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    172 views27 pages

    10.CHẬM PHÁT TRIỂN TÂM THẦN PDF

    Uploaded by

    anhkhue2011

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 27

    CHM PHT TRIN TM THN

    BS. PHM TH MINH CHU


    B MN TM THN
    I HC Y DC TP. H CH MINH
    MC TIU HC TP
    Hiu c c im lm sng, tiu chun chn
    on chm pht trin tm thn.
    Phn bit c 4 mc ca chm pht trin
    tm thn.
    Bit c mt s nguyn nhn thng gp ca
    chm pht trin tm thn.
    Bit nguyn tc iu tr v phng nga chm pht
    trin tm thn.
    I. I CNG:
    Chm pht trin tm thn l mt ri lon ton th thng
    xy ra trc tui thnh nin, khng c nguyn nhn, c
    im bnh l v tin trin thun nht v r rng.
    Theo DSM-IV: Chm pht trin tm thn c nh ngha l
    hot ng tr tu di mc trung bnh mt cch ng k
    km theo hn ch r rng kh nng thch nghi, khi pht
    trc 18 tui.
    Theo ICD 10: Chm pht trin tm thn l mt tnh trng
    ngng pht trin, hay pht trin bt ton ca tr tu, c
    trng bi s suy gim cc k nng lin quan n hot ng
    tr tu nh nhn thc, ngn ng, vn ng, k nng x hi.
    II. DCH T HC:

    Tn s ca CPPTT thay i ph thuc vo nh ngha v


    phng php nh gi c s dng:
    Khi s dng nh ngha CPPTT khi IQ thp hn tr s
    trung bnh hai lch chun th tn sut l 3% dn s
    Nu xt c hai lch chun v kh nng thch nghi th
    t l ny khong 1% dn s.
    Tn s mi mc rt kh nh gi. Tn s mi mc cao
    nht tui i hc.
    Nam nhiu hn n, t l nam:n = 1.5:1
    CPPTT mc nh: 0.37-0.59%, trung bnh, nng v
    trm trng: 0.3-0.4%
    Tn s mc phi cc ri lon tm thn khc cao gp 3-4
    ln trong dn s chung.
    III. CN NGUYN

    tr em, khong 2/3 n trng hp l c


    th xc nh c nguyn nhn.
    Cc nguyn nhn gy CPPTT xy ra nhiu nht
    tr mi sinh l hi chng Down,
    Velocardialfacial syndrome, fetal alcohol
    syndrome.
    Cc nguyn nhn theo mc , bao gm:
    Nguyn nhn di truyn hc: hi chng Down, hi chng
    Klinefelter's, hi chng NST X d gy, nhc gip bm sinh,
    u x si thn kinh, hi chng Prader-Willi, Phenylketoine
    niu,..
    Cc bt thng xy ra trong thai k: m ung nhiu ru,
    nhim Rubella.
    Cc bt thng xy ra khi chuyn d gy tn thng no do
    thiu oxy, chn thng s no, xut huyt ni s..
    Nhim c cht nh ch hoc thy ngn hoc cc bnh l
    nh ho g, si, vim no- mng no khng c iu tr
    chm sc thch hp.
    Thiu iode nht l cc nc ang pht trin
    Suy sinh dng, thiu vitamine
    Mi trng: kinh t x hi thp, thiu ht tnh cm.
    IV. C IM LM SNG V
    CN LM SNG
    4.1. Cc du hiu gi :

    Khng t c cc mc pht trin tr tu


    bnh thng c trng i
    Tn ti dai dng cc hnh vi tr con
    Thiu s t m.
    Kh nng hc tp hn ch.
    4.2. Khm c th
    C th pht hin mt s c im bt thng l
    manh mi cho mt s tnh trng/ bnh l:

    - Kch thc u (nh, no ng thy)


    - Hnh dng khun mt (hai mt xa nhau, mi
    dt, tai ng thp, li l, rng mc ln
    xn), v mt kh kho..
    Mu sc, cu trc da, cc np da bt thng
    4.3. Khm thn kinh:

    Cc khim khuyt gic quan: gim th lc,


    gim thnh lc
    Ri lon co git
    Ri lon vn ng: ri lon trng lc c, c
    ng khng t ch (ma vn, ma git..), phi
    hp vn ng km, mt vn ng
    ..
    4.4. Khm tm thn:

    Cc ri lon tm thn c th xy ra trn ngi


    CPTTT cng tng t nh trong dn s chung,
    bao gm:
    Tm thn phn lit: 2-3%
    Ri lon kh sc: 50%
    Ri lon ng x
    Cc triu chng tm thn khc bao gm: tng
    ng gim ch , cc hnh vi nh hnh, cc
    ng tc lp i lp li, cm xc khng n nh,
    gy hn v cc hnh vi t gy thng tch (p
    u, cn tay..)
    4.5. nh gi:

    Cn nh gi 2 mt:
    Kh nng hot ng tr tu
    Mc hn ch kh nng thch nghi
    Hot ng tr tu c o lng bng cc trc
    nghim tr tu c chun ha c thc hin bi
    mt nh tm l c kinh nghim
    Thang o lng tr tu Binet-Simon
    Thanh nh gi tr tu tr em v ngi ln
    ca Weshler (WISC, WAIS)
    Cc test tr tu, thang nh gi s trng
    thnh v thch nghi x hi phi c chun
    ha theo cc tiu chun vn ha a phng,
    nu khng c chun ha th vic chn on
    phi c xem nh l tm thi.
    Theo quan im ca ICD-10 hin nay, cc
    thang o cng nh mc tr tu nn c
    Mc hn ch kh nng thch nghi

    Thng hin nay s dng thang Vineland


    (Vineland Adaptive Behavior Scales ), nh gi
    trn k nng giao tip, cc k nng trong i
    sng hng ngy, kh nng x hi ha, k nng
    vn ng, cc hnh vi iu chnh sai lc
    Thng bnh nhn chm pht trin tm
    thn bc l khim khuyt ti thiu 2 trong cc
    lnh vc sau: giao tip, t kim sot bn thn,
    cuc sng ti nh, tho vc trong x hi, cng
    ng, k nng hc tp, t gim st, gii tr, sc
    6. Cn lm sng
    Xt nghim mu, nc tiu tm cc ri lon
    chuyn ha
    Xt nghim sinh hc phn t tm cc ri lon
    NST , c bit xt nghim dch i, sinh thit
    nhung mao mng m nghin cu v di
    truyn v sinh ha trong thai k
    Xt nghim FP, HCG, uE3 gip pht hin sm
    hi chng Down
    Siu m tm sot cc bt thng ca thai
    trong 3 thng u thai k
    V. CHN ON
    1. Chn on xc nh:

    Theo DSM-IV
    A. Hot ng tr tu di mc trung bnh mt
    cch r rt: IQ 70 c nh gi bng mt trc
    nghim nh gi IQ trn tng c nhn. i vi tr
    nh cn da trn mt s phn on lm sng l
    hot ng tr tu di mc lm sng mt cch r
    rt.
    B. Nhiu khim khuyt hoc suy gim ng thi
    trong hot ng thch nghi hin ti lin quan t
    nht hai trong cc lnh vc sau: giao tip, t chm
    sc bn thn, cuc sng ti nh, cc k nng x
    2. Mc :
    a. Mc nh:
    Thng gp nht, chim khong 80% cc trng
    hp CPTTT
    IQ: 50-69
    Thng t c chn on hoc nhn bit cho
    n khi tr i hc.
    C th t c k nng hc tp tnh ton tng
    ng lp 6.
    Thng c th t chm lo bn thn v sng c
    lp trong cng ng hoc ch cn gim st ti
    thiu.
    C th i lm c trong mi trng c nng
    b. Mc trung bnh:

    - Chim t l 12%
    - IQ: 35-49
    - Nhiu kh nng c nhn thy nm u i.
    - Du hiu thng gp nht l chm pht trin ngn
    ng.
    - Thng khng vt qua c trnh lp 2
    - H c th hc nhng hot ng i sng n
    gin.
    - H cn s quan tm ng k trong trng hc,
    nh, v ngoi x hi. H cn phi sng vi gia
    c. Mc nng
    Chim t l 7%
    IQ: 20-34
    Km pht trin v vn ng.
    Khng pht trin hoc pht trin rt t v ngn
    ng, khng giao tip
    Khng c kh nng ngh nghip.
    Khng th sng c lp. Lun lun cn s
    gim h cht ch.
    Rt t kh nng t kim sot bn thn. Ch c
    th t phc v bn thn phn no nu c
    d. Mc trm trng:

    Chim t l 1%
    IQ < 20
    Hn ch trm trng trong giao tip v k nng
    vn ng.
    Pht trin rt km cc chc nng gic quan.
    Khng t chm sc bn thn c. i hi s
    gim st chm sc lin tc
    3. Chn on phn bit:
    CPTTT gi
    c ch cm xc.
    Mi trng vn ha x hi ngho nn
    Khim khuyt cc gic quan.
    Chm pht trin ngn ng.
    Ri lon hc tp
    Sa st tm thn
    Ri lon pht trin lan ta
    Lon thn tr em
    VI. TIN TRIN V TIN LNG:

    Tin lng khng kh quan, thng khng c


    ci thin tt v mt tr tu.Tuy nhin v hot
    ng thch nghi c th c ci thin theo
    hng tch cc bi mt mi trng nng
    thun li.
    Tin lng d dt nu c cc ri lon tm thn
    ng thi xut hin
    VII. IU TR
    Hin ti khng c phng php iu tr khi
    CPTTT
    Phng nga l phng php c s dng v
    pht trin nhiu nht hin nay.
    1. Phng nga cp I:
    Bao gm cc hnh ng loi tr hay lm gim cc
    tnh trng dn n s pht trin cc ri lon lin quan
    n CPTTT.
    2. Phng nga cp II v III:
    iu tr cc ri lon xy ra rt ngn din
    tin bnh v hn ch ti a di chng.
    Can thip bng ha dc

    Cc ri lon tm thn: iu tr tng t nh


    bnh nhn c ri lon tm thn khng c
    CPTTT
    Hnh vi gy hn v t gy thng tch:
    Lithium, Naltrexone, Carbamazepine, Valproic
    acide, Risperidone
    Cc c ng nh hnh: Haloperidol,
    Chlorpromazine
    Cc triu chng m nh cng bc: SSRIs nh
    Fluoxetine, Fluvoxamine, Paroxetine
    Cc liu php tm l

    Liu trnh nhiu nm


    Liu php hnh vi: un nn cc hnh vi x hi,
    kim sot v hn ch ti a s gy hn v cc
    hnh vi ph hoi
    Liu php nhn thc: dnh cho nhng ngi
    CPTTT c th theo c li hng dn. bao
    gm cc bi tp th gin v loi b cc tin
    tng sai lm.
    Liu php phn tm: ch nh cho ngi CPTTT
    v gia nh, lm gim cc xung t v k vng
    THANK YOU

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