聊療書

• 所謂快速循環型躁鬱症是指過去12個月中，至少有四次之情緒障礙，症狀符合躁症、輕躁、或嚴重憂鬱發作之診斷標準
• 傳統抗精神病藥物是以D2 受體阻斷為主

Ketamine is a partial agonist of D2 receptor 

• According to Jaspers, primary delusions (sometimes called true delusions) are distinguished by a transformation of meaning, so that the world, or aspects of it, are interpreted in a radically different way by the delusional person. To others, this intepretation is 'un-understandable' in terms of the normal mental causality, mood, environmental influences and other psychological or psychopathological factors. Jaspers describes four types of primary delusion:

  delusional intuition - where delusions arrive 'out of the blue', without external cause.

  delusional perception - where a normal percept is interpreted with delusional meaning. For example, a person sees a red car and knows that this means their food is being poisoned by the police.

  delusional atmosphere - where the world seems subtly altered, uncanny, portentous or sinister. This resolves into a delusion, usually in a revelatory fashion, which seems to explain the unusual feeling of anticipation.

  delusional memory - where a delusional belief is based upon the recall of memory or false memory for a past experience. For example, a man recalls seeing a woman laughing at the bus stop several weeks ago and now realises that this person was laughing because the man has animals living inside him.

  Secondary delusions (sometimes called delusion-like ideas) are considered to be, at least in principle, understandable in the context of a person's life history, personality, mood state or presence of other psychopathology. For example, a person becomes depressed, suffers very low mood and self-esteem, and subsequently believes they are responsible for some terrible crime which they did not commit.

•  DSM-5與DSM-IV-TR中 Schizophrenia 診斷之差異：

  在DSM-IV-TR criterion A部分, 只要有怪異妄想(bizarre delusion) 或Schneiderian first-rank symptom (eg. 持續批評式的人聲聽幻覺/兩人交談式的人聲聽幻覺/thought echo, delusion of control, thought withdrawal, thought insertion, thought broadcasting, delusional perception) 就可診斷思覺失調症, 在DSM-5中此條款被去除了

  Delusions, hallucinations, and disorganized speech. At least one of these core “positive symptoms” is necessary for a reliable diagnosis of schizophrenia.

  取消Schizophrenia subtypes

• 目前精神病患強制住院的流程與條件：

   經專科醫師診斷為嚴重病人並置保護人一人

   評估有全日住院之必要但病人拒絕住院

   由兩位專科醫師強制鑑定並通報地方主管機關，由指定精神醫療機構申請強制住院許可（須完成強制住院基本資料表、通報表、嚴重病人之意見說明、保護人之意見書、相關診斷証明文件及病歷摘要、及審查會指定之其他文件）

   審查會審查准許強制住院