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5.3Expand Resources

20世纪抑郁症研究的突破性进展是提出了“单胺类假说”,在此假说的指导下,建立了目前抑郁症治疗的理论基础。根据单胺类假说,抑郁症是由于患者脑内单胺类神经递质如5-HT或NE(去甲肾上腺素)减少所致,目前所有治疗抑郁症的药物实质上都以5-HT或NE等为靶点。药物治疗主要是通过三种机制:一是抑制单胺能神经元的再摄取;二是抑制单胺类神经递质在突触中的代谢;三是通过阻断单胺能神经元上的自身和异身受体来增加单胺类神经递质的释放。从机制上,可以看出几乎所有的抗抑郁药都是通过增加突触间隙单胺类神经递质的利用率来发挥作用的。此外,对于神经递质转运蛋白的研究开发可能是新的突破点,如细胞膜上的NE和5-HT转运蛋白。


电休克疗法(electroconvulsive therapy,ECT),它是一种疗效好、见效快的治疗方法。通过电休克机,利用微弱、短暂、适量的电流,由置于头皮的两根电极刺激大脑,在颞叶诱发癫痫样发作性放电,引起精神患者意识丧失和全身抽搐发作,以达到控制精神症状的一种治疗方法。ECT需由医生对患者实施必要的检查,严格掌握适应症和排除禁忌症后才能进行。一般ECT整个疗程需要6至12次,通常治疗一个疗程即可见效,每隔天实施一次,每次治疗需要20分钟,患者能够很快从麻醉中清醒过来,2个小时之内即可离开。有些患者甚至治疗一次即能获得显著疗效,尤其对伴有严重自杀企图、木僵拒食、剧烈兴奋躁动及有严重攻击冲动行为的患者,电疗常可使症状迅速消除。

以往的电休克治疗,被治疗时患者眼睛上翻,脖子后挺,治疗过程非常像癫痫患者的抽搐大发作。患者在治疗过程中需要医护人员分别对患者的胳膊、腿和腰部加以压服以加强对患者的保护。目前多采用的是改良电休克(Modified electroshock therapy,MECT)治疗,又称无抽搐电休克治疗,安全性更高,禁忌症也较少。如今的医院里往往出现刚刚接受了电休克治疗的患者醒来时,会怀疑自己是否真的经历了这个治疗过程。

但ECT治疗也有其副作用,如头痛、恶心、呕吐、和可逆性的记忆减退等。但这种治疗对记忆的影响通常只是暂时的,一般在治疗后都会自行好转。


关于抑郁症的预后。抑郁症平均起病年龄为20-30岁,目前从起病到就医接受疗的时间平均为3年。抑郁发作治疗后痊愈平均需要时间约为20周,若不治疗,疾病一般会持续6个月以上。经过抗抑郁治疗,大部分患者抑郁症状会缓解,但仍有约15%未达到临床治愈。首次抑郁发作的患者在缓解后,约半数不再复发,但3次发作、又没有接受维持治疗的患者,复发风险几乎是100%。抑郁症状缓解后,患者一般可恢复到病前的功能水平,但有20%~35%的患者会有残留症状,其中最突出的是焦虑和躯体症状。抑郁症状残留会增加复燃和复发风险。


下一节:5.4 Women and Depression

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Personality and Mental Disorders—Be a Therapist of Your Own 课程列表:

Chapter 1 Understanding Personality

-1.1 Character = Temperament = Personality? NO!

--1.1 Character = Temperament = Personality? NO!

--1.1PPT

--1.1Test

--1.1Expand Resources 《Rorschach Ink Test and Freud》

-1.2 Characteristics of Personality

--1.2 Characteristics of Personality

--1.2PPT

--1.2Test

-1.3 Is Personality Measurable?

--1.3 Is Personality Measurable?

--1.3PPT

--1.3Tesst

-Unit 1 Test

Chapter 2 Personality Disorder

-2.1 Personality Traits and Personality Disorders

--2.1 Personality Traits and Personality Disorders

--2.1PPT

--2.1Test

--2.1Expand Resources

-2.2 Types of Personality Disorders

--2.2 Types of Personality Disorders

--2.2PPT

--2.2Test

--2.2Expand Resources

-2.3 Can Personality Disorders are Treated?

--2.3 Can Personality Disorders are Treated?

--2.3PPT

--2.3Test

--2.3 Expand Resource 《What is Dialectical Behavior Therapy (DBT) in Psychotherapy》

-Unit 2 Test

Chapter 3 The Prelude of Mental Disorders

-3.1 Characteristics and Diagnostic Criteria of Mental Disorders

--3.1 Characteristics and Diagnostic Criteria of Mental Disorders

--3.1PPT

--3.1Test

-3.2 Symptomatology of Mental Disorders

--3.2 Symptomatology of Mental Disorders

--3.2PPT

--3.2Test

-3.3 Treatment Options for Patients with Mental Disorders

--3.3 Treatment Options for Patients with Mental Disorders

--3.3PPT

--3.3Test

--3.3Expand Resources

--《Assessment of Bereavement》

-Unit 3 Test

Chapter 4 Are Hyperactivity and Twitch Diseases in Children? -- Developmental Disorders in Children

-4.1 Mental Retardation

--4.1 Mental Retardation

--4.1PPT

--4.1Test

--4.1Expand Resources

-4.2 Autism

--4.2 Autism

--4.2PPT

--4.2Test

--4.2Expand Resources

-4.3 Attention Deficit Hyperactivity Disorder

--4.3 Attention Deficit Hyperactivity Disorder

--4.3PPT

--4.3Test

--4.3Expand Resources

-4.4 Twitch Disorder

--4.4 Twitch Disorder

--4.4PPT

--4.4Test

--4.4Expand Resources

--《How to Carry out Psychological Rescue in Epidemic Situation》

-Unit 4 Test

Chapter 5 I Have a Black Dog -- Depression

-5.1 Concept and Causes of Depression

--5.1 Concept and Causes of Depression

--5.1PPT

--5.1Test

--5.1Expand Resources

-5.2 Clinical Manifestations and Diagnostic Evaluation of Depression

--5.2 Clinical Manifestations and Diagnostic Evaluation of Depression

--5.2PPT

--5.2Test

--5.2Expand Resources

-5.3 Treatment of Depression

--5.3 Treatment of Depression

--5.3PPT

--5.3Test

--5.3Expand Resources

-5.4 Women and Depression

--5.4 Women and Depression

--5.4PPT

--5.4Test

-Unit 5 Test

Chapter 6 Emotion is Like Riding a Roller Coaster -- Bipolar Disorder

-6.1 Concept and Pathogenesis of Bipolar Disorder

--6.1 Concept and Pathogenesis of Bipolar Disorder

--6.1PPT

--6.1Test

--6.1Expand Resources

-6.2 Clinical Manifestations and Diagnosis of Bipolar Disorder

--6.2 Clinical Manifestations and Diagnosis of Bipolar Disorder

--6.2PPT

--6.2Test

--6.2Expand Resources

-6.3 comorbidity and Differential Diagnosis of Bipolar Disorder

--6.3 comorbidity and Differential Diagnosis of Bipolar Disorder

--6.3PPT

--6.3Test

--6.3Expand Resources

-6.4 treatment of Bipolar Disorder

--6.4 treatment of Bipolar Disorder

--6.4PPT

--6.4Test

--《Self-identification and management of bipolar disorder in epidemic situation》

-Unit 6 Test

Chapter 7 The Invisible World -- Schizophrenia

-7.1 What is Schizophrenia?

--7.1 What is Schizophrenia?

--7.1PPT

--7.1Test

-7.2 Clinical Manifestations and Symptoms of Schizophrenia

--7.2 Clinical Manifestations and Symptoms of Schizophrenia

--7.2PPT

--7.2Test

-7.3 Assessments of Diagnosis and Prognosis of Schizophrenia

--7.3 Assessments of Diagnosis and Prognosis of Schizophrenia

--7.3PPT

--7.3Test

--7.3Expand Resources

-7.4 Treatment and Rehabilitation of Schizophrenia

--7.4 Treatment and Rehabilitation of Schizophrenia

--7.4PPT

--7.4Test

--Film Analysis of《A Beautiful Mind》

-Unit 7 Test

Chapter 8 The Department of Psychiatry "Cancer" -- Obsessive-Compulsive Disorder

-8.1 Uncover Obsessive-Compulsive Disorder

--8.1 Uncover Obsessive-Compulsive Disorder

--8.1PPT

--8.1Test

-8.2 Diagnosis and Differentiation of OCD

--8.2 Diagnosis and Differentiation of OCD

--8.2PPT

--8.2Test

-8.3 Treatment of OCD

--8.3 Treatment of OCD

--8.3PPT

--8.3Test

--8.3Expand Resources 1

--8.3Expand Resources 2

-Unit 8 test

Chapter 9 Panics, Chest Tightness, Are There Something Wrong with the Heart? -- Anxiety Disorde

-9.1 What is Anxiety Disorder?

--9.1 What is Anxiety Disorder?

--9.1PPT

--9.1Test

-9.2 Diagnosis and Comorbidity of Anxiety Disorders

--9.2 Diagnosis and Comorbidity of Anxiety Disorders

--9.2PPT

--9.2Test

--9.2Expand Resources

-9.3 Treatment of Anxiety Disorder

--9.3 Treatment of Anxiety Disorder

--9.3PPT

--9.3Test

--9.3Expand Resources 1

--9.3Expand Resources 2

--《Cognitive Behavioral Therapy for Anxiety Disorders》

-Unit 9 Test

Chapter10 Are Cowards Born? -- Phobia

-10.1 Classification and Causes of Phobias

--10.1 Classification and Causes of Phobias

--10.1PPT

--10.1Test

-10.2 Diagnosis and Differentiation of Panic Attacks

--10.2 Diagnosis and Differentiation of Panic Attacks

--10.2PPT

--10.2Test

--10.2Expand Resources

-10.3 Treatments of Panic Attacks

--10.3 Treatments of Panic Attacks

--10.3PPT

--10.3Test

-Unit 10 Test

Chapter 11 The Struggle of the Skinny and the Fat -- Eating Disorders

-11.1 Concepts and Clinical Manifestations of Eating Disorders

--11.1 Concepts and Clinical Manifestations of Eating Disorders

--11.1PPT

--11.1Test

-11.2 Diagnosis and Differential Diagnosis of Eating Disorders

--11.2 Diagnosis and Differential Diagnosis of Eating Disorders

--11.2PPT

--11.1Test

-11.3 Treatments of Eating Disorders

--11.3 Treatments of Eating Disorders

--11.3PPT

--11.1Test

-Unit 11 Test

Chapter 12 Bring Your Own Smoky Eyes Every Day -- Sleep-Related Disorders

-12.1 Insomnia Disorder

--12.1 Insomnia Disorder

--12.1PPT

--12.1Test

--12.1Expand Resources

-12.2 Obstructive Sleep Apnea Syndrome

--12.2 Obstructive Sleep Apnea Syndrome

--12.2PPT

--12.2Test

-12.3 Other Sleep-Wake Disorders

--12.3 Other Sleep-Wake Disorders

--12.3PPT

--12.3Test

-Unit 12 Test

Chapter 13 The Survivor's Misfortune -- Stress Disorder

-13.1 Post-Traumatic Stress Disorder

--13.1 Post-Traumatic Stress Disorder

--13.1PPT

--13.1Test

-13.2 Stress Disorder

--13.2 Stress Disorder

--13.2PPT

--13.2Test

-13.3 Treatments of Trauma and Stress-Related Disorders

--13.3 Treatments of Trauma and Stress-Related Disorders

--13.3PPT

--13.3Test

-Unit 13 Test

Chapter 14 Is Bad Memory a Disease? -- Alzheimer’s Disease

-14.1 Etiology and Clinical Manifestations of Alzheimer’s Disease

--14.1 Etiology and Clinical Manifestations of Alzheimer’s Disease

--14.1PPT

--14.1Test

-14.2 Diagnoses and Differential Diagnosis of Senile Dementia

--14.2 Diagnoses and Differential Diagnosis of Senile Dementia

--14.2PPT

--14.2Test

-14.3 Prevention and Treatment of Senile Dementia

--14.3 Prevention and Treatment of Senile Dementia

--14.3PPT

--14.3Test

-Unit 14 Test

Chapter 15 Summary and Discussion

-Summary and Discussion

Final Exam

-Final Exam

5.3Expand Resources笔记与讨论

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