怎样鉴别伪装精神病(假精神病).ppt

Faking it: How to detect malingered psychosis or false mental illness伪装：怎样鉴别伪装精神病（假精神病） Martin R. Sheehan, Ph.D. What is Malingering? Malingering, as defined by the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), is the intentional production of false or exaggerated physical or psychological symptoms motivated by external incentives. 什么是伪装？美国精神障碍诊断和统计手册第四版(DSM-IV) ：伪装是指受某种外界动机因素影响，故意表现出虚假或夸大躯体或精神症状 Common motives of malingerers 诈病者的常见动机 To avoid pain（避免痛苦） To avoid: Arrest Criminal prosecution Conscription into the military （避免监禁、刑事起诉、军队征兵） To seek pleasure（寻求快乐） To obtain: Controlled substances Free room and board Workers compensation or disability benefits for alleged psychological injury （获得管制物质、免费食宿、职工赔偿金、精神损害的残疾利益） Interview Style（精神检查方式） When you suspect a patient is malingering, keep your suspicions to your-self and conduct an objective evaluation. Patients are likely to become defensive if you show annoyance or incredulity, and putting them on guard decreases your ability to uncover evidence of malingering. 当怀疑患者诈病时，你应保持警惕并进行客观评估。如果你表现出厌烦或怀疑，可能会使患者有防备心理或保持警惕，进而降低你发现各种诈病迹象的能力。 Begin by asking open-ended questions, which allow patients to report symptoms in their own words. 开始检查时通过开放式提问，允许患者用自己的话汇报症状。 To avoid hinting at correct responses, carefully phrase initial inquiries about symptoms. Later in the interview, you can proceed to more-detailed questions of specific symptoms, as discussed below. 给患者恰当的回应，避免暗示，开始询问症状时用语应谨慎。 Malingered Psychotic Symptoms 伪装精神病性症状 Hallucinations 幻觉 Delusions 妄想 Where Malingerers Trip Up （诈病者失败在哪里？） Malingerers may have inadequate or incomplete knowledge of the mental illness they are faking. Indeed, malingerers are like actors who can portray a role only as well as they understand it. They often overact their part or mistakenly believe the more bizarre their behavior, the more convincing they will be. 诈病者可能对他们所伪装的精神疾病有些一知半解的了解。的确，诈病者象演员一样能逼真的扮演他们所理解的病人角色，但他们的表现常显得过度夸张，甚至错误地认