�@
| Adjustment disorder: DSM-IV criteria |
| A. The development of
emotional or behavioral symptoms in response to
an
identifiable stressor(s) occurring
within 3 months
of the onset of the stressor(s).
B. These symptoms or behaviors
are clinically significant as evidenced by either of
the following:
(1) marked distress that
is in excess of what would be expected
from
exposure to the stressor
(2) significant impairment in
social or
occupational (academic) functioning
C. The stress-related
disturbance does not meet the criteria for another
specific Axis I disorder and is not merely an
exacerbation of a preexisting Axis I or Axis II
disorder.
D. The symptoms do not
represent Bereavement.
E. Once the stressor (or its
consequences) has terminated, the symptoms do not
persist for more than an additional 6 months. |
|
309.0 With Depressed Mood
309.24 With Anxiety
309.28 With Mixed Anxiety and Depressed Mood
309.3 With Disturbance of Conduct
309.4 With Mixed Disturbance of Emotions and
Conduct
309.9 Unspecified |
|
�@ |
| Adjustment disorder: |
��Diagnosis ��made by
excluding an anxiety
or depressive disorder
��Aetiology
��stressful environment+ individual vulnerability
��Treatment
1.help a resolution of the stressful problem
2.aid the natural process
��by reducing denial and avoidance
��by encouraging problem solving
��discouraging maladaptive coping responses
��reducing anxiety by talking about the stress and expressing
feelings
�@ |
| Adjustment to illness: Sick role |
Parsons(1951) 1.Exemption from certain
social responsibilities
2.Right to expect help and care from others
3.Obligation to seek and cooperate with treatment
4.Expectation that the sick person will have a desire to
recover
�@ |
| Adjustment to Bereavement: Normal Grief |
1st Stage: denial, numbness, feeling of
unreality, restlessness
2nd Stage:
extreme sadness, anxiety, yearning of the dead, guilty, anger,
projection, vivid experience or hallucination of the dead, intrusive
images, social withdrawal, physical symptoms
3rd Stage:
resumed, recall the good times
�@ |
| Adjustment to Bereavement: Treatment |
1.talk about the loss, to express feelings
of sadness, guilt, or anger, and to understand the normal course of
grieving 2.forewarn the unusual experiences
3.to accept that the loss is real; to work through the stages of
grief; to adjust to life without the deceased
4.maintaining and caring for the young
5.resume social contacts, talk to other people about the loss,
remember happy and fulfilling experiences
6. consider positive activities that the deceased would have
wanted survivors to undertake
�@ |
| Adjustment to death |
��Symptoms:
1.Anxiety: pain, disfigurement, incontinence, fear of death,
concerns about the future of the family
2.Depression: separation from family, loss of valued
activities
3.Guilt: excessive demands, punishment for wrongdoing
4.Anger: unjustness
��Kubler-Ross(1969): DABDA��Defense mechanisms: (3D)
Denial, Dependency, Displacement�]�E��^
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�ͩR�����(�F����F�p�G�ͩR���j)�C ���A�����`���N�q�b��A������{���ëD�@�إ~�Ӫ��B���ͪ��L�{�A�ӬO
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�����F�@�N��U�B���|���
��Treatment 1.reduce symptoms as much as possible: adequate
control of pain and breathlessness and the reduction of confusion
2.establish a good relationship with the patient: explanation,
expressing feelings 3.talk with relatives(anxiety,
depression����guilt, anger, denial) 4.dealing with psychiatric
symptoms or behavioral disturbance 5.depressive disorder: esp.
early morning wakening, extreme hopelessness and self-blame �@ |
| Generalized Anxiety Disorder |
| A.
Excessive anxiety and worry
(apprehensive expectation), occurring more
days than not for at least 6 months, about
a number
of events or activities (such as work or school
performance). B. The
person finds it difficult to control the worry.
C. The anxiety and worry are
associated with three (or more) of the following six
symptoms (with at least some symptoms present for
more days than not for the past 6 months). Note:
Only one item is required in children.
(1) restlessness or
feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going
blank
(4) irritability
(5) muscle tension
(6) sleep disturbance (difficulty falling or
staying asleep, or restless unsatisfying sleep)
D. The focus of the anxiety
and worry is not confined to features of an Axis I
disorder, e.g., the anxiety or worry is not about
having a Panic Attack (as in Panic Disorder), being
embarrassed in public (as in Social Phobia), being
contaminated (as in Obsessive-Compulsive Disorder),
being away from home or close relatives (as in
Separation Anxiety Disorder), gaining weight (as in
Anorexia Nervosa), having multiple physical
complaints (as in Somatization Disorder), or having
a serious illness (as in Hypochondriasis), and the
anxiety and worry do not occur exclusively during
Posttraumatic Stress Disorder.
E. The anxiety, worry, or
physical symptoms cause clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
F. The disturbance is not due
to the direct physiological effects of a substance
(e.g., a drug of abuse, a medication) or a general
medical condition (e.g., hyperthyroidism) and does
not occur exclusively during a Mood Disorder, a
Psychotic Disorder, or a Pervasive Developmental
Disorder. |
|
�@ |
| Panic Attack |
�@
�ҿת��y���W�o�@�z�h�O���b�@�q�S�w���ɶ������j�P���`�ȩΤ��A�A�æ��H�U�C�g�������|���H�W�C�o�ǯg���]�A�G�߱��Τ߸��[�֡B�X���B�o�ݡB�I�l�x���B�C��P�B�ݵh�Τ��A�B���ߩθ������A�B�Y�w�B���h�ۧڷP�B�`�ȥ��h����B�`�ȧY�N���h�B�Pı���`�B�y����C�o�صo�@�q�`�O��M�}�l�è��t�F����Y�����{�סC
�]1�^�Ī��v���G�ثe���T���Ī��]�]�AXanax�BZoloft�BSeroxate�^�O�gFDA�q�L�ﮣ�W�g���Ī��Ī��A���Ī����v�����ī�A�@��ݭn�A����A��8��12�Ӥ�C
�]2�^�{���欰�v���G
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�@ |
|
Obsessive-Compulsive Disorder |
| A. Either
obsessions or
compulsions:
Obsessions as defined by (1),
(2), (3), and (4):
(1) recurrent and
persistent thoughts, impulses, or images that
are experienced, at some time during the
disturbance, as intrusive
and inappropriate and that
cause marked anxiety or
distress
(2) the thoughts, impulses, or images are not
simply excessive worries about real-life
problems
(3) the person attempts to
ignore or suppress such thoughts,
impulses, or images, or to neutralize them with
some other thought or action
(4) the person recognizes that the obsessional
thoughts, impulses, or images are
a product of his or her
own mind (not imposed from without as in
thought insertion)
Compulsions as defined by
(1) and (2):
(1)
repetitive behaviors (e.g., hand washing,
ordering, checking) or mental acts (e.g.,
praying, counting, repeating words silently)
that the person feels driven to perform
in response to an obsession, or according to
rules that must be applied rigidly
(2) the behaviors or mental acts are
aimed at preventing or
reducing distress or preventing some
dreaded event or situation; however, these
behaviors or mental acts either are
not connected in a realistic way with
what they are designed to neutralize or prevent
or are clearly excessive
B. At some point during the
course of the disorder, the person has recognized
that the obsessions or compulsions are
excessive or unreasonable.
Note: This does not apply to
children.
C. The obsessions or
compulsions cause marked distress, are
time consuming (take
more than 1 hour a day), or significantly interfere
with the person's normal routine, occupational (or
academic) functioning, or usual social activities or
relationships.
D. If another
Axis I disorder is
present, the content of the obsessions or
compulsions is not restricted to it (e.g.,
preoccupation with food in the presence of an
Eating Disorders; hair
pulling in the presence of
Trichotillomania;
concern with appearance in the presence of
Body Dysmorphic Disorder;
preoccupation with drugs
in the presence of a Substance
Use Disorder; preoccupation with having a
serious illness in the presence of
Hypochondriasis;
preoccupation with sexual urges or fantasies in the
presence of a
Paraphilia; or
guilty ruminations in the
presence of Major Depressive Disorder).
E. The disturbance is not due
to the direct physiological effects of a
substance (e.g., a drug
of abuse, a medication) or a general medical
condition. |
|
�@ |
| OCD: psychotherapy |
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�Ҧp�J�n�f�H�h�N���ż �A���O���\�L�]�o�^�h�~��C���M���~��J�{�|�@���A���O�J�{�i�H�۵M�a�v�����h�C�f�H�̫�Ǩ�J�� �h�~��A����ä��|�����}����G�o���C�p���]�i�H�h���f�H�ǵ۬~��Ӵ�ֵJ�{���a�ߺD�C
�u²����n�����q�v�B�@�P���w�@�ӥؼСB�Y�ϥu�O�p�p���i�B�]�n�����[�H���y�B���Ϋ��q�C
�@ |
| Acute stress disorder: Treatment |
�@ 1.Reducing the emotional response:
talk and express emotion to understanding person, anxiolytics
2.Encouraging recall: to prevent "avoidance" or "denial", phobias or PTSD
3.Learning effective coping skills
�@ |
| Posttraumatic Stress
Disorder |
A. The person has been
exposed to a traumatic event in which both of the
following were present:
(1) the person
experienced, witnessed, or was confronted with
an event or events that involved actual or
threatened death or serious injury, or a threat
to the physical integrity of self or others
(2) the person's response involved intense fear,
helplessness, or horror. Note: In
children, this may be expressed instead by
disorganized or agitated
behavior
B. The traumatic event is
persistently reexperienced
in one (or more) of the following ways:
(1) recurrent and
intrusive distressing
recollections of the event, including
images, thoughts, or perceptions. Note:
In young children, repetitive play may occur in
which themes or aspects of the trauma are
expressed.
(2) recurrent distressing
dreams of the event. Note: In
children, there may be frightening dreams
without recognizable content.
(3) acting or feeling as if the traumatic event
were recurring
(includes a sense of reliving the experience,
illusions, hallucinations, and dissociative
flashback episodes, including those that occur
on awakening or when intoxicated). Note:
In young children, trauma-specific reenactment
may occur.
(4) intense psychological distress at exposure
to internal or external
cues that symbolize or resemble an aspect
of the traumatic event
(5) physiological reactivity on exposure to
internal or external cues that symbolize or
resemble an aspect of the traumatic event
C.
Persistent avoidance of stimuli associated
with the trauma and numbing of general
responsiveness (not present before the trauma), as
indicated by three (or more) of the following:
(1) efforts to avoid
thoughts, feelings, or conversations associated
with the trauma
(2) efforts to avoid activities, places, or
people that arouse recollections of the trauma
(3) inability to recall an important aspect of
the trauma
(4) markedly diminished interest or
participation in significant activities
(5) feeling of detachment
or estrangement from others
(6) restricted range of
affect (e.g., unable to have loving
feelings)
(7) sense of a
foreshortened future (e.g., does not
expect to have a career, marriage, children, or
a normal life span)
D. Persistent symptoms of
increased arousal (not
present before the trauma), as indicated by two (or
more) of the following:
(1) difficulty falling or
staying asleep
(2) irritability or outbursts of anger
(3) difficulty concentrating
(4) hypervigilance
(5) exaggerated startle
response
E. Duration of the disturbance
(symptoms in Criteria B, C, and D) is more than
1 month.
F. The disturbance causes
clinically significant distress or impairment in
social, occupational, or other important areas of
functioning. |
|
�@ |
| Post-traumatic stress disorder:
Symptoms |
���@�ӤH�g����
�ת��ж����O�ƥ�ӥB����X�{�`�ȡB�L�U�P�B�ή��ƷP�������A�H����H�H�U�T�j���g���G
�]1�^ ���ж����O�ƥ�g�ѹڹҩΦ^�Ы���Q�A�g��C
�]2�^ ��жˬ�������E���Ͱk�פ����ι�@�몺�����¤�C
�]3�^ ����ɰ�ĵı�ʡC 1.Hyperarousal
persistent anxiety
irritability
insomnia
poor concentration
2.Intrusions
difficulty in recalling
flashbacks
recurring dreams
3.Avoidance
avoid reminders
detachment
numbness
avolition
�@ |
| Post-traumatic stress disorder:
Treatment
�@ |
Immediate measures:
1.encouragment to
recall the stressful experiences
2.express associated emotions to an understanding person
Later treatment:
��Councelling
1.provide emotional support
2.encourage recall of the traumatic events
3.facilitate "working through" the associated emotions
4.dealing with guilty feeling
5.existential concerns about the
meaning and purpose of life and death
��Behavioural techniques
desensitize pts to intrusive
memories by relaxing/flooding
��Psychodynamic psychotherapy
��Drug: Anxiolytics, MAOI, TCA, SSRI
�@ |
| �@ |
�@ |
| PTSD: rape |
1.Acute reactions:
(1)Anxiety and depressive disorders
(2)Psychosexual dysfunction
(3)PTSD(94%)2. Feelings:
vulnerability, self-blame, loss of self-esteem
why chosen as victim
�@ |
| PTSD: Catastrophe |
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