Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
ึ ษา ปั ญหาทางจิตเวชทีพ ่ บบ่อยในนักศก รองศาสตราจารย์.นพ.ณรงค์ มณีทอน ภาควิชาจิตเวชศาสตร์ ี งใหม่ คณะแพทยศาสตร์ มหาวิทยาลัยเชย ึ ษา ปั ญหาทางจิตเวชทีพ ่ บบ่อยในนักศก โรคจิต (Psychotic disorders) ความผิดปกติทางอารมณ์ (Mood disorders) โรควิตกกังวล (Anxiety disorders) ั ้ (Attention-deficit hyperactivity สมาธิสน disorder) ความผิดปกติของบุคลิกภาพ(Personality disorders) โรคจิต (Psychotic disorders) - Psychotic (hallucinations/delusions) dimension: อาการหลงผิด ประสาทหลอน - Disorganized dimension: disorganized speech, disorganized behavior, อารมณ์ไม่เหมาะสม (inappropriate affect) - Negative dimension: อารมณ์เฉยเมย (affect flattening), ไม่พด ู (alogia), ไม่มแ ี รงจูงใจ (avolition) โรคจิต (Psychotic disorders) Classification of Schizophrenia & Other Psychotic Disorders: - Schizophrenia (SCZ) - Schizophreniform Disorder (SCF) - Schizoaffective Disorder (SAD) - Delusional Disorder (DD) - Brief Psychotic Disorder (BPD) - Shared Psychotic Disorder (SPD) Schizophrenia (SCZ) Lifetime prevalence: 0.5-1.0 % Incidence rate: 1:10,000/year Prevalence rate: male = female Etiology: genetic factors, lateral ventricle enlargement, gestational and birth complications and winter birth (related to unknown virus infection at birth) Schizophrenia (SCZ) Pathophysiology: dopamine hypothesis - previously: dopamine hyperactivity hypothesis postsynaptic D2 receptor blockade effect of antipsychotics - recently: positive symptoms ~ dopamine hyperactivity in mesolimbic pathways; : negative symptoms ~ dopamine hypoactivity in prefrontal region : serotonin ~ SCZ symptoms Schizophrenia (SCZ) ี หน ้าที่ high prevalent rate, มักเรือ ้ รัง เสย การทางาน (e.g., self care, occupation, social) Schizophrenia (SCZ) การรักษา Antipsychotic drug (AD) Conventional AD: Haloperidol, Chlorpromazine Atypical AD: Risperidone, Clozapine Electroconvulsive therapy Psychosocial Supportive psychotherapy Family therapy Social skill training ความผิดปกติทางอารมณ์ (Mood disorders) Two poles of mood: depression and mania Mood Disorders: Depressive Disorders and Bipolar Disorders DSM-IV classification of Mood Disorders 1. Major Depressive Disorder (MDD) 2. Dysthymic Disorder (DD) 3 Bipolar I Disorder (BD I) 4. Bipolar II Disorder (BD II) Major Depressive Disorder (MDD) Lifetime prevalence rates of 10-25% of female population and 5-12% in male population (female: male ~ 2:1) Pathophysiology: lack of norepinephrine (NE) and/or serotonin (5-HT) NE and/or 5-HT reuptake inhibition of antidepressants. Major Depressive Disorder (MDD) Pathophysiology: biological abnormalities, e.g., endocrine systems, neuroanatomy, sleep-wake cycle Pathophysiology: stress biological abnormalities MDD Major Depressive Disorder (MDD) Clinical manifestation 1. Depressed mood 2. Marked diminished interest or pleasure 3. Weight loss or gain/ or appetite 4. Insomnia or hypersomnia 5. Psychomotor agitation or retardation 6. Fatigue or loss of energy Major Depressive Disorder (MDD) 7. Worthlessness/excessive or inappropriate guilt 8. thinking ability or concentration/ indecisiveness 9. Repeated suicide ideation, attempt or plan Major Depressive Disorder (MDD) Treatment Antidepressant: growth factor; brain derive neurotropic factor (BDNF) Tricyclic Selective serotonin reuptake inhibitors อื่นๆ Psychotherapy CBT: thinking process distortion misinterpretation depression IPT: interpersonal conflicts depression Major Depressive Disorder (MDD) 2/3 of MDD patients improved Relapse risk: 50%, 70%, and 90% after 1st, 2nd, and 3rd (or more) episodes Bipolar Disorder Core of manic symptoms: euphoric, elevated, or irritable mood Lifetime prevalence: 1.3% of gen. population; male ~ female (BDI); male < female (BDII) Unknown etiology but genetic factor may play a role Recurrent disorder: risk for manic relapse > 90% Most patients back to normal selves Bipolar Disorder BD I: Mania or Mixed Episode +/- Major depressive Episode BD II: Hypomanic Episode + Major depressive Episode Manic episode Bipolar Disorder Manic/Hypomanic episode 1. Inflated self-esteem or grandiosity 2. need for sleep 3. More talkative or pressure to keep talking 4. Flight of ideas or racing thought 5. Distractibility 6. goal-directed activity or psychomotor agitation 7. Excessive involvement in pleasurable activities (but painful consequences) Bipolar Disorder Treatment Mood stabilizers at present: Li, valproic acid (VPA), carbamazepine (CBZ) Atypical antipsychotics Psychosocial intervention Family therapy: e.g., accept the disease, search for the stressor, etc. Psychoeducation and skills training Recurrent disorder: risk for manic relapse > 90% Most patients back to normal selves โรควิตกกังวล (Anxiety disorders) 1. Panic Disorder 2. Specific Phobia (SpP) 3. Social Phobia (SoP) 4. Obsessive-Compulsive Disorder (OCD) 5. Posttraumatic Stress Disorder (PTSD) 6. Acute Stress Disorder (ASD) 7. Generalized Anxiety Disorder (GAD) Obsessive-Compulsive Disorder (OCD) Core symptoms: obsession anxiety or tension compulsion the relief of anxiety or tension Unreasonable and embarrassment Treatment SSRIs are first-line tx Clomipramine: slightly more effective than other Attention-deficit Hyperactivity Disorder Prevalence: 3-5% Male: Female= 3-5:1 Attention-deficit Hyperactivity Disorder Inattention Hyperactivity Impulsivity Treatment Medication Stimulant: Ritalin Non-stimulant : Atomoxetine ความผิดปกติของบุคลิกภาพ (Personality disorders) Borderline personality disorder Unstably stable Histrionic personality disorder Self center Obsessive compulsive persionality disorder Perfectionist Passive aggressive personality disorder ดือ ้ เงียบ วิธีการสัมภาษณ์ ฟั งอย่างตัง้ ใจ (active listening) ิ (non-judment) ห ้ามตัดสน ห ้ามให ้คาแนะนาก่อนได ้ข ้อมูลครบ (immature suggestion) ห ้ามขัดจังหวะโดยไม่จาเป็ น แสดงท่าทางสนใจ ด ้วยความจริงใจ