怎樣鑒別偽裝精神病(假精神病)課件

Fakingit:Howtodetectmalingeredpsychosisorfalsementalillness

偽裝：怎樣鑒別偽裝精神?。倬癫。㎝artinR.Sheehan,Ph.D.WhatisMalingering?Malingering,asdefinedbytheDiagnosticandStatisticalManualofMentalDisordersfourthedition(DSM-IV),istheintentionalproductionoffalseorexaggeratedphysicalorpsychologicalsymptomsmotivatedbyexternalincentives.什么是偽裝？美國(guó)精神障礙診斷和統(tǒng)計(jì)手冊(cè)第四版(DSM-IV)：偽裝是指受某種外界動(dòng)機(jī)因素影響，故意表現(xiàn)出虛假或夸大軀體或精神癥狀Commonmotivesofmalingerers

詐病者的常見(jiàn)動(dòng)機(jī)Toavoidpain（避免痛苦）

Toavoid:ArrestCriminalprosecutionConscriptionintothemilitary（避免監(jiān)禁、刑事起訴、軍隊(duì)征兵）

InterviewStyle（精神檢查方式）Whenyoususpectapatientismalingering,keepyoursuspicionstoyour-selfandconductanobjectiveevaluation.Patientsarelikelytobecomedefensiveifyoushowannoyanceorincredulity,andputtingthemonguarddecreasesyourabilitytouncoverevidenceofmalingering.當(dāng)懷疑患者詐病時(shí)，你應(yīng)保持警惕并進(jìn)行客觀評(píng)估。如果你表現(xiàn)出厭煩或懷疑，可能會(huì)使患者有防備心理或保持警惕，進(jìn)而降低你發(fā)現(xiàn)各種詐病跡象的能力。

Beginbyaskingopen-endedquestions,whichallowpatientstoreportsymptomsintheirownwords.開始檢查時(shí)通過(guò)開放式提問(wèn)，允許患者用自己的話匯報(bào)癥狀。Toavoidhintingatcorrectresponses,carefullyphraseinitialinquiriesaboutsymptoms.Laterintheinterview,youcanproceedtomore-detailedquestionsofspecificsymptoms,asdiscussedbelow.給患者恰當(dāng)?shù)幕貞?yīng)，避免暗示，開始詢問(wèn)癥狀時(shí)用語(yǔ)應(yīng)謹(jǐn)慎。

MalingeredPsychoticSymptoms偽裝精神病性癥狀Hallucinations幻覺(jué)Delusions妄想WhereMalingerersTripUp（詐病者失敗在哪里？）Malingerersmayhaveinadequateorincompleteknowledgeofthementalillnesstheyarefaking.Indeed,malingerersarelikeactorswhocanportrayaroleonlyaswellastheyunderstandit.Theyoftenoveracttheirpartormistakenlybelievethemorebizarretheirbehavior,themoreconvincingtheywillbe.詐病者可能對(duì)他們所偽裝的精神疾病有些一知半解的了解。的確，詐病者象演員一樣能逼真的扮演他們所理解的病人角色，但他們的表現(xiàn)常顯得過(guò)度夸張，甚至錯(cuò)誤地認(rèn)為越稀奇古怪的行為越能讓人信服。

Extremelyunusual(‘Doyoubelievethatcarsareapartofanorganizedreligion?’)罕見(jiàn)的癥狀（如你相信小汽車是一個(gè)有組織宗教的一部分嗎？）Patientisevasiveoruncooperative患者回避或不配合檢查?Excessivelyguardedorhesitant過(guò)度謹(jǐn)慎或猶豫不決?Frequentlyrepeatsquestions經(jīng)常重復(fù)提問(wèn)?Frequentlyreplies,‘Idon'tknow’tosimplequestions?；卮穑何疫B簡(jiǎn)單的問(wèn)題都不知道?Hostile,intimidating;seekstocontrolintervieworrefusestoparticipate敵對(duì)、威脅，試圖控制精神檢查或拒絕參與

ConfrontingtheMalingerer

(面對(duì)詐病者)Ifathoroughinvestigationindicatesthatapatientismalingeringpsychosis,youmaydecidetoconfronttheevaluee.Avoiddirectaccusationsoflying,andgivethesuspectedmalingerereveryopportunitytosaveface.Forexample,itispreferabletos