抗神失常药(浙江大学药学院)总结.ppt

Case report W.G, 19 years old, undergraduate, member of rowing team of school, was found staying by himself, avoiding the company of friends and skipping school and athletic training. Later, he was heard speaking to himself as he sat isolated in his room, mumbling and smiling. Then he confided to his roommate that he had uncovered a grand conspiracy to rob him of his athletic abilities and that he could hear the conspirator’s voices as they plans to destroy him. Finally, he accused his roommate of being a part of the conspiracy. Epidemiology Incidence consistent worldwide 1% general population 10% siblings , parents / offspring, dizygotic twins 50% monozygotic twins Environmental factors implicated Prenatal stress - infection, famine, war, death of spouse Season of birth - winter summer Urban setting rural setting Age of onset Men 17 – 27, Women 17 - 37 Childhood onset extremely rare: 1 in 10,000-100,000 Duration – life Outcome 10 % good - optimistic 80% remission without full recovery 10 % no remission Box 1 精神分裂症(schizophrenia)表现 表现为基本个性改变，思维、情感、行为的分裂，精神活动与社会环境不协调。起病缓慢，发病年龄多在16～40岁之间，20～30岁更为多见。 ■ 基本个性改变 与人的关系方面，病人逐渐变得少言寡语，不愿与人交往；在工作与学习方面，他们懒于劳动，工作、学习，不守纪律，工作或学习质量逐渐下降；在个人生活方面，病人懒于料理个人生活，有的常年不理发、不更衣、不洗澡、不打扫房间卫生等，自己不干也不允许别人帮助。 ■ 阳性和阴性症状 阳性症状指典型的幻觉、荒谬偏执的妄想、不合情理的恐惧等；阴性症状则指情感淡漠、情绪退缩、言语内容贫乏以及快感体验丧失；认知障碍包括记忆缺陷和智能低下，病人的社会功能受损。 Signs Symptoms Positive symptoms Delusions - fixed false belief outside cultural norm (bizarre vs. non bizarre) Hallucinations - perceptual (hearing), have no outside source “Like my voice” Not an illusion (a mistaken perception for which there is an actual external stimulus) Disorganization - pattern of speech or behavior, making up words without a meaning (neologisms) Signs Symptoms Negative symptoms Affective flattening情感冷淡 Avolition / Amotivation (decreased motivation) Autistic behaviors (social withdrawal ) Anhedonia (inability to experience pleasure )兴致缺乏 Ambivalence (coexistence of opposing attitudes or feelings) Anosogn