|
|
楼主 |
发表于 2013-9-7 00:30:42
|
显示全部楼层
国外OCDObsessive-compulsive disorder
A woman visits her dermatologist, complaining of extremely dry skin and seldom feeling clean. She showers for two hours every day.
A lawyer insists on making coffee several times each day. His colleagues do not realize that he lives in fear that the coffee will be poisoned, and he feels compelled to pour most of it down the drain. The lawyer is so obsessed with these thoughts that he spends 12 hours a day at work -- four of them worrying about contaminated coffee.
A man cannot bear to throw anything away. Junk mail, old newspapers, empty milk cartons all \"could contain something valuable that might be useful someday.\" If he throws things away, \"something terrible will happen.\" He hoards so much clutter that he can no longer walk through his house. Insisting that nothing be thrown away, he moves to another house where he continues to hoard.
A 10 year old girl keeps apologizing for \"disturbing\" her class. She feels that she is too restless and is clearing her throat too loudly. Her teachers are puzzled and over time become annoyed at her repeated apologies since they did not notice any sounds or movements. She is also preoccupied with \"being good all the time\".
These people suffer obsessive-compulsive disorder (OCD). The National Institute of Mental Health estimates that more than 2 percent of the US population, or nearly one out of every 40 people, will suffer from OCD at some point in their lives. The disorder is two to three times more common than schizophrenia and bipolar disorder.
What is Obsessive-compulsive disorder?
Obsessions are intrusive, irrational thoughts -- unwanted ideas or impulses that repeatedly well up in a person\'s mind. Again and again, the person experiences disturbing thoughts, such as \"My hands must be contaminated; I must wash them\"; \"I may have left the gas stove on\"; \"I am going to injure my child.\" On one level, the sufferer knows these obsessive thoughts are irrational. But on another level, he or she fears these thoughts might be true. Trying to avoid such thoughts creates great anxiety.
Compulsions are repetitive rituals such as handwashing, counting, checking, hoarding, or arranging. An individual repeats these actions, perhaps feeling momentary relief, but without feeling satisfaction or a sense of completion. People with OCD feel they must perform these compulsive rituals or something bad will happen.
Most people at one time or another experience obsessive thoughts or compulsive behaviors. Obsessive-compulsive disorder occurs when an individual experiences obsessions and compulsions for more than an hour each day, in a way that interferes with his or her life.
OCD is often described as \"a disease of doubt.\" Sufferers experience \"pathological doubt\" because they are unable to distinguish between what is possible, what is probable, and what is unlikely to happen.
Who gets OCD?
People from all walks of life can get OCD. It strikes people of all social and ethnic groups and both males and females. Symptoms typically begin during childhood, the teenage years or young adulthood.
What causes OCD?
A large body of scientific evidence suggests that OCD results from a chemical imbalance in the brain. For years, mental health professionals incorrectly assumed OCD resulted from bad parenting or personality defects. This theory has been disproven over the last 20 years. OCD symptoms are not relieved by psychoanalysis or other forms of \"talk therapy,\" but there is evidence that behavior therapy can be effective, alone or in combination with medication. People with OCD can often say \"why\" they have obsessive thoughts or why they behave compulsively. But the thoughts and the behavior continue.
People whose brains are injured sometimes develop OCD, which suggests it is a physical condition. If a placebo is given to people who are depressed or who experience panic attacks, 40 percent will say they feel better. If a placebo is given to people who experience obsessive-compulsive disorder, only about two percent say they feel better. This also suggests a physical condition.
Clinical researchers have implicated certain brain regions in OCD. They have discovered a strong link between OCD and a brain chemical called serotonin. Serotonin is a neurotransmitter that helps nerve cells communicate.
Scientists have also observed that people with OCD have increased metabolism in the basal ganglia and the frontal lobes of the brain. This, scientists believe, causes repetitive movements, rigid thinking, and lack of spontaneity. Successful treatment with medication or behavior therapy produces a decrease in the over activity of this brain circuitry. People with OCD often have high levels of the hormone vasopressin.
In layperson\'s terms, something in the brain is stuck, like a broken record. Judith Rapoport, MD, describes it in her book, The Boy Who Couldn\'t Stop Washing , as \"grooming behaviors gone wild.\"
How do people with OCD typically react to their disorder?
People with OCD generally attempt to hide their problem rather than seek help. Often they are remarkably successful in concealing their obsessive-compulsive symptoms from friends and co-workers. An unfortunate consequence of this secrecy is that people with OCD generally do not receive professional help until years after the onset of their disease. By that time, the obsessive-compulsive rituals may be deeply ingrained and very difficult to change.
How long does OCD last?
OCD will not go away by itself, so it is important to seek treatment. Although symptoms may become less severe from time to time, OCD is a chronic disease. Fortunately, effective treatments are available that make life with OCD much easier to manage.
Is age a factor in OCD?
OCD usually starts at an early age, often before adolescence. It may be mistaken at first for autism, pervasive developmental disorder, or Tourette\'s syndrome, a disorder that may include obsessive doubting and compulsive touching as symptoms.
Like depression, OCD tends to worsen as the person grows older, if left untreated. Scientists hope, however, that when the OCD is treated while the person is still young, the symptoms will not get worse with time.
What are other examples of behaviors typical of people who suffer from OCD?
People who do the following may have OCD:
repeatedly check things, perhaps dozens of times, before feeling secure enough to go to sleep or leave the house. Is the stove off? Is the door locked? Is the alarm set?
fear they will harm others. Example: A man\'s car hits a pothole on a city street and he fears it was actually a body.
feel dirty and contaminated. Example: A woman is fearful of touching her baby because she might contaminate the child.
constantly arrange and order things. Example: A child can\'t go to sleep unless he lines up all his shoes correctly.
are excessively concerned with body imperfections -- insist on numerous plastic surgeries, or spend many, many hours a day body-building.
are ruled by numbers, believing that certain numbers represent good and others represent evil.
are excessively concerned with sin or blasphemy.
Is OCD commonly recognized by professionals?
Not nearly commonly enough. OCD is often misdiagnosed, and it is often underdiagnosed. Many people have dual disorders of OCD and schizophrenia, or OCD and bipolar disorder, but the OCD component is not diagnosed or treated. In children, parents often are aware of some anxiety or depression but not of the underlying OCD. Researchers believe OCD, anxiety disorders, Tourette\'s, and eating disorders such as anorexia and bulimia can be triggered by some of the same chemical malfunctioning of the brain.
Is heredity a factor in OCD?
Yes. Heredity appears to be a strong factor. If you have OCD, there\'s a 25-percent chance that one of your immediate family members will have it. It definitely seems to run in families.
Can OCD be effectively treated?
Yes, with medication and behavior therapy. Both affect brain chemistry, which in turn affects behavior. Medication can regulate serotonin, reducing obsessive thoughts and compulsive behaviors.
Anafranil (clomipramine) : A tricyclic antidepressant , Anafranil has been shown to be effective in treating obsessions and compulsions. The most commonly reported side effects of this medication are dry mouth, constipation, nausea, increased appetite, weight gain, sleepiness, fatigue, tremor, dizziness, nervousness, sweating, visual changes, and sexual dysfunction. There is also a risk of seizures, thought to be dose-related. People with a history of seizures should not take this medication. Anafranil should also not be taken at the same time as a monoamine oxidase inhibitor (MAOI).
Many of the antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs) have also proven effective in treating the symptoms associated with OCD. The SSRIs most commonly prescribed for OCD are Luvox (fluvoxamine), Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline).
Luvox (fluvoxamine) : Common side effects of this medication include dry mouth, constipation, nausea, sleepiness, insomnia, nervousness, dizziness, headache, agitation, weakness, and delayed ejaculation.
Paxil (paroxetine) : Side effects most associated with this medication include dry mouth, constipation, nausea, decreased appetite, sleepiness, insomnia, tremor, dizziness, nervousness, weakness, sweating, and sexual dysfunction.
Prozac (fluoxetine) : Dry mouth, nausea, diarrhea, sleepiness, insomnia, tremor, nervousness, headache, weakness, sweating, rash, and sexual dysfunction are among the more common side effects associated with this drug.
Zoloft (sertraline) : Among the side effects most commonly reported while taking Zoloft are dry mouth, nausea, diarrhea, constipation, sleepiness, insomnia, tremor, dizziness, agitation, sweating, and sexual dysfunction.
Celexa (Citalopram) Side effects may include dry mouth, nausea, or drowsiness .
SSRIs should never be taken at the same time as MAOIs.
How log should an individual take medication before judging its effectiveness?
Some physicians make the mistake of prescribing a medication for only three or four weeks. That really isn\'t long enough. Medication should be tried consistently for 10 to 12 weeks before its effectiveness can be judged.
What is behavior therapy, and can it effectively relieve symptoms of OCD?
Behavior therapy is not traditional psychotherapy. It is \"exposure and response prevention,\" and it is effective for many people with OCD. Consumers are deliberately exposed to a feared object or idea, either directly or by imagination, and are then discouraged or prevented from carrying out the usual compulsive response. For example, a compulsive hand-washer may be urged to touch an object he or she believes is contaminated and denied the opportunity to wash for several hours. When the treatment works well, the consumer gradually experiences less anxiety from the obsessive thoughts and becomes able to refrain from the compulsive actions for extended periods of time.
Several studies suggest that medication and behavior therapy are equally effective in alleviating symptoms of OCD. About half of the consumers with this disorder improve substantially with behavior therapy; the rest improve moderately.
Will OCD symptoms go away completely with medication and behavior therapy?
Response to treatment varies from person to person. Most people treated with effective medications find their symptoms reduced by about 40 percent to 50 percent. That can often be enough to change their lives, to transform them into functioning individuals.
A few consumers find that neither treatment produces significant change, and a small number of people are fortunate to go into total remission when treated with effective medication and/or behavior therapy.
Reviewed by Judith Rapoport, MD May 2003
简略译文:
强迫症
一个女人参观她的皮肤科医生，极干性皮肤，很少抱怨感觉干净。 她淋浴，每天两个小时。
一位律师坚持泡咖啡每天数次。 他的同事们没有意识到，他生活在恐惧中，咖啡会中毒，他不得不倒最付诸东流。 这些想法是如此痴迷，他花了12个小时，一天的工作-他们担心受污染的咖啡四个律师。
一个人不能舍不得扔任何东西。 垃圾邮件，旧报纸，空牛奶盒“可能包含一些有价值的东西，有一天，可能是有用的。” 如果他抛出的东西了，“什么可怕的事情会发生。” 他囤积这么多杂乱，他可以通过他的房子再也走不动。 坚持没有扔掉，他移动到另一个房子里，他继续囤积。
一名10岁的女孩道歉“扰乱”她的课。 她认为她太不安和清除她的喉咙实在太大声了。 她的老师感到困惑，并随着时间的推移变得恼火，她反复道歉，因为他们没有注意到任何声音或动作。 她还斤斤计较与“善待所有的时间”。
这些人患有强迫症（OCD）。 美国国家精神卫生研究所估计，超过2％的美国人口，每40万人中有将近三分之一的，将在一些点在他们的生活中患上强迫症。 障碍是精神分裂症和双相情感障碍较常见的两到三倍。
什么是强迫症？
强迫观念是侵入性的，非理性的想法-不必要的想法或冲动，反复在一个人的心中。 一遍又一遍，这个人出现令人不安的想法，如“我的手被污染，我必须把它们洗干净”，“我可能已经离开了燃气灶”，“我要伤害我的孩子。” 在一个水平上，患者知道这些强迫想法是不合理的。 但在另一个层面上，他或她担心这些想法可能是真实的。 试图避 ??免这样的想法，创造了巨大的焦虑。
强迫重复的仪式，如洗手，计数，检查，囤积居奇，或安排。 一个单独的重复这些动作，可能感觉一时的救济，但没有感到满意感或完成。 强迫症的人觉得他们必须执行这些强迫性仪式或坏的东西会发生。
大多数人在同一时间或其他经验的强迫意念或强迫行为。 强迫症发生，当一个人出现强迫观念和强迫超过一个小时的每一天，与他或她的生活的方式，干扰。
强迫症经常被描述为“一种疾病的疑问。” 患者的经验“病理无疑”，因为他们无法区分什么是可能的，什么是可能的，什么是不可能发生的。
谁得到强迫症？
来自各行各业的人们可以得到强迫症。 罢工的所有社会群体和族裔群体的人，男性和女性。 症状通常在童年，在十几岁或成年年轻开始。
强迫症是什么原因导致？
庞大的身躯的科学证据表明，强迫症大脑中的一种化学物质失衡的结果。 多年来，心理健康专业人士错误地认为强迫症导致坏父母或人格缺陷。 在过去的20年中，这一理论被证伪。 强迫症状不缓解精神或其他形式的“谈话疗法”，但有证据表明，行为疗法是有效的，单独或联合用药。 强迫症的人常说的“为什么”，他们有强迫思想，为什么他们的行为强制。 但是，思想和行为的继续。
受伤人的大脑有时会发展强迫症，这表明它是一种物理条件。 如果安慰剂郁闷的人谁是或谁恐慌的经验，40％的人会说，他们感觉更好。 如果安慰剂谁遇到强迫症的人，只有约2％的人说他们感觉更好。 这也表明身体状况。
在强迫症的临床研究人员有牵连某些大脑区域。 他们已经发现了一种强迫症和脑称为血清素的化学物质之间的密切联系。 5 -羟色胺是一种神经递质，帮助神经细胞沟通。
科学家还观察到，有强迫症的人的大脑基底节和额叶代谢增加。 ，科学家们相信，这会导致重复的动作，思想僵化，缺乏自发性。 成功的治疗药物或行为疗法产生减少活动过这个大脑电路。 强迫症的人往往有高的抗利尿激素的水平。
在外行人的术语，在大脑中的东西被卡住，像一个破纪录。 朱迪思·拉波波特博士，介绍了它在她的书中， 男孩身上，他不停止洗涤 ，“狂野的美容行为。”
怎么有强迫症的人通常他们的障碍作出反应？
强迫症的人通常试图隐藏他们的问题，而不是寻求帮助。 他们往往是从朋友和同事隐瞒自己的强迫症状显着的成功。 这种保密的一个不幸后果是强迫症的人一般不接受专业帮助他们的疾病，直到多年后发病。 到那个时候，强迫仪式可能是根深蒂固的，很难改变。
多久去年OCD？
OCD不会去的本身，所以重要的是要寻求治疗。 虽然症状可能不时变得不那么严重，强迫症是一种慢性疾病。 幸运的是，有效的治疗强迫症更容易管理，使生活。
年龄是强迫症的一个因素吗？
强迫症通常在幼年时开始，往往在青春期前。 它可能被误认为是自闭症，广泛性发育障碍或抽动秽语综合征，一种疾病，可能包括强迫性怀疑和强迫症状感人的第一。
如抑郁症，强迫症趋于恶化的人逐渐变老，如果不及时治疗。 然而，科学家们希望，当强迫症的人时，被视为还很年轻，症状会不会随着时间的推移变得更糟。
其他典型的人患有强迫症的人的行为的例子是什么？
谁做以下的人可能有强迫症：
反复检查东西，也许数十次，才足够安全的去睡觉或离开家的感觉。 炉子？ 大门紧锁？ 报警设定？
担心自己会伤害别人。 例如：一个人的车打一个坑洞的城市街道上，他担心它实际上是一个身体。
觉得脏和污染。 例如：一个女人抚摸她的宝宝是可怕的，因为她可能会污染孩子。
不断安排和秩序的东西。 例如：一个孩子可以去睡觉了他所有的鞋子，除非他行正确。
过分在意身体缺陷-坚持大量的整形手术，还是花很多很多时间一天体建设。
排除数字，相信某些数字代表和其他代表邪恶的。
过分在意罪或亵渎。
强迫症通常是由专业人士的认可呢？
几乎不常用不够。 OCD是常常被误诊，而且往往是漏诊。 很多人都有强迫症和精神分裂症，强迫症和躁郁症的双重障碍，但没有被诊断或治疗强迫症的组件。 在儿童中，父母往往是知道一些焦虑症或抑郁症，但不是底层的强迫症。 研究人员认为，强迫症，焦虑症，抽动-秽语，如厌食症和贪食症和饮食失调可以触发一些相同的化学失灵的大脑。
强迫症的一个因素是遗传吗？
是。 遗传似乎是一个强有力的因素。 如果你有强迫症，有您的直系亲属成员之一将有25％的机会。 它肯定似乎在家庭。
OCD可以得到有效的治疗呢？
是的，与药物治疗和行为治疗。 两者均会影响大脑的化学反应，这反过来又影响行为。 药物可以调节5 -羟色胺，减少强迫思想和强迫行为。
安那芬尼（氯丙咪嗪）： 三环类抗抑郁药 ，Anafranil已被证明是有效的治疗强迫观念和强迫。 这种药物最常见的副作用是口干，便秘，恶心，食欲增加，体重增加，嗜睡，乏力，震颤，头晕，紧张，出汗，视力改变，以及性功能障碍。 还有一个癫痫发作的风险，被认为是剂量相关。 癫痫病史的人不宜服用这种药物。 安那芬尼也应该不会被作为单胺氧化酶抑制剂（MAOI）在同一时间。
许多被称为选择性5 -羟色胺再摄取抑制剂（SSRIs）的抗抑郁药物也被证明是有效的治疗与强迫症有关的症状。 强迫症最常用的处方SSRIs的兰释氟伏沙明，帕罗西汀（帕罗西汀），百忧解（氟西汀）和Zoloft（舍曲林）。
兰释（氟伏沙明）：此药常见的副作用包括口干，便秘，恶心，嗜睡，失眠，精神紧张，头晕，头痛，情绪激动，无力，射精延迟。
帕罗西汀（帕罗西汀）：多数伴有这种药物的副作用包括口干，便秘，恶心，食欲减退，嗜睡，失眠，震颤，头晕，精神紧张，乏力，出汗，性功能障碍。
百忧解（氟西汀）：口干，恶心，腹泻，嗜睡，失眠，震颤，精神紧张，头痛，乏力，出汗，皮疹，性功能障碍是较常见的副作用与这种药物相关。
左洛复（舍曲林）：其中最常报告的同时服用左洛复的副作用有口干，恶心，腹泻，便秘，嗜睡，失眠，震颤，头晕，情绪激动，出汗，性功能障碍。
Celexa的（西酞普兰）的副作用包括口干，恶心，或嗜睡。
SSRI类药物不应该被作为单胺氧化酶抑制剂在同一时间。
如何记录个人应采取服药前判断其有效性？
有些医生做出错误的处方用药只有三个或四个星期。 这真的是不够长。 用药时应始终试图为10至12周才可以判断其有效性。
什么是行为疗法，它可以有效地缓解强迫症的症状？
行为疗法是不是传统的心理治疗。 它是“暴露预防和响应，”强迫症对许多人来说，它是有效的。 的消费者故意露出一个令人生畏的对象或想法，无论是直接或通过想象，然后进行通常的强迫响应劝阻或防止。 例如，强迫手垫圈可能会敦促他或她认为被污染，并否认洗几个小时的机会接触对象。 当治疗效果很好，消费者逐渐经历较少焦虑强迫思想变得能避免长时间的强制行为。
一些研究表明，药物治疗和行为疗法同样有效地缓解强迫症的症状。 大约有一半的消费者与这种疾病行为疗法显着改善，其余的温和改善。
请问强迫症状完全消失药物治疗和行为治疗？
对治疗的反应不同，从人到人。 有效的药物治疗的大多数人发现他们的症状减轻了大约40％至50％。 这往往是足以改变他们的生活，把它们转化为正常运作的个人。
几个消费者发现，无论是治疗产生重大变化，少数人是幸运的进入有效的药物和/或行为疗法治疗时，总缓解。
朱迪思·拉波波特，医学博士，2003年5月 |
|
发表于 2013-9-4 02:50:01