精神科综合征..

• DSM-Ⅳ-TR Criteria • Factitious Disorder • A. Intentional production or feigning of physical or psychological signs or symptoms. • B. The motivation for the behavior is to assume the sick role. • C. External incentives for the behavior (such as economic gain, avoiding legal responsibility, or improving physical wellbeing, as in malingering) are absent.
• Factitious Disorder with Combined Psychological and Physical Signs and Symptoms
• Clinical Vignette • A 46-year-old man presented complaining of symptoms of post traumatic stress disorder (PTSD). He reported intense fl ashbacks, numbing and avoidance, and irritability resulting from his experience as a combat veteran. He began intensive treatment for PTSD including support groups, individual therapy and medication management. He was an extremely active participant in the support groups and would recount detailed horrors of his time in combat. A staff member verifying the patient’s history learned the patient had served in the military but was not a combat veteran. The patient was confronted in a supportive manner, and he admitted that he had fabricated his history. It was recommended that the patient continue in psychiatric treatment, and he agreed to do so.
gastrointestinal, 1 nonpain sexual or reproductive, and 1 Pseudoneurological (conversion or dissociative) No exclusive list of symptoms
• Epidemiology • female/male ratio of approximately 10 : 1 • The lifetime prevalence … 0.2 and 2%
Treatment
• Treatment is difficult and patients often consume large amount of resources • The foundations of treatment for this disorder are: 1) establishment of a strong physician–patient relationship or bond;2) education of the patient regarding the nature of the psychiatric condition; and 3) provision of support and reassurance.
• Course, Natural History and Prognosis Somatization disorder is rare in children younger than 9 years of age. • Characteristic symptoms of somatization disorder usually begin during adolescence, and the criteria are met by the midtwenties. • Somatization disorder is a chronic illness characterized by fluctuations in the frequency and diversity of symptoms. • Full remissions occur rarely, if ever • Longitudinal follow-up studies have confirmed that 80 to 90% of patients initially diagnosed with somatization disorder will maintain a consistent clinical picture and be rediagnosed similarly after 6 to 8 years
• General Description • “A history of many physical complaints” • Symptoms required: 4 pain, 2 nonpain
• Onset ‘‘…before age 30 years” “…occur for a period of several years”
• 13、Othello综合征(Othello’s syndrome)
病理嫉妒综合征，奥赛罗综合征
• 14、Capgras综合征
双重错觉综合征，双重人身症，替身综合征
• 15、Fregoli综合征
替身错觉症，人身变换症，Fregoli妄想
One man show
• 16、De Clerambault syndrome
• 18、Munchausen’s syndrome 做作性障碍（Factitious Disorder） 住医院癖 住院流浪者症
• Munchausen’s syndrome by Proxy
• The term “factitious” means “willfully produced”. • Factitious disorders are disorders in which the individual produces the signs or symptoms of illness.The illness may be manifested either by physical or psychological symptoms. • The patient’s primary goal is to receive medical,surgical,or psychiatric care; secondary motivations involve obtaining drugs or financial assistance.
色情综合征 爱情狂
• 17、Briquet’s syndrome
躯体化障碍
• Definition • As defined in DSM-IV, somatization disorder is a polysymptomatic somatoform disorder characterized by multiple recurring pains and gastrointestinal, sexual and pseudoneurological symptoms occurring for a period of years with onset before age 30 years. • The physical complaints are not intentionally produced and are not fully explained by a general medical condition or the direct effects of a substance.
精神科综合征
• 1、幻觉症 • 2、幻觉妄想综合征 • 3、精神自动症综合征 Kandinsky- Clerambault 综合征
• 4、疑病综合征 • 5、遗忘综合征 • 6、紧张综合征
柯萨可夫综合征或遗忘—虚构综合征
• 7、人格解体-现实解体综合征
• 8、神经衰弱综合征
• 9、赔偿综合征 特点
• Asher, who in 1951 coined the term Munchausen’s syndrome to denote a disorder observed in certain patients who traveled widely in England
Factitious Disorder with Predominantly Physical Signs and Symptoms
• 多数病人具有极强的赔偿意识，并表现在其言行举止 上； • 临床表现虽有表演性、夸张性，但不因环境、对象改 变而消失，不完全受其主观意志控制； • 症状常迁延不愈，心理、药物治疗效差； • 病人为其症状存在而感到苦恼，有的可发现躯体征， 如代偿性肢体增粗、萎缩
• 10、脑震荡后综合征
• 11、幸存者综合征 • 12、Cotard综合ห้องสมุดไป่ตู้(Cotard’s syndrome)
• Factitious Disorder with Predominantly Psychological Signs and Symptoms
• There are reports of factitious psychosis, posttraumatic stress disorder and bereavement. In addition, there are reports of psychological distress due to false claims of being a victim of stalking, rape, or sexual harassment, and these cases are often diagnosed with a factitious psychological disorder such as post traumatic stress disorder.
• The three main methods patients use to create illness are: 1) giving a false history, 2) faking clinical and laboratory findings, and 3) inducing illness (e.g., by surreptitious medication use, inducing infection, or preventing wound healing). • There are reports of factitious illnesses in all of the medical specialties. • Particularly common presentations include fever, selfinduced infection, gastrointestinal symptoms, impaired wound healing, cancer, renal disease (especially hematuria and nephrolithiasis), endocrine diseases, anemia, bleeding disorders and epilepsy (Wise and Ford, 1999)