心身障碍的识别PPT参考课件.pptVIP

门诊焦虑/抑郁患者的筛查流程 自评量表：9条目健康问卷（PHQ—9），广泛性焦 虑自评量表（GAD—7） 烦躁，紧张，担心，失眠 简短的三问法 （1）是否有睡眠不好？（2）是否有心烦不安或失去兴趣？（3）是否有明显身体不适，但多次检査都没有发现能够解释的原因。 放松训练 生物反馈技术 运动疗法 . * 病人健康问卷（PHQ-9）的评分及治疗建议 0—4分 ： 没有抑郁 ； 5—9分： 轻度抑郁 ：观察，随访；? 10—14分：中度抑郁：心理咨询，随访和/或药物治疗； 15—19分：中重度抑郁：药物治疗和/或心理治疗； 20—27分：重度抑郁：立即首先选择药物治疗，建议转诊。? ? * GAD-7 广泛性焦虑量表评分标准? 0—4分： 正常； 5-9分： 轻度焦虑； ?10-14分：中度焦虑； ?15-21分：重度焦虑。 * * * * 自愿原则与自愿医疗 第二十七条：“除法律另有规定外，不得违背本人意志进行确定其是否患有精神障碍的精神检查” 第二十八条：“除个人自行到医疗机构……” 第三十条：“精神障碍的住院治疗实行自愿原则” 第四十四条：“自愿住院治疗的精神障碍患者可以随时要求出院，医疗机构应当同意” 以上规定从 “送”、“诊”、治”、“出”四个关键环节全面体现自愿原则 * * * * 要点提示： 在神经科许多情绪疾患的患者可能常表现为躯体的不适。情绪疾患是一种全身性的疾患，患者常常表现为情绪困扰和许多身体的不适。 * PURPOSE OF THE SLIDE Focus on the high prevalence of associated pain in patients with depression. KEY POINTS In a major meta-analysis, two-thirds of patients with depression experienced pain symptoms as well. Symptoms included headaches, and back, neck, extremity/joint, chest, pelvic, abdominal, and general pain. The prevalence rates of associated painful symptoms in patients with depression did not differ in psychiatric vs primary care settings. BACKGROUND Bair et al searched MEDLINE database from 1966 through July 30, 2002, using the combined search terms depression or depressive disorders and pain. Articles were identified by a manual search of bibliographies from all retrieved articles. Studies were limited to human studies reported in English. Studies were eligible for inclusion if they addressed both depression and pain symptoms, loosely defined. The definition of pain condition, location of pain, and duration of pain complaint varied considerably among studies. Several different scales were used to assess depression. REFERENCES Bair MJ, Robinson RL, Katon W, et al. Depression and pain comorbidity. Arch Intern Med. 2003;163:2433-2445. 多种生理功能的紊乱，带来复杂多样的症状表现。有专家对抑郁症的症状进行了高度的概括，划分为三大症状群。抑郁症最有代