2 IChao Liu Cardinal Tien hospital Fu Jen

精神疾患介紹(2) I-Chao Liu Cardinal Tien hospital Fu Jen Catholic University

Overview l Depressive ¡ Major l Anxiety ¡ Panic disorders depressive disorders disorder l Delirium, dementia, and amnestic and other cognitive disorders ¡ Delirium l Adjustment disorders

DSM-IV Depressive disorders l Major depressive disorder (重鬱症) l Dysthymic disorder l Depressive disorder, NOS ¡ Examples: Premenstrual dysphoric disorder l Minor depressive disorder l Recurrent brief depressive disorder l Postpsychotic depressive disorder l

Anxiety disorders l l l l l Panic disorder without agoraphobia Panic disorder with agoraphobia Agoraphobia without history of panic disorder Specific phobia Social phobia Obsessive-compulsive disorder Posttraumatic stress disorder Acute stress disorder Generalized anxiety disorder

Delirium, dementia, and amnestic and other cognitive disorders l Delirium l Dementia l Amnestic Disorders

Definition of delirium a syndrome developing acutely (hours to days) l symptoms fluctuating throughout its course l l Symptoms ¡ Disturbance of consciousness ¡ Inability to maintain attention ¡ Cognitive deficits ¡ Perceptual changes

Epidemiology 10% - 18% of hospital medical and surgical patients. l Elderly patients at high risk for developing delirium (14% - 56%) l l Other populations at risk: - postoperative patients - sensory-deprived patients - with head injury - with renal failure - with cardiac failure - burn patients - with HIV - with seizure - with hepatic failure

The Delirium Rating Scale-Revised-98 (DRS-R-98) Date : Name of patient : / / Time : Name of Rater : SEVERITY SCORE Severity Item TOTAL SCORE Optional Information Item Score Sleep-wake schedule 0 1 2 3 Naps Nocturnal distbns D-N reversal Perceptual disturbance 0 1 2 3 Type of illusion or H: AH VH OH TH Format of illusion or H: simple complex Delusions 0 1 2 3 Type of delusion: Nature: poorly formed Lability of affect 0 1 2 3 Type: Language 0 1 2 3 Check here if intubated, mute, etc. Thought process 0 1 2 3 Check here if intubated, mute, etc. Motor agitation 0 1 2 3 Check here if restrained Type of restrains: Motor retardation 0 1 2 3 Check here if restrained Type of restrains: angry elated anxious irritable systematized dysphoric J Trzepacz PT(2001) J Neuropsychiatry Clin Neurosci 13: 2

The Delirium Rating Scale-Revised-98 (DRS-R-98) Severity Item Score Optional Information Sleep-wake schedule 0 1 2 3 Naps Orientation 0 1 2 3 Date: Attention 0 1 2 3 Short-term memory 0 1 2 3 Record # of trials for registration of items: Check here if category cueing helped Long-term memory 0 1 2 3 Check here if category cueing helped Visuospatial ability 0 1 2 3 Check here if unable to use hands Diagnostic item Item Score Temporal onset of symptoms 0 1 2 Fluctuation of symptoms severity 0 1 2 Nocturnal distbns D-N reversal Place: Person: Optional Information 3 Check here if symptoms only appeared on a background of other psychopathology Check here if symptoms only appear during the night Trzepacz PT(2001) J Neuropsychiatry Clin Neurosci 13: 2

Four Major Organic Factors That Cause Delirium Primary cerebral diseases l Systemic diseases affecting the brain secondarily l Exogenous toxic agents l medical and illicit drugs ¡ industrial poisons ¡ poisons of animal, plant, and mushroom origin ¡ l Withdrawal from certain substance abuse ¡ alcohol and sedative-hypnotic drugs

Four Major Organic Factors That Cause Delirium Primary cerebral diseases l Systemic diseases affecting the brain secondarily l Exogenous toxic agents l medical and illicit drugs ¡ industrial poisons ¡ poisons of animal, plant, and mushroom origin ¡ l Withdrawal from certain substance abuse ¡ alcohol and sedative-hypnotic drugs

Adjustment disorders l with depressed mood ¡ with anxiety ¡ with mixed anxiety and depressed mood l with disturbance of conduct l with mixed disturbance of emotions and conduct

Other conditions that may be a focus of clinical attention l Psychological factors affecting medical condition l Medication-Induced Movement Disorders l Relational Problems Related to Abuse or Neglect