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1.
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   

2.
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   

3.
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   

4.
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   

5.
本文目的是通过报道病例诊疗过程,呈现依赖型人格障碍共病持续性抑郁障碍的临床诊疗思路及治疗方案的制定。咨客为一名17岁的未婚男性,父母溺爱且凡事包办,咨客不能独立生活,人际交往困难,生活懒散被动,情绪低落伴自伤行为,沉迷游戏,部分言语脱离现实,学业和日常生活明显受损。经本次咨询,咨客被诊断为依赖型人格障碍共病持续性抑郁障碍。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,使用哌甲酯缓释片作为SSRIs类药物草酸艾司西酞普兰的增效剂改善情绪和注意力,提高动力;心理治疗推荐认知行为治疗;社会资源,继续休学一段时间,待独立生活能力和社交功能进一步改善后再恢复学业,为将来谋生做准备。  相似文献   

6.
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   

7.
44岁男性咨客是一名本科学历的教师,胞八行末,从小受家人照顾。近两年由于得罪领导,工作不顺,导致失眠、抵触工作;又因母亲自杀身亡而失眠加重,内疚、自责。咨客有着一贯的人际关系模式,即与低级别者关系良好,如儿子、学生;但难以与同级别、高级别者相处,如妻子、同事、领导。该咨客被诊断为适应障碍伴焦虑与C组人格特质,应采用生物、心理、社会的综合干预。具体做法是鼓励运动,使用米氮平改善症状;使用认知行为疗法(CBT)及人际关系疗法改善认知、减轻压力、学习人际交往策略;积极争取调动工作岗位。  相似文献   

8.
本文目的是通过报道病例诊疗过程,呈现边缘型人格障碍伴转换症状的临床诊疗思路及治疗方案的制定。咨客为一名46岁的女性,因长期无法与人建立亲密关系,常感到空虚、孤独,遇事容易出现多汗、头晕、心慌、胸闷、呼吸困难等症状。经本次咨询,被诊断为边缘型人格障碍伴转换症状。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,并使用β受体阻滞剂普萘洛尔改善转换症状;心理治疗推荐辩证行为治疗(DBT);社会资源方面,鼓励咨客先助己后助人,且工作方向定位在大众一般心理保健。  相似文献   

9.
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   

10.
一名45岁女性咨客几乎没有亲密的朋友。她认为身边亲人虐待自己、想侵占自己的财产,认为自己遭受了不公平对待;曾在遭受情感挫折时有过短暂幻听,两次在半睡半醒时有过短暂幻视;相信前世今生、潜意识催眠;感到"从潜意识中排出了深海生物,全身换血获得新生";与婆婆生气后感到肚子里充满气体。该咨客被诊断为分裂型人格障碍,应采用生物-心理-社会的综合干预。具体做法是鼓励咨客进行运动,使用认知行为疗法(CBT)及正念疗法改善认知、减轻压力,学习应对策略,避免工作压力及复杂人际关系。  相似文献   

11.
《L'Encéphale》2016,42(3):281-283
IntroductionAripiprazole, an atypical or second-generation antipsychotic, is usually well tolerated. It is an approved treatment for schizophrenia and mania in bipolar disorder type 1. Unlike the other antipsychotics, it has high affinity agonist properties for dopamine D2 and D3 receptors. It has also 5-HT1A partial agonist and 5-HT2A antagonist properties. Aripiprazole is a first or second line treatment frequently used because it has reduced side effects such as weight gain, sleepiness, dyslipidemia, insulin resistance, hyperprolactinemia and extrapyramidal symptoms.Case-reportWe report the case of a 28-year-old male patient diagnosed with schizoid personality disorder. He was a moderate smoker with occasional social gambling habits. After several psychotic episodes, he was first treated with risperidone, but he experienced excessive sedation, decreased libido, erectile dysfunction and was switched to 15 mg aripiprazole. He developed an addiction habit for gambling at casino slot machines. Due to large gambling debts, he requested placement on a voluntary self-exclusion list. Thereafter, he turned his attention towards scratch card gambling. The patient described his experience of gambling as a “hypnotic state”. He got several personal loans to obtain money to continue gambling. He was then referred to an addiction unit. Before being treated with aripiprazole, he was an exclusive heterosexual with a poor sexual activity. Under treatment, he switched to a homosexual behavior with hypersexuality, unprotected sex and sadomasochistic practices. The craving for gambling and compulsive sexual behavior ceased two weeks after aripiprazole was discontinued and he was switched to amisulpride. Thereafter, he reported a return to a heterosexual orientation.DiscussionCompulsive behaviors such as gambling, hypersexuality and new sexual orientation are common in patients with Parkinson's disease treated with dopaminergic agonists. These behaviors involve the reward system, with an enhanced dopaminergic activity in the mesolimbic pathways and occur more frequently in young subjects, males with previous gambling habits and tobacco use. A few cases of aripiprazole-induced pathological gambling as well as aripiprazole-induced hypersexuality have been reported. To our knowledge, we are the first to report a case of gambling disorder associated with hypersexuality and change of sexuality orientation. Aripiprazole is the only antipsychotic with agonist properties for the D2 dopamine receptor. It may also act as an enhancer in the mesolimbic dopaminergic pathways. Aripiprazole also has 5-HT1A partial agonist and 5-HT2A antagonist properties that may promote sexual activity.ConclusionAripiprazole is an antipsychotic associated with reduced side effects compared to other antipsychotics. We report the case of a patient who experienced gambling disorder, hypersexuality and a new sexual orientation under treatment. These side effects are little known. They are usually difficult for patients to mention due to feelings of guilt. The consequences on social life, family and health may be serious. Clinicians and patients should be aware about the possible issue of these behavior disorders with aripiprazole.  相似文献   

12.
为了提高广大精神心理科医务工作者的临床访谈及诊断技能,本文对一例较特殊的合并了两种强迫谱系障碍的患者进行了案例访谈报告。这是一位27岁的男性患者,执着于练习弹钢琴十几年,仪式化的行为与执着让患者不能正常工作,成为大家眼中的怪人。离职后逐渐开始关注排便问题,纠结于便秘、腹胀等感受问题,总认为自己患有肛肠疾病,开始反复检查就诊。在检查无明显异常的情况下,反复要求行手术治疗四次以解决肛肠问题,结果越治越难受。本案例患者被诊断为强迫症共病疾病焦虑障碍,需要采取生物-心理-社会的综合治疗。调整以往用药,加强运动,调整饮食结构。施行强迫症一线治疗方案,焦虑缓解后进行认知行为疗法(CBT)来改善自我认知,减轻心理压力。今后工作中放弃不切实际的想法,学习应对策略,合理安排工作和生活。  相似文献   

13.
We report a 68-year-old man with progressive speech disturbance and dementia. He was well until 1995, when he noted an onset of difficulty in speech. He was able to name simple objects and understand language, however, he showed great difficulty in spontaneous speech. In 1998, he visited our service. He was alert and oriented, but he showed moderate degree of dementia. He did not appear to have aphasia but he showed marked dysarthria and slurred speech. He showed limb-kinetic apraxia in his right hand. He showed moderate restriction in his vertical gaze, masked face, and dysphagia. He walked normally. No rigidity, ataxia, or abnormal involuntary movement was noted. He showed grasp response and he was bradykinetic. He was treated with levodopa without effect. His condition deteriorated slowly and he was admitted to our service because of fever on February 13, 1999. He was alert but almost mute. He was unable to look upward or downward. Oculocephalic response was preserved. Axial rigidity was noted but no limb rigidity was present. He walked with small steps. Retropulsion was present. Deep tendon reflexes were diminished and the plantar response was flexor bilaterally. Laboratory examinations were unremarkable and his fever went down within a few days by supportive treatment. He was discharged to his home, where his condition deteriorated further. He developed cardiopulmonary arrest on May 3, 1999 and was brought into ER again. Cardiopulmonary resuscitation was unsuccessful and he was pronounced dead at 7:30 in the morning on the same day. The patient was discussed in a neurological CPC. The chief discussant arrived at the conclusion that this patient had corticobasal degeneration. But he felt that the differential diagnosis from atypical progressive supranuclear palsy, in which cortical pathology and symptoms predominated as in corticobasal degeneration, would be extremely difficult. Most of the participants felt that this patient had corticobasal degeneration, but a few thought that he had atypical PSP. Post-mortem examination revealed asymmetric cortical atrophy, which was accentuated in the left motor cortical area. Microscopic examination of the precentral cortex revealed neuronal loss and gliosis. Ballooned neurons and astrocytic plaques were also seen. The substantia nigra showed marked neuronal loss. Neuropil threads were observed in the nigra. Those threads were positive for anti-tau immunohistochemistry. The internal segment of the globus pallidus, the subthalamic nucleus, and the cerebellar dentate nucleus showed mild to moderate neuronal loss. A few neurofibrillary tangle-positive neurons were seen in these structures. Neuropil threads were also seen throughout. Pathologic changes were consistent with the diagnosis of corticobasal degeneration. One of the participants pointed out that he was able to walk at the time when he was showing marked speech disturbance and limb-kinetic apraxia, which was rather unusual for PSP suggesting corticobasal degeneration.  相似文献   

14.
Vincent Van Gogh is one of the most celebrated creative artists of all time. All his life, he was afflicted by some kind of neurological or psychiatric disorder, which remains a mystery even today. Many historians and his personal physicians believe that he suffered from epilepsy while others felt that he was affected by Ménière''s disease. Features such as hypergraphia, atypical sexuality, and viscosity of thinking suggest the possibility of Gastaut-Geschwind phenomenon, a known complication of complex partial seizure. On the contrary, some historians feel that he was forced to sever his right ear in order to get relief from troublesome tinnitus, a complication of Ménière''s disease. He was addicted to the liquor absinthe, which is known to lead to xanthopsia, and many authorities argue that this was the reason for his penchant for the deep and bright yellow color in many of his paintings. Others have suggested the possibility of bipolar disorder, sunstroke, acute intermittent porphyria, and digitalis toxicity as well.  相似文献   

15.
We report a 65-year-old man with rigid-bradykinetic parkinsonism, vertical gaze palsy, difficulty in eye-lid opening, and marked pseudo-bulbar palsy. He felt difficulty of it, hand movement at 59 years old. When he was 60 years old, monotonous speech and slowness of movement appeared. He visited a neurologist who noted vertical gaze palsy, neck rigidity, and bradykinesia. He was diagnosed as progressive supranuclear palsy (PSP) and given 300 mg L-Dopa/Benserazide by the neurologist. This medication improved his rigidity and bradykinesia. At 62 years of the age, his eye-lids closed involuntary and it was difficult to open. In addition, he began to complain of wearing-off, autonomic symptoms, and dysphagia. Anti-parkinsonian drugs were increased, but his bradykinesia progressed. At 64 years of the age, he was admitted to the Neurology Service of Juntendo Hospital. On admission, he was alert and not demented. No aphasia, apraxia, or agnosia was noted. In the cranial nerves, upward and downward gaze were markedly restricted. His face was hypomimic and seborrhoic. It was difficult to swallow liquid or solid for him. No weakness was noted, but he walked in small steps with freezing and falling tendency to backward. Rigidity was noted on his extremities and stronger on his left side than right. Tremor was absent. Bradykinesia of his body and extremities was marked. No cerebellar ataxia was noted. Deep tendon reflexes were within normal range. Planter response was flexor bilaterally. Myerson's sign was noted. Sensory and autonomic function were normal. He was treated with L-Dopa, Pergolide, and Bromocriptine. However, these medications improved his bradykinesia and gait disturbance only slightly, dysphagia became progressively worse. He developed aspiration pneumonia when he was 65 years old and admitted to Juntendo Hospital. A large amount of sputum was aspirated from his trachea. Two days after from admission, he was found dead on his bed. He was discussed in a neurological CPC and the chief discussant arrived at a conclusion that the patient had progressive supranuclear palsy (PSP). Other differential diagnoses included Parkinson's disease, pallido-nigroluysian atrophy (PNLA), multiple system atrophy (MSA), and corticobasal degeneration(CBD). Many participants considered that PSP or PNLA was most likely. Post-mortem exmination revealed marked nigral neuronal loss and gliosis. The globus pallidus and the luysian body changed mildly. However, the frontal cortex was relatively spared, there were many ballooned neurons in the cortical layer. Other parts were spared. With sliver (Bodian and Gallyas-Braak) and anti-phsphorylated tau stain, abundant astrocytic plaques, neurofibrillary tangles, and argyrophilic threads on the frontal cortex, striatum, and substantia nigra were seen. There was no tufted astrocyte which was hallmark of diagnosis of PSP. In addition, several Lewy bodies were seen in the brainstem. Because astrocyte plaque was considered specific for pathology of CBD, the pathologist revealed that the pathological diagnosis of this patient was CBD. Nevertheless, discussion was focused on the relatively mild degeneration of the frontal cortex for CBD.  相似文献   

16.

Objectives

Following an aggressive situation, can the aggressors, as for the victims, suffer from a traumatic breakdown. As Military Psychiatrists, we have met veteran military murderers. All these patients present with a state of Post-Traumatic Stress Disorder with either severe alcoholism or severe depression (melancholy). We also compared the effects of treatment within the two groups, i.e. murders, and victims.

Patients

We chose four patient observations murderers. Their acts were committed “Except for the laws of war”, that is to say, forbidden by the Geneva Conventions. The alcoholic patients: Guillaume is a 45-year-old veteran from the wars in Indochina and Algeria. He has undergone several unsuccessful detoxification programs. One day, he finally tells the most significant episode of his history. While in Algeria, his lieutenant asked him to execute a prisoner. Since then, he has nightmares where he sees the scene, and calms his anxiety with alcohol. He was hospitalized and commenced psychotherapeutic treatment during which he relived his childhood, adolescence and his military career. Two months later, he is cured from his post-traumatic stress condition and alcoholism. Another veteran from Algeria, who was also a severe alcoholic: whilst there, he was ordered by his chief to execute three prisoners. A few years later, by chance he meets his former boss who tells him that the three victims were brothers. He is very shocked because he comes from a region of “vendettas” where it is said that one does not eliminate a family. These nightmares and his alcoholic career started there. Treatment will prove ineffective. The melancholic patients: Andre is a former veteran of Indochina. There, he participated in the massacre of villagers who had hidden enemies. He returned to France after his time engagement, married, had five children, and resumed his profession as industrial painter. After 5 years, he is assailed by nightmares and cannot stop to tell of the horrors to those around him. His wife eventually threw him out and he became a hobo (tramp) in his small town. Gradually during the night, he has hallucinations: he hears his Vietnamese enemies lurking around him waiting for a day to take revenge. He was hospitalized and fairly gradually, the nightmares disappear and then, slowly, his depressive state. Yanis is a 40-year-old veteran of the French Foreign Legion. He lives in Paris and gradually felt he was the center of a complot by Arab youths in the capital. He became aware of surprised looks and conversations, which indicated that they want to kill him. He took refuge in the Military Hospital, where he recounted the circumstances in which, in Africa, he killed a teenager. This act was the result of a misunderstanding, but he saw himself as a murderer of children. Again, the psychotherapeutic treatment resulted in healing.

Results

In three of our patients, the disappearance of the syndrome of repetition (repetition syndrome) and the alcohol and the melancholic state was achieved quickly. Probably because the “enjoyment” attached to traumatic images when the patient is a victim, here is outweighed by the horror of an act that the person has committed itself. Thus, the patient is willing much faster than when a victim, to get rid of the repetition syndrome.

Conclusion

Patient murderers feel themselves as guilty, which turn them to alcohol and ideas of persecution. Despite the severity of the conditions of post-traumatic stress presented by criminal murderers, do not hesitate to commence psychotherapeutic therapy.  相似文献   

17.
Inpatient treatment of obsessive–compulsive disorder in a child and adolescent psychiatry ward M. USAMI National Center of Neurology and Psychiatry, Kohnodai Hospital, Chiba, Japan This is a case report of a 13‐year‐old‐boy (2nd grade in junior high school). His father had poor communication; his mother was a very fragile woman. The boy had been overprotected by his parents, as long as he responded to their expectations. He did not have any other siblings. He played well with his friends since he was young, and did not have problems until the 1st term (from April to July) of 1st grade in junior high school. However, in September he started to have difficulties going well with his friends, and going to school. He spent most of his time in his room, and began to repeat checking and hand‐washing frequently. Even at midnight, he forced his mother to touch the shutter from outside of the house for many times. He also ritually repeated to touch his mother's body, after he licked his hands, for over an hour. He became violent, when his parents tried to stop him. In April, year X, his parents visited our hospital for the first time. From then, his mother could not tolerate her son's coerciveness any longer. His father explained to the boy that ‘your mother has been hospitalized’, and she started to live in the next room to the boy's without making any noise. After 3 months he noticed that his mother was not hospitalized, and he got very excited. He was admitted to our hospital with his family and relatives, in October, year X. At the initial stage of hospitalization he showed distrust and doubt towards the therapist and hospital. He had little communication with other boys and did not express his feelings. Therefore, there was a period of time where he seemed to wonder whether he could trust the treatment staff or not. During his interviews with his therapist he repeated only ‘I’m okay’ and did not show much emotional communication. For the boy, exposing himself was equivalent to showing his vulnerability and incompleteness. Therefore, the therapist considered that he was trying to denying his feelings to avoid this. The therapist set goals for considering his own feelings positively and expressing them appropriately. Also, the therapist carried out behavioral restrictions towards him. He hardly had any emotional communication with the staff, and his peer relationship in the ward was superficial. Therefore, he gradually had difficulty spending his time at the end of December On the following day in which he and the therapist decided to return to his house for the first time, he went out of the ward a few days before without permission. From thereon it was possible for him to share feelings such as hostility and aggression, dependence and kindness with the therapist. The therapist changed his role from an invasive one to a more protective one. Then, his unsociability gradually faded. He also developed good peer relationships with other boys in the ward and began to express himself feeling appropriately. He was also able to establish appropriate relations with his parents at home, and friends of his neighborhood began to have normal peer relationships again. During childhood and adolescence, boys with obsessive–compulsive disorder are known to have features such as poor insight and often involving their mothers. We would like to present this case, through our understanding of dynamic psychiatry throughout his hospitalization, and also on the other therapies that were performed. Psychotherapy with a graduate student that discontinued after only three sessions: Was it enough for this client? N. KATSUKI Sophia University, Tokyo, Japan Introduction: Before and after the psychotherapy, SWT was administrated in this case. Comparing these two drawings, the therapist was provided with some ideas of what kind of internal change had taken place inside this client. Referring to the changes observed, we would like to review the purposes and the ways of the psychotherapy, as well as the adequacy of the limited number of the sessions (vis‐a‐vis result attained.) Also we will discuss later if any other effective ways could be available within the capacities of the consulting system/the clinic in the university. Case: Ms. S Age 24 years. Problems/appeal: (i) awkwardness in the relationship with the laboratory colleagues; (ii) symptoms of sweating, vomiting and quivering; and (iii) anxiety regarding continuing study and job hunting. Diagnosis: > c/o PTSD. Psychotherapeutic setting: At the therapy room in the clinic, placed at the university, 50 min‐session; once a week; paralleled with the medical treatment. Process: (1) Since she was expelled from the study team in the previous year, it has become extremely difficult for her to attend the laboratory (lab) due to the aforementioned symptoms. She had a feeling of being neglected by the others. When the therapist suggested that she compose her mental confusions in the past by attending the therapy room, she seemed to be looking forward to it, although she said that she could remember only a few. (2) She reported that she overdosed on sedatives, as she could not stop irritating. She was getting tough with her family, also she slashed the mattress of her bed with a knife for many times. She complained that people neither understood nor appreciated her properly. and she said that she wanted revenge on the leader of the lab by punishing him one way or other. (3) Looking back the previous session, she said ‘I had been mentally mixed up at that time, but I feel that now I can handle myself, as I stopped the medication after consulting the psychiatrist. According to what she said, when she disclosed the occurrences in the lab to her mother, she felt to be understood properly by her mother and felt so relieved. and she also reported that she had been sewing up the mattress which she slashed before, without any reason. She added, “ although I don’t even know what it means, I feel that this work is so meaningful to me, somehow”. Finally, she told that she had already made her mind to cope with the situation by herself from now on, although it might result in a flinch from the real solution. Situations being the above, the session was closed. Swt: By the remarkable changes observed between the two drawings, the meanings of this psychotherapy and its closure to the client would be contemplated. Question of how school counselors should deal with separation attendant on students’ graduation: On a case in which the separation was not worked through C. ASAHARA Sophia University, Tokyo, Japan Although time limited relationship is one of the important characteristics in school counseling, the question of separation attendant on it has not been much discussed based on specific cases. This study focuses on the question of separation through looking at a particular case, in which the separation was not worked through, and halfway relationship continued even after the student's graduation and the counselor's resignation. I was a part time school counselor at a junior high school in Tokyo. The client was a 14‐year‐old female student, who could not go to her classroom, and spent a few hours in a sick bay when she came to school. She was in the final grade and there was only half a year left before graduation when we first met, and we started to see each other within a very loose structure. As her personality was hyper‐vigilant and defensive, it took almost 2 months before I could feel that she was nearer. Her graduation was the first occasion of separation. On that occasion, I found that there had been a discrepancy between our expectations; while I took it for granted that our relationship would end with the graduation, she expected to see me even after she graduated, and she actually came up to see me once in a while during the next year. A year later, we faced another occasion of separation, that was my resignation. Although I worried about her, all I have done for her was to hand a leaflet of a counseling office, where I work as a part time counselor. Again I could not refer to her feelings or show any concrete directions such as making a fixed arrangement. After an occasional correspondence for the next 10 months (about 2 years after her graduation), she contacted me at the counseling office asking for a constant counseling. Why could I not deal with both occasions? and how did that affect the client thereafter? There were two occasions of separation. At the time of the client's graduation, I seemed to be enmeshed in the way of separation that is peculiar to the school setting. In general in therapeutic relationship, mourning work between counselor and client is regarded as being quite important. At school, however, separation attendant on graduation is usually taken for granted and mourning work for any personal relationship tends to be neglected. Graduation ceremony is a big event but it is not about mourning over one's personal relationships but separation from school. That may be why I did not appreciate how the client counted on our relationship. At the time of my resignation I was too worried about working through a change from very loose structure which is peculiar to the school setting to a usual therapeutic structure (fees are charged, and time, place are fixed). That is why I did nothing but give her a leaflet. In this way, we never talked about her complex feelings such as sadness or loneliness, which she was supposed to experience on separation. Looking at the aforementioned process from the client's viewpoint, it can be easily imagined that she could not accept the fact of separation just because she graduated. and later, she was forced to be in double‐bind situation, in which she was accepted superficially (handed a leaflet), while no concrete possibility was proposed concerning our relationship (she could never see me unless she tries to contact me.) As a result, she was left alone and at a loss whether she could count on me or not. The halfway situation or her suspense was reflected in her letter, in which she appeared to be just chatting at first sight, but between the lines there was something more implying her sufferings. Above discussion suggests that in some case, we should not neglect the mourning work even in a school setting. To whom or how it is done is the next theme we should explore and discuss in the future. For now, we should at least be conscious about the question of separation in school setting. Study of the process of psychotherapy with intervals for months M. TERASHIMA Bunkyo Gakuin University, Tokyo, Japan This is a report on the process of psychotherapy of an adolescent girl who showed manic and depressive state. At the time of a depressed state, she could not go to a college and withdrew into home, and the severe regressive situation was shown. Her therapy began at the age of 20 and she wanted to know what her problem was. The process of treatment went on for 4 years but she stopped coming to sessions for several months because of failure of the therapist. She repeated the same thing twice. After going through these intervals the client began to remember and started to talk about her childhood – suffering abusive force from her father– with vivid impressions. They once were hard for her to accept, but she began to establish the consistent figure of herself from past to present. In this case, it could be thought that the intervals of the sessions had a certain role, with which the client controlled the structure of treatment, instead of an attack against the therapist. Her object relation, which is going to control an object offensively, was reflected in these phenomena. That is, it can be said that the ambivalence about dependency – difficult to depend but desirous of the object – was expressed. Discontinuation of the sessions was the product of the compromise formation brought about the ambivalence of the client, and while continuing to receive this ambivalence in the treatment, the client started to realize discontinuance of her memories and then advanced integration of her self‐image. For the young client with conflict to dependence such as her, an interval does not destroy the process of treatment but in some cases it could be considered as a therapeutic element. In the intervals the client could assimilate the matter by herself, that acquired by the sessions. Psychotherapy for a schizoid woman who presented eccentric speech and behaviour M. OGASAWARA Osaka University Graduate School of Medicine, Osaka, Japan Case presentation: A case of a 27‐year‐old woman at the beginning of therapy. Life history: She had been having a wish for death since she was in kindergarten and she had been feeling strong resistance to do the same as others after school attendance. She had a history of ablutomania from the age of 10–15, but the symptom disappeared naturally. and she said that she had been eliminated from groups that she tried to enter. After graduating a junior college, she changed jobs several times without getting a full‐time position. Present history: Scolded by her boy friend for her coming home too late one day, she showed confusion such as excitement, self‐injury or terror. She consulted a psychiatrist in a certain general hospital, but she presented there eccentric behaviours such as tense facial expression, stiffness of her whole body, or involuntary movement of limbs. and because she felt on bad terms with the psychiatrist and she had come to cause convulsion attacks in the examination room, she was introduced to our hospital. Every session of this psychotherapy was held once a week and for approximately 60 min at a time. Treatment process: She sometimes presented various eccentric attitudes, for example overturning to the floor with screaming (1), going down on her knees when entrance at the door (5), entering with a knife in her mouth and hitting the wall suddenly (7), stiffening herself just outside the door without entering the examination room (9), taking out a knife abruptly and putting it on her neck (40), exclaiming with convulsion responding to every talk from the therapist (41), or stiffening her face and biting herself in the right forearm suddenly (52). She also repeated self‐injuries or convulsion attacks outside of the examination room in the early period of the therapy. Throughout the therapy she showed hypersensitivity for interpersonal relations, anxiety about dependence, terror for self‐assertion, and avoidance for confrontation to her emotional problems. Two years and 6 months have passed since the beginning of this therapy. She ceased self‐injury approximately 1 year and 6 months before and her sense of obscure terror has been gradually reduced to some extent. Discussion: Her non‐verbal wariness and aggression to the therapist made the sessions full of tension and the therapist felt a sense of heaviness every time. In contrast, she could not express aggression verbally to the therapist, and when the therapist tried to identify her aggression she denied it. Her anxiety, that she will be thoroughly counterattacked to self‐disintegration if she shows aggression to other persons, seems to be so immeasurably strong that she is compelled to deny her own aggression. Interpretations and confrontations by the therapist make her protective, and occasionally she shows stronger resistance in the shape of denial of her problems or conversion symptoms (astasia, aphonia, or involuntary movements) but she never expresses verbal aggression to the therapist. and the therapist feels much difficulty to share sympathy with her, and she expresses distrust against sympathetic approach of the therapist. However, her obvious disturbance that she expresses when she feels the therapist is not sympathetic shows her desire for sympathy. Thus, because she has both strong distrust and desire for sympathy, she is in a porcupine dilemma, which is characteristic of schizoid patients as to whether to lengthen or to shorten the distance between herself and the therapist. This attitude seems to have been derived from experience she might have had during her babyhood and childhood that she felt terror to be counterattacked and deserted when she showed irritation to her mother. In fact, existence of severe problems of the relationship between herself and her mother in her babyhood and childhood can be guessed from her statement. Although she has been repeating experiences to be excluded from other people, she shows no attitude to construct interpersonal relationship actively. On the contrary, by regarding herself to be a victim or devaluating other persons she externalizes responsibility that she herself should assume essentially. The reason must be that her disintegration anxiety is evoked if she recognizes that she herself has problems; that is, that negative things exist inside of her. Therefore, she seems to be inhibited to get depressive position and obliged to remain mainly in a paranoid–schizoid position. As for the pathological level, she seems to have borderline personality organization because of frequent use of mechanisms to externalize fantastically her inner responsibility. For her high ability to avoid confronting her emotional problems making the most of her verbal ability, every intervention of the therapist is invalidated. So, it seems very difficult for her to recognize her own problems through verbal interpretations or confrontation by the therapist, for the present. In general, it is impossible to confront self problems without containing negative emotions inside of the self, but her ability seemed to be insufficient. So, to point out her problems is considered to be very likely to result in her confusion caused by persecution anxiety. Although the therapy may attain the stage on which verbal interpretation and confrontation work better some day, the therapist is compelled to aim at promoting her ability to hold negative emotion inside of herself for the time being. For the purpose, the therapist is required to endure the situation in which she brings emotion that makes the therapist feel negative counter‐transference and her process to experience that the therapeutic relation itself would not collapse by holding negative emotion. On supportive psychotherapy with a male adolescent Y. TERASHIMA Kitasato University Health Care Center, Kanagawa, Japan Adolescent cases sometimes show dramatic improvements as a consequence of psychotherapy. The author describes how psychotherapy can support an adolescent and how theraputic achievements can be made. Two and a half years of treatment sessions with a male adolescent patient are presented. The patient was a 19‐year‐old man, living with his family. He had 5 years of experience living abroad with his family and he was a preparatory school student when he came to a mental clinic for help. He was suffering from not being able to sleep well, from difficulties concerning keeping his attention on one thing, and from fear of going to distant places. He could barely leave his room, and imagined the consequence of overdosing or jumping out of a window. He claimed that his life was doomed because his family moved from a town that was familiar to him. At the first phase of psychotherapy that lasted for approximately 1 year, the patient seldom responded to the therapist. The patient was basically silent. He told the therapist that the town he lives in now feels cold or that he wants to become a writer. However, these comments were made without any kind of explanation and the therapist felt it very difficult to understand what the patient was trying to say. The sessions continued on a regular basis. However, the therapist felt very useless and fatigued. Problems with the patient and his family were also present at this phase of psychotherapy. He felt unpleasant at home and felt it was useless to expect anything from his parents. These feelings were naturally transferred to the therapist and were interpreted. However, interpretation seemed to make no changes in the forms of the patient's transference. The second phase of psychotherapy began suddenly. The patient kept saying that he did not know what to talk about. However, after a brief comment made by the therapist on the author of the book he was reading, the patient told the therapist that it was unexpected that the therapist knew anything of his favorite writer. After this almost first interaction between the patient and the therapist, the patient started to show dramatic changes. The patient started to bring his favorite rock CDs to sessions where they were played and the patient and the therapist both made comments on how they felt about the music. He also started asking questions concerning the therapist. It seemed that the patient finally started to want to know the therapist. He started communicating. The patient was sometimes silent but that did not last long. The therapist no longer felt so useless and emotional interaction, which never took place in the first phase, now became dominant. The third phase happened rapidly and lasted for approximately 10 months. Conversations on music, art, literature and movies were made possible and the therapist seldom felt difficulties on following the patient's line of thought. He started to go to schools and it was difficult at first but he started adjusting to the environment of his new part‐time jobs. By the end of the school year, he was qualified for the entrance to a prestigious university. The patient's problems had vanished except for some sleeping difficulties, and he did not wish to continue the psychotherapy sessions. The therapist's departure from the clinic added to this and the therapy was terminated. The patient at first reminded the therapist of severe psychological disturbances but the patient showed remarkable progress. Three points can be considered to have played important roles in the therapy presented. The first and the most important is the interpretation by behavior. The patient showed strong parental transference to the therapist and this led the therapist to feel useless and to feel fatigue. Content analysis and here‐and‐now analysis seemed to have played only a small part in the therapy. However, the therapist tried to keep in contact with the patient, although not so elegant, but tried to show that the therapist may not be useless. This was done by maintaining the framework of the therapy and by consulting the parents when it was considered necessary. Second point is the role that the therapist intentionally took as a model or target of introjection. With the help of behavioral interpretation that showed the therapist and others that it may not be useless, the patient started to introject what seemed to be useful to his well being. It can be considered that this role took some part in the patient going out and to adjust to the new environment. Last, fortune of mach must be considered. The patient and the therapist had much in common. It was very fortunate that the therapist knew anything about the patient's favorite writer. The therapist had some experience abroad when he was young. Although it is a matter of luck that the two had things in common, it can be said that the congeniality between the patient and the therapist played an important role in the successful termination of the therapy. From the physical complaint to the verbal appeal of A's recovery process to regain her self‐confidence C. ITOKAWA and S. KAZUKAWA Toyama Mental Health Center, Toyama, Japan This is one of the cases at Toyama Mental Health Center about a client here, we will henceforth refer to her simply as ‘A’. A was a second grade high school student. We worked with her until her high school graduation using our center's full functions; counseling, medical examination and the course for autogenic training (AT). She started her counseling by telling us that the reason for her frequent absences from school began because of stomach pains when she was under a lot of stress for 2 years of junior high school, from 2nd grade to 3rd grade. Due to a lack of self confidence and a constant fear of the people around her, she was unable to use the transportation. She would spend a large amount of time at the school infirmary because she suffered from self‐diagnosed hypochondriac symptoms such as nausea, diarrhea and a palpitation. She continued that she might not be able to have the self‐confidence to sit still to consult me on her feelings in one of our sessions. A therapist advised her to take the psychiatric examination and the use of AT and she actually saw the medical doctor. In counseling (sessions), she eventually started to talk about the abuse that started just after her entering of junior high school; she approached the school nurse but was unable to tell her own parents because she did not trust them. In doing so, she lost the rest of her confidence, affecting the way she looked at herself and thought of how others did. At school she behaved cheerfully and teachers often accused her of idleness as they regarded this girl's absences along with her brightly dyed hair and heavy make‐up as her negligent laziness. I, as her therapist, contacted some of the school's staff and let them know of her situation in detail. As the scolding from the teachers decreased, we recognized the improvement of her situation. In order to recover from the missed academic exposure due to her long absence, she started to study by herself. In a couple of months her physical condition improved gradually, saying ‘These days I have been doing well by myself, haven’t I?’ and one year later, her improved mental condition enabled her to go up to Tokyo for a concert and furthermore even to enjoy a short part‐time job. She continued the session and the medical examination dually (in tangent) including the consultation about disbelief to the teachers, grade promotion, relationships between friends and physical conditions. Her story concentrated on the fact that she had not grown up with sufficiently warm and compassionate treatment and she could not gain any mental refuge in neither her family nor her school, or even her friends. Her prospects for the future had changed from the short‐ranged one with no difficulty to the ambitious challenge: she aimed to try for her favorite major and hoped to go out of her prefecture. But she almost had to give up her own plan because the school forced her to change her course as they recommended. (because of the school's opposition with her own choice). So without the trust of the teachers combined with her low self‐esteem she almost gave up her hopes and with them her forward momentum. In this situation as the therapist, I showed her great compassion and discussed the anger towards the school authorities, while encouraging this girl by persuading her that she should have enough self‐confidence by herself. Through such sessions, she was sure that if she continued studying to improve her own academic ability by herself she could recognize the true meaning of striving forward. and eventually, she received her parents’ support who had seemed to be indifferent to her. At last she could pass the university's entrance exams for the school that she had yearned to attend. That girl ‘A’ visited our center 1 month later to show us her vivid face. I saw a bright smile on her face. It was shining so brightly.  相似文献   

18.
A high variety of factors were found to be implicated in the emergence of depersonalization episodes. The remarkable case of a patient who developed a hemi-depersonalization syndrome is reported in a patient with known obsessive–compulsive disorder. He complained of feeling his left half of the body as if it was detached from him. The part of the body that was perceived as estranged was inconsistent with the anatomical distribution of the nervous system as the entire left part of his body was concerned, from head to toe. He always remained aware that the sensations were not real, and felt like being an outside observer of the left side of his body. He also developed an isolated delusional idea. The hemi-depersonalization syndrome as well as the delusional idea did not respond to citalopram 20 mg/day, but remitted rapidly under olanzapine 10 mg/day, the obsessive–compulsive symptomatology persisting for several weeks. From the course of hemi-depersonalization syndrome and the available literature, it is concluded that this syndrome is independent from the concomitant OCD and that the observed hemi-depersonalization syndrome is likely to be a manifestation of a psychotic reaction which consisted of both the hemi-depersonalization and delusions.  相似文献   

19.
《Brain & development》2022,44(3):259-262
BackgroundDevelopmental disorders associated with Becker muscular dystrophy (BMD), possibly resulting from a lack of dystrophin in the brain, have been reported, but their importance is not fully understood. We report a case of a BMD patient who had been socially withdrawn due to mental retardation and autism spectrum disorder and could not receive appropriate medical services, resulting in delayed detection of severe cardiomyopathy and embolic strokes which developed as complications of BMD.Case report: The case is a 41-year-old male. In elementary school, he was the slowest runner in his class and had poor grades. He started missing school due to bullying in junior high school and had been socially withdrawn for 24 years. He developed difficulty walking due to progressive muscle weakness in the extremities and lost ambulation at age 36. At age 41, he was referred to our hospital by public health support services to address his social withdrawal. Muscle biopsy led to the diagnosis of BMD. Psychological examination revealed mild mental retardation and autism spectrum disorder, which may have resulted in social isolation. He had severe cardiomyopathy and asymptomatic cerebral infarction due to heart failure.ConclusionIn BMD patients, developmental disorders can potentially hinder access to appropriate medical treatment. BMD is an important differential diagnosis for physically disabled children with developmental disorders. Early intellectual and psychological interventions and evaluation of complications are important for improving patient prognosis and quality of life.  相似文献   

20.
After the successful treatment of a hypothalamic germinoma, a 31-year-old right-handed male developed a difficulty in memory and admitted to our department for detailed evaluation. Neuropsychologically he showed no personality change, confabulation, misidentification, delusion or disorientation to physical time. Neither aphasia, dementia or frontal lobe dysfunction was found. However, he showed a moderate degree of anterograde amnesia and a retrograde amnesia for the last 5 years judged by a public events test. Moreover, his temporal markings of a correctly remembered event in the post high school days shifted strongly toward the high school days. This temporal location abnormality was largely limited to the events from the days of his graduation from the high school to the period 5 years prior to the present incident. He felt personal events happened during this period as if they had occurred in the high school days, although he well knew that they actually happened much later. At the same time he felt that memories of the high school days were abnormally vivid and recent. Most interestingly, he was found to have been experiencing a funny feeling that he was living in the high school days and the present at the same time. The feeling occurred either simultaneously or alternatively. In the latter instance, he would suddenly start behaving as if he were a high school student. He would start urging his wife to go to the school together immediately. This behavior would be over in several minutes. His consciousness was clear in these instances and there was no amnesia for these periods. A brain MRI with gadolinium enhancement showed a lesion extending in the hypothalamus, anterior thalamus, basal forebrain and midbrain bilaterally. After eight months this abnormality of temporal sensation disappeared. However, tendency to make the date of public event nearer to the high school period persisted. We hypothesize that impaired temporal estimation for an event recalled from the retrograde memory store and mis-arousal of familiarity evoked at the time of spontaneous recollection are responsible for double feeling of time of an experience. These phenomenon might be attributable to the partial destruction of the Papez' and the basolateral limbic circuits.  相似文献   

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