Mental Health-Psychosis Accessibility

8/12/2019 Mental Health-Psychosis Accessibility

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:1. / 2. 3. PASS84.


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(3 .)

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(1.30 .)

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(2 .)


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( ECT, psychotherapy)


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1. ..... 1.1

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(Relapse)

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2.

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

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

( ) (.)


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4. 5.

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2) 3)


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(Neurotransmitters)

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ventricle


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4 : 1.

2. (prodromalstate) 3. (active phase)

4. (residual phase)


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Stigma /

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Stigmatization Goffman,1963

Stigmatization

Stigma

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stigma

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link /

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1

( Flow Slide)


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1: (Assessment)1.1: 1.2: 1.3: 1.4:

4 1 :

(assessment)

2 : (diagnosis)

3 : (treatment)

4 : (follow-up)

2: (Diagnosis)

2.1: 2.2: 2.3:


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3: (Treatment)3.1: 3.2:

3.3:

4: (Follow-up)4.1: 4.2: 4.3:

1.

2.

(Baseline assessment questionnaire)

-13. (Psychotic screeningtest) -2

4. GlobalAssessment of Function (GAF) -3

5. (WHOQOL- BREF- THAI) 26 -4


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() 6. 1: -1

7. 2: -2

8. 3: -3

9. 4: -410. 5:

-5


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3

1. 2.

1. :

2. /3.


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1. /

3

() 3.3 PSY 4:

PSY 5: PSY 6: PSY 7:


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1,2,3,5,6,7,8

3 4

1. 2. 6 1

A 1: :

() 6 1


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1.

2.

3. 4.

1. 2.

1. 2. 3.


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1. 2. 3.

1. 2. 3. () 4.

1.

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


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1 30

2 .. 27 . 5 2 .. ( ..)

.. 1 .. ....

1 6

1

/


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1. : 9 2 Major depressivedisorder

A3:

(mania)

A 2 :

: 6 1

: 6 schizophrenia 6 1

schizophreniform disorder 6 1

Brief psychotic disorder


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A4: /

()

/

cerebral malaria, sepsis, head injury : ( )

3 4

50 57 78

2. mania : Bipolar disorder


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1. / 2. /

() 3.

/ 4. //


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1. 2. 3.

1 /

2

(

)


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/

2 1 6

7-8


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PSY 5 : (early sign)

PSY 5 : 60-70

2-3 10

1-2 () 5


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PSY 6 :

1. 2. 3. () 4.

1. : ,

, ( ) 2. : , 3. : ,


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PSY 7 : 1.

2. ( 2-4 ) 3.

( , , )

4. :

5. : , () 6. :


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PSY 7 :

( ) 30 3

4.

5. 6. ( , )

7.


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/

1 /

2 / 1

PSY 7:


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4/

1. / 2. 3. PASS8 4.

1.

(Adherence assessment and intervention)2. /

PASS8

3.


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1. 2.

3. PASS8 4.

dopamine cytochrome P450 2D6

4

/


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2-4

2 (Conventional

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


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5-7 artane, benzhexol

1-2


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2

Insulin CBT, Milieu therapy

1. Parkinsonism

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

3. anticholinergic extrapyramidal


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1. 2. 3. 4. CGI 6

PANSS 25 ( 10 ) 1.5 3-4

MRI scan 5

/

(60%) 1 60% 20%


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5

/

1. 2. 3.

1. (long acting antipsychotic)

/ 2. 3. 4. 5.


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3

(poor adherence)

58% 65% 76% (Cramer et al., 1998)

(home visit) Fendec, HaldolDecanoate, Fluanxol Depot, Clopixal Depot Risperidol Consta


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48 10.3

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

3 1. 1 39

2. (partial adher-ence) 43 3. (poor adherence) 18 partial poor adherence 61


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(Adherenceintervention)

1


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1

2 3 4 5

8 (Prasri Assessment Schizophrenia Scale : PASS 8) 2 : /

8 ()Prasri Assessment Schizophrenia Scale (PASS 8) 1. (passive/apathetic

social)2. (delusions)3. (unusual thought

content)4. (hallucinatory behavior)5. (Blunted affect)6. (conceptual disorganization)7.

(lack of spontaneity and ow of conversation)8. (mannerism

and posturing)


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1. 2. 3. 4.

5.

1. (passive/apatheticsocial)


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1. 2.

3. 4. 5.

2. (delusions)


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

3.

(unusual thought content)

( )

( )


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4.

(hallucinatory behavior)

( )

( )

1. 2.

3. 4.

5.


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1. 2.

3. 4.

5.

5. (Blunted

affect)


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6. (conceptual disorganization)

1. 2.

3.

4.

5. word salad mutism


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1. 2.

3. 4.

( ) 1-2 5.

7.

(lack of spontaneity and ow ofconversation)


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1. 2.

3. (ritual) 4. (ritual) mannerisms stereotyped movements 5. ritual, mannerism stereotyped movements

8.

(mannerism and posturing)


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.. .

/ 8 16 ** 2, 3,4, 6 8 4 17 30 ** 2,

3, 4, 6 8 4 31 *** 2, 3, 4, 6 8 4 ()


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1.

2. 3. 4. 5. 6.


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1. 10 1 10 1

1. 2.

3. 4. 5.


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3.

4.

2.


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6 18-24

1. 2. 3. 4.

5.


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1. /

2. 3. 4. 5.

( ) ( ) ( )

1. Institute based rehabilitation

2. Community based rehabilitation


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8

PrasriAssessment

SchizophreniaScale:PASS8

2

:

/

1.(passive/apathetic

social)

1.

2.

3.

4.

5.

2.(delusions)

1.

2.

3.

4.

5.


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3.(unusual

thought

content)

()

(

)

1.

2.

3.

4.

(

,

)

(

)

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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5.

1. 2. 3. 4.

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

12. 13. 14.

12 13 2556


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Mental Health-Psychosis Accessibility