先期徵兆..schizo + ADHD

童年腦部模式 透露罹精神病風險


更新日期:2010/07/05 21:59 （路透倫敦5日電）英國科學家相信，他們已發現兒童與年輕人腦部活動的特定模式，可能是以後罹患精神分裂等心理疾病的徵兆或指標。

英國諾丁漢大學（Nottingham University）研究員表示，此模式顯示未來可能在症狀出現前，早一步發現有患病風險的人。他們在荷蘭阿姆斯特丹歐洲神經科學研討會（Forum for European Neuroscience）發表這項研究。

進行該研究的葛魯姆（Maddie Groom）博士說：「我們或能透過神經認知腦部指標，來辨認罹患精神分裂症風險特別高的人。如果可以，就能降低風險並幫助他們過得更好。」他於倫敦向記者進行簡報。

　　他說：「如果我們給他們較好的開始，他們或許能以較正面的方式面對精神疾病，就不會病得那麼重。」

　　全世界數億人深受諸如精神分裂症、過動症（ADHD）、憂鬱症、癲癇與失智症等心理、行為與神經系統疾病影響。

　　許多心理健康出問題的人，童年就有行為問題病史。但專家表示，在童年階段及早發現問題所在的困難在於，當時的異常通常極難察覺。中央社（翻譯）

By Kate Kelland

LONDON (Reuters) - British scientists believe they have found specific patterns of brain activity in children and young people which could be signs or "markers" of those who will later go on to develop mental illnesses such as schizophrenia.



Researchers from Nottingham University, who presented their study at the Forum for European Neuroscience in Amsterdam, said the patterns suggest it may be possible in future to identify those at risk of becoming ill before they develop symptoms.



"If we can identify people who are at particularly high risk of developing schizophrenia, perhaps using neurocognitive brain markers, then we might be able to reduce that risk and also help them to function better," said Dr Maddie Groom, who worked on the study and gave a briefing to reporters in London.



"If we give them a better start, they may encounter the illness in a more positive way and not get quite so ill."



Hundreds of millions of people worldwide are affected by mental, behavioural and neurological illnesses such as schizophrenia, attention deficit hyperactivity disorder (ADHD), depression, epilepsy and dementia.



Many people who go on to develop diverse mental health problems will have a history of behavioural problems going back to childhood, but experts say the problem with finding them at that stage is that differences then are often extremely subtle.



In one study, Groom and her colleagues investigated looked at the healthy siblings of people with schizophrenia, who also have a very slightly increased risk of developing schizophrenia compared with the general population.



Using brain imaging to read activity levels, the scientists asked the siblings to perform task which involved playing an alien-zapping computer game in which they needed to respond quickly, and crucially, halt the urge to respond if the wrong kind of alien popped up. The task was called a "go, no-go" task.



"When we measured the brain activity of the siblings of people with schizophrenia, their brain activity was reduced at the time when they needed to pay attention to the stimulus, and when they needed to inhibit their response," Groom explained.



She said this suggested the subtle differences in brain activity may act as a risk marker for the disorder.



In a second study, scientists compared brain activity of children with ADHD -- a mental disorder that affects between 8 and 12 percent of children, and 4 percent of adults worldwide.



The researchers used the same "go, no-go" task in various scenarios, including when the children were taking their medication, Ritalin, and when they were not, and then using an additional system of rewards and penalties.



Millions of people take ADHD drugs including Novartis (NOVN.VX) Ritalin, which is known generically as methylphenidate, and Shire Plc's (SHP.L) Adderall and Vyvanse. In the United States alone, 2008 sales for these drugs was about $4.8 billion, according to data from IMS Health.



Groom's results showed that children who were taking medication, and children given an incentive, performed better than those who had neither medicines nor incentives.



This suggests, Groom said, that doctors may be able to find new ways to treat children with ADHD using a combination of behavioural strategies and drugs.



(Editing by Jon Boyle)





(For more news on Reuters India, click in.reuters.com)

Ｋ他命 -- 小常識+案例

Ｋ他命小常識：



「K他命」（Ketamine）為一種麻醉藥品，吸食後會產生類似迷幻藥的效果及視覺作用，藥效約可維持一小時，但影響吸食者感覺、協調及判斷能力則可長達16至24小時。

濫用K會產生幻覺並有心、嘔吐、複視、影像扭曲、說話遲緩、暫時性失憶、身體失去平衡等症狀。急性中毒或大劑量、快速靜脈注射，還會造成呼吸抑制的危險，民眾切勿輕易嘗試。

近年來K他命濫用情形愈來愈普遍，許多人認為K他命不會上癮，但醫師警告說，臨床醫學界發現，K他命具有成癮性，個案會有無法控制使用的衝動，並且會出現許多戒斷症狀，包括焦慮、失眠、煩躁、不安與渴求感為主。

台北市立聯合醫院松德院區成癮防治科主任束連文表示，部份個案在使用後，亦會併發頻尿與其它身體不適，許多個案因而求助醫療。

有位26歲的陳先生，數年前在學校時參與了某次同學們所替他舉辦的慶生Party，在熱烈氣氛與高漲好奇心簇擁下，抽了數口當下流行的K煙。在一陣暈眩中，宛如進入夢境中乖離脫序世界，片刻間，他感受到特殊視覺經驗，思考和動作明顯減慢，奇特事在於，他發現自己居然可以暫時靈魂出竅。

數年之後，陳先生進入職場為生計賣命工作，大環境不景氣讓他屢次遭到老闆指責，情緒低落下，他為麻痺自己而和同事到PUB作樂一番，而他再度接觸到K他命，雖然工作收入不高，陳先生仍花費自己微薄收入，換取可以固定接觸K他命機會，他愛上了它。

束連文表示，隨著使用頻率增加，使用量也逐漸上升，陳先生也試著使用鼻吸方式使用K他命，漸漸地，家人發現他常常失神、反應遲鈍、記憶力變得很差，脾氣也變得十分暴躁，常常與家人衝突，一個人時卻又常偷偷講電話，行蹤捉摸不定。

不知不覺中，陳先生感到自己已經將K他命作為生活重心，整個心思盤據不再是工作進度，而是K他命取貨細節，包括如何避他人眼目與疑心，同時對K他命有強烈渴求感，也逐漸出現失眠與焦慮問題，並且他發現自己開始嚴重頻尿，曾多次就診泌尿科卻都沒有異常發現，陳先生感到事態嚴重，經過與家人坦承與溝通後，在家人建議下到醫院尋求治療。束連文呼籲大眾正視K他命此一新興成癮物質及相關問題。◇

文／台北市立聯合醫院電子報

吸食K他命會對泌尿系統產生嚴重的副作用

小玉是一個18歲的高職生，第一次來泌尿科門診時即有下腹嚴重疼痛，小便疼痛、頻尿、血尿及尿不出來，驗尿報告有發炎指數升高，依長期的臨床經驗告訴我們：一個健康的年輕女性出血性膀胱炎不難治療，只要給藥治療後約定時間回診，但小玉的治療效果卻極差，症狀沒有改善外，而且下腹痛與頻尿的更厲害，一天上廁所次數高達四、五十次，甚至須包上尿布，不禁令人困惑，到底是什麼病菌引起這麼難治療的膀胱炎呢？經再三詢問之下才知小玉有吸食K他命的習慣，但只有三個月的時間。這個時間已對小玉產生了膀胱嚴重的傷害性。




K他命原作為一種全身麻醉的藥品(稱為氯胺酮)，對呼吸系統比較不會產生抑制作用，常用用於兒童或老人的手術麻醉過程。K他命是一種液態製劑，經過蒸餾之後變成粉末，無論是液體或粉末，都可以經過鼻孔進入呼吸道，產生麻醉效果，吸食者通常會體驗到光的感覺，身體扭曲，喪失時間感，產生渾渾噩噩、做夢的狀態；高劑量的K他命則會發生靈魂出竅的幻覺，身體與知覺發生解離現象，有些人沈迷於K他命產生的幻覺，幻想自己可以飛翔。



青少年濫用K他命的研究顯示，長期吸食K他命，會對腦部造成永久損害。這些損害顯現出來的病徵主要如下，對藥物有依賴，記憶力及智力減退，說話迷糊口齒不清及情緒不穩定。 K他命對泌尿系統有何影響呢？這是K他命遭濫用以後我們必須面對的另一種後遺症，一開始我們對於K他命引起的泌尿系統疾病一無所知，回想我好幾年前在門診遇過幾個在特種行業上班的女孩告訴我她只要上班陪客人喝酒以後膀胱或下腹部會特別不舒服，接著可能會頻尿血尿，當時醫界並未了解K他命會對泌尿系統產生傷害，只能不解的對著病人問是不是未按醫囑吃藥？現在想起來恍然大悟，原來是吸食K他命引起的膀胱炎。



吸食多久或多少的K他命以後會產生膀胱的症狀？目前沒有尚未有定論，臨床上有吸食不到半年即產生症狀，但也有病人吸時長達多年以後才產生。致病機轉可能是是K他命的代謝物存在尿液中產生膀胱壁的刺激性，使膀胱黏膜表層產生發炎潰瘍，而產生嚴重頻尿、血尿、下腹痛甚至尿不出來，長期下來會導致膀胱壁嚴重的纖維化 ，使病人的膀胱容量極小，甚至不到50㏄，最後有可能需膀胱全切除，終其一生用人造膀胱或背尿袋，不可不慎啊。目前最新的報告發現有一部份病人會引起腎水腫甚至腎衰竭須終身接受洗腎。



治療的原則是先戒掉K他命，我們發現這比較困難些，常常是醫護人員想盡辦法改善症狀，病患卻聯絡藥頭送藥至病房，鼻頭仍沾著白粉，令人心痛。在泌尿科方面的副作用上，泌尿科醫師會開立抗生素，類固醇，抗組織胺來減緩症狀；愛泌羅(pentosan polysulfate)做為膀胱黏膜修護剤；必要時膀胱內視鏡合併膀胱黏膜燒灼術。同時，需要精神科醫師的協助，在戒除K他命的工作上，治療包括要藥物與心理治療，或家族治療。



貪圖一時好奇或快感而吸食K他命是不智之舉，家有青少年的父母要多注意，提醒孩子們吸食毒品是傷身傷財，K他命雖不是大毒品傷害泌尿系統的程度卻是難以挽回的。

夢遊

性侵女子辯「夢遊」　醫師狂遷戶口躲刑責


更新日期:2010/05/25 16:05 社會中心／綜合報導

一名彭姓外科醫生性侵女朋友的房客，開庭時謊稱是因為吃了安眠藥「夢遊」，法官拆穿他的謊言，判他7年徒刑，這名醫生不願入監，進行戶口大搬遷，一個月搬了三個縣市，檢察官強制執行，今天（25日）上午把他關進看守所。

記者來到彭醫師台北的住家，門鈴沒人應、沒人理，因他為了躲避坐牢早就搬離老家。2006年6月22日晚上，他拿著女朋友的房間鑰匙潛入房客住處，對房客性侵得逞，還辯稱自己是吃了安眠藥「夢遊」，把犯行推得一乾二淨。

一開始法院委託亞東醫院鑑定 (沒有判別力的鑑定)，沒想到報告竟指出，醫生「前途無限，應會愛惜羽毛」，證明他是吃藥夢遊而犯案；後來法官查出，彭姓醫生犯案竟然記得戴口罩遮臉，和被害人對話很有條理，還能清楚描述性侵過程，和醫學文獻上指出，夢遊醒來什麼都記不得並不相符，戳破他的謊言，重判7年。

全案三審判刑確定後，彭姓醫師就開始到處搬家，2月判刑確定，3月到4月他的戶口從台北搬到高雄左營，再搬到台中清水，最後搬到屏東新埤，只要叫他入監服刑，他就說因為搬家，必須換地方坐牢，公文來來往往拖了好幾個月。

最後檢方強迫執行，再不報到就要通緝，今日上午9點，他戴著口罩墨鏡進入執行科，低調入監服刑。（新聞來源：東森新聞記者謝家璇、許舒銘）

一閃一閃亮晶晶

肯納氏症候群 Kanner syndrome 又稱自閉症 autism 定義如下..

Definition of Kanner syndrome

Kanner syndrome: (Also called autism). A spectrum of neuropsychiatric disorders characterized by deficits in social interaction and communication, and unusual and repetitive behavior. Some, but not all, people with autism are non-verbal.




Autism is normally diagnosed before age six and may be diagnosed in infancy in some cases. The degree of autism varies from mild to severe in different children. Severely afflicted patients can appear profoundly retarded.



The cause (or causes) of autism are not yet fully understood. However, it is believed that at least some cases involve an inherited or acquired genetic defect. Researchers have proposed that the immune-system, metabolic, and environmental factors may play an important part as well. It is not caused by emotional trauma, as was once theorized.



Autism or autistic-like behavior may co-occur with many other neurological conditions.



The optimal treatment of autism involves an educational program that is suited to the child's developmental level.



Kanner syndrome (i.e., autism) is also called infantile autism. See also Asperger syndrome, elective mutism, Pervasive Developmental Disorder, Rett syndrome

DSM-V分類

將Wiki 的文章 .. 稍做修飾

這裡將 disorder 翻譯為 異常  中國的翻譯 是 障礙 (哪個好哪個壞 留待後人評斷 )

DSM的發展史

以下根據DSM-IV和DSM-IV-TR之序言，
DSM之所以被發展出來，一開始是由於美國二戰後退伍軍人症候群在門診上的表現，為能提供更多客觀的詞彙給精神醫學研究，而將ICD-6改編為DSM-I。在DSM出版之前，精神醫學家之間的溝通並不統一，尤其是在不同的國家之間，因此建立特定判準是試圖使有關精神健康的研究和溝通更為容易。
不過，多軸系統的設立直到DSM-III才發展出來，以因應產生對於病患之更完整的圖像，而不僅僅是簡單的診斷。

DSM-I的出現時詞彙充滿「反應」(reaction)，且其理論根據是Adolf Meyer所主張的「精神異常是患者人格對於心理、社會、及生物因素的反應」。

而DSM-II則修飾精神異常的描述以及增加精神異常的診斷的區別力，然而「反應」的觀點仍保留著。

直到1980年DSM-III出版後試圖以客觀、中立的方式而擺脫各種病因學的理論與說法，而只著重於描述精神異常的症狀（以提高診斷者間信度）；但是，DSM的內容卻沒能反映出關於心理病理學（psychopathology）議題的所有意見、比如情緒困厄（emotional distress）及社會功能（social functioning）的狀態。而且關於那些診斷準則與分類，也沒有完全客觀的、生物可驗證性（verifiable）支持。

這類型的缺失一如Peterson在其著作「變態心理學」(Abnormal Psychology)中引述的Alloy(1989)觀點：精神異常的分類應該按照病源來分類，而不是將憂鬱症全部分放在一起而不管病源為何；Peterson又引用Vaillant(1984)的說明例子，把一堆不同原因的喉嚨痛症狀全湊在一起而不管是感冒還是喉嚨炎，不是很可笑嗎？

對此，DSM-IV以及TR版本都強調病因學的問題容易牽涉到詮釋理論、研究方法以及診斷類別的普遍性等錯綜問題。而這些診斷準則以及它們被臨床醫師應用的方式在某種程度上又會隨著文化差異影響，且必須週期性地被修改以反映當代的社會風俗（social landscape)。又「精神異常」的觀點常隨著時間而改變，例如在1973年的精神醫學表決之前，同性戀被列在DSM中，當作可診斷的精神異常，直到因應社會運動以及人們對於同性戀觀念逐漸改變才去汙名化從DSM中除去。

DSM-IV開始回顧過去的文獻資料，然而由於許多文獻不是過期的觀念、就是資料不足，故文獻回顧的作用並不大。而DSM-IV工作小組則又系統性地檢驗各理論以及其它實驗室數據，而若有大量數據顯示則診斷判準需變更，診斷準則的陳述又比DSM過去版本更為簡潔；然而若被認為是「應該刪除的異常」卻發現過去文獻具有相當高的診斷信度(reliability)則被列在DSM-IV準則之相關議題、或列入附錄中做為以後研究之參考(如女性經前症候群)。除此之外，在DSM-III-R版無法診斷或未註明之異常經由重新調查後，若是已被ICD-10納入者則優先考慮納入DSM-IV，次之則是有最新大量的研究數據顯示其一致性高者、最後才將DSM-III-R版本無法診斷的異常列入DSM-IV之「其它未註明之異常」以做為後續研究用。最後進行實地試用（field trial），分別在不同國家、社會文化背景進行調查，直到確認該診斷判準在不同時地背景具有一致性便正式納入DSM-IV正式版本。

DSM-IV-TR則修改一些診斷實用性遭質疑的異常：如急性壓力症候群(Acute Stress Disorder,簡稱ASD)及創傷後壓力症候群(Post-traumatic Stress Disorder，簡稱PTSD)，在DSM-IV僅在於ASD事發後三個月便可改診斷為PTSD，而在TR版則於ASD上又增加「三個月內必須出現解離性行為」以便跟PTSD「或重複出現解離性行為」區別開來。

DSM-V的實地研究（field study）及出版

DSM-V實地研究的總體目標是評估其可行性、臨床實用性、信度、以及診斷準則草案的效度和診斷特異性、以及回應所有對DSM-V交叉測試之建議。從訪問DSM-V網站收到訪客的反饋意見整理後，工作小組修改診斷準則草案，並隨著DSM-V研究小組檢討哪些診斷準則最需要進行實地調查。

DSM-V首先在美國和加拿大進行實地調查，而後對於該診斷類別進行再測信度及分析研究，最後再對DSM-V的新診斷症狀進行跨領域的信度測試。在實地調查中有三篇結果發表於「美國精神醫學雜誌」(American Journal of Psychiatry)，全部內容為23項新編診斷準則，其中有14項兒童及成人精神異常被發現具有相當高信度，尤其是過動症、創傷後壓力症候群及暴食症，在精神異常的「交叉症狀」測試中亦發現具有不錯的信度。然而有六項診斷信度較低，比如常見的憂鬱症和廣泛性焦慮症，對此負責小組主席 David Kupfer說他們專注於憂鬱症和焦慮症共存的診斷準則；而在美國及加拿大從2010年到2012年底進行再測信度後發現患者罹患憂鬱症及焦慮症在幾個星期內可以產生很大的波動，且兩個獨立的症狀再測信度很低，而有三個診斷信度低到DSM-V編輯小組決定大幅修改或不再列入診斷準則裡。另外，DSM-V雖然探討「網路成癮異常」(Internet addiction disorder)且有大量的研究文獻，然而卻未納入正式診斷裡。

最後，DSM-V決定去除從DSM-III發展出來的五軸診斷只保留準則ABCDE，每一項診斷準則都經過各工作小組內部相當多的辯論，包含從方法學、觀念上的演變、診斷類別或向度、以及跨領域研究人員的溝通，以確保DSM-V的多元性及高特異性(Specify)。

DSM-V項目重編以及診斷準則的改變

DSM-V最著名的診斷方法為去除五軸診斷而只保留診斷準則ABCDE，而各異常之準則改變如亞斯伯格症不再設獨立診斷，而精神分裂症的各個亞型(妄想型、緊張型、混亂型、殘餘型)也都去除，而哀慟反應(bereavement)也可包含於憂鬱症裡面而不再相斥。而性別認同異常的準則則大幅修改，並且新增加了賭博性異常(gambling disorder)。

各重編之診斷項目如下︰

Neurodevelopmental disorders

• "Mental retardation" has a new name: "intellectual disability (intellectual developmental disorder)."^[4]
• Phonological disorder and stuttering are now called communication disorders—which include language disorder,speech sound disorder, childhood-onset fluency disorder, and a new condition characterized by impaired social verbal and nonverbal communication called social (pragmatic) communication disorder.^[4]
• Autism spectrum disorder incorporates Asperger disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) - see Diagnosis of Asperger syndrome#Proposed changes to DSM-5.^[5]
• A new sub-category, motor disorders, encompasses developmental coordination disorder, stereotypic movement disorder, and the tic disorders including Tourette syndrome.^[6]

神經發展異常(Neurodevelopmental disorders)

•    心智遲緩(Mental Retardation)改名為「智力失能」(intellectual disability )或「智力發展異常」((intellectual developmental disorder)。

•    語音異常(Phonological disorder)和口吃已經改名為「溝通異常」(communication disorders )，該異常包含「語言異常」、「說話語音異常」(speech sound disorder)、「兒童期開始的流暢異常」(childhood-onset fluency disorder)、以及社交溝通異常(Social communication disorder，其特點為社會語意以及非語意性的溝通損傷)。

•    自閉症光譜異常已經合併亞斯伯格異常、童年瓦解性異常、以及其它未註明之廣泛性發展異常。

新次分類--動作異常 包括 developmental coordination disorder發展協調異常, stereotypic movement disorder刻板動作異常, and the tic disorders抽動異常 including Tourette syndrome.妥瑞症後群

Schizophrenia spectrum and other psychotic disorders[edit]

• All subtypes of schizophrenia were deleted (paranoid, disorganized, catatonic, undifferentiated, and residual).
• A major mood episode is required for schizoaffective disorder (for a majority of the disorder's duration after criterion A is met).
• Criteria for delusional disorder changed, and it is no longer separate from shared delusional disorder.
• Catatonia in all contexts requires 3 of a total of 12 symptoms. Catatonia may be a specifier for depressive, bipolar, and psychotic disorders; part of another medical condition; or of another specified diagnosis.

精神分裂光譜 以及 其它 精神病性異常

•    刪除所有的精神分裂症亞型（妄想型，混亂型，緊張型，未分化型，殘餘型）。

•    「情感性分裂異常」至少需要情感性異常發作且需滿足主要的情感性異常的準則A之持續發作時間。

•    妄想症準則的改變，並且「共享型妄想症」不再和妄想症區別。妄想指的當不是來自於一般普通經驗時，而是不可信且固著的信念且無法改變，甚至有證據可以駁斥這想法為離奇的。

•    緊張型症狀(原緊張型亞型)在準則中需在12種症狀中滿足至少3項以上。

Bipolar and related disorders[edit]

• New specifier "with mixed features" can be applied to bipolar I disorder, bipolar II disorder, bipolar disorder NED (not elsewhere defined, previously called "NOS", not otherwise specified) and MDD.
• Allows other specified bipolar and related disorder for particular conditions.
• Anxiety symptoms are a specifier ( called "anxious distress") added to bipolar disorder and to depressive disorders (but are not part of the bipolar diagnostic criteria).

雙極性以及相關之異常

•    註記「混合特徵」可適用於第一型及第二型雙極性異常、以及雙極性           異常NED型(過去稱NOS，其它未註明)及重鬱異常。

•    允許其它特異型雙極性及特殊情境之相關異常於雙極性異常。

•    註記焦慮性症狀添加於雙極性異常及憂鬱性異常，但並非雙極性異常           診斷準則的一部分。

Depressive disorders[edit]

• The bereavement exclusion in DSM-IV was removed from depressive disorders in DSM-5.^[8]
• New disruptive mood dysregulation disorder (DMDD)^[9] for children up to age 18 years.^[2]
• Premenstrual dysphoric disorder moved from an appendix for further study, and became a disorder.^[2]
• Specifiers were added for mixed symptoms and for anxiety, along with guidance to physicians for suicidality.^[2]
• The term dysthymia now also would be called persistent depressive disorder.

憂鬱異常

•    「傷慟反應」在DSM-IV裡需排除憂鬱症的準則已在DSM-V裡移除該準則。

•    增加新的異常為「破裂性心情失調異常」( disruptive mood dysregulation disorder，DMDD)，於兒童18歲以前發作。

•    過去在DSM-IV/TR裡的附錄裡「經前症候群」正式成為一個異常診斷。

•    註記添加混合性症狀(mixed symptoms)以及同樣適用於焦慮症，且在醫師醫囑下仍有自殺傾向。

• 詞彙 dysthymia 可被稱為 持續憂鬱異常 persistent depressive disorder.

Anxiety disorders[edit]

• For the various forms of phobias and anxiety disorders, DSM-5 removes the requirement that the subject (formerly, over 18 years old) "must recognize that their fear and anxiety are excessive or unreasonable". Also, the duration of at least 6 months now applies to everyone (not only to children).^[2]
• Panic attack became a specifier for all DSM-5 disorders.^[2]
• Panic disorder and agoraphobia became two separate disorders.^[2]
• Specific types of phobias became specifiers but are otherwise unchanged.^[2]
• The generalized specifier for social anxiety disorder (formerly, social phobia) changed in favor of a performance only (i.e., public speaking or performance) specifier.^[2]
• Separation anxiety disorder and selective mutism are now classified as anxiety disorders (rather than disorders of early onset).

焦慮異常

•    對於畏懼症及焦慮症，DSM-V刪除DSM-IV過去要求的準則︰"18歲以           上，且必須認識到，他們的畏懼和焦慮是過分或不合理的。"

•    恐慌發作(Panic attack)在DSM-V中變成正式的異常而非現象。

•    恐慌症和懼曠症分開成為兩個獨立的診斷。

•    特定類型的畏懼症(Specific types of phobias)變成註記但其內容不變。

•    改變廣泛註記「社交焦慮異常」(社交畏懼症)以利於註記只有出現                 「表現型行為問題」(如公眾演講或表演)。

•    分離性焦慮以及選擇性緘默從「初發於早期之異常」                                          (disorders of early onset)移出並歸類於 焦慮性異常。

Obsessive-compulsive and related disorders

• A new chapter on obsessive-compulsive and related disorders includes four new disorders: excoriation (skin-picking) disorder, hoarding disorder, substance-/medication-induced obsessive-compulsive and related disorder, and obsessive-compulsive and related disorder due to another medical condition.^[2]
• Trichotillomania (hair-pulling disorder) moved from "impulse-control disorders not elsewhere classified" in DSM-IV, to an obsessive-compulsive disorder in DSM-5.^[2]
• A specifier was expanded (and added to body dysmorphic disorder and hoarding disorder) to allow for good or fair insight, poor insight, and "absent insight/delusional" (i.e., complete conviction that obsessive-compulsive disorder beliefs are true).^[2]
• Criteria were added to body dysmorphic disorder to describe repetitive behaviors or mental acts that may arise with perceived defects or flaws in physical appearance.^[2]
• The DSM-IV specifier “with obsessive-compulsive symptoms” moved from anxiety disorders to this new category for obsessive-compulsive and related disorders.^[2]
• There are two new diagnoses: other specified obsessive-compulsive and related disorder, which can include body-focused repetitive behavior disorder (behaviors like nail biting, lip biting, and cheek chewing, other than hair pulling and skin picking) or obsessional jealousy; and unspecified obsessive-compulsive and related disorder.

強迫症及相關異常

•    在該章節新增了四個異常︰剝皮(excoriation)異常、囤積症、物質/藥物引起之強迫性異常、其它醫學條件引起之強迫症及相關異常。

•    拔毛癖(Trichotillomania)從「其它未分類型衝動控制異常」移出而列入強迫症。

•    註記「身體畸形異常」和「囤積症」以說明良好的病識感、不好的病識感、以及缺乏病識感/妄想(如完整卻不真實的信念，強迫症所意識到的信念是「真實」的)。

•    增加「身體畸形異常」描述重複性的行為、或心理不斷感覺到身體外觀的缺陷之診斷準則。

•    在DSM-IV的焦慮性異常裡註記"伴隨強迫性症狀"之異常移出到該章節診斷裡。

•    其它特定的強迫症及相關異常可包含集中於身體之重複行為異常(如咬指甲、咬嘴唇、臉頰咀嚼、拔頭髮、撥皮)、強迫性的忌妒/醋意(jealousy)，或未註明的強迫性相關異常。

Trauma- and stressor-related disorders

• Posttraumatic stress disorder (PTSD) is now included in a new section titled "Trauma- and Stressor-Related Disorders."^[10]
• The PTSD diagnostic clusters were reorganized and expanded from a total of three clusters to four based on the results of confirmatory factor analytic research conducted since the publication of DSM-IV.^[11]
• Separate criteria were added for children six years old or younger.^[2]
• For the diagnosis of acute stress disorder and PTSD, the stressor criteria (Criterion A1 in DSM-IV) was modified to some extent. The requirement for specific subjective emotional reactions (Criterion A2 in DSM-IV) was eliminated because it lacked empirical support for its utility and predictive validity.^[11] Previously certain groups, such as military personnel involved in combat, law enforcement officers and other first responders, did not meet criterion A2 in DSM-IV because their training prepared them to not react emotionally to traumatic events.^{[12] [13] [14]}
• Two new disorders that were formerly subtypes were named: reactive attachment disorder and disinhibited social engagement disorder.^[2]
• Adjustment disorders were moved to this new section and reconceptualized as stress-response syndromes. DSM-IV subtypes for depressed mood, anxious symptoms, and disturbed conduct are unchanged.

創傷及壓力相關之異常++

•    創傷後壓力症候群現包含在「創傷及壓力相關異常」並且跟強迫性異常一樣從「焦慮性異常」獨立出來，除此之外，除了診斷準則B、C、D外，另外再添加行為上的症狀，如創傷後壓力異常試圖改變之準則；
The PTSD diagnostic clusters were reorganized and expanded from a total of three clusters to four based on the results of confirmatory factor analytic research conducted since the publication of DSM-IV.
對於6歲和以下孩童的診斷準則也獨立出來放在此項目。

而個體對於急性壓力症候群或創傷後壓力症候群的壓力源之主觀反應亦改變或取消。

•    這個項目分類主要是暴露於創傷或災難性事件，並強調和焦慮性異常、強迫性異常及解離性異常之間密切的關連。

•    過去有兩個亞型被納入此項目並且形成新的異常︰
「反應性依附異常」( reactive attachment disorder)及
「去抑制型社會參與異常」(disinhibited social engagement disorder)。

•    適應異常被移到該分類的 壓力-反應症候群 項目裡。

•    313.89 反應性依附異常(Reactive attachment disorder)︰指出生的嬰兒或是孩子於童年早期時雖然被認為能夠形成選擇性依附，然而並沒有從照顧者身上得到舒適、保護者或其他相關養育之依附，且當照顧者提供照顧時無法充分反應回饋 (註明︰至少持久至12個月以上)。註明當前的嚴重性(Specify current severity)。

•    313.89 去抑制性社會參與障礙(Disinhibited social engagement disorder)︰與相對的陌生孩子比較，該患者表現出過度不適當的行為模式於熟悉環境的和文化上，且已經嚴重違反社會邊界(註明︰至少持久至12個月以上)。

•    309.81 創傷後壓力異常(Posttraumatic stress disorder)︰在此異常中另外再分出6歲或更年輕的小孩子。註明是否︰

 伴隨解離性症狀

 1.自我消失感/去人格化(Depersonalization)

 2.去現實化(Derealization)
註明︰伴隨延遲性表達(完整準則為經歷創傷事件後，六個月內並未表現症狀)

•    308.3 急性壓力異常

•309    適應障礙

 註明是否︰

            309.0   伴隨憂鬱的心情

            309.24 伴隨焦慮

            309.28 伴隨混和焦慮和憂鬱情緒

            309.3  伴隨行為障礙

            309.4  伴隨混合情緒和行為障礙

 309.9  未註明

         •309.89 其它註明之創傷及壓力相關異常

•309.9   未註明之創傷及壓力相關異常

Dissociative disorders[edit]

• Depersonalization disorder is now called depersonalization/derealization disorder.^[15]
• Dissociative fugue became a specifier for dissociative amnesia.^[2]
• The criteria for dissociative identity disorder were expanded to include "possession-form phenomena and functional neurological symptoms". It is made clear that "transitions in identity may be observable by others or self-reported".^[2]Criterion B was also modified for people who experience gaps in recall of everyday events (not only trauma).

解離異常

•    自我消失感異常 在DSM-V被改為「去人格化/去真實化異常」。

•    解離性迷遊症 被註解在解離性失憶症裡而不再獨立診斷。

•    新增 解離性身分異常 診斷準則為︰「附身/佔有形式的現象和功能性之神經症狀」且「轉換之身分可以觀察別人或自我陳述」；而準則B亦修飾為「該患者無法回憶每天的事件(不僅限於創傷)」。

•    這些異常的共同特徵為對患者的主觀經驗、情緒、記憶之正常整合性造成干擾或空隙導致患者的主觀經驗、情緒、記憶產生不連續性。

Somatic symptom and related disorders

• Somatoform disorders are now called somatic symptom and related disorders.
• Diagnoses of somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder were deleted.
• People with chronic pain can now be diagnosed with somatic symptom disorder with predominant pain; orpsychological factors that affect other medical conditions; or with an adjustment disorder.^[2]
• Somatization disorder and undifferentiated somatoform disorder were combined to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms.^[2]
• Somatic symptom and related disorders are defined by positive symptoms, and the use of medically unexplained symptoms is minimized, except in the cases of conversion disorder and pseudocyesis (false pregnancy).^[2]
• A new diagnosis is psychological factors affecting other medical conditions. This was formerly found in the DSM-IV chapter "Other Conditions That May Be a Focus of Clinical Attention".^[2]
• Criteria for conversion disorder (functional neurological symptom disorder) were changed.

軀體性症狀及相關異常 Somatic symptom and related disorders

• Somatoform disorders are now called somatic symptom and related disorders.

• 在DSM-V，該項目已刪除了身體化異常、慮病症、疼痛異常及未分化型軀體形式異常。
• 患有慢性疼痛的患者在DSM-V可能被診斷為「軀體性症狀異常主要伴隨疼痛」、或「心理因素影響其它醫學性狀況」、或「伴隨適應性障礙」。
• 軀體化異常somatization disorder和未分化的軀體形式異常合併成為軀體性症狀異常(somatic symptom disorder)。
• 軀體性症狀在DSM-V被定義為「陽性症狀」，故儘量減少醫學性狀況無法解釋的異常，除了轉化症和假孕的狀況。而原來在DSM-IV裡「其它臨床關注的焦點」(DSM-V稱心理因素影響到其它醫療狀況)則被命名到新的精神異常。
• 轉化症(在DSM-V稱為「功能性神經性症狀異常」)診斷準則已改變。

Feeding and eating disorders[edit]

• Criteria for pica and rumination disorder were changed and can now refer to people of any age.^[2]
• Binge eating disorder graduated from DSM-IV's "Appendix B -- Criteria Sets and Axes Provided for Further Study" into a proper diagnosis.^[16]
• Requirements for bulimia nervosa and binge eating disorder were changed from "at least twice weekly for 6 months to at least once weekly over the last 3 months".
• The criteria for anorexia nervosa were changed; there is no longer a requirement of amenorrhea.
• "Feeding disorder of infancy or early childhood", a rarely used diagnosis in DSM-IV, was renamed toavoidant/restrictive food intake disorder, and criteria were expanded.

餵食或飲食異常

•    反芻異常及異食癖(pica，指喜歡吃非食物的物品如粉筆、黏土等)的診斷準則改變，且不限於任何年齡的人。

•    暴食症(binge eating disorder，指患者服用的食物大量超過該餐所需)從DSM-IV-TR的附錄B之「尚待進一步研究」獨立出來成為正式的診斷異常。

•    神經性暴食症(bulimia nervosa，指患者大量進食然後催吐)和暴飲暴食症(binge eating disorder)診斷需求改變為︰至少6個月內每週兩次以及至少最近3個月內每週都發生。

•    神經性厭食症(anorexia nervosa)準則改變，並且不再有月經失調(menstrual disorder)的要求準則。

•    過去於DSM-IV的「嬰兒及童年早期餵食異常」(Feeding disorder of infancy or early childhood)被重新命名為「迴避/限制攝取飲食異常」(avoidant/restrictive food intake disorder)，並且擴大其診斷準則。

Sleep–wake disorders[edit]

• "Sleep disorders related to another mental disorder, and sleep disorders related to a general medical condition" were deleted.^[2]
• Primary insomnia became insomnia disorder, and narcolepsy is separate from other hypersomnolence.^[2]
• There are now three breathing-related sleep disorders: obstructive sleep apnea hypopnea, central sleep apnea, and sleep-related hypoventilation.^[2]
• Circadian rhythm sleep–wake disorders were expanded to include advanced sleep phase syndrome, irregular sleep–wake type, and non-24-hour sleep–wake type.^[2] Jet lag was removed.^[2]
• Rapid eye movement sleep behavior disorder and restless legs syndrome are each a disorder, instead of both being listed under "dyssomnia not otherwise specified" in DSM-IV.

睡眠-覺醒異常

•    "關於其他精神異常之睡眠異常、且關於一般性醫學狀況之睡眠異常"被刪除。

•    原發性失眠異常(Primary insomnia )成為失眠異常(Insomnia disorder)，猝睡症(narcolepsy)則獨立於其他嗜睡症(hypersomnolence)。

•    新增三個與呼吸相關的睡眠異常：中樞性睡眠呼吸中止症(central sleep apnea)、低通氣阻塞性睡眠呼吸中止症(obstructive sleep apnea hypopnea)及與通氣不足相關的睡眠異常(sleep-related hypoventilation)。

•    晝夜節律睡眠 - 覺醒異常(Circadian rhythm sleep–wake disorders)擴增到包含下述的睡眠時相症候群：不規則 睡眠-覺醒型(irregular sleep–wake type)、非24小時睡眠 - 覺醒型(non-24-hour sleep–wake type)；睡眠時差問題(Jet lag)已刪除。

•    快速動眼睡眠行為異常(Rapid eye movement sleep behavior disorder)及腿不安寧症候群(restless legs syndrome)已從DSM-IV的「其它未註明之睡眠異常」裡移出而納入每一個睡眠異常準則裡。

Sexual dysfunctions[edit]

• DSM-5 has sex-specific sexual dysfunctions.^[2]
• For females, sexual desire and arousal disorders are combined into female sexual interest/arousal disorder.^[2]
• Sexual dysfunctions (except substance-/medication-induced sexual dysfunction) now require a duration of approximately 6 months and more exact severity criteria.^[2]
• A new diagnosis is genito-pelvic pain/penetration disorder which combines vaginismus and dyspareunia from DSM-IV.^[2]
• Sexual aversion disorder was deleted.^[2]
• Subtypes for all disorders include only "lifelong versus acquired" and "generalized versus situational" (one subtype was deleted from DSM-IV).^[2]
• Two subtypes were deleted: "sexual dysfunction due to a general medical condition" and "due to psychological versus combined factors".^[2]

性功能異常

 DSM-V新增與「性之特異性」(sex-specific)之性功能異常。

 女性之性慾(sexual desire)和性慾喚起異常(arousal disorders)合併為女性性趣/性慾喚起異常(female sexual interest/arousal disorder)。

 性功能異常（除物質/一般性醫學狀況引起之性功能障礙）現在要求持續時間約6個月及更確切的嚴重程度標準。

•    新增一種診斷：生殖系統-骨盆腔疼痛/插入異常(genito-pelvic pain/penetration disorder)，並與DSM-IV的「陰道痙攣和性交疼痛」(vaginismus and dyspareunia)相合併。

•    性厭惡異常(Sexual aversion disorder)已被刪除。

•    所有的性功能異常亞型 包含只有"終身或後天"(lifelong versus acquired)及"廣泛或情境型"(generalized versus situational)，另一種亞型刪除。

刪除兩個亞型:「由一般性醫學狀況引起之性功能異常 」及「合併相對於源自心理因素」(due to psychological versus combined factors)。

Gender dysphoria[edit]

Further information: Gender dysphoria

• DSM-IV gender identity disorder is similar to, but not the same as, gender dysphoria in DSM-5. Separate criteria for children, adolescents and adults that are appropriate for varying developmental states are added.
• Subtypes of gender identity disorder based on sexual orientation were deleted.^[2]
• Among other wording changes, criterion A and criterion B (cross-gender identification, and aversion toward one’s gender) were combined.^[2] Along with these changes comes the creation of a separate gender dysphoria in children as well as one for adults and adolescents. The grouping has been moved out of the sexual disorders category and into its own. The name change was made in part due to stigmatization of the term "disorder" and the relatively common use of "gender dysphoria" in the GID literature and among specialists in the area.^[17] The creation of a specific diagnosis for children reflects the lesser ability of children to have insight into what they are experiencing and ability to express it in the event that they have insight.^[18]

Disruptive, impulse-control, and conduct disorders[edit]

Some of these disorders were formerly part of the chapter on early diagnosis, oppositional defiant disorder; conduct disorder; and disruptive behavior disorder not otherwise specified became other specified and unspecified disruptive disorder, impulse-control disorder, and conduct disorders.^[2] Intermittent explosive disorder, pyromania, and kleptomaniamoved to this chapter from the DSM-IV chapter "Impulse-Control Disorders Not Otherwise Specified".^[2]

• Antisocial personality disorder is listed here and in the chapter on personality disorders (but ADHD is listed under neurodevelopmental disorders).^[2]
• Symptoms for oppositional defiant disorder are of three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness. The conduct disorder exclusion is deleted. The criteria were also changed with a note on frequency requirements and a measure of severity.^[2]
• Criteria for conduct disorder are unchanged for the most part from DSM-IV.^[2] A specifier was added for people with limited "prosocial emotion", showing callous and unemotional traits.^[2]
• People over the disorder's minimum age of 6 may be diagnosed with intermittent explosive disorder without outbursts of physical aggression.^[2] Criteria were added for frequency and to specify "impulsive and/or anger based in nature, and must cause marked distress, cause impairment in occupational or interpersonal functioning, or be associated with negative financial or legal consequences".^[2]

Substance-related and addictive disorders[edit]

• Gambling disorder and tobacco use disorder are new.
• Substance abuse and substance dependence have been combined into single substance use disorders specific to each substance of abuse within a new "addictions and related disorders" category.^[19] "Recurrent legal problems" was deleted and "craving or a strong desire or urge to use a substance" was added to the criteria.^[2] The threshold of the number of criteria that must be met was changed.^[2] Severity from mild to severe is based on the number of criteria endorsed.^[2] Criteria for cannabis and caffeine withdrawal were added.^[2] New specifiers were added for early and sustained remission along with new specifiers for "in a controlled environment" and "on maintenance therapy".^[2]

Neurocognitive disorders[edit]

• Dementia and amnestic disorder became major or mild neurocognitive disorder (major NCD, or mild NCD).^[2][20] DSM-5 has a new list of neurocognitive domains.^[2] "New separate criteria are now presented" for major or mild NCD due to various conditions.^[2] Substance/medication-induced NCD and unspecified NCD are new diagnoses.^[2]

Paraphilic disorders[edit]

• New specifiers "in a controlled environment" and "in remission" were added to criteria for all paraphilic disorders.^[2]
• A distinction is made between paraphilic behaviors, or paraphilias, and paraphilic disorders.^[21] All criteria sets were changed to add the word disorder to all of the paraphilias, for example, pedophilia is now pedophilic disorder.^[2] There is no change in the basic diagnostic structure since DSM-III-R; however, people now must meet both qualitative (criterion A) and negative consequences (criterion B) criteria to be diagnosed with a paraphilic disorder. Otherwise they have a paraphilia (and no diagnosis).^[2]

Personality disorders

• Personality disorder previously belonged to a different axis than almost all other disorders, but is now in one axis with all mental and other medical diagnoses.^[22] However, the same ten types of personality disorder are retained.

舊的 DSM 分類..

010 Disorders usually first diagnosed in infancy, childhood or adolescence. *Disorders such as ADHD and epilepsy have also been referred to as developmental disorders and developmental disabilities.

Examples

Mental retardation, ADHD


020 Delirium, dementia, and amnesia and other cognitive disorders

Examples

Alzheimer's disease


030 Mental disorders due to a general medical condition

Examples

AIDS-related psychosis


040 Substance-related disorders

Examples
Alcohol abuse


050 Schizophrenia and other psychotic disorders

Examples

Delusional disorder


060 Mood disorders

Examples

Major depressive disorder, Bipolar disorder


070 Anxiety disorders

General anxiety disorder


080 Somatoform disorders

Somatization disorder


090 Factitious disorders

Munchausen syndrome


100 Dissociative disorders

Dissociative identity disorder


110 Sexual and gender identity disorders

Dyspareunia, Gender identity disorder


120 Eating disorders

Anorexia nervosa, Bulimia nervosa


130 Sleep disorders

Insomnia


140 Impulse control disorders not elsewhere classified

Kleptomania


150 Adjustment disorders

Adjustment disorder


160 Personality disorders  (2nd Axis)

Narcissistic personality disorder


170 Other conditions that may be a focus of clinical attention

Tardive dyskinesia, Child abuse




CCMD-3目錄  ( 尚須要實徵研究加強 )


中國精神疾病分類與診斷標準，簡稱CCMD

現行的分類與診斷標準為《中國精神疾病分類與診斷標準第3版(CCMD-3)》，由衛生部科學研究基金資助，通過41家精神衛生機構負責對24種精神障礙的分類與診斷標準完成了前瞻性隨訪測試，於2001年完成，並編寫了《CCMD-3》和《CCMD-3相關精神障礙的治療和護理》[1]。

國際上通行的精神疾病診斷為美國《精神疾病診斷與統計手冊》（現行版本DSM-IV-TR）與世界衛生組織的《國際疾病與相關健康問題統計分類》（現行版本為ICD-10）。


• (0)器質性精神障礙

  o (00)阿爾茨海默(Alzheimer)病

  o (01)腦血管病所致精神障礙

  o (02)其他腦部疾病所致精神障礙

  o (03)軀體疾病所致精神障礙

  o (09)其他或待分類器質性精神障礙



• (1)精神活性物質或非成癮物質所致精神障礙

  o (10)精神活性物質所致精神障礙

  o (11)非成癮物質所致精神障礙

• (2)精神分裂症(分裂症)和其他精神病性障礙

  o (20)精神分裂症(分裂症)

  o (21)偏執性精神障礙

  o (22)急性短暫性精神病

  o (23)感應性精神病

  o (24)分裂情感性精神病

  o (29)其他或待分類的精神病性障礙

• (3)心境障礙(情感性精神障礙)

  o (30)躁狂發作

  o (31)雙相障礙

  o (32)抑鬱發作

  o (33)持續性心境障礙

  o (39)其他或待分類的心境障礙

• (4)癔症、應激相關障礙、神經症

  o (40)癔症

  o (41)應激相關障礙

  o (42)與文化相關的精神障礙

  o (43)神經症

• (5)心理因素相關生理障礙

  o (50)進食障礙

  o (51)非器質性睡眠障礙

  o (52)非器質性性功能障礙

• (6)人格障礙、習慣與衝動控制障礙、性心理

  o (60)人格障礙

  o (61)習慣與衝動控制障礙

  o (62)性心理障礙（性變態）

• (7)精神發育遲滯與童年和少年期心理發育障礙

  o (70)精神發育遲滯

  o (71)言語和語言發育障礙

  o (72)特定學校技能發育障礙

  o (73)特定運動技能發育障礙

  o (74)混合性特定發育障礙

  o (75)廣泛性發育障礙

• (8)童年和少年期的多動障礙、品行障礙、情緒障礙

  o (80)多動障礙

  o (81)品行障礙

  o (82)品行與情緒混合障礙

  o (83)特發於童年的情緒障礙

  o (84)兒童社會功能障礙

  o (85)抽動障礙

  o (86)其他童年和少年期行為障礙

  o (89)其他或待分類的童年和少年期精神障礙

• (9)其他精神障礙和心理衛生情況

  o (90)待分類的精神病性障礙

  o (91)待分類的非精神病性精神障礙

  o (92)其他心理衛生情況

  o (99)待分類的其他精神障礙