精神病学精神病学 神经症 张亚林张亚林 Zhang Ya-lin M.D & Ph.DHistory 历史沿革历史沿革 W.Cullen , 1769 H.Bernheim, 1884 S.FreudThe Modern View for Neuroses 五个共同特征五个共同特征 1. The stress is related to the onset of neuroses 发病与心理因素相关；2. The personality is an importance although it is not grossly abnormal 个性特征突出；The Modern View for Neuroses 五个共同特征五个共同特征3. Neuroses are not caused by any kind of organic brain disorders 无相应的器质病变;4. The social function is normal on the whole 社会功能相对完好;5. The neurotic patients do not lose insight 自知力充分.The Classification of Neuroses 分类分类 Phobia 恐惧症 Anxiety disorder 焦虑症 Obsessive-compulsive disorder 强迫症 Hypochondriasis 疑病症 Neurasthenia 神经衰弱 Hysteria 癔症 Other 其他The epidemiology 患病率患病率 22.21%0Etiology?/Theories! 相关学说相关学说 Psychoanalytic theories 精神分析学说精神分析学说v unconsciousness 潜意识潜意识 dream wrong neurotic symptoms 梦 错误 神经症症状v personality structure 人格构成人格构成 id ego superego 原我 自我 超我Etiology?/Theories! 相关学说 Behavior theories 行为科学理论 stress-response 刺激刺激- -反应反应 认知学说SRC 认知知 Cognitive theoriesPhobia 恐惧症恐惧症 Clinical picture 临床表床表现 1. agoraphobia 广广场恐惧恐惧 2. simple phobia 单一恐惧一恐惧 3. social phobia 社交恐惧社交恐惧 Treatment 治治疗 1. behavior therapy 行行为疗法法 2. drugs 药物物Anxiety neurosis 焦虑症焦虑症 Clinical picture 1. feeling of anxiety 焦焦虑的体的体验 2. physical symptoms 运运动/植物神植物神经症状症状 Panic attack 惊恐发作惊恐发作 Generalized anxiety disorder 广泛性焦虑症广泛性焦虑症 Treatment 1. drugs 药物物 2. relaxation training 放松放松训练Obsessive-compulsive neurosis 强迫症强迫症 Clinical picture 1. obsessive thoughts 强迫迫观念念 2. obsessive mood 强迫情迫情绪 3. obsessive impulses & behavior 强迫冲迫冲动/行行为 Personality features 人格特征 scrupulousness 小心多小心多虑, rigidity 严谨规矩僵化矩僵化, perfectionism 追求完美追求完美, insecurity 不安全感不安全感Treatment 1. drugs； 2. behavior therapyHypochondriasis 疑病症疑病症 Clinical picture pain-head, lower lumbar region worries about “medical students illness” “医学生病医学生病” Treatment ?Neurasthenia 神经衰弱神经衰弱 Clinical picture 1. mental and physical fatigue 心身疲心身疲劳 2. irritability 易激惹易激惹/烦恼/紧张 3. psychophysiological symptoms 心理生理症状心理生理症状: 失眠失眠/疼痛疼痛/食欲食欲/性欲性欲 Treatment 1. drugs: valium 2. psychotherapy Hysteria 癔症癔症 Clinical picture 1. somatic disorder: 躯体障碍 motor disorder , sensory disorder 2. psychological disorder: 精神障碍 amnesia, fugue, identity disorder 遗忘 神游 多重人格 Personality features suggestion, self-centred, dramatization, fantasy 暗示性 自我中心 戏剧性 幻想 Treatment induced therapy 诱导疗法Men learn while they teach 教学相长礼记学记