Mental Health-Psychosis Accessibility for Physician

8/12/2019 Mental Health-Psychosis Accessibility for Physician

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1 : 2557 : 2,000 : :


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1 5 14.3 7 0.8 400,000 2.8 1.4 ..2556 48.8 33.34 (Disability)

2554-2555 2557 1 1


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11 32 153 27

4 375 49 55 56


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/

1

:

2

:

3

:

5

:

4

: 1. 2. 3.


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1

(1.30 .)

(1.30 .)

(1 .)

(1 .)

(1 .)


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1.

2.

1


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1

:


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9 2546 58 43

?

( 11 )


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..... 1.

2. 3.

4.

5.


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(.) (.) (.) (.)

(.) (.) (.) (.) (.) (.) (.) (.) (.)

( ) (.)

1.

2.


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/

1

( Flow Slide)


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? 1. 2552 1.2 580,000 390,000

33 2. ()


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() ( )


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1.

2. 3. () ( )

(Neurotransmitters)

1 13 9

ventricle


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18 25

4 (

)1: (Assessment)1.1 :

1.2 : 1.3 : 1.4 :


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2: (Diagnosis)2.1 : 2.2 : 2.3 :

3: (Treatment)3.1 : 3.2 : 3.3 :

4: (Follow-up)

4.1 : 4.2 : 4.3 :


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1.

2. 3.

2


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1.

2. 2.1 2.2 3.

2


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(1 : )

-

(Diagnosis) : 1 :

2 : 3 :


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(Brief psychotic disorder)

1 1 (Sch izophren iformdisorder) 6 (Schizophreniform disorder)

1. 2. 3. () ( )


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2 1 6

1. 2. 3. 4. 5. 3 1. (prodromal)

2. (active phase)

3. (residual phase)


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Schizophreniform disorder Brief psychotic disorder Major depressive disorder Bipolar disorder Psychotic disorder due tosubstance use due to medical conditions

/

/ : 2553 , : (.); 2553


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(Delirium) 1. 2. (Confusion) (disorientation) 3. (uctuating)

4. 5. 6.

: HIV/ (HIV/AIDS) (Malaria) (Typhoid fever) (Hypertension)

(Diabetes) (Stroke)


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: 1 3 4 1.

2. 3. 4. 5. 6. 7. : :


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: 1. 2 2. 3 6

Chronic schizophrenia 30-50 (quadriplegia) 0.7-1 1 1 30


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2

: /

Acute Psychotic Episode

1

3 6


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1. 2.

3.

(Diagnosis) : 1 : 2 : 3 :


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1.

(conventional antipsychotics) (new/atypical antipsychotics) 2. 3.

3


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1.

(conventional antipsychotics)(new/atypical antipsychotics)2.

3.

3


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2 (conventional

antipsychotics) Chlorpromazine, Haloperidol,Perphenazine, Fluphenazine (Atypical Antipsychotics)Risperidone, Clozapine

D2 Dopaminergic receptor D2 Dopaminergicreceptor Dopamine 4 1. mesolimbic pathway 2. mesocortical pathway 3. nigrostr iatal pathway

4. tuburoinfundibular pathway


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4-6

haloperidol 5-15 mg/day (long-acting antipsychotic depot) Fluphenazine decanoate 6.25-50 mg. 2-4

2

2 1. Risperidone 2. Clozapine


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Risperidone second generation antipsychotic Benzisoxazole second-generation antipsychotics 5-HT2A receptor D2 -receptors

1 Csernansky JG Risperidone 34 Haloperidol 60 risperidone Hypersensitivity reactions anaphylacticreactions angioedema

CPZ equivalent . 1. chlorpromazine 100 ./

Perphenazine 10 ./

Haloperidol 2 ./ Risperidone 1 ./ Clozapine 50 ./ 2. uphenazine depot 25 . 2-4


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(inadequate response) 1 ()

(rule out) /

risperidone

:

2

Clozapine CBC 1 18 1 (agranulocytosis) 1%


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5-7 artane, benzhexol 1-2


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.....Neuroleptic malignant syndrome

:

1. Parkinsonism

2. tardive dyskinesia (buccolingual) choreiform, athetoid 3. Acute dystonia 4. Akathisia 1. 2. haloperidol risperidone 3. anticholinergic

extrapyramidal


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Anticholinergic drugs # Biperiden : 1 . 2 3-12 . : (angle - closure glaucoma) #Trihexyphenidyl (benzhexol): 4-12 mg Biperiden


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1.

2. 3.

1. 2. 3.

4


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1.

2. 3.

4

1. 2. 3.


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(60%)

1 60% 20%

4 :

1. 2. (prodromalstate)

3. (active phase)

4. (residual phase)


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5 4 1.

8 2. 39 3. 44.3 4. 8

MRI scan 5

Key Points: (gray matter) frontal temporal parietal


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1. 2. 3. 4. CGI 6

PANSS 25 ( 10 ) 1.5 3-4

(relapse)


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5 /

1. (long acting antipsychotic)

/ 2. 3. 4.

5.


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(home visit)

Fendec, HaldolDecanoate, Fluanxol Depot, Clopixal Depot Risperidol Consta

1.

2. 3.


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3

(poor adherence) 58%

65% 76% (Cramer et al., 1998)

3 1. 1 39 2. (partialadherence) 43 3. (poor adherence) 18 partial poor adherence 61


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1. 2. 3. 4. 5. MPR 6. drug adherenceMorisky MARS

48 10.3


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(Adherence intervention)

1


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1. 2. 3. 4.

5. 6. 7.

(Psychoeducation)


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1.

2. 3. ...

5


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...

5


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. 30-50 (

401/402 2539-2543)

1 30 (LibermanRP, Falloon IRH, Wallace CJ. Drug psychosocialinterventions in the treatment of schizophrenia. In: Marabi M, ed. The Chronic Mentally Ill: Researchand Services. New York : SP Medical and Scientic

Books, 1984.) . CARE CURE 10

. ; 2551

1. 2. 3. 17 13 .

1-2 5


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/

()


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.

()


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1. 2. /

3.

4. /

teleconference 5.


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2554 2555 : , 2554.. 2012

2555 ; 57 (3) : 357-370., , , , , .

2009 8 (Prasri Assessment Schizophrenia Scale : PASS 8) , 2555.

Andreasen N, Carpenter W, Kane J, Lasser R, Marder S, Weinberger D. Remission in schizophrenia :

proposed criteria and rationale for consensus. Am J Psychiatry 2005 ; 162:441-49.Nilchaikovit T, Uneanong S, Kessawai D, Thomyangkoon P. The Thai version of the Positive and

Negative Syndrome Scale (PANSS) for schizophrenia: criterion validity and interraterreliability. J Med Assoc Thai 2000; 83:646-51.


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1. 2. 3. 4. 5.

1. 2. 3.

4. 5. 6. 7. 8. 9. 10.

11. 12. 13. 14.

12 13 2556


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1. 2. 3. 4. 5. 6. 7.

1. 2. 3. 4.

5. 6. 7. 8. 9. 10. 11. 12.

13. 14. 15.


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Mental Health-Psychosis Accessibility for Physician

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