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“阴滋病”原来只是心病
http://www.gd.xinhuanet.com | 来源： 南方日报 | 时间： 2011-04-13 14:34 |
传说中的艾滋病变种体——“阴滋病”已被证实只是某些人的恐艾症而已。你可知道，在艾滋病恐惧症出现之前，还有“梅毒恐惧症”、“性病恐惧症”，同样都是因为某一次或几次的高危性行为，内心产生极度恐惧，即便反复医学检验是阴性，仍高度怀疑自己被感染。医学上，这类心理问题被统称为“躯体形式障碍”，是一种以持久地担心或相信各种躯体症状的优势观念为特征的神经症。病人因这些症状反复就医，各种医学检查阴性和医生的解释均不能打消其疑虑，类似癌症恐惧症、乙肝恐惧症等等。
手中化验单一摞，就是查不出问题
我们常可以看到，某些艾滋病、乙肝、癌症论坛中，有这样一类人，路人甲、乙、丙、丁，自感症状明显，去医院检查却一无所获，于是在网上互相交流迫切想知自己是否患上艾滋病、乙肝抑或是肝癌，一点点轻微的症状也让他们成了惊弓之鸟。经常接触这类人的广东省人民医院精神科主任、医学心理研究室主任谢永标告诉记者，他们是患病了，但不是躯体病而是心病，“他们往往穿梭于各大医院，手中的病例、检查化验单厚厚一摞，但就是查不出所谓的身体疾病”。他们许多人没有也不愿意识到自己其实是要治心病。
这个心病就是“躯体形式障碍”。谢永标介绍其临床表现有：躯体化障碍、疑病症、躯体形式的自主神经功能紊乱、持续性躯体疼痛障碍等等，“躯体化障碍和疑病症是其中最有代表性的两种，艾滋病恐惧症就属于疑病症”。躯体化障碍是感觉身体某部位不舒服、难受，但说不清是什么病，疑病症顾名思义怀疑自己有某一种病，如艾滋病。
焦虑型人格易生心病
“躯体形式障碍”的确切病因尚不明，心理学认为，该病病人往往容易探究自己内在的心理。谢永标根据多年临床观察，认为这类患者有一定的人格基础，例如孤僻、内向、敏感多疑，容易焦虑，容易受暗示影响，对身体健康的变动十分关注等。也就是说，并非所有做过高危性行为的人都会产生艾滋病恐惧症，那些内心防御机制很强的人，俗称内心强大的人，一般也会担心焦虑，但未必会表现出走火入魔的状态。
此外，有关病因和发病机制还研究提出社会因素和躯体因素。社会心理因素包括错误的传统观念，例如对乙肝传染途径、人群影响的夸大，不愿意和病人在一起吃饭，入学、入职需 要 乙 肝体检；还有不良的医源性影响都可促成疑病观念，电线杆上、街边医疗宣传声称，前列腺是男性不育罪魁祸首。躯体因素则指，处于青春期或更年期的人，较易出现植物神经不稳定的病状，如心慌、潮热等。对这类生理现象过分敏感、关注，甚至曲解，可以促成疑病观念。
躯体形式障碍病人的治疗，根据个人情况通常采取综合性治疗，包括心理、药物对症治疗等。病人常常拒绝接受症状的根本在于心理问题，以提高内在反省能力为目的心理治疗可以帮助病人探究并解决引起症状的内心冲突，一旦内心冲突解决，症状常常自动消失。当然，有的病人对这种治疗有阻抗。焦虑、抑郁症状明显者可予适量抗焦虑药物或抗抑郁药。
典型表现一：躯体化障碍
躯体化障碍主要体现为多种多样、经常变化的躯体症状，症状可涉及身体的任何系统或器官。最重要的特点是，应激反应引起的不快心情，以转化成躯体症状的方式出现。
谢永标例举说，最常见的是胃肠道不适(如疼痛、打嗝、返酸、呕吐、恶心等)、异常的皮肤感觉(如瘙痒、烧灼感、刺痛、麻木感、酸痛等)、皮肤斑点，性及月经方面的主诉也很常见，常存在明显的抑郁和焦虑。可有多种症状同时存在。病人为此进行过许多检查，均没有阳性发现，甚至手术探察却一无所获。常为慢性波动性病程，并伴有社会、人际及家庭行为方面长期存在的严重障碍，很少能够完全缓解。女性远多于男性，多在成年早期发病，女性最早的症状可能与性方面的困难或婚姻、恋爱问题有关。
案例
小米6年前剖腹产生下一个女孩，手术比较成功，只是有点轻微发烧，术后回到家坐月子，她开始感觉肚子不舒服、疼痛，怀疑和之前的发烧有关，这种感觉持续了3个月，她开始频繁跑医院，想知道是伤口感染了还是肚子里长东西了，反复检查就是没问题，伤口也在逐步恢复，可小米坚信肚子有问题，一有空就往医院跑。直到医生怀疑小米是心病建议她去看心理科时，她手中的病例检查单已经有一尺多厚。
分析：经过了解，发现小米的肚子疼痛感源于生养孩子的焦虑，小米大学毕业没多久，还没有心理准备生孩子，面对意外而来的新生命措手不及，不知怎么喂养，丈夫是家中独苗，婆婆认为小米生的是女孩，没续上香火，不愿意帮她带孩子，丈夫生性内向，不会协调婆媳关系。小米为此持续焦虑，进而将这种焦虑转换成对肚子的不舒服感。谢永标表示，这就是应激反应引起的不快心情，以转化成躯体症状的方式出现。
典型表现二：疑病症
疑病症是指病人以担心或相信患严重躯体疾病的持久性优势观念为主(疑病观念)。病人因此反复就医，各种医学检查阴性和医生的解释均不能打消其疑虑，常伴有焦虑或抑郁。具体表现为：
1.常在躯体疾病或精神刺激诱因作用下发病，表现为对身体健康或疾病过分担心，病人为自己认为罹患的某种疾病感到苦恼，而非对疾病的后果或继发性社会效应感到苦恼；
2.常有敏感多疑、对健康过分关切并要求较高，对日常出现的某些生理现象和异常感觉(如心跳、腹胀等)作出疑病性解释；
3.病人的疑病观念很牢固，不是妄想，对有关疾病的各种读物十分注意，阅读后往往对号入座，加强疑病观念。但缺乏充分根据，病人知道自己的疾病证据不充分，才迫切要求检查和治疗。
4.虽经反复就医或医学检查，但阴性结果和医生的合理解释不能打消其疑虑。还有些青少年病人，坚信自己身体外表，如鼻子、嘴唇等部位。存在严重缺陷，要求施行矫形手术。
案例
文斌人到中年，身体一直不错，去年开始感觉下体不适，身体虚弱，他怀疑是艾滋病或者是性病，跑了几家医院，检查结果都一样：没感染。后来文斌发现生殖器上长了小颗粒，他更坚定自己有病的看法，但就是没医生证实。
分析：刚和心理医生交谈，文斌少言寡语，不认为自己心理有何异常。经过了几次回合的交流，建立起信任感，文斌才透露，自己在事业单位工作，妻子是外企中层，比自己忙很多，两人少有交流，他就通过网络找乐趣，去年年初曾和女网友见过面，差点发生实质性的性关系，因为父母传输的传统观念，让他此后一直为此懊悔不已，又不敢和周围的人倾述，进而老是感觉下体不适，一会觉得痒，一会觉得疼，还出现心悸、出汗，和艾滋病的症状越看越像，即使过了3-6个月的艾滋病潜伏期，检测是阴性，文斌还是没法释怀。谢永标说，类似的患者在防御机制推动下，常将该不该做高危性行为这一内心冲突转换成对疾病的担心。表面上是担心患病，实际是对高危性行为的不安和焦虑。（记者 李劼）
艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
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| 图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构 |
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"Yin AIDS" was originally just heart disease
http://www.gd.xinhuanet.com | Source: Nanfang Daily | Time: 2011-04-13 14:34 |
Variant of the legendary body of AIDS - "HIV negative" has been confirmed only in some people's fear of AIDS patients only. You know, before the advent of AIDS phobia, as well as "syphilis-phobia", "STD phobia", the same one or a few times because of a high-risk sexual behavior, the feeling of extreme fear, even if repeated medical tests are negative still highly suspected that they have been infected. Medicine, these psychological problems are referred to as "somatoform disorders", is a kind of fear or believe that a lasting advantage of a variety of somatic symptoms characterized by the concept of neurosis. These symptoms must seek medical treatment for patients with various medical tests were negative and the doctor's explanation does not dispel their doubts, like cancer phobia, fear of hepatitis B and so on.
The hands of a single pile test is can not find the problem
We often can see some of the AIDS, hepatitis B, cancer forum, there is a class of people, passers-A, B, C, D, self symptoms, go to the hospital but found nothing, so urgent in the online exchange would like to know if they are suffering from AIDS, hepatitis B or is liver cancer, a little bit of minor symptoms so that they become frightened. Regular contact with these people, Guangdong Provincial People's Hospital of Psychiatry Director, Medical Psychology Research Office Renxie Yong marked told reporters that they are sick, but not a physical disease but heart disease, "they tend to shuttle in the major hospitals, in the hands of the cases, Check a thick stack of single tests, but that can not find the so-called physical illness. " They do not want a lot of people do not realize that heart disease is to rule.
The heart is the "somatoform disorders." Tse Wing-scale description of its clinical manifestations are: somatization disorder, hypochondriasis, somatoform autonomic dysfunction, persistent physical pain disorder, etc., "somatization disorder and hypochondriasis is one of the two most representative, AIDS phobia belong to hypochondria. " Somatization disorder is a part of the body does not feel comfortable, uncomfortable, but can not tell what disease, hypochondria definition of a doubt that they have a disease such as AIDS.
Anxiety, heart disease-prone personality
"Somatoform disorders," the exact cause is not yet clear, psychology, disease patients are often easy to explore their inner psychology. Tse Wing-scale based on years of clinical observation, that these patients have a certain personality based, for example, withdrawn, introverted, sensitive, suspicious, anxious, vulnerable to suggest the impact of change on health is very concerned and so on. In other words, not all high-risk sexual behavior done will have AIDS phobia, those inside were very strong defense mechanism, commonly known as a strong heart who will worry about the general anxiety, but may not show the deranged state.
In addition, the etiology and pathogenesis but also of social factors and physical factors proposed. Psychosocial factors include the traditional concept of error, for example, mode of transmission of hepatitis B, people exaggerate the effects, and patients do not want to eat together, entry, entry physical examination require hepatitis B; iatrogenic adverse effects can also contribute to the concept of hypochondriasis , utility poles, street medical propaganda claims that the prostate is a male infertility culprit. Physical factor is that, in adolescence or menopause, who are prone to autonomic instability symptoms, such as palpitation, hot flushes and so on. Overly sensitive to such physical phenomena, concerns, or even distort, the concept can contribute to hypochondria.
The treatment of patients with somatoform disorders, according to their personal situation usually adopt a comprehensive treatment, including psychological, drug and other symptomatic treatment. Patients often refuse to accept the basic symptoms of psychological problems is to enhance the capacity of the internal reflection for the purpose of psychotherapy can help patients explore and resolve the symptoms caused by internal conflicts, once the inner conflict resolution, the symptoms often go away. Of course, some patients have resistance to this treatment. Anxiety and depression symptoms may be appropriate anti-anxiety drugs or antidepressants.
A typical example: somatization disorder
Somatization disorder is mainly reflected a wide variety, constantly changing physical symptoms, the symptoms may involve any body system or organ. The most important feature is that stress caused by unpleasant feelings, to the way into physical symptoms appear.
Tse Wing-scale examples that the most common gastrointestinal discomfort (such as pain, belching, acid back, vomiting, nausea, etc.), abnormal skin sensation (such as itching, burning, tingling, numbness, pain, etc.), skin spots, the main aspects of sexual and menstrual complaints are also common, often obvious depression and anxiety. There are many symptoms can exist. Check this for many patients, are not positive findings, even exploratory surgery to no avail. Volatility often chronic course, and accompanied by social, interpersonal and family behavior of the persistence of serious obstacles, few can be complete remission. Women far more than men, and more disease in early adulthood, women may be the earliest symptoms of sexual difficulties or marriage, love issues.
Case
Millet caesarean section 6 years ago gave birth to a girl, the more successful operation, just a little mild fever after home confinement, she began to feel stomach problems, pain, doubt and before the fever is related to that feeling lasted for 3 months, she began to frequently go to the hospital, want to know is the stomach wound infection or something long and repeated checking is no problem, the wound is gradually restored, can be convinced millet stomach problems, go out into the hospital for a free run. Until the doctor suspects heart disease suggested that she go to the millet is the psychologist, she has been in the hands of a single case of checking more than a foot thick.
Analysis: After getting to know and found that stomach pain millet from the anxiety of raising a child, graduated from college not long millet, children not yet prepared to face unexpected surprise from the new life I do not know how to feed, the husband is the only child at home, her mother that the millet students are girls, no continued on incense, not willing to help her kids, her husband, within nature, not coordinated law relationship. Millet this continued anxiety, this anxiety in turn will translate into the stomach discomfort. Tse Wing-scale, said this is the stress caused by unpleasant feelings, to the way into physical symptoms appear.
Typical performance II: hypochondria
Hypochondria is to worry about or believe the patient suffering from persistent severe somatic diseases main advantages of the concept (the concept of hypochondriasis). The case was therefore repeated medical care, various medical tests were negative and the doctor's explanation does not dispel their doubts, often accompanied by anxiety or depression. Specific performance:
1. Often in physical illness or mental stimulation incentives under the disease, manifested as excessive worry about physical health or disease, the patient is suffering from a disease they think frustrated, rather than the consequences of the disease or secondary social effects of distressed ;
2. Often sensitive, suspicious, and called on the health concerns over higher on the day for some of the physiological and abnormal sensory phenomena (such as heart rate, abdominal distension, etc.) and hypochondriacal interpretation;
3. The patient is very strong concept of hypochondria, not wishful thinking, the various books on the disease are aware that often the condemnation after reading to enhance the concept of hypochondriasis. But the lack of sufficient basis for a patient to know their disease is not sufficient evidence, it urgently requires examination and treatment.
4. Despite repeated medical treatment or medical examination, but the negative results and the doctors can not give a reasonable explanation of its concerns. And some young patients, believes his physical appearance, such as nose, lips and other parts. Seriously flawed, requiring implementation of orthopedic surgery.
Case
Wenbin into middle age, the body has been good, last year, lower body began to feel unwell, poor health, he suspected AIDS or sexually transmitted diseases, running several hospitals, examination results are the same: no infection. Later, long Wenbin found small particles on the genitals, he determined his view of illness, but is not a doctor confirmed.
Analysis: The first and talk to a psychiatrist, Wenbin reticent, do not think any abnormal psychology. After several rounds of communication, build trust, Wenbin was revealed that their work in public institutions, the wife is a foreign middle class, busy with a lot more than their own, they rarely communicate, he would through the network to have fun, who early last year and Nvwang met almost materially sexual relationship, because the traditional concept of parental transmission, so that he has been this deeply regret it later, did not dare to tell their people around, and then lower body does not always feel, for a that itch, one would feel pain, but also palpitations, sweating, and then ever more like the symptoms of AIDS, even after 3-6 months incubation period of AIDS, testing is negative, Wenbin still can not explain. Tse Wing-scale, said a similar defense mechanism, driven by patients, often the high-risk sexual behavior should not do translate into diseases of the inner conflict concerns. Appears to be worried sick, is actually a high-risk sexual behavior unease and anxiety. (Xinhua Jie)
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