怎樣鑒別偽裝精神病(假精神病)課件

Fakingit:Howtodetectmalingeredpsychosisorfalsementalillness

偽裝：怎樣鑒別偽裝精神病（假精神?。㎝artinR.Sheehan,Ph.D.WhatisMalingering?Malingering,asdefinedbytheDiagnosticandStatisticalManualofMentalDisordersfourthedition(DSM-IV),istheintentionalproductionoffalseorexaggeratedphysicalorpsychologicalsymptomsmotivatedbyexternalincentives.什么是偽裝？美國精神障礙診斷和統計手冊第四版(DSM-IV)：偽裝是指受某種外界動機因素影響，故意表現出虛假或夸大軀體或精神癥狀Commonmotivesofmalingerers

詐病者的常見動機Toavoidpain（避免痛苦）

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

InterviewStyle（精神檢查方式）Whenyoususpectapatientismalingering,keepyoursuspicionstoyour-selfandconductanobjectiveevaluation.Patientsarelikelytobecomedefensiveifyoushowannoyanceorincredulity,andputtingthemonguarddecreasesyourabilitytouncoverevidenceofmalingering.當懷疑患者詐病時，你應保持警惕并進行客觀評估。如果你表現出厭煩或懷疑，可能會使患者有防備心理或保持警惕，進而降低你發(fā)現各種詐病跡象的能力。

Beginbyaskingopen-endedquestions,whichallowpatientstoreportsymptomsintheirownwords.開始檢查時通過開放式提問，允許患者用自己的話匯報癥狀。Toavoidhintingatcorrectresponses,carefullyphraseinitialinquiriesaboutsymptoms.Laterintheinterview,youcanproceedtomore-detailedquestionsofspecificsymptoms,asdiscussedbelow.給患者恰當的回應，避免暗示，開始詢問癥狀時用語應謹慎。

MalingeredPsychoticSymptoms偽裝精神病性癥狀Hallucinations幻覺Delusions妄想WhereMalingerersTripUp（詐病者失敗在哪里？）Malingerersmayhaveinadequateorincompleteknowledgeofthementalillnesstheyarefaking.Indeed,malingerersarelikeactorswhocanportrayaroleonlyaswellastheyunderstandit.Theyoftenoveracttheirpartormistakenlybelievethemorebizarretheirbehavior,themoreconvincingtheywillbe.詐病者可能對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，但他們的表現常顯得過度夸張，甚至錯誤地認為越稀奇古怪的行為越能讓人信服。

Extremelyunusual(‘Doyoubelievethatcarsareapartofanorganizedreligion?’)罕見的癥狀（如你相信小汽車是一個有組織宗教的一部分嗎？）Patientisevasiveoruncooperative患者回避或不配合檢查?Excessivelyguardedorhesitant過度謹慎或猶豫不決?Frequentlyrepeatsquestions經常重復提問?Frequentlyreplies,‘Idon'tknow’tosimplequestions常回答：我連簡單的問題都不知道?Hostile,intimidating;seekstocontrolintervieworrefusestoparticipate敵對、威脅，試圖控制精神檢查或拒絕參與

ConfrontingtheMalingerer

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