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精神病学神经症张亚林ZhangYa-linM.D&Ph.DHistory历史沿革W.Cullen,1769H.Bernheim,1884S.FreudTheModernViewforNeuroses五个共同特征1.Thestressisrelatedtotheonsetofneuroses发病与心理因素相关；2.Thepersonalityisanimportancealthoughitisnotgrosslyabnormal个性特征突出；TheModernViewforNeuroses五个共同特征3.Neurosesarenotcausedbyanykindoforganicbraindisorders无相应的器质病变;4.Thesocialfunctionisnormalonthewhole社会功能相对完好;5.Theneuroticpatientsdonotloseinsight自知力充分.TheClassificationofNeuroses分类Phobia恐惧症Anxietydisorder焦虑症Obsessive-compulsivedisorder强迫症Hypochondriasis疑病症Neurasthenia神经衰弱Hysteria癔症Other其他Theepidemiology患病率22.21%0Etiology?/Theories!相关学说Psychoanalytictheories精神分析学说unconsciousness潜意识dreamwrongneuroticsymptoms梦错误神经症症状personalitystructure人格构成idegosuperego原我自我超我Etiology?/Theories!相关学说Behaviortheories行为科学理论stress-response刺激-反应认知学说SRC认知CognitivetheoriesPhobia恐惧症Clinicalpicture临床表现1.agoraphobia广场恐惧2.simplephobia单一恐惧3.socialphobia社交恐惧Treatment治疗1.behaviortherapy行为疗法2.drugs药物Anxietyneurosis焦虑症Clinicalpicture1.feelingofanxiety焦虑的体验2.physicalsymptoms运动/植物神经症状Panicattack惊恐发作Generalizedanxietydisorder广泛性焦虑症Treatment1.drugs药物2.relaxationtraining放松训练Obsessive-compulsiveneurosis强迫症Clinicalpicture1.obsessivethoughts强迫观念2.obsessivemood强迫情绪3.obsessiveimpulses&behavior强迫冲动/行为Personalityfeatures人格特征scrupulousness小心多虑,rigidity严谨规矩僵化,perfectionism追求完美,insecurity不安全感Treatment1.drugs；2.behaviortherapyHypochondriasis疑病症Clinicalpicturepain---head,lowerlumbarregionworriesabout“medicalstudents’illness”“医学生病”Treatment?Neurasthenia神经衰弱Clinicalpicture1.mentalandphysicalfatigue心身疲劳2.irritability易激惹/烦恼/紧张3.psychophysiologicalsymptoms心理生理症状:失眠/疼痛/食欲/性欲Treatment1.drugs:valium2.psychotherapyHysteria癔症Clinicalpicture1.somaticdisorder:躯体障碍motordisorder,sensorydisorder2.psychologicaldisorder:精神障碍amnesia,fugue,identitydisorder遗忘神游多重人格Personalityfeaturessuggestion,self-centred,dramatization,fantasy暗示性自我中心戏剧性幻想Treatmentinducedtherapy诱导疗法Menlearnwhiletheyteach教学相长《礼记﹒学记》