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1.
咨客,女性,25岁,经常感觉眼睛变小,反复为此纠结。个人情绪不稳定、易激动,在人际关系方面存在问题。在本次咨询中患者被诊断为躯体变形障碍合并边缘型人格障碍,建议采用生物-心理-社会的综合干预模式治疗。鼓励咨客规律运动,服用选择性5-羟色胺再摄取抑制剂(SSRIs)和第二代抗精神病药物联合治疗;采用辩证行为治疗(DBT)调整咨客认知、稳定情绪、改善人际技能;工作上建议选择人际压力小的工作环境,如影像学类临床辅助科室。  相似文献   

2.
本文对躯体变形障碍的咨客进行案例报告,目的是提高精神科临床工作者的临床访谈技巧、诊疗思路及治疗方案的制定。咨客17岁,未婚男性,因为对自己的相貌不满意、自卑来访。咨客在学习环境转换后,出现对外貌的过度关注,伴情绪差。咨客被诊断为躯体变形障碍。建议采用生物-心理-社会综合干预的方法,生物治疗方面,给予舍曲林联合喹硫平,改善咨客的焦虑抑郁情绪和认知。心理治疗方面,采用正念减压和认知行为治疗,帮助咨客学会放松,纠正认知偏差。社会资源方面,鼓励家属积极关注咨客的优点,加强校园内课业管理,促进咨客自信心的发展。  相似文献   

3.
咨客是一名18岁高三女生,自幼便秘,恋爱受挫后出现胸口痛、胃部不适、食物难以下咽、呼吸不畅等症状,在压力下表现明显。身体检查无异常,倾诉后可迅速缓解,但因症状反复而休学1年。咨客表现出的所有症状都曾在其奶奶身上出现过。该咨客被诊断为转换障碍,躯体症状是在心理作用及焦虑的驱使下产生的,应采用生物、心理、社会的综合干预。具体做法是鼓励咨客运动并使用药物改善焦虑与躯体症状;运用认知行为疗法(CBT)让咨客改变看待问题的角度,运用正念疗法改善强迫思维;规律作息,避免学业及人际压力。  相似文献   

4.
咨客是一名26岁大专学历的已婚未育男性,事业单位职员。从初中开始参与小额赌博,逐渐加大赌注,反复戒赌失败,目前欠下巨额赌债,严重影响工作和生活,感到内疚后悔。咨客本次咨询的目的是想了解如何才能彻底戒除赌瘾。该咨客被诊断为赌博障碍,属于物质相关及成瘾障碍,容易复发,应采用生物-心理-社会的综合干预。具体做法是鼓励咨客发展健康的爱好来激活大脑;采用认知行为疗法(CBT)让咨客直面赌博的严重后果,认识到自己作为儿子、丈夫的责任和义务;使用动机面询激发咨客为家人和未来孩子戒赌的决心;鼓励患者认真工作,回归家庭,脱离赌博圈子,按时复诊。  相似文献   

5.
本文对一例强迫及相关障碍的咨客进行了案例访谈报告,目的是提高精神科医疗工作者的临床访谈技巧和诊疗水平。一位17岁的男性咨客因难以自控地在街上抢女士的高跟鞋、引起群众恐慌而来访。他的行为极具违法的风险,警察已经多次上门问询。咨客被诊断为强迫症共病皮肤搔抓障碍,采取生物-心理-社会的整合式治疗进行干预。咨客既往使用氟西汀时造成肝功能损害,需要调整用药。运用认知行为疗法(CBT)治疗强迫症状。本案例中涉及了司法精神医学的相关知识,为临床访谈提供一定的借鉴。  相似文献   

6.
本文目的是通过报道病例诊疗全过程,呈现创伤后应激障碍(PTSD)合并酒精使用障碍的临床诊疗思路及治疗方案。咨客,男性,55岁。12岁时目睹母亲自杀的全过程,随后出现恐惧、孤独、失眠、回避谈论创伤相关话题、反复出现与创伤相关的梦境、易激惹、疼痛及酗酒等一系列情绪、认知、躯体及行为改变,并持续至今。社会功能明显受损,近1年和妻子离婚后症状加重而前来咨询。经过本次咨询,被诊断为PTSD合并酒精使用障碍。建议采用生物-心理-社会的综合干预方法,鼓励咨客进行规律运动,使用选择性5-羟色胺和去甲肾上腺素再摄取抑制剂(SNRI)及第二代抗精神病药物改善情绪、缓解疼痛;心理治疗方面,推荐延迟暴露疗法和认知调整;社会资源方面,在症状缓解后,鼓励咨客积极寻找工作,创造挽回其前妻的可能性。  相似文献   

7.
本文目的是通过报道病例诊疗过程,呈现智力发育障碍共病盗窃狂、注意缺陷/多动障碍的临床诊疗思路及治疗方案。咨客为一名27岁未婚男性,自幼愚笨,难以集中注意力,伴有反复偷窃女性衣物的冲动行为。该咨客被诊断为智力发育障碍共病偷盗狂、注意缺陷/多动障碍。建议采用生物-心理-社会综合干预方法,鼓励咨客进行规律运动,以药物治疗改善偷窃的冲动行为和注意力缺陷;心理治疗推荐认知行为治疗;社会资源方面,鼓励咨客进行简单的工作,财务交由家属代为管理。  相似文献   

8.
本文目的是呈现一例嗜睡障碍共病抽动障碍的临床诊疗思路及治疗方案的制定。咨客15岁,女性,高一年级学生,自幼存在频繁眨眼、歪嘴,诊断为抽动障碍,学习成绩一贯良好。自2020年新冠肺炎疫情以来,该咨客出现睡眠增多,平均每天睡眠12小时,伴日间睡眠增加,醒后疲惫乏力,学习成绩明显下降,被老师和家长多次批评,认为其学习态度不端正。咨客被诊断为嗜睡障碍共病持续性(慢性)运动或发声抽动障碍。建议采用生物-心理-社会综合干预的方法,生物治疗给予盐酸哌甲酯缓释片提高患者的觉醒程度,增强注意力,改善嗜睡的同时监测抽动症状的变化。心理治疗采用认知行为治疗,帮助患者纠正认知偏差,重塑认知结构,树立康复信心。采用正念治疗,帮助咨客调整情绪。社会资源方面,鼓励咨客积极探索资源,寻求社会支持,构建治疗联盟。在各方资源协调运行下,减少嗜睡症状,增强适应能力,继续完成学业。  相似文献   

9.
咨客是一名30岁左右的已婚女性,研究生学历。两年前第一次怀孕,孕8周时发生胎停育。一年前再次怀孕,但孕9周时再次胎停育。在此期间,咨客对怀孕的事情感到非常焦虑,反复去医院检查,几乎每日以泪洗面。两次怀孕失败后,咨客非常消沉,有自杀观念,睡眠质量也很差。她的丈夫在这段时间被查出心脏有问题。经过家人和病友开导,半年后逐渐好转。两个多月前,咨客第三次怀孕,孕9周时再次发生胎停育。咨客重新陷入之前的焦虑和抑郁状态,同时,她也开始隐隐地担心丈夫的健康状况。虽然她知道心脏疾病与怀孕之间并无明确联系,但仍然难以控制自己的情绪。经过治疗,她被诊断为适应障碍伴焦虑和抑郁心境,并给予认知行为治疗和焦点解决短程治疗。值得一提的是,医生将这件事重新定义,告知咨客并非"运气不好"或者自身有过错,这使得咨客感觉好多了。根据咨客的病史,医生建议她在尝试再次怀孕之前先明确是否有其他医学原因导致流产。咨客逐渐认识到,她对丈夫的担心以及自责感都是毫无根据的,因为丈夫目前的情况不会威胁生命,也并非她怀孕所致。  相似文献   

10.
本文目的是通过报道病例诊疗过程,呈现口吃共病强迫症的临床诊疗思路及治疗方案的制定。咨客是一位23岁的未婚男性,自幼口吃,在应激和焦虑状态下加重,影响工作和社交。咨客自高中二年级开始时出现反复数钱、反复计算的行为,被诊断为强迫症,予以SSRIs类药物联合第二代抗精神病药物治疗,强迫思维和强迫行为得到改善,但出现嗜睡、情绪烦躁等,减少思瑞康剂量后,出现失眠,焦虑加重影响口吃,伴有心慌、紧张、进食后腹泻等。咨客被诊断为口吃共病强迫症,建议采用生物-心理-社会综合干预方法,通过积极运动缓解压力,继续服用百忧解,降低思瑞康剂量,减轻嗜睡,予以β-受体阻断剂普萘洛尔弥补思瑞康减量带来的焦虑。心理治疗推荐认知行为治疗和正念减压;社会学方面,继续从事会计等人际交往较少的工作。  相似文献   

11.
1 病史简介 患者,男,34岁,工人,已婚。因反复烦躁不安、情绪低落发作19年,于2011年5月26日第1次住我院。患者于1992年读初中二年级时与同学打架后,对老师的处理方式不满,渐出现不愿意读书,眠差,情绪不稳定,烦躁,之后出现情绪低落,注意力不易集中,记忆力下降,兴趣减退,自1992年起休学。  相似文献   

12.
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15.
Objective: Anxiety disorders such as posttraumatic stress disorder (PTSD) and substance use disorders (SUD) are increasingly recognized as comorbid disorders in children with bipolar disorder (BPD). This study explores the relationship between BPD, PTSD, and SUD in a cohort of BPD and non‐BPD adolescents. Methods: We studied 105 adolescents with BPD and 98 non‐mood‐disordered adolescent controls. Psychiatric assessments were made using the Kiddie Schedule for Affective Disorders and Schizophrenia–Epidemiologic Version (KSADS‐E), or Structured Clinical Interview for DSM‐IV (SCID) if 18 years or older. SUD was assessed by KSADS Substance Use module for subjects under 18 years, or SCID module for SUD if age 18 or older. Results: Nine (8%) BPD subjects endorsed PTSD and nine (8%) BPD subjects endorsed subthreshold PTSD compared to one (1%) control subject endorsing full PTSD and two (2%) controls endorsing subthreshold PTSD. Within BPD subjects endorsing PTSD, seven (39%) met criteria for SUD. Significantly more SUD was reported with full PTSD than with subthreshold PTSD (χ2 = 5.58, p = 0.02) or no PTSD (χ2 = 6.45, p = 0.01). Within SUD, the order of onset was BPD, PTSD, and SUD in three cases, while in two cases the order was PTSD, BPD, SUD. The remaining two cases experienced coincident onset of BPD and SUD, which then led to trauma, after which they developed PTSD and worsening SUD. Conclusion: An increased rate of PTSD was found in adolescents with BPD. Subjects with both PTSD and BPD developed significantly more subsequent SUD, with BPD, PTSD, then SUD being the most common order of onset. Follow‐up studies need to be conducted to elucidate the course and causal relationship of BPD, PTSD and SUD.  相似文献   

16.
Personality disorders (PDs) and substance use disorders (SUDs) frequently co-occur in both the general population and in clinical settings. Literature is reviewed documenting high comorbidity between these two classes of disorders, possible mechanisms of comorbidity, and the clinical implications of this comorbidity. Special emphasis is given to antisocial personality disorder (ASPD) and borderline personality disorder (BPD) as these disorders not only co-occur frequently with SUDs in the clinical populations and present clinical challenges, but also because recent research points to etiologic processes that are common to these specific PDs and SUDs. Although most attention on comorbidity between PDs and SUDs has focused on ASPD and BPD, it is also clear that other PDs (in particular, avoidant PD and paranoid PD) are prevalent among those suffering from SUDs.  相似文献   

17.

概述

在双相障碍患者中强迫症状是常见的。因为双相障碍和强迫症的共病状态会令这两种障碍的临床治疗复杂化,所以确定这些共病的患者是很重要的。我们讨论了强迫症和双相障碍的共病,介绍了可能导致这种常见共病状态的发病机制,也讨论了该领域最新的研究进展,并提出一些管理这些患者的临床原则。

中文全文

本文全文中文版从2015年10月26日起在http://dx.doi.org/10.11919/j.issn.1002-0829.215009可供免费阅览下载 Previous studies have documented high rates of comorbidity of other psychiatric conditions among individuals with bipolar disorders (BD).[1] One study estimated that obsessive-compulsive disorders (OCD) accounted for 21% of all comorbidities in BD.[2] There is continuing debate about whether (a) these are two independent conditions that can co-occur or (b) OCD is a specific subtype of BD. Regardless of the interrelationship of the two conditions, the comorbid occurrence of these two types of symptoms can cause a clinical dilemma because selective serotonin reuptake inhibitors (SSRIs)-which are quite commonly used to treat OCD-increases the risk of precipitating manic symptoms.[3,4,5,6] The OCD symptoms that occur in individuals with BD often occur during the depressive episodes or during the intervals between episodes of depressive or manic symptoms.[7,8] This timing of OCD symptoms during BD is consistent with the cyclic nature of BD and suggests shared biological mechanisms between the two disorders. In support of this hypothesis, a study using Positron Emission Tomography (PET) found that in untreated persons with BD the serotonin-transporter binding potential in the insular and dorsal cingulate cortex was higher among BD patients with pathological obsessions and compulsions than among BD patients without such symptoms.[9] Moreover, a linkage study found that compared to OCD patients without comorbid BD, patients with comorbid OCD and BD were more likely to have a family history of mood disorders but less likely to have a family history of OCD.[10] However, another study found no significant difference in the rates of a positive family history of OCD between patients with OCD alone and those with comorbid OCD and BD.[11] Further support for the hypothesized common etiology comes from a preliminary molecular genetic study which found that hyperpolarization activated cyclic nucleotide-gated channel 4 (HCN4) is a common susceptible locus for both mood disorders and OCD, but further studies with larger sample sizes are needed to replicate this finding.[12] The presence of OCD in BD complicates the clinical presentation. Compared to patients with BD without comorbid OCD, those that have comorbid BD and OCD often have a more severe form of BD, have more prolonged episodes, are less adherent to medication, and are less responsive to medication. Recent studies about comorbid BD and OCD have reported the following: (a) Temporal relationship. Some studies suggest that OCD is an antecedent of BD,[10] but others report concurrent onset of OCD and BD.[13,14] (b) Course of disease. In 44% of patients with comorbid BD and OCD the episodes are cyclic.[15] The course of disease is more chronic among BD patients with OCD compared to those without comorbid OCD.[16,17] OCD is more commonly observed in patients with Type II BD, among whom the prevalence of OCD has been reported to be as high as 75%.[18] (c) Compulsive behaviors. The most commonly reported compulsions among patients with comorbid OCD and BD are compulsive sorting,[14,19,20,21] controlling or checking, [20] repeating behaviors,[13,22] excessive washing,[20] and counting.[19] Obsessive reassurance-seeking is also commonly reported in these patients.[23] In children and adolescents with BD, compulsive hoarding, impulsiveness,[24] and sorting[25] are more common. (d) Substance and alcohol abuse. A study found a higher prevalence of sedative, nicotine, alcohol, and caffeine use among individuals with comorbid OCD and BD compared to those with BD without OCD.[14] Similarly, compared to OCD patients without comorbid mood disorders, those with a comorbid mood disorder were more likely to have a substance abuse diagnosis (OR=3.18, 95%CI=1.81-5.58) or alcohol abuse diagnosis (OR=2.21, 95%CI=1.34-3.65).[11,13,26,27,28] (e) Suicidal behaviors. Compared to BD patients without OCD, a greater proportion of patients with both disorders had a lifetime history of suicidal ideation and suicide attempts.[2,11,13,29,30] The clinical management of comorbid OCD and BD requires first focusing on stabilizing the patient’s mood, which requires the combined use of multiple medications such as the use of lithium with anticonvulsants or atypical antipsychotic medications such as quetiapine;[31,32,33] adjunctive treatment with aripiprazole may be effective for the comorbid OCD symptoms.[4] In the case of OCD comorbid with type II BD, after full treatment of the mood symptoms with mood stabilizers the clinician can, while monitoring for potential drug interactions, cautiously try adjunctive treatment with antidepressants that are effective for both depressive symptoms and OCD symptoms and that have a low risk of inducing a full manic episode, including the selective serotonin reuptake inhibitors (SSRIs): fluoxetine, fluvoxamine, paroxetine, and sertraline.[32,35] In summary, BD comorbid with OCD may be etiologically distinct from either of the disorders. Clinicians should pay attention to its complex clinical manifestations and carefully consider the treatment principles outlined above.  相似文献   

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Thought disorder in attention-deficit hyperactivity disorder   总被引:4,自引:0,他引:4  
OBJECTIVE: This study compared thought disorder and associated cognitive variables in attention-deficit hyperactivity disorder (ADHD) and schizophrenia. METHOD: Speech samples of 115 ADHD, 88 schizophrenic, and 190 normal children, aged 8 to 15 years, were coded for thought disorder. A structured psychiatric interview, the WISC-R, the Continuous Performance Test, and the Span of Apprehension task were administered to each child. RESULTS: The ADHD and schizophrenic groups had thought disorder compared with the normal children. However, the subjects with ADHD had a narrower range of less severe thought disorder than did the schizophrenic subjects. The younger children with ADHD and schizophrenia had significantly more thought disorder than did the older children with these diagnoses. IQ, attention, and working memory were associated with thought disorder in the ADHD but not the schizophrenic group. CONCLUSIONS: Thought disorder in childhood is not specific to schizophrenia and reflects impaired development of children's communication skills.  相似文献   

20.
Comorbid oppositional defiant disorder (ODD) and conduct disorder (CD) are common in clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Early recognition and treatment of co-occurring ADHD and ODD and/or CD is important because comorbidity influences symptom severity, prognosis, and treatment. Research on treatment supports the importance of behavior therapies for ODD and multimodal psychosocial interventions delivered simultaneously and intensively for CD with adjunctive medication for ADHD symptoms. Clinical trials are beginning to show that stimulants and atomoxetine are effective for ADHD and ODD symptoms when the disorders occur together. It is presently unclear if ODD in the absence of ADHD responds to pharmacotherapy. More research is needed examining the effects of commonly prescribed ADHD medications on CD symptoms. Research suggests a high prevalence of lifetime comorbidity with ODD in clinically referred patients with ADHD.  相似文献   

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