神经症与癔症患者的护理.ppt

神经症和癔症患者的护理 社区护理学教研室 李静芝 概述 定义：神经症又称神经官能症，是一组精神障碍的总称 共同特征： 与心理社会因素有关 有一定的个性基础 均不伴有器质性病变 有自知力 社会功能较完整 病程大多持续迁延 绪论 焦虑症： 广泛性焦虑 (generalized anxiety disorder) 惊恐障碍 (panic disorder) 强迫症 (obsessive-compulsive neurosis) 恐惧症 (phobia) 场所恐惧症 (agoraphobia) 社交恐惧症 (social phobia) 单一恐惧症 (simple/specific phobia) DSM-Ⅳ 神经症发病情况 各型神经症的临床表现 广泛性焦虑 精神焦虑 － 对未来可能发生的某种危险经常担心，自知而无法自控，有大祸临头之感 躯体焦虑 － 搓手顿足、肌肉紧张、气短、心悸、出汗、口干等 Lucy is a 49-year-old legal secretary. she comes to the clinic and tells the nurse, “it was probably foolish to come here. Nobody understand me.” she is shaky and diaphoretic（出汗的）. Her only daughter is expecting her first child. Although the pregnancy is going well. Lucy worries that something is wrong with the baby. Lucy describes herself as tense and irritable. She has difficulty initiating sleep and cannot concentrate at work. She worries about making mistakes at work, about being fired from her position, and about the financial problems the could result. 各型神经症的临床表现 惊恐障碍 特点：无特殊的恐惧性处境，突然感到一种突如其来的惊恐体验，伴濒死感或失控感及自主神经紊乱 起病急，终止快（5-20min），再发 Dora, a 30-year-old pharmacist, lives at home and cares for her mother. After her mother’s death from heart disease, Dora begins to experience tension, irritability, and sleep disturbance. On several occasions, Dora awakens gasping for breath. Her heart pounds, and she feels a tight sensation, like a band around her chest, her pulse typically increase to more than 110 beats per minute, and she experiences dizziness. She fears that she is going to die. 各型神经症的临床表现 强迫症 强迫观念，伴强迫行为 自我强迫与反强迫并存 不确定、不安全感、不完美感 各型神经症的临床表现 场所恐惧症 e.g. Jim is a 28-year-old man. He once lived a very active life. Jim’s father, who had severe cardiovascular disease, died 2 years ago on his way to work. Since that time, Jim has become increasingly fearful of the outdoors. He learned that he would die if he left home. 各型神经症的临床表现 社交恐惧症 e.g. Tim, a 22-year-old music theater major, develops a fear of performing on stage. He suffers severe anxiety attacks