器质性精神障碍英文培训课件.ppt

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1、器质性精神障碍英文,器质性精神障碍英文,Introduction-Definition,Organic Mental Disorders: The term is used to denote psychiatric disorders that arise from demonstrable biological etiology. It includes brain organic mental disorder and mental disorder caused by physical diseases.,2,器质性精神障碍英文,Introduction-DefinitionOrgan

2、,IntroductionClassification,A. Mental Disorders due to Brain DiseasesB. Mental Disorders due to Physical Diseases,3,器质性精神障碍英文,IntroductionClassification3器质,Mental Disorders due to Brain Diseases,Degenerative brain diseasesCerebro-vascular diseasesIntracranial infectionBrain damageMalignancies of CNS

3、,4,器质性精神障碍英文,Mental Disorders due to Brain,Mental Disorders due to Brain Diseases,Feature: there is demonstrable structural and pathologic change in the brain . The psychiatric disorders arise from these changes.,5,器质性精神障碍英文,Mental Disorders due to Brain,Mental Disorders due to Physical Diseases,Men

4、tal disorders arise from brain dysfunction which is clearly caused by disease outside the brain.,6,器质性精神障碍英文,Mental Disorders due to Physic,Mental Disorders due to Physical Diseases,Feature: brain dysfunction, shows some atypically pathological change such as congestion, dropsy, etc. Mental disorder

5、s is one of symptoms of physical diseases.,7,器质性精神障碍英文,Mental Disorders due to Physi,Historical background,Past history: Kraepelin showed that the different physiological causes contribute to the specificity clinical manifestation. Bonhoeffer showed that physiological causes of any kind contribute t

6、o a few syndromes of common clinical characteristics.,8,器质性精神障碍英文,Historical background Past h,Historical background,Present history：The correspondence between biological etiology and clinical features is ambiguous, which means that the different physiological causes contribute to the similar clinic

7、al manifestation, and different manifestations may result from the same causes.,9,器质性精神障碍英文,Historical background Present,Aspect of diferential diagnosis,1. It is whether the syndrome is acute or chronic.2. It is whether the impairment of psychological function is general or local.3. It is whether t

8、he underlying dysfunction of the brain is general or local.4.Constitution Age Previous experience Personality.,10,器质性精神障碍英文,Aspect of diferential diagnosi,Acute generalized psychological impairment-DeliriumChronic generalized psychological impairment-DementiaSpecific psychological impairment -impair

9、ment of memory, thinking, perception, personality, or mood.,Aspect of diferential diagnosis,11,器质性精神障碍英文,Acute generalized psychologica,Diagnoses of organic mental disorders,Method of diagnosis : 1)To collect clinical data objectively and accurately by history taking and mental examination. To take

10、basic laboratory exmination. 2) Further investigation: X-rays, CT, MRI, DSA, SPECT, EEG.,12,器质性精神障碍英文,Diagnoses of organic mental di,Diagnose of organic mental disorders,3) Psychological test:Wechsler Adult Intelligence Scale(WAIS), Wisconsin Card Sorting Test, HR (神经心理成套测验)MMPI（明尼苏达多相人格测定） EPQ（艾森克人

11、格测定） MMSE（简明智能检查）,13,器质性精神障碍英文,Diagnose of organic mental dis,Diagnoses of organic mental disorders,Functional or Organic Acute Chronic Widespread Limited,14,器质性精神障碍英文,Diagnoses of organic mental d,Treatment of organic mental disorders,Management of physical causes and control of the psychiatric sym

12、ptoms.,15,器质性精神障碍英文,Treatment of organic mental di,Syndrome,综合征,16,器质性精神障碍英文,Syndrome综合征16器质性精神障碍英文,Delirium（谵妄综合征),1.Definition: The syndrome is characterized by impairment of consciousness. It is one of the common symptoms of systematic diseases. 2.Epidemiology :Occurring in about 5 to 15 percent

13、of patients in general medical or surgical wards,and 20 to 30 percent of patients in surgical intensive care units.,17,器质性精神障碍英文,Delirium（谵妄综合征)1.Definition: T,Delirium（谵妄综合征),3.Aetiology: The main causes of the delirium are shown in the book of page 53. The condition appears particularly in associa

14、tion with: increasing age; anxiety; sensory under-or overstimulation; drug dependence;and brain damage of any kind. Previous experience and personality influences the clinical picture.,18,器质性精神障碍英文,Delirium（谵妄综合征)3.Aetiology: Th,Delirium（谵妄综合征),4.Pathomechanism：It shows acute , generalized metabolic

15、 disorder in the brain. It has no pathological change of nerve cell in brain .5.Clinical features: 1)The most important feature is impairment of consciousness and tends to fluctuate during the course of the day,19,器质性精神障碍英文,Delirium（谵妄综合征)4.Pathomechanis,Delirium（谵妄综合征),Reduced clarity of awareness

16、of the enviroment1) With reduced ability to focus ,sustain,or shift attention. Change in cognition(such as memory deficit ,disorientation.) 2) Perception disorders (知觉障碍) 3) Thought disorders (思维障碍),20,器质性精神障碍英文,Delirium（谵妄综合征) Reduced clari,Delirium（谵妄综合征),4） Memory disorders (记忆障碍)5） Affective dis

17、orders (情感障碍)6） Psychomotor disorders (精神运动障碍)7）Involuntary movement(不自主运动)8） Functional disorder of autonomic nerve(植物神经功能紊乱),21,器质性精神障碍英文,Delirium（谵妄综合征)4） Memory disor,Delirium（谵妄综合征),6.Course and Prognosis of disease (病程与预后)： Generally,prognosis of the disease is good. Course of disease generall

18、y lasts a few hours, a few days,or one month.Death of the patient probably occurs.,22,器质性精神障碍英文,Delirium（谵妄综合征)6.Course and Pr,Delirium（谵妄综合征),7.Diagnosis and differential diagnosis： 1) Whether the patient suffer from delirium. 2) To identify the cause of delirium. 3) To distinguish between delirium

19、 and psychogenic disorders.,23,器质性精神障碍英文,Delirium（谵妄综合征)7.Diagnosis and,Diagnostic Criteria,A.Disturbance of consciousness(ie,reduced clarity of awareness of the enviroment) with reduced ability to focus ,sustain,or shift attentionB.Change in cognition(such as memory deficit ,disorientation,language

20、 disturbance) or development of a perceptual disturbance that is not better accounted for by a pre- existing,established ,or evolving dementia,24,器质性精神障碍英文,Diagnostic Criteria A.Distur,Diagnostic Criteria,C.The distrubance develops over a short period of time (usually hours to days) and tends to flu

21、ctuate during the course of the day,25,器质性精神障碍英文,Diagnostic CriteriaC.The distr,Delirium （谵妄综合征),8. Treatment (治疗)： The basic treatment for these disorders includes management of physical causes and control of the psychiatric symptoms.,26,器质性精神障碍英文,Delirium （谵妄综合征)8. Treatment (,Dementia (痴呆),1.Defi

22、nition: The syndrome are characterized by generalized impairment of intellect, memory, and personality, with no impairment of consciousness. It is an acquired disorder, distincting from amentia which is present from birth.,27,器质性精神障碍英文,Dementia (痴呆) 1.Definition:,Dementia (痴呆),2.Epidemiology: Most c

23、ases occur in the old people（65）Over 65 year：4 % 7%Over 80 year：20 % 30%Incidence：1%,28,器质性精神障碍英文,Dementia (痴呆)2.Epidemiology: M,Dementia (痴呆),3.Aetiology ：It has many causes. The main causes are listed in table 5-1 in the textbook. The common causes are: Alzhermer,s Disease 50 % 70% Multi-infarct D

24、ementia 10% Alcohol Dementia 10%,29,器质性精神障碍英文,Dementia (痴呆)3.Aetiology ：It h,Dementia (痴呆),4.Clinical features ： In the early stage： 1）impairment of recent memory 2）Difficulty in new knowledge learning 3）negative psychic reaction 4）personality changing,30,器质性精神障碍英文,Dementia (痴呆)4.Clinical featur,器质性

25、精神障碍英文培训课件,Dementia(痴呆),3）Hallucination(幻觉)、Delusions(妄想); Mood disorder(情绪障碍） 4)Behaviour disorder (行为异常) ： muddled; inappropriate, distractable, and restless.,32,器质性精神障碍英文,Dementia(痴呆)3）Hallucination(幻觉,Dementia (痴呆),In later stage:1）The memory worsens.2）Disability of care for themselves. 3）Thinki

26、ng grossly fragmented and incoherent,-meaningless noises or mute.4) Incontinent of urine and faeces.5) System failure leads to death.,33,器质性精神障碍英文,Dementia (痴呆)In later stage:33,Dementia (痴呆),5. Diagnosis (诊断)：1）Final diagnosis：according to clinic feature and results of intellectual test.2）To identi

27、fy the cause of dementia: clinic feature, CT, MRI, and further laboratory investigation.,34,器质性精神障碍英文,Dementia (痴呆)5. Diagnosis (诊断),Diagnostic Criteria,The development of multiple cognitive deficits manifested by both of the following1.Memory , perceptivity, judgement, calculate ability). 2.At leas

28、t one of the following cognitive disturbances: A.Aphonia失语(language disturbance),35,器质性精神障碍英文,Diagnostic CriteriaThe develop,Diagnostic Criteria,B.Apraxia失用(inability to carry out motor activities despite intact sensory function)C.Agnosia失认(failure to recognize or identify objects despite intact sen

29、sory function)D. Disturbance in executive functioning(Ie,planning, organizing, sequencing, abstracting.,36,器质性精神障碍英文,Diagnostic CriteriaB.Apraxia失用,痴呆(Dementia),6. Differential Diagnosis (鉴别诊断)： 1）Decrease of memory in normal aging 2）Depression 3) Delirium,37,器质性精神障碍英文,痴呆(Dementia)6. Differential Di

30、,Dementia(痴呆),7、Management of dementia(治疗)： The plan of treatment should seek to improve functional ability as far as possible. drugs: calmative, anti-psychotic drug, etc. behavioural methods.,38,器质性精神障碍英文,Dementia(痴呆)7、Management of de,Organic amnestic syndrome(Korsakoff syndrome),1.Definition: It

31、is characterized by a prominent disorder of recent memory and by disordered time-sense, in the absence of generalized intellectual impairment.2.Aetiology and pathology: Alcohol abuse, the most common cause, seems to act by causing a deficiency of thiamine.,39,器质性精神障碍英文,Organic amnestic syndrome(Kors

32、,Organic amnestic syndrome(Korsakoff syndrome),2.Aetiology and pathology: At post mortem such cases generally have haemorrhagic lesions in the mamillary bodies, hippocamp, and parts of certain thalamic nuclei.,40,器质性精神障碍英文,Organic amnestic syndrome(Kors,Organic amnestic syndrome(Korsakoff syndrome),

33、3.Clinical features: It is a profound impairment of recent memory. New learning is grossly defective, but remote memory is relatively preserved. Gaps in memory are often filled by confabulating. Other cognitive function are relatively well preserved.,41,器质性精神障碍英文,Organic amnestic syndrome(Kors,Organ

34、ic amnestic syndrome(Korsakoff syndrome),4.Diagnosis: according to symptom.The diagnosis of amnestic syndrome tends to be made wrongly in cases that are really alcoholic dementia and dementia by other cause.,42,器质性精神障碍英文,Organic amnestic syndrome(Kors,Organic amnestic syndrome(Korsakoff syndrome),6.

35、Course and prognosis: (245) 17% death rate in the acute stage. 84%-a typical amnesic syndrome-impairment of memory continue lifetime.,43,器质性精神障碍英文,Organic amnestic syndrome(Kors,Others,Organic delusional syndrome Organic personality syndrome(change)Organic depressive/manic syndromeOrganic anxiety syndromeOrganic catatonic syndrome,44,器质性精神障碍英文,OthersOrganic delusional syn,谢谢,45,器质性精神障碍英文,谢谢45器质性精神障碍英文,