“未特定的精神病性障碍”的访谈与诊疗

The interview and treatment of unspecified psychotic disorder

一位男性建筑工人,20岁出头,中学学历,目前正在住院治疗,因为害怕在得不到救助的时候死掉,所以拒绝出院。患者反复表现出惊恐症状、担心自己在劫难逃、害怕死亡并且脸上有刀割感。他先前使用抗焦虑药物治疗无效,而使用电抽搐治疗获得短期疗效。数年前,他是毒品滥用者,在使用毒品时出现过严重的幻觉,现已戒毒5年。医生的诊断是"未特定的精神病性障碍,伴物质滥用缓解期",患者的严重程度还没有达到精神分裂症的诊断标准。在干预措施上,给患者处方抗精神病药并预防再次接触毒品,并叮嘱患者在工作中操作重型机械时谨防事故,因为服用阻断多巴胺受体的药物会影响其认知和运动技能。

Male construction worker in his early twenties with a middle school education has been hospitaliaed and refuses to be discharged due to feeling he will die without help. Patient presents with panic,worry,anxiety,feelings of impending doom,fear of death,insecurity,and tactile sensations of someone repeatedly cutting his face. His prior mental health history includes anti - anxiety medications which had no effect and electroconvulsive therapy,with only short - term results. For several years,he was a substance abuser but has maintained sobriety for the past year. Previously,while stressed or under the influence of drugs,he experienced more severe hallucinations. Patient’s diagnosis is Unspecified Psychotic Disorder with substance abuse in remission,not severe enough to meet the criteria for schiaophrenia. Antipsychotic medication and continued drug abstinence is indicated. Patient is further advised of the long - term side effects of prolonged drug use and recommended to use caution while operating heavy machinery while taking anti - dopamine medication,which affects cognitive and motor skills.