disorder ???? Psychotic Disorder)
  • F. ????????????????????????(???? ?? Factitious
    Disorder ???? Malingering)

116
Somatoform Disorder NotOtherwiseSpecified(NOS)
????????????????
  • ???????????????????????? Somatoform ???
    ?????????????????????? Specific Somatoform
    Disorder ?? ??????

117
  • Pseudocyesis ????????????????????????????????????
    ???????????????????????????????????? ????
    ????????, ?????????????????????,
    ?????????????????, ????????, ?????????????????????
    ??, ???????????????????????????????
    ??????????????????????????????????????????????????
  • Nonpsychotic Hypochondriacal Symptom
    ??????????????? 6 ?????
  • Unexplained Physical Complaints (????????? ????
    ??????????????)??????????????? 6 ????? ???
    ?????????????????????????????

118
??????????????????? Factitious Disorder
  • A. ??????????? ???? ??????????????? ???????
    ?????????
  • B. ?????????????????????????? ??????????????????(s
    ick role)
  • C. ??????????????????? ???? ???????,
    ???????????????????????????? ?????????????????????
    ????????????? Malingering
  • ????
  • With Predominantly Psychological Signs and
    Symptoms
  • With Predominantly Physical Signs and Symptoms
  • With Combined Psychological and Physical Signs
    and Symptoms

119
Malingering
  • Definition ?????????????????????? ???? ?????
    ???????????????????????????????????? ????
    ??????????, ??????????????? ???? ????????

120
Dissociative Disorders
  • ??????????????????????????????????????????????????
    ??????(unitary sense of self) ???
    ????????????????? ????????????????????????????????
    ?????(a single basic personality)
  • ??????????????????????????????????????????????????
    ???????????(thoughts),??????????(feelings)????????
    ??? (actions) ????????????????????????????????????
    ???(unique personality)
  • dissociative disorders ????????????? ???
    ?????????????????????????????????????

121
?????????????? DSM-IV
  • 1. Dissoiative Amnesia ????????? Psychogenic
    Amnesia
  • 2. Dissociative Fugue ????????? Psychogenic Fugue
  • 3. Dissociative Identity Disorder ( Multiple
    Personality Disorder)
  • 4. Depersonalization Disorder
  • 5. Dissociative Disorder Not Otherwise specified
    (NOS)

122
Dissociative Amnesia
  • ??????????(amnesia)??????????????
  • ?????????? dissociative amnesia
    ??????????????????????????????????????????????????
    ?????????????????????????stressful or traumatic
    events
  • ?????????????????? dissociative amnesia ???
    personal identity ????????????????????????????????
    ??????????

123
  • ????????????????????????????????????? dementia
    ??????????????????????????????????????????????
    ???? ???????????????????????? ????????????????????
    ??????????????????????????? ??????????????????????
    ??????????

124
???????????????? Dissociative Amnesia
  • A. ??????????????????? ??? ???????????????????????
    ??????????????? ???????????????????????
    ????????????????????????? ???? ???????????????(tra
    umatic or stressful nature) ??????????????????????
    ?????????????????????????????????????(ordinary
    forgetfulness)

125
  • B. ???????????????????????????????????????????????
    ???????(course) dissociative disorder,
    dissociative fugue, posttraumatic stress
    disorder, acute stress disorder, ????
    somatization disorder ????????????????????????????
    ??????????????(???? ????????? ???? ??)
    ?????????????????????? ?????????????????(amnestic
    disorder ?????????????????????)

126
  • C. ???????????????????????????????????????????????
    ???????? ???? ??????????????????? ?????, ??????,
    ???? ???????????????????

127
????? amnesia ??????
  • localized amnesia ???????????????????????
    ???????????????????????????????????????(??????????
    ????????????????)
  • generalized amnesia ????????????????????????????
    ??????????(whole lifetime experience)
  • selective(systematized) amnesia
    ?????????????????????????????????????????????????

128
????????(Treatment)
  • ??????????????????????????????????????
    ?????????????????????????????????????????
    ??????????????????????????????????????????????????
    ???????? ?????????????????????????????????????????
    ?????????????

129
  • ??????????????????????????????????????????????????
    ????????????????????????? ?????? intermediate ???
    short acting barbiturate ???? thiopental(Pentothal
    ) ??? sodium amobarbital ????????????
    ??????????????????????????????????????
    (drug-assisted interview)
  • ??????????(hypnosis) ?????????????????????????????
    ???????????????????????????
  • ?????????????????????????????????
    ???????????????????????????????????????????????(in
    corporate)?????????????

130
Dissociative Fugue
  • ??dissociate fugue ???????????????????????????????
    ?????????????????????????????????????????
    dissociative amnesia
  • ?????????????????????????? ????????????
    ??????????????????????????????????????(????,
    ????????, ??????)
  • ?????????????????????????????????
  • ???????????????????????????????????????????????
    dissociative identity disorder

131
???????????????? Dissociative Fugue
  • A. ??????????????????? ????????????????????????
    ?????????????????????????????????????????
    ???????????????????????????????????
  • B. ?????????????????????????????????? ????
  • (assume)?????????????(??????? ???? ???????)

132
  • C. ???????????????????????????????????????????????
    ??????? dissociative identity disorder
    ??????????????????????????????????????????(????
    ????????? ???? ??) ???? ????????????????(????
    temporal lobe epilepsy)
  • D. ???????????????????????????????????????????????
    ???????? ???? ??????????????????? ?????, ??????,
    ???? ???????????????????

133
????????(Treatment)
  • ???????????????? dissociative amnesia
    ????????????????????,???????????????????????(drug-
    assisted interviewing), ?????????????
    ????????????????? ????????????????????????????????
    ????????????
  • ??????????????????????????????????????????????????
    ?????????????????? ???????????? treatment of
    choice ??? dissociative fugue ???
    expressive-supportive psychodynamic psychotherapy

134
Dissociative Identity Disorder ( DID)
(Multiple
Personality Disorder)
  • ???? dissociative disorder ??????????????????
    ???????????????????????????????????????
    ???????????????????????????????????????
    ???????????????????
  • ??????????????????????????????????????????????????
    ????????????????????????????????????????????????
  • ???? dissociatice disorder ??????????????????????

135
???????????????? Dissociative Identity Disorder
  • A. ?????????????? ???? ???????????????????????????
    ????????????? 2 ?????????(????????????????????????
    ??????????????????, ???????????,
    ????????????????????????????? ????????)
  • B. ??????????? 2 ????????? ???? ?????????
    ????????????????????????????????????

136
  • C. ????????????????????????????????
    ??????????????????????????????????????????????????
    ??????????
  • D. ????????????????????????????
    ??????????????????????????(????
    ????????-blackouts ????????????????????????-chaoti
    c behavior ?????????????? ????????????????????(???
    ? complex partial seizures) ????????
    ?????????????????????????????????
    ????????????????????????????(imaginary playmates)
    ???? ??????????????????????(fantasy play)????

137
???????????????(Clinical Features)
  • ??????????????????? 5-10 ??????
    ?????????????????? 20 ?????? ?????????????????????
    ????????? ????? 2-3 ?????? ???????????????????????
    ??????????
  • ??????????????????????????????????
    ????????????????????????????????????????????
  • ???????????????????????????????????????????? ????
    ??????? ??? ????????????????????????????????(frien
    ds/companions) ???? ???????(adversaries)

138
  • ?????????????????????????????????? ?????????????
    ???? the protector
  • ????????????????????????????????????????????
  • ??????????????? host personality????????????????
    ???????????????
  • host personality ?????????? ????? ???? ???
    ????????? masochistic personality traits
    ??????????????????????????????????

139
  • ??????????? secondary personality????
    subordinate personality ??????????????????????
    ???? ??????????????????????? ??????? ??????????
    ????????????????????????????? ??????????,
    ?????????, ???? ??????????
  • ????????????????????????? ?????????????????????
  • ????????????????????????????????????? (childlike
    personality)

140
  • ?????????????????????????????????????? ??????
    ???????????????????
  • ??????????????? ???? ?????????????????????????????
    ???????
  • ?????????????????? diary ?????????????? multiple
    personalities ????????????????? diary
  • ?????? 60 ??????????????????????????????????
    ?????? 20????????????????????????
    ???????????????????????????????????

141
????????(Treatment)
  • ???????????????????????? ??? insight- oriented
    psychotherapy ????????????? hypnotherapy ????
    drug-assisted interviewing technique??????????????
    ????????????????,???????(identifying)?????????????
    ???????????????, ?????????????????? abreaction
  • ????????????????????, ???????????????????
    ???????????????
  • ????????????????? ???? Carbamazepine ???????????

142
Depersonalization Disorder
  • depersonalization disorder ????????????????
    ????????????????????????(persistent)?????????????(
    recurrent) ????????????(perception)??????????????(
    self) ???????????????????(sense)
    ???????????????????????????????????

143
????????????? Depersonalization Disorder
  • A. ??????????????? ????? ???? ????????????????????
    ????? ??????????????, ????????????????????????????
    ??,????????????????(mental process) ????
    ??????????????? (???? ?????????????????????????)
  • B. ?????????????? depersonalization
    ???????????????????????????????????

144
  • C. ????? depersonalization ???????????????????????
    ?????????????????????? ???? ???????????????????
    ?????, ??????, ???? ???????????????????
  • D. ?????depersonalization ??? ????????????????????
    ???????????????????????????????? ????
    schizophrenia, panic disorder, acute stress
    disorder, ?????????????? dissociative disorders
    ????, ??? ????????????? ??????????????????????????
    (???? ?????????, ??) ???? ????????????????(????
    temporal lobe epilepsy)

145
???????????????(Clinical Features)
  • ???????????????????????????? ??????
    ??????????????????????????? ??????????????????????
    ??????????? ????????????????????????????
    ??????????????????????????????? ????
    ??????????????? ????????? ???????????????
    ?????????? ???????????????????????????????????????
    ?????

146
  • ????????? ?????????????????????????????????????
    ??????????? ???? ???????????????
  • ?? hemidepersonalization ???????????????????????
    ????????????????????????????? ???? ?????????????
    ????????????????????????? parietal lobe
    ???????????

147
  • ???????????????????????????? doubling
    ???????????????????? ?????????????? I-ness
    ??????????????????? ????????????????? 2-3 ???
  • ??????????????????????????????????????????????????
    ????????????? reduplicative paramnesia ????
    double orientation
  • ?????????????????????????????????????????????????
    sense of reality

148
????????(Treatment)
  • ?????????????? ??????????????????????? ????
    antianxiety ??????????????????? anxiety
  • Psychoanalysis ???? insight-oriented
    psychotherapy ???????????????????????????????????
    ?????????, ??????????????????????,
    ???????????????????

149
Dissociative Disorder Not OtherwiseSpecified(NOS)
  • ????????????????? dissociative symptoms
    ???????????
  • (???? ?????????????(disruption)
    ????????????????????????? ????????????, ??????,
    ????????? , ???? ????????????????????)????????????
    ????????????????dissociative disorder ??? ??????

150
  • ??????????????????? DID ?????????????????????????
    DID ???? a) ??????????????????????????????????????
    ??????? 2 ????????? b) ??????????????????????????
    ???????????????
  • ???????????? derealization ????????
    depersonalization ????????

151
  • ???? dissociation ????????????????????????????????
    ??????????(coercive persuasion)??????????? ???
    ?????? ???? ???????????(brain washing),
    ????????????????(thought reform), ????
    ??????????????????????? (indoctrination)??????????
    ???????

152
  • Dissociative trance disorder ???????????????????
    ????????????????, ?????????, ???? ??????
    ????????????????????? ???? ?????????????
    ??????????????????????????????????????????? ????
    ???????? dissocitive trance ?????????????????????
    ??????????????????????????? ????
    ??????????????????????????????????????????????????
    ????

153
  • posssesion trance ??????????? ???????????????????
    ???????????????????? ???????????????????? ??????,
    ????, ???????, ???? ?????????, ?????????????????
    ???????????????????????????????? ???? ????????
    ???? amok (Indonesia), piblokto(Arctic), ataque
    de nervios(Latin America), ??? possession(India)
    dissociative ???? trance disorders ??????
    ??????????????????????????????????????????????????
    ????????????????????????????

154
  • Loss of consciousness, stupor, ???? coma
    ???????????????? ????????????????
  • Ganser syndrome ?????????????????????????????????
    ?? (???? 225) ???????????????????? dissociative
    amnesia ???? dissociative fugue
About PowerShow.com