应激相关障得教案 Subject Psychiatry Teacher LI Ling-jiang Target Clinical Medicine Teaching place The second classroom Chapters:Chapter 7 Teaching hour 100 minutes Content Stress-related disorders Dte:2001 【Purpose and requireaent】 1.To master concepts of stressor,stress,and process of stress. 2.To uderstand the etiology of mental stress. 3.To master classification,clinical features,diagmoses and differential diagnoses of stress-related disorders. 4.To understand treatment principles of stress-related disorders. 【Key points of teaching】 1.The features of stress. 2.Classification of stress-related disorders and diagnostie points. 3.The etiology of post-traumatic stress disorder. 4.Treatment principles of post-traumatic stress disorder. 【Difficult points of teaching】 The etiology of post-traumatic stress disorder. 【Type of teaching】 New knowledge teaching. 【Teaching nethod】 Bilinguistic teaching.lecture and heuristic method. 【Teaching aid】 Multimedia nix and lantern slide. 【Content and step of teaching】
应激相关障碍教案 Subject ： Psychiatry Teacher ：LI Ling-jiang Target ：Clinical Medicine Teaching place : The second classroom Chapters: Chapter 7 Teaching hour ：100 minutes Content ： Stress-related disorders Date ：2004 【 Purpose and requirement 】 1. To master concepts of stressor, stress, and process of stress. 2. To understand the etiology of mental stress. 3. To master classification, clinical features, diagnoses and differential diagnoses of stress-related disorders. 4. To understand treatment principles of stress-related disorders. 【 Key points of teaching 】 1. The features of stress. 2. Classification of stress-related disorders and diagnostic points. 3. The etiology of post-traumatic stress disorder. 4. Treatment principles of post-traumatic stress disorder. 【 Difficult points of teaching 】 The etiology of post-traumatic stress disorder. 【 Type of teaching 】 New knowledge teaching. 【 Teaching method 】 Bilinguistic teaching, lecture and heuristic method. 【 Teaching aid 】 Multimedia mix and lantern slide. 【 Content and step of teaching 】
1.Basic concepts of mental stress and features of stress.(10min) 2.Clinical features,diagnoses and differential diagnoses,treatpent prineiples of acute stress disorder.(10min) 3.Epidemiology,clinical features,etiology and treatment principles of post-traunatic stress disorder.(50min) 4.Clinical features,diagnoses and treatment of adjustmont disorder.(10min) 5.Psychological response and intervention of serious physical disease. (10ain） 6.Summary and discussion.(10min) CHAPTER 7 STRESS-RELATED DISORDERS 1.Basie concepts of mental stress and features of stress 1.1 Psychological response: Anxiety Depression 1.2 Physical response Sympathetic sat-sy再athetic 1.3 Psychological coping style: Help-seeking Problem-solving Adaptation Abreacting Escaping Suhstance ahuse Suicide Others 1.4 Defensive mechanisn: Inhibition
1. Basic concepts of mental stress and features of stress. (10min) 2. Clinical features, diagnoses and differential diagnoses, treatment principles of acute stress disorder. (10min) 3. Epidemiology, clinical features, etiology and treatment principles of post-traumatic stress disorder. (50min) 4. Clinical features, diagnoses and treatment of adjustment disorder. (10min) 5. Psychological response and intervention of serious physical disease. (10min) 6. Summary and discussion. (10min) CHAPTER 7 STRESS-RELATED DISORDERS 1. Basic concepts of mental stress and features of stress 1.1 Psychological response: Anxiety Depression 1.2 Physical response Sympathetic Sub-sympathetic 1.3 Psychological coping style: Help-seeking Problem-solving Adaptation Abreacting Escaping Substance abuse Suicide Others 1.4 Defensive mechanism: Inhibition
Withdraw Deny Projection Rationalization Sublination Self-identity Others 2.Clinical features,diagnoses and differential diagnoses,treatment principles of Acute Stress Disorder 2.1 Clinical features Strong psychological stress Psychoootor excitenent Psychomotor inhibition Others:impairment of comsciousness,attention,direction and psychiatric syrptons,et al 2.2 Diagnoses and differeatial diagnoses Serious psychological stress event Coming on after stress in few minutes or hours Tvo main syndromes (excitenent or repression) Social function damaged badly Persisting a few hours or one week,I month Different from mood disorder,hysteria 2.3 Treatment Reducing emotional response by psychological therapy or drugs Learning to face stress event Using effective coping strategies Solving related problers 3.Epidemiology,clinical features,etiology mechanism and treatment principles of Post-Traunatic Stress Disorder 3.1 Epideniology
Withdraw Deny Projection Rationalization Sublimation Self-identity Others 2. Clinical features, diagnoses and differential diagnoses, treatment principles of Acute Stress Disorder 2.1 Clinical features Strong psychological stress Psychomotor excitement Psychomotor inhibition Others: impairment of consciousness, attention, direction and psychiatric symptoms, et al 2.2 Diagnoses and differential diagnoses Serious psychological stress event Coming on after stress in few minutes or hours Two main syndromes (excitement or repression) Social function damaged badly Persisting a few hours or one week, < 1 month Different from mood disorder, hysteria 2.3 Treatment Reducing emotional response by psychological therapy or drugs Learning to face stress event Using effective coping strategies Solving related problems 3. Epidemiology, clinical features, etiology mechanism and treatment principles of Post-Traumatic Stress Disorder 3.1 Epidemiology
Lifetime prevalence of traumatie events:68.1589.6% Lifetime prevalence of PTSD:9.25"13.65.5-6%men,10-145 vomen The highest risk trauma of PTSD:assaultive violence The nost common trauma of PTSD: Medical utilization Impact of PTSD Suicide and PTSD 3.2 Clinical features Hyperarousal: Persistent anxiety Irritability Insomnia Poor coecentration. Intrusions: Difficulty in recalling stressful events at will Intense intrusive inagery ("flashback") Recurring distressing dreams Avoidance: Avoidance of reminders of the events Detachnent Inability to feel emotion ("nurbness") Diminished interest in activities 3.3 Etiology mechanism Traumatic events Susceptibility diathesis Post traua factors Biological nechanisn:biochemical hypotheses,HPA axis,others. 3.4 Treatment principles Psychotherapy: CBT (comnitive behavior therapy).Psycho-education.EIDR,et al
Lifetime prevalence of traumatic events: 68.1%~89.6% Lifetime prevalence of PTSD: 9.2%~13.6%, 5-6% men, 10-14% women The highest risk trauma of PTSD: assaultive violence The most common trauma of PTSD: Medical utilization Impact of PTSD Suicide and PTSD 3.2 Clinical features Hyperarousal: Persistent anxiety Irritability Insomnia Poor concentration. Intrusions: Difficulty in recalling stressful events at will Intense intrusive imagery (“flashback”) Recurring distressing dreams Avoidance: Avoidance of reminders of the events Detachment Inability to feel emotion (“numbness”) Diminished interest in activities 3.3 Etiology mechanism Traumatic events Susceptibility diathesis Post trauma factors Biological mechanism: biochemical hypotheses, HPA axis, others. 3.4 Treatment principles Psychotherapy: CBT (cognitive behavior therapy), Psycho-education, EMDR, et al
Medication:SSRIs,al Selecting the overall treatent strategy. Others Prevention of PTSD: Crisis intervention for individul 4Climical features,diagoses and treatent of Adjustent disorder 4.1 Clinical features Mod disorder: Less severe than that of severe depression Ko apparent lagging phencen Valadaptive behavior: Stealing Lying Substance abuse Others Disturbance of nbysialosical functign Sleep disorder Anorexia Loss of wih Others Life cvents in one nonth The ahility of adaptation is low Danage of social function Duration is I ponth and 6 months 4.3 Treatment 5.Psychological response and intervention of scrious physical discaso
Medication: SSRIs, et al. Selecting the overall treatment strategy. Others Prevention of PTSD: Crisis intervention for individual. Crisis intervention for group: CISD (crisis incidence stress debriefing) 4. Clinical features, diagnoses and treatment of Adjustment disorder 4.1 Clinical features Mood disorder: Less severe than that of severe depression No apparent lagging phenomena Maladaptive behavior: Stealing Lying Substance abuse Too early sexual behavior Others Disturbance of physiological function: Sleep disorder Anorexia Loss of weight Others 4.2 Diagnoses Life events in one month The ability of adaptation is low Mood disorder, behavioral disorder, physiological function disorder Damage of social function Duration is > 1 month and < 6 months 4.3 Treatment 5. Psychological response and intervention of serious physical disease
5.1 Stressors:Being afraid of disease The change of life style Others 5.3 Nethods of psychological interventian Inforned and skill of informed iving hope Regulating coping styles Nedication Adaptation and new life span 6.Suanary and discussion 1.Sadock.J..Sadock.V.A.Kaplan Sadock's Camprchensive Textbook of Willians Vilkins,Philadelphia,2000 2.Waldinger R.J.Psychiatry for Wedical Students.(Third edition).Anerica Psychiatric Press.7 3.Michael Gelder,Dennis Gath,Richard Nayou,te al.Oxford Textbook of 【Writing design】 Seo the lantern slide 【Sumary after clss】 1.Question:what are the nain features of acute stress response and PTSD? 2.What is stress?
5.1 Stressors: Being afraid of disease The change of life style Others 5.2 Psychological response: Instant response Chronic response 5.3 Methods of psychological intervention Informed and skill of informed Giving hope Regulating coping styles Medication Adaptation and new life span 6. Summary and discussion 【 Reference material 】 1. Sadock, B. J., Sadock, V. A.: Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 7th edition. Lippincott Williams & Wilkins, Philadelphia, 2000. 2. Waldinger R.J. Psychiatry for Medical Students. (Third edition). American Psychiatric Press. 1997 3. Michael Gelder, Dennis Gath, Richard Mayou, te al. Oxford Textbook of Psychiatry.3th edition. Oxford MedicalPublications.1996. 【 Writing design 】 See the lantern slide. 【 Summary after class 】 1. Question: what are the main features of acute stress response and PTSD ? 2. What is stress?