真性痴呆?假性痴呆?

病例摘要张×,男、37岁、已婚、工人。83.6.17入院,住院号24-95549。初中毕业后分配现单位,工作积极,曾被评为先进工作者。68年患“肝炎”,愈后调换轻工作,不悦,开始话多、罗嗦、劳动纪律差、易激动、好与人争执。78年再调工种,接触甲苯二异氰酸酯,半年后又调离。此间除言语罗嗦、纠缠外,无明显精神异常。     

散发性脑炎?精神分裂症?

病史摘要:陆某某,女,19岁,未婚,辍学青年。院号28-109936,患者85年2月份,因无故发笑、哭泣一周,被家人送当地县人民医院,拟诊“散脑”收住入院(治疗情况不清楚)。治疗10余日,未见好转而作自动出院监复学。但课堂纪律较前涣散,上课时不是打哈欠,便是伏案打盹,抑或双手搭在男同学肩背上,对于教师批评、同学嘲笑也取无所谓态度。学习成绩明显下降。除此     

Schizophrenias and epilepsies: why? when? how?

Detailed studies of the association between the epilepsies and the schizophrenias extend over 40 years. Recent studies are abundant and make fertile use of new technologies. However, the pathological changes described in schizophrenias are quite varied. Studies fail to recognize that "epilepsies" and "schizophrenias" have varied in definition over time, and have always been weak categories with which to do science. Now that it is possible to measure deficits in brain structure, it would be better to see what behavioral problems are associated with specific cerebral pathology. It would be wise to be very precise in describing the behaviors and the nature and timing of their emergence rather than using terms such as psychoses. Schizophrenias have neurological, neuropsychological, and behavioral antecedents in childhood. Those associated with later epilepsies show biases, persistent in many studies over a number of years, toward relative excess of females, left temporal lobe structural deficits, and non-right-handedness. Schizophrenia should now be a predictable eventuality in certain people with epilepsies, an important factor in medical and surgical treatment.     

?rztliche Suizidassistenz bei Demenzerkrankungen?

Physician-assisted suicide in Germany is limited by criminal law and disapproved by professional authorities. A physician who is willing to help a demented patient in terminating his life has to be definitely sure that the disease does not interfere with the patient's capacity for decision-making. In cases of early dementia the reason why assisted suicide will usually be requested is not the actual suffering of the patient but his negative expectations for the future. As long as there are sufficient opportunities for palliative care, the progressive course of the dementia process does not imply a state of unbearable suffering which could justify an assisted suicide. Nevertheless there may be certain circumstances--as for instance the value that an individual attributes to his integrity or to the narrative unity of his life--which might possibly provide an ethical justification for the assistance in life termination. A physician who helps a demented person in performing a suicidal act does not necessarily oppose essential principles of medical ethics. Yet, especially with regard to possible societal consequences of physician-assisted suicide in dementia, the rejecting attitude of medical authorities against that activity must be considered as well founded and legitimate. Deviations from these general guidelines ought to be respected as long as they are limited to exceptional situations and correspond to a thorough consideration of a physician's professional duties. They should remain open to public control, but not be ultimately specified by unequivocal normative regulations.     

偏执狂?偏执性精神病?

一、病历摘要患者滕××,女,60岁,已婚,农民。因疑人迫害、上访12年于1990年6月22日首次住我院治疗。家族史阴性。既往体健。有15年饮酒史(3两/日),但从未醉过。病前性格:脾气暴躁,固执已见,为人正直、诚实。已绝经10年。     

Emotionale Teilleistungsst?rungen und ?first impression formation�� bei Pers?nlichkeitsst?rungen

"Minimal cerebral dysfunctions" are isolated impairments of basic mental functions, which are elements of complex functions like speech. The best described are cognitive dysfunctions such as reading and writing problems, dyscalculia, attention deficits, but also motor dysfunctions such as problems with articulation, hyperactivity or impulsivity. Personality disorders can be characterized by isolated emotional dysfunctions in relation to emotional adequacy, intensity and responsivity. For example, paranoid personality disorders can be characterized by continuous and inadequate distrust, as a disorder of emotional adequacy. Schizoid personality disorders can be characterized by low expressive emotionality, as a disorder of effect intensity, or dissocial personality disorders can be characterized by emotional non-responsivity. Minimal emotional dysfunctions cause interactional misunderstandings because of the psychology of "first impression formation". Studies have shown that in 100?ms persons build up complex and lasting emotional judgements about other persons. Therefore, minimal emotional dysfunctions result in interactional problems and adjustment disorders and in corresponding cognitive schemata.From the concept of minimal emotional dysfunctions specific psychotherapeutic interventions in respect to the patient-therapist relationship, the diagnostic process, the clarification of emotions and reality testing, and especially an understanding of personality disorders as impairment and "selection, optimization, and compensation" as a way of coping can be derived.