Monthly Archives: April 2017

Obsession or Psychosis?

The girl has been housebound for several months now. Though she managed to come to the clinic, but was seemingly restless and anxious, pacing the floor in the waiting area. She couldn’t see people using smartphones anywhere near her. She would think people are taking her pictures and use them for detrimental purposes. When she is in such situation, she experiences strong urges to grab the phone from others.

She does recognise those intrusive thoughts as irrational and could restrain herself from doing so. But like many other with OCD, she is staying home more and more to avoid such situations. When she first consulted a psychiatrist, it was about two years ago. She was quiet, introverted, sensitive, and repetitive in her speech, but wasn’t diagnosed as having OCD.

To really consider her current presentation, she seems to be having persecutory delusions (a common form of delusion in paranoid schizophrenia, where the person believes that ”he or she is being tormented, followed, tricked, spied on, or ridiculed.”).

So, how do you know or decide the diagnosis? Is it OCD or is it borderline psychotic of sorts?

Looking at the backgrounds, the mother who came with her said that she (the mother) has been “depressed” and taking psychiatric drugs for the past 10 years, it was mainly due to the stress caused by her daughter (only child). Though one of the mother’s symptoms, is compulsive washing(!), fear of contamination. It’s not difficult to imagine some OCD can be so severe and disabling leading to depression (the comorbidity rate is high anyway). But here through the mother at least a family history of OCD is exhibited.

In DSM-5, it is specified that OCD may be seen with: (i) good or fair insight, (ii) poor insight, or (iii) absent insight/delusional beliefs.  In all previous editions of the DSM, the criteria for the diagnosis of obsessive-compulsive disorder included the sufferer’s realization that their obsessions and compulsions are irrational or illogical. Now, absent insight/delusional beliefs can be part of an OCD diagnosis. Though we have all noticed that OCD sufferers’ levels of insight can change quickly, often depending on the circumstances and situations (e.g. the intrusive thought was felt completely real when she’s in the public noticing someone holding the phone VS when she’s at home thinking about that situation).

Some psychiatrists would prescribe both anti-depressants (serving as anti-OCD) and anti-psychotics. However, there were cases where OCD patients were first misdiagnosed as psychotic, and taking anti-psychotic very much worsened their OCD (though once they stopped the anti-psychotics and took anti-depressants at the right dosage, their OCD symptoms alleviated).

So time spent for detailed psychopathology and specific diagnosis would be of greatest importance. The presentation of suspiciousness (paranoia) as the main symptom suggested possibility of psychosis, however, the repetitive nature of the thought, which was stereotyped, causing severe distress, also the family history of OCD, pointed toward a greater possibility of obsessions. What is more difficult with this case is the absence of compulsions and reassurance seeking. And my final point, it’s not necessarily “either or”, it could be both! But still it takes much time and effort to really work that out.

一个真实的故事

女儿 Candace 打电话来的时候,Wilma 正在打扫客厅。他们一家住在加拿大的Winnepeg, Manitoba. 那是十一月,外头的天气很冷。Candace那年13岁,正和一个男同学聊完天,想问妈妈可不可以来学校载她回家。Wilma 想了想,他们家只有一辆车,一个小时后她得去接先生Cliff 下班,家里还有两个孩子,一个两岁一个九岁。她必须为他们准备出门,去接Candace,再去接先生。那会是和三个饿坏的小孩一起呆的一个小时。Candace已经13岁了,不是小孩了,她可以乘搭巴士回家。所以确认了Candace有足够的零钱乘搭巴士后,Wilma 继续打扫。

忙了一阵子后,Wilma 突然觉得有点不对劲,她看了看时钟,发现Candace早该到家了。外面开始下雪了。她开始不停往外张望,看看Candace是不是要回到家了。过了一阵子,也到了接先生Cliff的时间,她打理了两个孩子上车,沿路慢驶,看看是不是会遇上Candace正回家。她也驶到学校,大门已经上锁。接了Cliff后,他们回家,在附近寻找,然后逐个联络Candace的朋友,下午以后就没有人见到她了。Wilma去找那个男同学,他最后看见她往巴士站的方向走。夫妻俩只好报警。他们成立了搜寻小组,也四处张贴海报。他们祈祷、他们哭泣、他们无法入眠。七个星期后,警察联络他们,Candace的尸体被寻获。手脚被捆绑着,冻死的。

那天下午家里聚了不少亲戚和朋友,一直到晚上10时,只剩下几个最亲密的朋友。这时门铃响起,一个陌生人站在门口,“我也是一个孩子被谋杀的父亲”。这男士大约五十几岁,他的女儿几年前在甜甜圈店被杀,在这小地方也是有名的案件,嫌疑犯Thomas Sophonow 被逮捕并审讯诉讼三次,他坐了四年牢,又被上述庭放了出来。屋里的每个人围着桌子,听着男士细述整个过程,他有本小簿子,记录了每个细节,包括他因此而花的单据也整齐排列其中。他也说起Sophonow,说起司法的不公。这整个过程毁了他,也毁了他的家庭。他无法继续工作,健康很糟糕,吃着很多药。虽然他没有直接说起他和太太,但是言词间也透露他们的关系似乎已经是过去式。关于他的女儿,他没说得太多,反而都在说努力寻求公平公正的过程和想法。到最后午夜以前,他临走前说,“我把这一切告诉你们,是要让你们知道,前方有些什么在等着你们。”

我把这一切告诉你们,是要让你们知道,前方有些什么在等着你们。

对Wilma 和 Cliff 而言,男子所说的并不是预言,而是一个警示,那有可能就是他们的未来。他们可能因为女儿遭谋杀而失去健康,失去理智,失去彼此,失去这个家。因为男子的到访和分享,强迫他们去考虑其他的选择,寻找一条不一样的路。隔天就是Candace的葬礼,过后他们同意召开记者会。Candace的遭遇引起了整个城市的注意,几乎所有报章媒体都出席了。

“你们对残害Candace的人有什么感受?”一名记者问。

“我们想要知道这个人、或这群人是谁,好让我们可以分享一些爱,给这些生命里似乎缺乏爱的人” Cliff 说。

“我们的目的是要找到Candace,而我们已经找到了。我不能说此时此刻我能原谅这个人” Wilma继续说到,强调的是此时此刻,并继续说“每个人一生中都曾经做过一些可怕的事,或有那个念头。”


我很想分享这个真实的故事。每个人的生命都有些英雄,每个族群也有他们信仰的民族大英雄。而像 Wilma 的Mennonites,他们的英雄是Dirk Willems,他在16世纪因为信仰而被关在牢塔里,在一条绳子的帮助下,他成功逃脱牢塔,渡过塔外被冰覆盖的冰河,他成功到了河的对岸,但追逐他的狱卒却掉入冰水中。Willems 停了下来,回来拯救追兵。就因为他的大爱,他被抓了回去,虐待,被慢火活活烧死,过程中重复了无数次“主啊,我的天”。

我想我的生命并不缺乏爱,却缺乏了分享爱的能力,读到上面那句话的时候,我几乎不能置信的再看了几遍。谨此用这个故事提醒自己和看到这里的每个人,这世界上有很多处理不公平的方式,换个角度,你可能在寻求所谓公平的路上付出更多或经历更惨痛,可以放下的话就放下,可以原谅的话就原谅,可以多分享一些爱的话就多分享一些爱。

Psychology-related Terms English-Chinese Translation

A

  • abnormal psychology 变态心理学
  • abnormality 变态性
  • abstract thinking 抽象思维
  • acute schizophrenia 急性精神分裂症(思觉失调症)
  • adjustment disorder 适应障碍
  • affective disorder 情感障碍
  • age regression
  • agoraphobia 广场恐怖/恐惧
  • alalia 语言不清
  • amnesia 遗忘症
  • anorexia nervosa 神经性厌食症
  • antidepressant drug 抗抑郁药物
  • antipsychotic drug 抗精神病药物
  • antisocial personality 反社会任何
  • anxiety disorder 焦虑障碍
  • apathy 情感淡漠
  • assessment 评估
  • association 联想
  • attempted suicide 自杀未遂
  • attention deficit disorder 注意力缺失障碍
  • attention span 注意广度
  • aversion therapy 厌恶疗法
  • avoidant personality  回避型人格

B

  • behaviour therapy 行为治疗
  • behaviour modification 行为矫正
  • belief 信念
  • biofeedback 生物反馈
  • biopsychosocial medical model 生物心理社会医学模式
  • bipolar disorder 双相情感障碍/躁郁症
  • borderline personality disorder 边缘型人格障碍

C

  • central nervous system 中枢神经系统
  • chronic schizophrenia 慢性精神分裂症
  • classical conditioning 经典性条件反射
  • client-centered therapy 来访者中心疗法
  • clinical psychology 临床心理学
  • clinical test 临床测验
  • cognitive behavioural therapy 认知行为疗法
  • cognitive process 认知过程
  • collaborative empiricism 协同检验
  • compulsion 强迫行为
  • concrete thinking 具体思维
  • conditioned reflex 条件反射
  • coping 应对
  • coping mechanism 应对机制
  • counselling 心理咨询
  • counselling psychology 咨询心理学
  • counterconditioning 对抗性条件反射
  • covert behaviour 隐匿性行为

D

  • defense mechanism 防御机制
  • delusion 妄想
  • dementia 痴呆
  • denial 否定
  • dependency 依赖
  • depression 抑郁
  • deterioration 衰退
  • dichotomous thinking 绝对性思考方式
  • distress 苦恼
  • drug abuse 药物滥用
  • dyslexia 诵读困难/失读症

E

  • ego 自我
  • emotion 情绪
  • emotional response 情绪反应
  • empathy 移情(?)/同理
  • epilepsy 癫痫
  • etiology 病因学
  • eye movement 眼动

F

  • flooding 满贯法 (a type of exposure therapy)
  • functional magnetic resonance imaging 功能性磁共振成象

G

  • generalisation 概括
  • generelised anxiety disorder (GAD) 广泛性焦虑症
  • graded exposure 逐级暴露

H

  • hallucination 幻觉
  • health care 保健
  • helplessness 无助
  • high risk group 高危人群
  • hostility 敌对
  • humanistic 人本主义
  • hyperactivity 活动过度
  • hypermnesia 记忆增强
  • hyperthymia 情感高涨
  • hypnosis 催眠
  • hypnotic trance 催眠恍惚状态
  • hypnotism 催眠术
  • hypochondria 疑病症/健康焦虑 (health anxiety)
  • hypomania 轻躁狂 (hypomania < mania < hypermania)
  • hypothymia 情感减退

I

  • Id 本我
  • imagination 想象
  • individual differences 个体差异
  • information retrieval, processing, storage 信息提取、加工、储存
  • insomnia 失眠
  • interpersonal 人际
  • interview 访谈
  • isolation 隔离

J

  • jealous delusion 嫉妒妄想

K

  • kleptomania 偷窃癖

L

  • language 语言
  • latency 潜伏期

M

  • mania 躁狂症
  • masochism 受虐狂
  • melancholic temperament 抑郁质
  • memory 记忆
  • mental activity 心理活动
  • mental deterioration 精神衰退
  • mental disorder 心理(精神)障碍
  • mental health 心理健康(心理卫生)
  • mental illness 心理疾病
  • mental status 心理状态
  • mind-body relation 心身关系
  • moritatherapy 森田疗法

N

  • neurolinguistics 神经语言学
  • neurosis 神经症
  • neurotransmitter 神经传递物质
  • noctambulism  梦游症
  • normal curve 正态曲线

O

  • obsession 强迫观念/ 强迫思维
  • obsessive compulsive disorder (OCD) 强迫症
  • operant conditioning 操作条件反射

P

  • panic 惊恐
  • panic attacks 惊恐发作
  • paranoid 偏执(容易引起误会的中文用字,别从字面理解)
  • paranoid psychosis 偏执型精神病
  • pedophilia 恋童癖
  • perception 知觉
  • persecutory delusion 迫害妄想
  • personality 人格
  • personality trait 人格特质
  • pharmacotherapy 药物疗法
  • phobia 恐怖症
  • physical sensation 躯体感觉
  • placebo 安慰剂
  • placebo effect 安慰剂效应
  • problem solving 问题解决
  • projection 投射
  • prosopagnosia 人面失认症 (me! Haha)
  • psychoactive drug 精神药物
  • psychodynamics 心理动力学
  • psychogenic disorder 心因性障碍
  • psychopathology 心理病理学
  • psychosocial factor 心理社会因素
  • psychosomatic diseases 心身疾病
  • psychotherapy 心理治疗

Q

  • questionnaire 问卷

R

  • Rapid Eye Movement (REM) sleep 快速眼动睡眠
  • rapport 和睦关系
  • rating scale 评估量表
  • reasoning 推理
  • recall 回忆
  • reflection 反映
  • regression
  • rehabilitation 康复
  • relaxation training 放松训练
  • remission 缓解
  • repression 抑制
  • resistance 阻抗
  • role-playing 角色扮演

S

  • sadism 性施虐癖
  • schema 图式
  • schizophrenia 精神分裂症(思觉失调症)
  • secondary delusion 继发性妄想
  • selective abstraction 以偏概全/选择性概括
  • self-actualisation 自我实现
  • self-defeating 自我挫败
  • self-help group 自助小组
  • self-monitoring 自我监察
  • self-regulation 自我调节
  • self-report inventory 自陈量表
  • senile psychosis 老年性精神病
  • sensation 感觉
  • sensory deprivation 感觉剥夺
  • social phobia 社交恐惧症
  • specific phobia 特殊恐惧症
  • somatisation 躯体化
  • stress 应激/压力
  • stress response 应激反应
  • stressor 应激源/压力源
  • structured interview 结构式晤谈
  • subjective unit of distress/disturbance 主观不适度/主观受困扰程度
  • suicidal ideation 自杀意念
  • suggestability 暗示性/暗示感受性
  • suggestion 暗示(催眠)
  • suppression 压抑
  • symptom 症状
  • syndrome 综合症

T

  • thinking 思维
  • token economy 标记奖励法/代币法
  • tolerance 耐受性(酒精、药物等)
  • trauma 创伤
  • treatment 治疗

V

  • validity 效度(有效程度?)
  • voyeurism 偷窥癖

W

  • withdrawal syndrome 撤药综合症

N.B. the list will be updated as it goes.