Symptoms Depression in General Practice 情緒障碍躯体化课件.pptVIP

Somatic Symptoms Depression in General Practice情緒障碍躯体化 David Wong 王大卫 MB.,BS, PDip.Com.Psy Med HONG KONG 9th Beijing/ Hong Kong Medical Exchange 第九届京港医学交流会议 Psychological medicine in Community社区心理医学 3 - 4 November 2007 Presidential, Plaza Hotel, Beijing, China S.1 What is this what do you see ? 猜猜这是什么? S.2 Review of patients’ record in General Practice 病人纪录在全科医学中的覆检 Somatic symptoms depression Associated with medical causes and now found increasingly so with psychiatric disorders as well. 一向被认以为是躯体的疾病, 现在我们知道精神障碍也可以引起同样症状. Some medically unexplainable symptoms may be listed under well defined psychiatric disorders, the rest is grouped loosely as medically `unexplained` symptoms (MUS). 部份躯体症状不能以身体疾病解释, 原来是精神障碍症侯一类. 目前还有一些躯体症状未能(起码暂时)有合理的解释, 有些学者就冠上一个名词”医学未能解释的症状” (MUS). Management of MUS, also not explainable by the present system of psychiatry, remains a challenge. 对临床和做研究的医学界MUS都是一个挑战. Somatic symptoms躯体症狀 S.3 Somatic symptoms(躯体症狀) in DSM IV HAM-D Somatic symptoms depression S.4 Symptoms症狀 DSM I V HAM-D Others Sleep 睡眠 Insomnia/hypersomnia 失睡, 昏睡 Early, middle late insomnia 早, 中, 晚段失睡 General 一般 Fatigue or loss of energy, 疲倦/沒有精力 Fatigue and loss of energy, heaviness, aches 疲倦, 乏力, 沉重,疼痛 GI腸臟-Appetite胃口 Weight体重 Decrease/increase 增加/减少胃口 significant weight gain/loss体重显著上升或减少 Marked reduction 沒有胃口 Weight loss体重下降 Head, Neck, 头, 颈 Aches (ANS) 疼痛 Aches, dizziness 疼痛, 暈眩 Mouth Throat 口腔喉咙 Globus hysteutus封喉, Spitting, pain 唾, 疼痛 Abdomen腹部 Stomach cramps胃抽筋 , belching, diarrhoea呕吐(ANS) Abdominal腹疼痛 and pelvic pain盆腔疼痛 , belching, vomiting呕吐diarrhoea,腹泻 Somatic symptoms(躯体症狀) in DSM IV HAM-D Somatic symptoms depression S.5 Symptoms症狀 DSM IV HAM-D Others Heart and Chest 心肺 Palpitation,心悸 hyperventilation过度换气(ANS) pain, palpitation心悸,dyspnoea 呼吸困难 , suffocation窒息, hyperventilation过度换气 Genital 泌尿 Urinary frequency频尿 (ANS) Gynecology 婦科 Menstrual disturbance 月经紊乱 Sex 性慾 Loss of libido 失去性慾 Limbs 四肢 Paranesthesia 麻脾, tremor震颤 (A