心理疾病
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心理疾病(或稱做情緒障礙、認知功能障礙)是所有有關感情和情緒不穩定、行為失控和認知失調或缺損的總稱。一些被當做是心理疾病的包含有憂鬱症、一般性焦慮失調、躁鬱症和精神分裂症等例子。心理疾病可分為生理因素(如結構上的、化學的、遺傳的)和心理因素(如創傷、矛盾)。它會影響一個人工作或上學的能力，而且會使人際關係發生問題。
[编辑] 病因Mental illness may be caused by a number of factors, or the confluence of several factors.不同的學科，如生物學、心理學、社會學等，都有不同的解釋，雖然現在的理論通常在對不同患者上都有不同的貢獻。 現今對心理疾病最熱門解釋是生物學上的解釋；一個有心理疾病的人可能有不同的腦部結構或功能，或者是有不同的神經化學反應，不論是由基因或環境傷害(如胎兒酒精症候群)引起的。舉例來說，許多被診斷有精神分裂症的病人被證實在大腦中有腫大的腦室和萎縮的灰質。另外，有些人認為神經傳導物質不平衡也會導致心理疾病。最後，許多的遺傳和雙胞胎研究都證實像躁鬱症和精神分裂症]]等心理疾病是會遺傳的。 即使生物學上的解釋是目前最受喜歡的，但心理學上的解釋也可以說得通。心理學家認為矛盾、危機、緊張和創傷可能會導致心理疾病，特別是在一個容易受傷的人身上。例如，一個目睹父母親殺人的小孩可能會發展出沮喪和緊張的情緒，甚至得到創傷後壓力心理障礙症。 最後一個，社會學家認為重大事件和情境會導致心理疾病。例如，在社會運動、戰爭或遭受天然或人為的疾病時，該地區的人們有較高的機會得到心理疾病。貧窮、無常和缺乏資源和援助的地區也會比富裕和穩定的地區有較高機會得到心理疾病。 心理疾病可能有多重的病因。已經有焦點放在神經導傳物質多巴胺、正腎上腺素和血清素上。每種疾病都有可能有它自己的病因。治療的方式有精神病用藥、心理輔導、調整生活方式和其他的支持性措施，或上述方法的綜合運用。患者通常等到精神症狀已明顯到不能生活了的時候，才會想去尋找治療，但及早治療(當症狀還輕微時)才能有較多的長期結果。和許多的身體疾病一樣，診斷過程很複雜，而且需要the careful skills of a gifted medical detective。診斷依然是個主觀(即使越來越循證和科學)的藝術，包括細心和仔細地安置病史及過去與現在的病症。 心理疾病依人而異，且有的輕微，有的嚴重，有的則介在兩者之間。即使是同一個病人，症狀也會隨時間而改變，由最嚴重的情況，到完全緩解。這種疾病通常是不連續的，而且可能會因壓力或其他因素而復燃。若一個人在症狀疏解的情況又開始發病的話，並不代表他缺乏意志力或自我控制，而但是疾病的月圓月缺罷了。適當的治療能夠幫助穩定疾病的療程，並減少症狀的波動。 看待主要的心理疾病(如躁鬱症、精神分裂症、憂鬱症、強迫症)，先天與後天的爭論常常會被提出來，答案是「兩者都有」。主要的心理疾病都有很強的證據指向遺傳。Using genograms, genetic studies and observing identical twins, one or both of whom had mental illness and who were reared apart (to control for environment), psychiatric researchers have shown high rates of heritability (significantly higher than for the population at large) for most mental illnesses, with bipolar disorder showing the highest inheritance and therefore strongest biological component. 一小部份的人疑問心理疾病是否為「真實的」。這一觀點的擁護者有山達基教教徒和反精神醫學運動。 [编辑] 發病率根據美國總統心理健康新自由委員會在2003年的報告指出，主要的心理疾病，如憂鬱症、躁鬱症、精神分裂症和強迫症等，和其他的疾病相比(如癌症或心臟病)，才是在美國導致殘疾的主要原因。另外，根據美國精神病人聯盟(NAMI，一個接受醫藥工業資助的美國倡導機構)的報告，百分之二十三的北美成年人在一年內會經歷一次可被診斷出的心理疾病，但不超過半數的人會有嚴重到影響他們日常機能的症狀。大約有百分之九至百分之十三的十八歲以下孩童會體驗到持續性機能缺損的情緒不安，百分之五至百分之九會因此而導致心理疾病。一般猜測大多數的年青人會在他們成年之前由疾病中恢復，然後繼續過著不被疾病捲入的正常生活。 [编辑] 診斷The diagnosis of a mental illness is usually done by a licensed mental health professional or medical doctor. The diagnosis of a mental illness usually involves a number of sources and instruments, including a personal history, a physical exam, an evaluation of behavior, a symptom inventory, condition-specific instrument (such as the Beck Depression Inventory), and other information as suggested by the history (including neuroimaging and blood tests) in order to arrive at a diagnosis. In the U.S., criteria for the diagnosis of a specific mental illness are given in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. At the start of the 20th century there were only a dozen recognized mental illnesses. By 1952 there were 192 and the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) today lists 374. Depending on perspective, this could be seen as the result of one or more of:
[编辑] 爭議Psychiatry remains somewhat controversial to some people. For example, over thirty years ago homosexuality was considered a mental disorder in American psychiatry (see DSM-II); at the same time, the American psychiatry establishment was also leading the way in refusing to pathologise homosexuality any more and has since argued against such practices as trying to turn gay people straight through therapy. It can be argued that what psychiatry used to consider disorder or illness was likely the result of cultural norms or bias and this perception varies over time and place, but this is true of all illnesses. Contemporary psychiatry, however, is said to be guided by evidence-based medicine. Thus, it has becoming much more scientific and much less speculative than it once was. However, some diagnoses remain controversial. For instance, whilst a person with transsexualism who is not suffering as a result would probably not be considered to be mentally ill, a person who is suffering from a belief that they are trapped in the wrong body may be considered to have gender dysphoria. Nevertheless, dysfunction or subjective distress are required before such a diagnosis can be made.[來源請求]
It is widely held that some features that are considered to be within the norm, such as sexual orientation or special talents are also likely to have a neurobiological or genetic basis. Traumatic life experiences that exceed an individual's coping ability and may result in lasting changes in brain chemistry. Patterns of learned behavior can also alter brain chemistry, for better or for worse. Cognitive behavior therapy focuses on changing patterns of thinking through learning, which relieve anxiety disorders, depressive disorders and to some extent bipolar disorders (accompanied by medication). Drug therapies for severe mental illnesses such as schizophrenia, bipolar disorder and clinical depression, consistent with biochemical models, are remarkably effective. They require a close collaboration between patient and prescriber, so that people with these illnesses understand the difference between being over-medicated and optimally-treated. Psychiatrists who "cripple" their patient's brain response system are actually over-medicating their patients; and patients who allow themselves to be over-medicated aren't discussing the problem with their psychiatrist. Others argue that the effectiveness of drugs does not imply that their use is safe or desirable. However, discussion with one's doctor of a certain drugs safety/side effects profile and intended effect on one's symptoms and disorder is one adaptive alternative to not using medications altogether. Psychiatrists make the analogy that many physical conditions, such as diabetes, must also be controlled with use of medications throughout the individuals lifetime. Moreover, in mental illness, studies show that patients' symptoms return once drug treatment is stopped. It is important to note that the existence of mental illness and the legitimacy of the psychiatric profession have not been universally accepted by some individuals and groups, although this view is changing rapidly. Some professionals, notably Thomas Szasz, Professor Emeritus of Psychiatry at Syracuse, are profoundly opposed to the practice of applying the label "mental illness." The anti-psychiatry movement often refers to what it considers to be the "myth of mental illness" and argues against a biological origin for mental disorders, pointing out that the differences in levels of neurotransmitter, or even in size of brain structures, cannot be taken as indications of illness. Alternatively, some argue that all human experience has a biological origin and so no pattern of behavior can be classified as an illness per se. Other arguments against psychiatry include the view that electroconvulsive therapy damages the person. It remains controversial even if it can be life-saving in many circumstances. Long-term institutionalization, for mental illness rarely occurs now, but hospitalization for acute psychiatric illness still does. Hospitalization is usually very short (some would argue too short to effectively stabilize the patient) due to the realities imposed by managed care. Some people currently diagnosed with autism are against the notion of a neuropsychiatric disorder. For example, some autistic individuals have organized and formed the autistic rights movement. They claim that autism is a form of neurodiversity. We are all neurodiverse. That is why we have different personalities, strengths and talents. Some argue that untreated mental disorders can get in the way of our expressing our signature strengths. On the other hand, neurodiversity advocates argue that there may be more positive potential in recognizing neurodiverse subjects outside the framework of pathology. In other words, it might prove more helpful to acknowledge a broader spectrum of human variation (e.g., "autism" or "schizophrenia" as a different type of "normal" human variation), rather than approaching these variations as "mental illnesses" in need of "cures." [编辑] 分類In the United States, mental illnesses have been categorized into groups according to their common symptoms in the Diagnostic and Statistical Manual of Mental Disorders, compiled by the American Psychiatric Association. One important caveat is that all the DSMs have shortcomings. Very often consumer groups or clincal researchers have different criteria for their diagnosis of a disorder. The DSM V due out in 2011 will hopefully address these differences. There are thirteen different categories, some containing a myriad of illnesses and others only a few. Selecting any of the Wikipedia categories in the table will allow you access to all the articles and subcategories in that category. Most organizations do not view mental retardation as a mental illness. The Mental Health Association of Southeastern Pennsylvania states: 'Mental illness and mental retardation are not the same thing. Some people are born with mental retardation, a condition characterized by below-average intelligence throughout one's life. Mental illness, however, can affect anyone at any time. In fact, certain mental illnesses are more common among people with high intelligence and creativity.' However, people with developmental disabilities, such as mental retardation, are more likely to experience mental illness than those in the general community [1]. [编辑] 症狀In addition to the categorized illnesses, there are many well-defined symptoms of mental illness, such as paranoia, that are not regarded as illnesses in themselves, but only as indicators of one of the illnesses belonging to one of the classes listed above. Crime is not a symptom of mental illness, however, movies often portray murderers as being mentally ill. This makes a villain more emotional, interesting, and dramatic. [编辑] 治療Medicine has been unable to cure mental illness. Many conditions, like schizophrenia, bipolar disorder, and depression, can be treated with medication, however. The function of the psychiatrist is to provide support, therapy and, if necessary, medications to address the symptoms, the patient's suffering. When medications are used, the psychiatrist and the patient are responsible for monitoring and managing the prescription of these medications and their effects. Some mental conditions can be "cured" insofar as symptoms go away, whether with medication or support, but the underlying vulnerability remains. Some mental conditions can be "cured" insofar as the patient no longer suffers significantly (like exposure and response for certain phobias). With chronic mental disorders, the chances of the symptoms recurring will be affected by the number of episodes the patient has had in the past, the effectiveness of the treatment, as well as external factors. Since mental illness is frequently a physical illness manifesting through and exacerbated by behavior, most people with mental illness also benefit from psychotherapy, either from a psychiatrist or some other qualified clinician, like a social worker or psychologist. The most basic treatment involves identifying maladaptive, self-destructive, or inappropriate behaviors and finding ways, with the patient, of coping with, eliminating, or altering those behaviors to promote overall mental health. Often individuals with serious mental illness will engage in several different treatment modalities, all with specific goals. For example, a patient with chronic schizophrenia may be involved in treatment with a psychiatrist for medication, and he or she may also be engaged in psychotherapy to help manage their life-long condition, as well being engaged in case management (sometimes referred to as "service coordination") or a day treatment, vocational, psychosocial rehabilitation program, or assertive community treatment program to help move them towards a more productive and independent role in the community. Robert Burton wrote in the 16th century in his classic work, The Anatomy of Melancholy, that music and dance were critical in treating mental illness, especially melancholia. [2] [3] [编辑] 病人權利倡導病人權利倡導(patient advocacy)組織已經有效地改變了心理疾病的刻板印象。 These stereotypes are typically made by individuals or groups who know little or nothing about psychiatric illness and mistakenly believe that these illnesses reflects a lack of willpower by the individual. It is important to emphasize that these illnesses are not a sign of personal weakness. In fact, the truth is that most psychiatric patients have endured more pain than those that do not have these illnesses will ever experience. A case could be made that these individuals are in fact quite strong, even when compromised by symptoms. Discrimination against people who have mental illnesses keeps them from seeking help. Mental health is as important as physical health to the overall well-being of individuals, societies and countries. Yet only a small minority of the 450 million people living with a mental or behavioral disorder is receiving treatment.1 While one in five Americans lives with a mental disorder in any given year, half of people with severe mental illnesses received no treatment in the past 12 months. Fear of disclosure, rejection by friends, and ultimately discrimination are just a few reasons why people with mental illnesses don't seek help. On-line supportive therapy from advocate mental health organizations have helped to educate and eliminate much of the stigma & shame they have felt in their aloneness to continue their journey from shame and isolation to dignity and responsibility by encouraging them to receive treatment and therapy. Moreover, most individuals would like to be productive and high-functioning. Thus, patient advocacy organizations try to reverse the stereotype problem by educating the public, fighting stigma, supporting local, state and national legislation that is helpful to individuals with psychiatric disorders, encouraging those with illnesses to seek treatment and to instill hope in those afflicted so that they can continue on the path toward recovery, wellness and a fulfilling and meaningful life. [编辑] 美術和文學[编辑] 書籍
[编辑] 故事
[编辑] 電影Many motion pictures portray mental illness in inaccurate ways leading to misunderstanding and heightened stigma. Some movies, however, are lauded for dispelling stereotypes and providing insight into mental illness. In a study by George Gerbner, it was determined that 5 percent of 'normal' television characters are murderers while 20% of 'mentally ill' characters are murderers. 40% of normal characters are violent while 70% of mentally ill characters are violent. Contrary to what is portrayed in films and television, Henry J. Steadman, Ph.D. and his colleagues at Policy Research Associates found that, overall, former mental patients did not have a higher rate of violence than their control group of people who were not formal mental health patients. In both groups, however, substance abuse was linked to a higher rate of violence. (Hockenbury and Hockenbury 2004) See List of films featuring mental illness. [编辑] 電視Many popular television shows feature characters with mental illness. Oftentimes these portrayals are inaccurate and reinforce existing stereotypes, thereby increasing stigma associated with mental illness. Common ways that television shows can generate misunderstanding and fear are by depicting the mentally ill as medically noncompliant, violent, and/or intellectually challenged. However, in recent years certain organizations have begun to advocate for accurate portrayals of mental illness in the media, and certain television shows have been applauded by mental health organizations for helping to dispel myths of mental illness. One show, "Wonderland", went on the air in 2000 and only lasted several episodes. It was largely critically acclaimed, but pressure from mental illness advocacy groups, and others, who felt the images presented were too negative, etc., took the show off the air prematurely. In 2005, the shows Huff, Monk, Scrubs and ER all won Voice Awards from the Substance Abuse and Mental Health Services Administration for their positive portrayal of people with mental illness. Neal Baer, executive producer of ER and Law & Order: Special Victims Unit also won a lifetime achievement award for his work in incorporating mental health issues into these two shows. See List of Television Shows Featuring Mental Illness. [编辑] 另見
[编辑] Notes
[编辑] 參考
[编辑] WikiBooks[编辑] 外部連結[编辑] 政府網站
[编辑] History and professional specialties
[编辑] Media coverage
[编辑] Compiled mental health news and resources
[编辑] Stories of Recovery from Mental Illness
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