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Интерпретация проективных тестов

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За последние 60 дней ни разу не выходила


Открыта: 25-03-2006
Адрес автора: psychology.rorschach-owner@subscribe.ru

Автор
Ольга Бермант-Полякова

Статистика

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Интерпретация проективных тестов


Rorschach & Psychoanalytic Diagnostics
Быть психологом

Здравствуйте, уважаемые читатели!
Выпуск третьей недели ноября 2010 года.

Давно мечтала показать свою работу, - а она конфиденциальна, как любое обращение к психологу, - и много раз просила у клиентов разрешения опубликовать диагностический отчёт в интернете. И вот наконец-то мечта сбылась, вашими молитвами, наверное :)

Читаем страницы 17-18 отчёта, Приложение 1. Документ попросила школа, а педагоги не обязаны досконально знать диагностические критерии психиатров, вот их мы и напоминаем. Если есть у терапевтов школы желание понять, каковы диагностические тонкости – нужная информация у них под рукой. Если у родителей есть желание задать вопросы психиатру, почему именно этот диагноз, а не другой, - а родители, когда дают информированное согласие на лечение, как правило задают такие вопросы, - нужная информация есть в Приложении к отчёту. Работу по написанию отчёта оплачивали родители из своего кармана, не забывайте, что читаем мы «второе мнение», первое готовит психиатр, работающий по договору со школой.

Olga Bermant-Polyakova PhD
Psychologist & Psychotherapist
Bet Shean Valley 13
Modiin-Makkabim-Reut Israel 71721
Tel/fax +97289718206 cell +972547441276

ד''ר אולגה ברמנט-פוליאקוב
פסיכולוגית, פסיכותרפיסטית
עמק בית שאן 13 מודיעין-מכבים-רעות 71721
טל/פקס 08-9718206 נייד 054-7441276
office_dr_olga@mail.ru


Psychological Assessment
הערכה פסיכולוגית

Приложение 1

Международная классификация болезней 10-го пересмотра
The ICD-10 Classification of Mental and Behavioural Disorders
World Health Organization, Geneva, 1992

МКБ-10 определяет расстройство поведения как повторяющийся и постоянный парттерн асоциального, агрессивного или дерзкого и вызывающего поведения, - открытого неповиновения. Поведение оценивают сравнительно с ровесниками, которые ведут себя соответственно социальным ожиданиям и выходит за рамки детского озорства или подросткового бунтарства. Однократные асоциальные поступки или правонарушения не являются основанием для диагноза. Для диагностики необходимо систематическое поведение любой из нижеследующих категорий:

- крайняя степень задиристости или запугивание других, - жестокость по отношению к животным или к другим, - серьёзное причинение вреда имуществу, - поджоги, - воровство, - лживость, - прогулы школьных занятий, - побеги из дома, - необычно частые и серьёзные вспышки гнева, - дерзкое, провокативное поведение, - стойкое серьёзное неповиновение. Нарушения поведения могут быть симптомами и других психиатрических расстройств, и в этом случае кодируется основной диагноз.

Полностью на английском языке:

F91 Conduct Disorders
Conduct disorders are characterized by a repetitive and persistent pattern of dissocial, aggressive, or defiant сonduct. Such behaviour, when at its most extreme for the individual, should amount to major violations of age-appropriate social expectations, and is therefore more severe than ordinary childish mischief or adolescent rebelliousness. Isolated dissocial or criminal acts are not in themselves grounds for the diagnosis, which implies an enduring pattern of behaviour.
Features of conduct disorder can also be symptomatic of other psychiatric conditions, in which case the underlying diagnosis should be coded.
Disorders of conduct may in some cases proceed to dissocial personality disorder (F60.2). Conduct disorder is frequently associated with adverse psychosocial environments, including unsatisfactory family relationships and failure at school, and is more commonly noted in boys. Its distinction from emotional disorder is well validated; its separation from hyperactivity is less clear and there is often overlap.
Diagnostic Guidelines
Judgements concerning the presence of conduct disorder should take into account the child's developmental level. Temper tantrums, for example, are a normal part of a 3-year-old's development and their mere presence would not be grounds for diagnosis. Equally, the violation of other people's civic rights (as by violent crime) is not within the capacity of most 7-year-olds and so is not a necessary diagnostic criterion for that age group.
Examples of the behaviours on which the diagnosis is based include the following: excessive levels of fighting or bullying; cruelty to animals or other people; severe destructiveness to property; firesetting; stealing; repeated lying; truancy from school and running away from home; unusually frequent and severe temper tantrums; defiant provocative behaviour; and persistent severe disobedience. Any one of these categories, if marked, is sufficient for the diagnosis, but isolated dissocial acts are not.
Exclusion criteria include uncommon but serious underlying conditions such as schizophrenia, mania, pervasive developmental disorder, hyperkinetic disorder, and depression.
This diagnosis is not recommended unless the duration of the behaviour described above has been 6 months or longer.
Differential diagnosis. Conduct disorder overlaps with other conditions. The coexistence of emotional disorders of childhood (F93.-) should lead to a diagnosis of mixed disorder of conduct and emotions (F92.-). If a case also meets the criteria for hyperkinetic disorder (F90.-), that condition should be diagnosed instead. However, milder or more situation-specific levels of overactivity and inattentiveness are common in children with conduct disorder, as are low self-esteem and minor emotional upsets; neither excludes the diagnosis.
Excludes:
* conduct disorders associated with emotional disorders (F92.-) or hyperkinetic disorders (F90.-)
* mood [affective] disorders (F30-F39)
* pervasive developmental disorders (F84.-)
* schizophrenia (F20.-)
The ICD-10 Classification of Mental and Behavioural Disorders
World Health Organization, Geneva, 1992 ________________________________________
F91.3 Oppositional Defiant Disorder
This type of conduct disorder is characteristically seen in children below the age of 9 or 10 years. It is defined by the presence of markedly defiant, disobedient, provocative behaviour and by the absence of more severe dissocial or aggressive acts that violate the law or the rights of others. The disorder requires that the overall criteria for F91 be met: even severely mischievous or naughty behaviour is not in itself sufficient for diagnosis. Many authorities consider that oppositional defiant patterns of behaviour represent a less severe type of conduct disorder, rather than a qualitatively distinct type. Research evidence is lacking on whether the distinction is qualitative or quantitative. However, findings suggest that, in so far as it is distinctive, this is true mainly or only in younger children. Caution should be employed in using this category, especially in the case of older children. Clinically significant conduct disorders in older children are usually accompanied by dissocial or aggressive behaviour that go beyond defiance, disobedience, or disruptiveness, although, not infrequently, they are preceded by oppositional defiant disorders at an earlier age. The category is included to reflect common diagnostic practice and to facilitate the classification of disorders occurring in young children.
Diagnostic Guidelines
The essential feature of this disorder is a pattern of persistently negativistic, hostile, defiant, provocative, and disruptive behaviour, which is clearly outside the normal range of behaviour for a child of the same age in the same sociocultural context, and which does not include the more serious violations of the rights of others as reflected in the aggressive and dissocial behaviour specified for categories F91.0 and F91.2. Children with this disorder tend frequently and actively to defy adult requests or rules and deliberately to annoy other people. Usually they tend to be angry, resentful, and easily annoyed by other people whom they blame for their own mistakes or difficulties. They generally have a low frustration tolerance and readily lose their temper. Typically, their defiance has a provocative quality, so that they initiate confrontations and generally exhibit excessive levels of rudeness, uncooperativeness, and resistance to authority.
Frequently, this behaviour is most evident in interactions with adults or peers whom the child knows well, and signs of the disorder may not be evident during a clinical interview. The key distinction from other types of conduct disorder is the absence of behaviour that violates the law and the basic rights of others, such as theft, cruelty, bullying, assault, and destructiveness. The definite presence of any of the above would exclude the diagnosis. However, oppositional defiant behaviour, as outlined in the paragraph above, is often found in other types of conduct disorder. If another type (F91.0-F91.2) is present, it should be coded in preference to oppositional defiant disorder.
Excludes:
* conduct disorders including overtly dissocial or aggressive behaviour (F91.0-F91.2)

Продолжение в следующем выпуске рассылки.
С уважением,
доктор Бермант-Полякова
психолог, психотерапевт, супервизор

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