器质性精神障碍英文培训课件.ppt

1、器质性精神障碍英文器质性精神障碍英文lOrganic 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lA.Mental Disorders due to Brain DiseaseslB.Mental Disorde

2、rs due to Physical Diseases3器质性精神障碍英文lDegenerative brain diseaseslCerebro-vascular diseaseslIntracranial infectionlBrain damagelMalignancies of CNS4器质性精神障碍英文lFeature: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lMent

3、al disorders arise from brain dysfunction which is clearly caused by disease outside the brain.6器质性精神障碍英文lFeature:brain dysfunction,shows some atypically pathological change such as congestion,dropsy,etc.lMental disorders is one of symptoms of physical diseases.7器质性精神障碍英文 Past history:lKraepelin sho

4、wed that the different physiological causes contribute to the specificity clinical manifestation.lBonhoeffer showed that physiological causes of any kind contribute to a few syndromes of common clinical characteristics.8器质性精神障碍英文 Present history：lThe correspondence between biological etiology and cl

5、inical features is ambiguous,which means that the different physiological causes contribute to the similar clinical manifestation,and different manifestations may result from the same causes.9器质性精神障碍英文l1.It is whether the syndrome is acute or chronic.l2.It is whether the impairment of psychological

6、function is general or local.l3.It is whether the underlying dysfunction of the brain is general or local.l4.Constitutionl Agel Previous experience l Personality.10器质性精神障碍英文lAcute generalized psychological impairment-DeliriumlChronic generalized psychological impairment-DementialSpecific psychologic

7、al impairment-impairment of memory,thinking,perception,personality,or mood.11器质性精神障碍英文lMethod of diagnosis:l 1)To collect clinical data objectively and accurately by history taking and mental examination.To take basic laboratory exmination.l 2)Further investigation:l X-rays,CT,MRI,DSA,SPECT,EEG.12器质

8、性精神障碍英文l3)Psychological test:lWechsler Adult Intelligence Scale(WAIS),Wisconsin Card Sorting Test,lHR(神经心理成套测验)lMMPI（明尼苏达多相人格测定）lEPQ（艾森克人格测定）lMMSE（简明智能检查）13器质性精神障碍英文Functional or Organic Acute Chronic Widespread Limited14器质性精神障碍英文lManagement of physical causes and control of the psychiatric symptoms

9、.15器质性精神障碍英文综合征16器质性精神障碍英文l1.Definition:The syndrome is characterized by impairment of consciousness.It is one of the common symptoms of systematic diseases.l2.Epidemiology:Occurring in about 5 to 15 percent of patients in general medical or surgical wards,and 20 to 30 percent of patients in surgica

10、l intensive care units.17器质性精神障碍英文l3.Aetiology:The main causes of the delirium are shown in the book of page 53.The condition appears particularly in association with:increasing age;anxiety;sensory under-or overstimulation;drug dependence;and brain damage of any kind.l Previous experience and person

11、ality influences the clinical picture.18器质性精神障碍英文l4.Pathomechanism：It shows acute,generalized metabolic disorder in the brain.It has no pathological change of nerve cell in brain.l5.Clinical features:l 1)The most important feature is impairment of consciousness and tends to fluctuate during the cour

12、se of the day19器质性精神障碍英文 Reduced clarity of awareness of the enviromentl1)With reduced ability to focus,sustain,or shift attention.lChange in cognition(such as memory l deficit,disorientation.)l2)Perception disorders(知觉障碍)3)Thought disorders(思维障碍)l 20器质性精神障碍英文l4）Memory disorders(记忆障碍)l5）Affective di

13、sorders(情感障碍)l6）Psychomotor disorders(精神运动障碍)l7）Involuntary movement(不自主运动)l8）Functional disorder of autonomic nerve(植物神经功能紊乱)21器质性精神障碍英文l6.Course and Prognosis of disease(病程与预后)：l Generally,prognosis of the disease is good.l Course of disease generally lasts a few hours,a few days,or one month.lDea

14、th of the patient probably occurs.22器质性精神障碍英文l7.Diagnosis and differential diagnosis：l 1)Whether the patient suffer from delirium.l 2)To identify the cause of delirium.l 3)To distinguish between delirium and psychogenic disorders.23器质性精神障碍英文 A.Disturbance of consciousness(ie,reduced l clarity of awa

15、reness of the enviroment)l with reduced ability to focus,sustain,orl shift attentionlB.Change in cognition(such as memory l deficit,disorientation,language disturbance)l or development of a perceptual disturbancel that is not better accounted for by a pre-l existing,established,or evolving dementia2

16、4器质性精神障碍英文lC.The distrubance develops over a short l period of time(usually hours to days)l and tends to fluctuate during the coursel of the day25器质性精神障碍英文l8.Treatment(治疗)：l The basic treatment for these disorders includes management of physical causes and control of the psychiatric symptoms.l 26器质性

17、精神障碍英文l1.Definition: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l2.Epidemiology:Most cases occur in the old people（65）lOver

18、65 year：4%7%lOver 80 year：20%30%lIncidence：1%28器质性精神障碍英文l3.Aetiology：It has many causes.The main causes are listed in table 5-1 in the textbook.l The common causes are:Alzhermer,s Disease 50%70%Multi-infarct Dementia 10%Alcohol Dementia 10%29器质性精神障碍英文l4.Clinical features：l In the early stage：l 1）imp

19、airment of recent memory 2）Difficulty in new knowledge learningl 3）negative psychic reactionl 4）personality changing30器质性精神障碍英文l3）Hallucination(幻觉)、Delusions(妄想);Mood disorder(情绪障碍）l 4)Behaviour disorder(行为异常)：muddled;inappropriate,distractable,and restless.32器质性精神障碍英文lIn later stage:l1）The memory w

20、orsens.l2）Disability of care for themselves.l3）Thinking grossly fragmented and incoherent,-meaningless noises or mute.l4)Incontinent of urine and faeces.l5)System failure leads to death.33器质性精神障碍英文l5.Diagnosis(诊断)：l1）Final diagnosis：according to clinic feature and results of intellectual test.l2）To

21、identify the cause of dementia:clinic feature,CT,MRI,and further laboratory investigation.34器质性精神障碍英文lThe development of multiple cognitive deficits manifested by both of the followingl1.Memory,perceptivity,judgement,calculate ability).l2.At least one of the following cognitive disturbances:l A.Apho

22、nia失语(language disturbance)35器质性精神障碍英文lB.Apraxia失用(inability to carry out motor activities despite intact sensory function)lC.Agnosia失认(failure to recognize or identify objects despite intact sensory function)lD.Disturbance in executive functioning(Ie,planning,organizing,sequencing,abstracting.36器质性

23、精神障碍英文l6.Differential Diagnosis(鉴别诊断)：l 1）Decrease of memory in normal agingl 2）Depressionl 3)Delirium37器质性精神障碍英文l7、Management of dementia(治疗)：l The plan of treatment should seek to improve functional ability as far as possible.l drugs:calmative,anti-psychotic drug,etc.l behavioural methods.38器质性精神障

24、碍英文l1.Definition:It is characterized by a prominent disorder of recent memory and by disordered time-sense,in the absence of generalized intellectual impairment.l2.Aetiology and pathology:Alcohol abuse,the most common cause,seems to act by causing a deficiency of thiamine.l 39器质性精神障碍英文l2.Aetiology a

25、nd pathology:At post mortem such cases generally have haemorrhagic lesions in the mamillary bodies,hippocamp,and parts of certain thalamic nuclei.l 40器质性精神障碍英文l3.Clinical features:It is a profound impairment of recent memory.New learning is grossly defective,but remote memory is relatively preserved

26、.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l4.Diagnosis:according to symptom.lThe 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l6.Cou

27、rse and prognosis:(245)l 17%death rate in the acute stage.l 84%-a typical amnesic syndrome-impairment of memory continue lifetime.l l 43器质性精神障碍英文lOrganic delusional syndrome Organic personality syndrome(change)lOrganic depressive/manic syndromelOrganic anxiety syndromelOrganic catatonic syndrome44器质性精神障碍英文45器质性精神障碍英文