167精神科相关护理学课件@承德_第九章 情感性精神障碍.ppt

第九章 情感性精神障碍病人的护理 Nursing Management for Patients with Alterations in Mood 第一节 概述 概念及特征 分类及流行病学特点 病因与发病机制 治 疗 分类 《中国精神疾病分类与诊断标准》第3版（CCMD-3）将情感性精神障碍主要分类为： 双相障碍 躁狂发作 抑郁发作 持续性心境障碍 其他或待分类的心境障碍 病因与发病机制 (一)遗传因素 1．家系研究 情感性精神障碍病人中，有家族史者为30%~41%。血缘关系越近，患病率越高。 2．双生子研究 国外研究发现单卵双生的同病率为56.7%，而双卵双生为12.9%，但遗传方式尚不清楚。 治疗 治疗原则 双相障碍应遵循长期治疗的原则。抗抑郁药物是当前治疗各种抑郁障碍的主要药物，在药物治疗的同时常需合并心理治疗。 治疗措施 药物治疗 改良电痉挛治疗 心理治疗 药物治疗 改良电痉挛治疗 第二节 常见情感性精神障碍病人的护理 躁狂发作病人的护理 抑郁发作病人的护理 其他类型情感障碍病人的临床特征及护理 CLLNICAL EXAMPLE “Hi! I’m Kevin 254!” The nurse, Jone, finds himself, back to the wall, confronted by a man 6 feet 6 inches tall who has fidgeted through the last 15 minutes of a group on an inpatient unit. The group was designed for significant others who needed to know about the origins and treatment of depression. “Kevin 254” had arrived 45 minutes late and noisily found a chair. Unfortunately, during the last 15 minutes of the group everybody was distracted by Kevin’s behavior and left almost immediately after the session ended. “Nice tie!” says Kevin to Jone, as he not so gently grabs it and pulls it to his face to inspect it more closely. CLLNICAL EXAMPLE Jone’s personal space is most definitely invaded, but Kevin does not seem to notice. “Kevin 254?” Jone asks. “Short for 254-35-1658. I’d much rather be called 254 than Kevin. I hate my name.” Losing interest in the tie, Kevin throws himself back into the chair he vacated, almost tipping it over, obvioussly enjoying being off balance, and even more enjoying Jone’s consternation that Kevin might hurt himself. “Oh great! A worrier! I’ll give you something to worry about. I’m going to hurt somebody—maybe that b_ you have in here, maybe her mother, maybe my mother—better yet, me! Yes, I’ll hurt myself. Great place, right here in this fancy hospital. CLLNICAL EXAMPLE Blood all over the place—bright red—place needs to be redone anyway—too drab—looks like a funeral parlor in here—how appropriate!” laughing raucous