แนวทางการดูแลผู้ป่วยจิตเวชในโรงพยาบาลชุมชน (รพ.จิตเวชสงขลาราชนครินทร์)

แนวทางการดแลผปวยจตเวชในโรงพยาบาลชมชน

โรงพยาบาลจตเวชสงขลาราชนครนทรSongkhla Rajanagarindra Psychiatric Hospitalโทร. 074-311319, 074-442477-8, 074-324868-9

โทร. 074-311319, 074-442477-8, 074-324868-9โรงพยาบาลจตเวชสงขลาราชนครนทรSongkhla Rajanagarindra Psychiatric Hospital

ÍÒ¡ÒÃ ËÅ§¼Ô´ »ÃÐÊÒ· ËÅÍ¹

อาการหลงผดประสาทหลอน

ÍÒ¡ÒÃà´‹¹ âÃ¤·Õè¤Ò´Ç‹Ò¨Ðà»š¹ ÃËÑÊ ICD 10

r ÁÕ»ÃÐÇÑµÔÍÒ¡ÒÃ ÍÒ¡ÒÃáÊ´§¢Í§¡ÒÃãªŒ ÊÒÃàÊ¾µÔ´

Substance use disorder F19.5

r ¤ÇÒÁ¡ÅÑÇ ¤ÇÒÁà¤ÃÕÂ´ Stress-related disorder/ Stress disorder (Acute psychosis)

F43.9 F23.9

r ÍÒÃÁ³�«ÖÁàÈÃŒÒ ·ŒÍá·ŒÊÔé¹ËÇÑ§ Depressive disorder/ Bipolar disorder depressive episode

F32.9 F31.3

r ÁÕÍÒÃÁ³�¤Ã×é¹à¤Ã§/Ë§Ø´Ë§Ô´§‹ÒÂ Bipolar disorder manic episode F31.1

r à¹×éÍËÒ¤ÇÒÁ¤Ô´á»Å¡ÊÑºÊ¹ Psychotic disorder Schizophrenia

F29 F20.9


¹Í¹ äÁ‹ËÅÑº

นอนไมหลบ

ÍÒ¡ÒÃà´‹¹ âÃ¤·Õè¤Ò´Ç‹Ò¨Ðà»š¹ ÃËÑÊ ICD 10

r ÇÔµ¡¡Ñ§ÇÅ·ÑèÇä» GAD F41.1

r ÍÒÃÁ³�«ÖÁàÈÃŒÒ ·ŒÍá·Œ Depressive disorder/ Bipolar disorder depressive episode

F32.9 F31.3

r ÍÒÃÁ³�¤Ã×é¹à¤Ã§/Ë§Ø´Ë§Ô´§‹ÒÂ Bipolar disorder manic episode

F31.1

r ÁÕ¡ÒÃ¡ÃÐµØŒ¹ªÑ´à¨¹ Stress-related disorder/ Stress disorder

F43.9



r ÍÒ¡ÒÃà»š¹ÃÐÂÐÊÑé¹ à»š¹ÁÒ¡àÇÅÒ¡ÅÒ§¤×¹ Delirium F05.9


¾ÄµÔ¡ÃÃÁ ¡ÃÐÇ¹ ¡ÃÐÇÒÂ

พฤตกรรมกระวนกระวาย

ÍÒ¡ÒÃà´‹¹ âÃ¤·Õè¤Ò´Ç‹Ò¨Ðà»š¹ ICD-10



r ÍÒÃÁ³�«ÖÁàÈÃŒÒ ·ŒÍá·Œ ÊÔé¹ËÇÑ§ Depressive disorder/ Bipolar disorder depressive episode

F32.9 F31.3

r ÍÒÃÁ³�¤Ã×é¹à¤Ã§/Ë§Ø´Ë§Ô´§‹ÒÂ ¾Ù´ÁÒ¡ ¹Í¹¹ŒÍÂ

Bipolar disorder manic episode

F31.1

r µÒÁËÅÑ§àËµØ¡ÒÃ³� ¡ÃÐµØŒ¹ªÑ´à¨¹ Stress-related disorder/ Stress disorder (anxiety)

F43.9 F41.9


หลงลม


r ÍÒÃÁ³�«ÖÁàÈÃŒÒ ·ŒÍá·Œ ÊÔé¹ËÇÑ§ Depressive disorder/ Bipolar disorder depressive episode

F32.9 F31.3

r ÇÔµ¡¡Ñ§ÇÅ·ÑèÇä» GAD F41.1

r ËÅ§Å×Á ÊÙÞàÊÕÂ ¤ÇÒÁ¨ÓÃÐÂÐÊÑé¹ äÁ‹ÃÙŒÇ‹ÒµÑÇàÍ§ÊÙÞàÊÕÂ¤ÇÒÁ¨Ó ¾º¼ÙŒ»†ÇÂ ã¹¼ÙŒÊÙ§ÍÒÂØ

Dementia F03

ËÅ§Å×Á


¤ÇÒÁ¤Ô´ ËÃ×Í

¾ÄµÔ¡ÃÃÁ ·ÓÃŒÒÂ µ¹àÍ§

ความคดหรอพฤตกรรมทำรายตนเอง


r ÁÕÍÒ¡ÒÃ«ÖÁàÈÃŒÒ ·ŒÍá·Œ ÊÔé¹ËÇÑ§

Depressive disorder/ Bipolar disorder depressive episode

F32.9 F31.3

r ÁÕ¤ÇÒÁ¤Ô´ËÅ§¼Ô´ »ÃÐÊÒ·ËÅÍ¹ ¾ÄµÔ¡ÃÃÁá»Å¡

Psychotic disorder Schizophrenia

F29 F20.9

r ÁÕ»ÃÐÇÑµÔÍÒ¡ÒÃ ÍÒ¡ÒÃáÊ´§¢Í§ ¡ÒÃãªŒÊÒÃàÊ¾µÔ´



สบสน


r ËÅ§Å×Á ÊÙÞàÊÕÂ¤ÇÒÁ¨Ó ÃÐÂÐÊÑé¹ ¤‹ÍÂà»š¹¤‹ÍÂä» r ¼ÙŒ»†ÇÂäÁ‹ÃÙŒµÑÇÇ‹ÒàÊÕÂ¤ÇÒÁ¨Ó r ¾º¼ÙŒ»†ÇÂã¹¼ÙŒÊÙ§ÍÒÂØ

Dementia F03

r ÊÑºÊ¹ àÊÕÂ¡ÒÃÃÑºÃÙŒÊÔè§áÇ´ÅŒÍÁ à¡Ô´·Ñ¹·Õ·Ñ¹ã´

Delirium (Organic delirium) F05.9

r ÁÕ»ÃÐÇÑµÔâÃ¤·Ò§¡ÒÂËÃ×Í¡ÒÃãªŒÊÒÃ àÊ¾µÔ´ ¤ÇÒÁ¤Ô´ËÅ§¼Ô´ »ÃÐÊÒ·ËÅÍ¹

Psychotic disorder/Substance induced psychotic disorder Schizophrenia

F29, F19.9

F20.9

r ÍÒÃÁ³�¤Ã×é¹à¤Ã§/Ë§Ø´Ë§Ô´§‹ÒÂ Bipolar disorder manic episode

F31.1

ÊÑºÊ¹


¤ÇÒÁ ÇÔµ¡ ¡Ñ§ÇÅ

ความวตกกงวล


r ÍÒ¡ÒÃ«ÖÁàÈÃŒÒ ·ŒÍá·Œ Depressive disorder/ Bipolar disorder depressive episode

F32.9 F31.3

r ËÅ§¼Ô´ »ÃÐÊÒ·ËÅÍ¹ Psychotic disorder F29

r µ×è¹µÃÐË¹Ñ¡ ¡Ñ§ÇÅÍÂ‹Ò§ÁÒ¡ ¤Çº¤ØÁµÑÇàÍ§äÁ‹ä´Œ àËÁ×Í¹¡ÓÅÑ§¨ÐµÒÂ

Panic disorder F41.0

r µÒÁËÅÑ§àËµØ¡ÒÃ³�¡ÃÐµØŒ¹·ÕèªÑ´à¨¹ Stress-related disorder/ Stress disorder

F43.9

r ÍÒ¡ÒÃÇÔµ¡¡Ñ§ÇÅ·ÑèÇä» Generalized anxeity disorder F41.1


Generalized Anxeity Disorder (GAD)

โรคกงวลทวไป

¡ÒÃÇÔ¹Ô¨©ÑÂ ¡ÒÃÃÑ¡ÉÒ

A. ÁÕ¤ÇÒÁÇÔµ¡¡Ñ§ÇÅà¡Ô¹¡Ç‹ÒàËµØ ËÅÒÂ æ àÃ×èÍ§ B. ¼ÙŒ»†ÇÂÃÙŒÊÖ¡äÁ‹ÊÒÁÒÃ¶¤Çº¤ØÁ¤ÇÒÁ¡Ñ§ÇÅ¹Õéä´Œ C. ÁÕÍÒ¡ÒÃ·Ò§¡ÒÂµ‹Ò§ æ ´Ñ§µ‹Íä»¹Õé (ÍÂ‹Ò§¹ŒÍÂ 3 ã¹ 6 ¢ŒÍ) 1. ¡ÃÐÊÑº¡ÃÐÊ‹ÒÂ 2. Í‹Í¹à¾ÅÕÂ àË¹×èÍÂ§‹ÒÂ 3. ÁÕ»˜ÞËÒ´ŒÒ¹ÊÁÒ¸Ô ¤ÇÒÁ¨Ó 4. Ë§Ø´Ë§Ô´ 5. »Ç´àÁ×èÍÂ µÖ§µÒÁ¡ÅŒÒÁà¹×éÍ 6. ÁÕ»˜ÞËÒà¡ÕèÂÇ¡Ñº¡ÒÃ¹Í¹ D. ÍÒ¡ÒÃ·Ñé§ËÁ´à»š¹ÍÂÙ‹º‹ÍÂ æ ¹Ò¹¡Ç‹Ò 6 à´×Í¹

1. ¨ÔµºÓºÑ´ W Cognitive behavior therapy W Relaxation technique 2. ¡ÒÃÃÑ¡ÉÒ´ŒÇÂÂÒ W Diazepam 5-15 mg/day ª‹ÇÂÅ´ÍÒ¡ÒÃÇÔµ¡ ¡Ñ§ÇÅáÅÐÍÒ¡ÒÃ·Ò§¡ÒÂ ãËŒÂÒµ‹Íà¹×èÍ§ÍÂ‹Ò§ ¹ŒÍÂ 6 à´×Í¹ W Fluoxetine 20 mg/day ãËŒÂÒµ‹Íà¹×èÍ§ 6-12 à´×Í¹ ËÃ×ÍÍÒ¨ãËŒ¹Ò¹¡Ç‹Ò¹Ñé¹ Ê‹Ç¹ãËÞ‹ äÁ‹¤‹ÍÂÁÕÍÒ¡ÒÃ´×éÍÂÒ W propranolol 10-40 mg/day ª‹ÇÂÅ´ÍÒ¡ÒÃ Á×ÍÊÑè¹ ã¨ÊÑè¹

GAD


Depressive Disorder

โรคซมเศรา


A. ÁÕÍÒ¡ÒÃµ‹Íä»¹ÕéÍÂ‹Ò§¹ŒÍÂ 5 ¢ŒÍ â´ÂµŒÍ§ÁÕ¢ŒÍ 1. ËÃ×Í ¢ŒÍ 2. ¹Öè§¢ŒÍ 1. «ÖÁàÈÃŒÒ 2. ¤ÇÒÁÊ¹ã¨ËÃ×Í¤ÇÒÁà¾ÅÔ¹ã¨ã¹ÊÔè§µ‹Ò§æ Å´Å§ÍÂ‹Ò§ÁÒ¡ 3. àº×èÍÍÒËÒÃ ËÃ×Í¹éÓË¹Ñ¡Å´Å§ÁÒ¡¡Ç‹ÒÃŒÍÂÅÐ 5 ã¹ 1 à´×Í¹ 4. ¹Í¹äÁ‹ËÅÑº ËÃ×Í¹Í¹ÁÒ¡¡Ç‹Ò»¡µÔ 5. ¡ÃÐÇ¹¡ÃÐÇÒÂ ËÃ×Í ¡ÒÃà¤Å×èÍ¹äËÇªŒÒÅ§ 6. Í‹Í¹à¾ÅÕÂ äÁ‹ÁÕáÃ§ 7. ÃÙŒÊÖ¡µ¹àÍ§äÃŒ¤‹Ò ËÃ×ÍÃÙŒÊÖ¡¼Ô´ 8. ÊÁÒ¸ÔÅ´Å§ ÅÑ§àÅã¨ 9. ¤Ô´àÃ×èÍ§¡ÒÃµÒÂ ËÃ×Í ¡ÒÃ¦‹ÒµÑÇµÒÂ ËÃ×Í ·Óáºº¤Ñ´¡ÃÍ§«ÖÁàÈÃŒÒ 2 ¤Ó¶ÒÁ ãËŒ¼ÅºÇ¡Ã‹ÇÁ¡Ñº áºº»ÃÐàÁÔ¹âÃ¤«ÖÁàÈÃŒÒ 9 ¤Ó¶ÒÁ ¤Ðá¹¹ÃÇÁ > 7 ¤Ðá¹¹

1. Ê‹§¼ÙŒ»†ÇÂà¢ŒÒÃÐºº¡ÒÃ´ÙáÅà½‡ÒÃÐÇÑ§âÃ¤«ÖÁàÈÃŒÒ 2. ¡ÒÃÃÑ¡ÉÒ´ŒÇÂÂÒ W Fluoxetine 20-60 mg/day W Diazepam 5-10 mg/day ËÃ×Í Amitriptyline 10-25 mg/day ª‹ÇÂàÃ×èÍ§¡ÒÃ¹Í¹ËÅÑº 3. ¡ÒÃÂØµÔ¡ÒÃÃÑ¡ÉÒ´ŒÇÂÂÒ àÁ×èÍ¤Ðá¹¹áºº»ÃÐàÁÔ¹âÃ¤«ÖÁàÈÃŒÒ 9 ¤Ó¶ÒÁ < 7 ¤Ðá¹¹ µÔ´µ‹Í¡Ñ¹ à»š¹àÇÅÒ¹Ò¹ 6 à´×Í¹ ¤‹ÍÂ æ Å´¢¹Ò´ÂÒÅ§ 25% ·Ø¡ æ 2 ÊÑ»´ÒË� ¢³ÐÅ´ÂÒ ¤ÇÃ»ÃÐàÁÔ¹âÃ¤«ÖÁàÈÃŒÒ 9 ¤Ó¶ÒÁ ·Ø¡¤ÃÑé§·Õè¾º¼ÙŒ»†ÇÂ ¶ŒÒ¤Ðá¹¹ 7 ãËŒà¾ÔèÁ¢¹Ò´ÂÒà·‹Ò¡Ñº¢¹Ò´¡‹Í¹·Õè¨ÐÅ´ »ÃÔÁÒ³Å§ áÅÐ¹Ñ´µÔ´µÒÁ»ÃÐàÁÔ¹ÍÒ¡ÒÃ·Ø¡à´×Í¹

Depressive Disorder


Bipolar disorder

โรคอารมณแปรปรวน


ÁÕÍÒ¡ÒÃ manic episode ÊÅÑº¡Ñº major depressive episode à¡³±�¡ÒÃÇÔ¹Ô¨©ÑÂ manic episode A. ÁÕÍÒÃÁ³� Ê¹Ø¡Ê¹Ò¹¤Ã×é¹à¤Ã§ áÊ´§ÍÍ¡·Ò§ÍÒÃÁ³�ÁÒ¡ ËÃ×Í ÍÒÃÁ³�Ë§Ø´Ë§Ô´·Õè¼Ô´»¡µÔ áÅÐ¤§ÍÂÙ‹µÅÍ´¹Ò¹à¡Ô¹¡Ç‹Ò 1 ÊÑ»´ÒË� (ËÒ¡µŒÍ§ÃÑºäÇŒã¹âÃ§¾ÂÒºÒÅ ¨Ðà»š¹à¾ÕÂ§äÁ‹¡ÕèÇÑ¹¡çä´Œ) B. ÁÕÍÒ¡ÒÃµ‹Íä»¹ÕéÁÒ¡¡Ç‹Ò 3 ÍÒ¡ÒÃ (ÁÒ¡¡Ç‹Ò 4 ÍÒ¡ÒÃ ËÒ¡à»š¹ ÍÒÃÁ³�Ë§Ø´Ë§Ô´) 1. ËÅ§¼Ô´ ¤Ô´Ç‹Òµ¹ÁÕ¤ÇÒÁÊÓ¤ÑÞ ÁÕÍÓ¹Ò¨ à»š¹¼ÙŒÂÔè§ãËÞ‹ 2. ¤ÇÒÁµŒÍ§¡ÒÃ¹Í¹Å´Å§ 3. ¾Ù´ÁÒ¡¡Ç‹Òà¤Â ËÃ×Í¾Ù´äÁ‹ËÂØ´ 4. ¤ÇÒÁ¤Ô´áÅ‹¹àÃçÇ à»ÅÕèÂ¹àÃ×èÍ§¾Ù´àÃçÇ 5. ÊÁÒ¸ÔÅ´Å§ ¤ÇÒÁÊÒÁÒÃ¶ã¹¡ÒÃ¨´¨‹Í·Ó§Ò¹µ‹Ò§ æ Å´Å§ 6. »ÃÐ¡Íº¡Ô¨¡ÃÃÁµ‹Ò§ æ ÁÒ¡¢Öé¹ ËÃ×ÍÁÕ¾ÄµÔ¡ÃÃÁ ¡ÃÐÊÑº¡ÃÐÊ‹ÒÂ ¡ÃÐÇ¹¡ÃÐÇÒÂ 7. à¢ŒÒÂØ‹§à¡ÕèÂÇ¡ÑºàÃ×èÍ§·Õè·ÓãËŒµ¹àÍ§à¾ÅÔ´à¾ÅÔ¹ÁÒ¡à¡Ô¹¤ÇÃ áµ‹ÁÑ¡ÁÕ¼ÅàÊÕÂµÔ´µÒÁÁÒ C. ÍÒ¡ÒÃÃØ¹áÃ§¨¹ÁÕ¼ÅàÊÕÂµ‹Í¡ÒÃ»ÃÐ¡ÍºÍÒªÕ¾ ¡ÒÃà¢ŒÒÊÑ§¤Á ËÃ×Í ÊÑÁ¾Ñ¹¸ÀÒ¾¡Ñº¼ÙŒÍ×è¹ ËÃ×Í¨Óà»š¹µŒÍ§ÍÂÙ‹âÃ§¾ÂÒºÒÅà¾×èÍ»‡Í§¡Ñ¹ÍÑ¹µÃÒÂ µ‹Íµ¹àÍ§ËÃ×Í¼ÙŒÍ×è¹ ËÃ×ÍÁÕÍÒ¡ÒÃ·Ò§âÃ¤¨Ôµ

1. ¡ÒÃÃÑºäÇŒÃÑ¡ÉÒã¹âÃ§¾ÂÒºÒÅ* W ¼ÙŒ»†ÇÂÁÕÍÒ¡ÒÃÃØ¹áÃ§ àª‹¹ ¡ŒÒÇÃŒÒÇ ·ÓÅÒÂ¢ŒÒÇ¢Í§ ÁÕÍÒ¡ÒÃâÃ¤¨Ôµ W Ãº¡Ç¹¤¹ã¹¤ÃÍº¤ÃÑÇ ËÃ×Í¼ÙŒÍ×è¹ ÞÒµÔ¤Çº¤ØÁ¾ÄµÔ¡ÃÃÁäÁ‹ä´Œ 2. ¡ÒÃÃÑ¡ÉÒ´ŒÇÂÂÒ W Lithium 600-900 mg/day ãËŒÃÐ´ÑºÂÒã¹àÅ×Í´ 0.8-1.2 mEq/L ª‹Ç§áÃ¡ÍÒ¨ãËŒ Diazepam 15-20 mg/day ËÃ×ÍÂÒÃÑ¡ÉâÃ¤¨Ôµ Haloperidal 10-20 mg/day Ã‹ÇÁ´ŒÇÂ áÅÐÅ´ÂÒÅ§àÁ×èÍÍÒ¡ÒÃ ·Ò§¨ÔµËÒÂ W Mood stabilizer Í×è¹ æ àª‹¹ Sodium Valproate 600-1500 mg/day *¡ÒÃÃÑºäÇŒÃÑ¡ÉÒ·ÕèâÃ§¾ÂÒºÒÅ¨ÔµàÇª ¢Öé¹ÍÂÙ‹¡Ñº´ØÅ¾Ô¹Ô¨¢Í§¨Ôµá¾·Â�

Bipolar disorder


Schizophrenia

โรคจตเภท


A. ÁÕÍÒ¡ÒÃµ‹Íä»¹ÕéµÑé§áµ‹ 2 ÍÒ¡ÒÃ¢Öé¹ä» ¹Ò¹ 1 à´×Í¹ 1. ÍÒ¡ÒÃËÅ§¼Ô´ 2. ÍÒ¡ÒÃ»ÃÐÊÒ·ËÅÍ¹ 3. ¾Ù´¨ÒÊÑºÊ¹ 4. ¾ÄµÔ¡ÃÃÁÊÑºÊ¹ 5. ÍÒ¡ÒÃ´ŒÒ¹Åº àª‹¹ ÊÕË¹ŒÒàÃÕÂºà©Â áÂ¡µÑÇ «ÖÁ äÁ‹¾Ù´ ËÁÒÂàËµØ áÁŒÁÕÍÒ¡ÒÃà´ÕÂÇ ¡ç¶×ÍÇ‹Òà¢ŒÒà¡³±� ËÒ¡à»š¹ÍÒ¡ÒÃËÅ§¼Ô´·Õè¼Ô´»¡µÔÁÕËÙáÇ‹ÇàÊÕÂ§ÊÑè§ãËŒ·ÓµÒÁ ËÃ×ÍÁÕàÊÕÂ§¤¹ÁÒ¾Ù´¤ØÂ¡Ñ¹ B. ÁÕ¤ÇÒÁàÊ×èÍÁ ËÃ×Í»˜ÞËÒã¹´ŒÒ¹¡ÒÃà¢ŒÒÊÑ§¤Á ¡ÒÃ·Ó§Ò¹ ÊÑÁ¾Ñ¹¸ÀÒ¾ ¡Ñº¼ÙŒÍ×è¹ ËÃ×ÍÊØ¢Í¹ÒÁÑÂ¢Í§µ¹àÍ§ C. ÁÕÍÒ¡ÒÃµ‹Íà¹×èÍ§¡Ñ¹¹Ò¹ 6 à´×Í¹¢Öé¹ä» â´ÂµŒÍ§ÁÕ active phase (µÒÁ¢ŒÍ A) ÍÂ‹Ò§¹ŒÍÂ 1 à´×Í¹ áÅÐÃÐÂÐ·ÕèàËÅ×ÍÍÒ¨à»š¹ prodomal ËÃ×Í residual phase

1. ¡ÒÃÃÑº¼ÙŒ»†ÇÂäÇŒÃÑ¡ÉÒã¹âÃ§¾ÂÒºÒÅ* W ¾ÄµÔ¡ÃÃÁà»š¹ÍÑ¹µÃÒÂµ‹Íµ¹àÍ§ ËÃ×Í¼ÙŒÍ×è¹ ¡‹Í¤ÇÒÁà´×Í¹ÃŒÍ¹ ÃÓ¤ÒÞá¡‹¼ÙŒÍ×è¹ W ÁÕ»˜ÞËÒÍ×è¹·ÕèµŒÍ§´ÙáÅã¡ÅŒªÔ´ àª‹¹ ÁÕÍÒ¡ÒÃ¢ŒÒ§à¤ÕÂ§¨Ò¡ÂÒÃØ¹áÃ§ W à¾×èÍ¤Çº¤ØÁàÃ×èÍ§ÂÒ ã¹¡Ã³Õ·Õè¼ÙŒ»†ÇÂäÁ‹ÂÍÁ¡Ô¹ÂÒ W ÁÕ»˜ÞËÒ¡ÒÃÇÔ¹Ô¨©ÑÂ 2. ¡ÒÃÃÑ¡ÉÒ´ŒÇÂÂÒ (àÅ×Í¡µÑÇã´µÑÇË¹Öè§) Haloperidal 5-20 mg/day Perphenazine 8-64 mg/day Chlopromazine 200-600 mg/day Clozapine 25-400 mg/day ã¹¡Ã³Õ¡Ô¹ÂÒäÁ‹µ‹Íà¹×èÍ§ ¤ÇÃà¾ÔèÁ long acting antipsychotic W Fluphenazine decanoate 25-150 mg IM ·Ø¡ 4 ÊÑ»´ÒË� Ã‹ÇÁ¡Ñº Benzhexol 6-20 mg/day

»ÃÑºà¾ÔèÁ¢¹Ò´ÂÒ¨¹ÍÒ¡ÒÃ·Ò§¨ÔµÊ§º ãËŒÂÒ¢¹Ò´à´ÔÁä»¹Ò¹ 6 à´×Í¹ àÁ×èÍäÁ‹ÁÕÍÒ¡ÒÃ´ŒÒ¹ºÇ¡ªÑ à¨¹áÅŒÇ Å´¢¹Ò´ÂÒÅ§ÃŒÍÂÅÐ 20 ·Ø¡ 4-6 à´×Í¹ ¨¹¶Ö§¢¹Ò´µèÓÊØ´·ÕèÊÒÁÒÃ¶¤ØÁÍÒ¡ÒÃä´Œ *¡ÒÃÃÑºäÇŒÃÑ¡ÉÒ·ÕèâÃ§¾ÂÒºÒÅ¨ÔµàÇª ¢Öé¹ÍÂÙ‹¡Ñº´ØÅ¾Ô¹Ô¨¢Í§¨Ôµá¾·Â�

Schizophrenia


Alcohol withdrawal delirium

Alcohol withdrawal delirium

อาการเพอ จากการขาดสรา


A. ÁÕ¡ÒÃËÂØ´ (ËÃ×ÍÅ´¡ÒÃ´×èÁ) áÍÅ¡ÍÎÍÅ� ËÅÑ§¨Ò¡ãªŒÍÂ‹Ò§ÁÒ¡áÅÐ à»š¹àÇÅÒ¹Ò¹ B. ÁÕÍÒ¡ÒÃµ‹Íä»¹Õé 2 ¢ŒÍ ËÃ×ÍÁÒ¡¡Ç‹Ò à¡Ô´¢Öé¹ã¹äÁ‹¡ÕèªÑèÇâÁ§¶Ö§ÊÍ§ÊÒÁÇÑ¹ ËÅÑ§¨Ò¡à¡³±�ã¹¢ŒÍ 1 1. ÃÐºº»ÃÐÊÒ·ÍÑµâ¹ÁÑµÔ·Ó§Ò¹ÁÒ¡¡Ç‹Ò»¡µÔ (àª‹¹àË§×èÍÍÍ¡ ªÕ¾¨ÃàÃçÇ ¡Ç‹Ò 100 ¤ÃÑé§/¹Ò·Õ) 2. Á×ÍÊÑè¹ÁÒ¡¢Öé¹ 3. ¹Í¹äÁ‹ËÅÑº 4. ¤Å×è¹äÊŒ ËÃ×ÍÍÒà¨ÕÂ¹ 5. àËç¹ÀÒ¾ËÅÍ¹ ËÙáÇ‹Ç ÊÑÁ¼ÑÊËÅÍ¹ ËÃ×ÍÁÍ§àËç¹ÀÒ¾ÊÔè§¢Í§¼Ô´¨Ò¡ ¤ÇÒÁà»š¹¨ÃÔ§ªÑèÇ¤ÃÒÇ 6. ¡ÃÐÇ¹¡ÃÐÇÒÂ ¡ÃÐÊÑº¡ÃÐÊ‹ÒÂ 7. ÇÔµ¡¡Ñ§ÇÅ 8. ªÑ¡·Ñé§µÑÇ (grandmal seizure) C. ÍÒ¡ÒÃµÒÁà¡³±� 2 ¡‹ÍãËŒà¡Ô´¤ÇÒÁ·Ø¡¢�·ÃÁÒ¹ ÍÂ‹Ò§ÁÕ¤ÇÒÁÊÓ¤ÑÞ·Ò§¡ÒÃ á¾·Â� ËÃ×Í¡Ô¨¡ÃÃÁ´ŒÒ¹ÊÑ§¤Á ¡ÒÃ§Ò¹ ËÃ×Í´ŒÒ¹Í×è¹ æ ·ÕèÊÓ¤ÑÞº¡¾Ã‹Í§Å§ D. ÍÒ¡ÒÃäÁ‹ä´Œà¡Ô´¨Ò¡ÀÒÇÐ¤ÇÒÁà¨çº»†ÇÂ·Ò§¡ÒÂ áÅÐäÁ‹à¢ŒÒ¡ÑºâÃ¤·Ò§¨ÔµàÇª Í×è¹ä´Œ´Õ¡Ç‹Ò

¡ÒÃµÃÇ¨»ÃÐàÁÔ¹ Ê‹§µÃÇ¨ËŒÍ§»¯ÔºÑµÔ¡ÒÃä´Œá¡‹ CBC, BUN, Cr, Electrolyte, Blood sugar, Liver function test, áÅÐÍ×è¹ æ µÒÁ¤ÇÒÁàËÁÒÐÊÁ ¡ÒÃÃÑ¡ÉÒ·ÑèÇä» W monitor Vital sings, Neuropsychiatric symptoms W Frequent Reassure, Reorientation W Decrease Stimulation (Å´¡ÒÃ¡ÃÐµØŒ¹¼ÙŒ»†ÇÂ) W Correct Fluid status, electrolyte imbalance and treat coexisting medical problem (àª‹¹ infection, head trauma) ¡ÒÃÃÑ¡ÉÒà©¾ÒÐ W Diazepam 40-100 mg/day ËÃ×Í Lorazepam 8-20 mg/day W Thiamine 100 mg 1x3 pc ËÃ×Í B1-6-12 1x3 pc W Thiamine 100 mg IM OD x 3 ÇÑ¹ W Folic acid 1x1 pc Å´ÂÒ Benzodiazepine 20-30% ·Ø¡ 3-7 ÇÑ¹ ¤ÇÃÅ´ÂÒËÁ´ã¹ 2 ÊÑ»´ÒË�


Extra pyramidal symptom

Extra pyramidal symptom

จากยาดานโรคจต

ÍÒ¡ÒÃ ¡ÒÃÃÑ¡ÉÒ

1. Acute Dystonia ¡ÅŒÒÁà¹×éÍµÒáÅÐÅÓ¤Í ÁÕÍÒ¡ÒÃºÔ´à¡Ãç§

2. Parkinsonism µÑÇá¢ç§ Á×ÍÊÑè¹ ¹éÓÅÒÂäËÅÁÒ¡, ¡Å×¹ÅÓºÒ¡

3. Akathisia ¡ÃÐÇ¹¡ÃÐÇÒÂ ¹Ñè§äÁ‹µÔ´·Õè ¢ÂÑº¢Òä»ÁÒ à´Ô¹ä»ÁÒ

4. Neuroleptic malignant syndrome ¡ÅŒÒÁà¹×éÍá¢ç§à¡Ãç§ ä¢ŒÊÙ§

à´Ô¹à« Conscious Å´Å§ ¼ÅµÃÇ¨·Ò§»¯ÔºÑµÔ¡ÒÃ CPK

ÊÙ§ > 3,000

W Bonztropine Mesylate (cogentin) 2 mg IM.

ËÃ×Í Diazepam 5-10 mg IV W Benzhexol 6-20 mg/day ÃÑº»ÃÐ·Ò¹µ‹Íä»

W Benzhexol 6-50 mg/day

W Å´¢¹Ò´ÂÒ´ŒÒ¹âÃ¤¨Ôµ W Propranolol 20-120 mg/day ËÃ×Í Diazepm 6-20 mg/day

ËÁÒÂàËµØ ÅÍ§Å´ÂÒ Propranolol /Diazepm ËÅÑ§ÍÒ¡ÒÃ´Õ¢Öé¹

4-8 ÊÑ»´ÒË�

W ËÂØ´ÂÒµŒÒ¹âÃ¤¨Ôµ·Ñ¹·Õ W ãËŒ Fluid replacement ãËŒà¾ÕÂ§¾Í W ãËŒÂÒÃÑ¡ÉÒµÒÁÍÒ¡ÒÃ W Bromocriptine 2.5 mg. 1x4 pc.


Organic Psychosis

»ÃÐÇÑµÔ ¡ÒÃµÃÇ¨Ã‹Ò§¡ÒÂ ¡ÒÃÃÑ¡ÉÒ

W ÍÒ¡ÒÃàÃÔèÁµŒ¹ÍÂ‹Ò§à©ÕÂº¾ÅÑ¹ W ÁÕ»ÃÐÇÑµÔâÃ¤·Ò§¡ÒÂÁÒ¹Ò¹ ËÃ×ÍàÃÔèÁ»†ÇÂ ·Ò§¡ÒÂ ¹ÓÁÒ¡‹Í¹ àª‹¹ ÁÕä¢Œ »Ç´ÈÕÃÉÐ ÁÕ¡ÒÃãªŒÂÒÃÑ¡ÉÒâÃ¤ºÒ§ÍÂ‹Ò§»ÃÐ¨Ó W µÔ´ÊÒÃàÊ¾µÔ´ W à¤ÂºÒ´à¨çº·Ò§ÊÁÍ§ W ÍÒ¡ÒÃà»ÅÕèÂ¹á»Å§ã¹áµ‹ÅÐª‹Ç§¢Í§ÇÑ¹ ÁÑ¡ÁÕ ÍÒ¡ÒÃÁÒ¡µÍ¹¡ÅÒ§¤×¹ W ÁÕÍÒ¡ÒÃà¨çº»†ÇÂ·Ò§¡ÒÂ àª‹¹ »Ç´ÈÕÃÉÐÃØ¹áÃ§ àËç¹ÀÒÂ«ŒÍ¹

W Vital signs àª‹¹ ÁÕä¢Œ ªÕ¾¨ÃàÃçÇ ¤ÇÒÁ´Ñ¹âÅËÔµÊÙ§ W ÁÕ¤ÇÒÁ¼Ô´»¡µÔã¹Ã‹Ò§¡ÒÂ ÃÐººÍ×è¹ æ â´Â à©¾ÒÐ·Ò§ÃÐºº»ÃÐÊÒ·

¡ÒÃµÃÇ¨ÊÀÒ¾¨Ôµ W ÁÕ¡ÒÃà»ÅÕèÂ¹á»Å§ÃÐ´Ñº¤ÇÒÁÃÙŒÊÖ¡µÑÇã¹àÇÅÒ µ‹Ò§ æ ¢Í§ÇÑ¹ W ÊÑºÊ¹ àÃ×èÍ§ àÇÅÒ Ê¶Ò¹·Õè W ÊÙÞàÊÕÂ¤ÇÒÁ¨Óâ´Âà©¾ÒÐ¤ÇÒÁ¨ÓÃÐÂÐÊÑé¹ W ÁÕ»ÃÐÊÒ·ËÅÍ¹·Ò§¡ÒÃÁÍ§àËç¹ ¡ÅÔè¹ ÃÊ ÊÑÁ¼ÑÊËÃ×ÍÊÔè§¡ÒÃá»ÅÊÔè§àÃŒÒ ¼Ô ¨Ò¡¤ÇÒÁà»š¹¨ÃÔ§ W ÍÒÃÁ³�à»ÅÕèÂ¹á»Å§§‹ÒÂ W àªÒÇ�»˜ÞÞÒº¡¾Ã‹Í§ä»¨Ò¡à´ÔÁ àª‹¹ ÇØ²Ô»ÃÔÞÞÒµÃÕ áµ‹äÁ‹ÊÒÁÒÃ¶µÍº 100-7 ä´Œ¶Ù¡µŒÍ§

¡ÒÃµÃÇ¨¾ÔàÈÉÍ×è¹ W ¡ÒÃµÃÇ¨·Ò§ËŒÍ§»¯ÔºÑµÔ¡ÒÃ W ·´ÊÍº´Ù¡ÒÃ·Ó§Ò¹·Ò§ÊÁÍ§ â´ÂãËŒ¼ÙŒ»†ÇÂ ÇÒ´ÃÙ»¹ÒÌ�¡Ò

1. ÃÑ¡ÉÒÊÒàËµØ¢Í§ Organic Psychosis ¹Ñé¹ æ â´ÂµÃ§ 2. ¡ÒÃ¤Çº¤ØÁÍÒ¡ÒÃâÃ¤¨Ôµ´ŒÇÂÂÒ (1) Haloderidol 2.5 - 5 mg IM ä´Œ·Ø¡ 30 ¹Ò·Õ (2) ¶ŒÒà»š¹ alcohol withdrawal delirium ÃÑ¡ÉÒµÒÁâÃ¤ 3. ¡ÒÃÃÑ¡ÉÒ·Ò§¨Ôµã¨ W ¤ÇÃÍ¸ÔºÒÂãËŒ¼ÙŒ»†ÇÂáÅÐÞÒµÔà¢ŒÒã¨´ŒÇÂ¤Ó·Õè ÊÑé¹ æ à¢ŒÒã¨§‹ÒÂ W ¨Ñ´àµÕÂ§¼ÙŒ»†ÇÂãËŒÍÂÙ‹ã¹·ÕèÊÇ‹Ò§¾ÍÊÁ¤ÇÃ ÁÕ ¹ÒÌ�¡ÒËÃ×Í»¯Ô·Ô¹ äÁ‹ÁÕàÊÕÂ§Ãº¡Ç¹ ãËŒÞÒµÔ ËÃ×Í¤¹¤ØŒ¹à¤Â¤ÍÂ´ÙáÅáÅÐ¡‹Í¹µÃÇ¨ÃÑ¡ÉÒ ·Ø¡¤ÃÑé§ ¤ÇÃÍ¸ÔºÒÂãËŒ¼ÙŒ»†ÇÂà¢ŒÒã¨ Organic

Psychosis


ผปวยกาวราวรนแรง Violent Patient

ÅÑ¡É³Ð¾ÄµÔ¡ÃÃÁ·Õèº‹§ºÍ¡ ¼ÙŒ»†ÇÂÍÒ¨áÊ´§ÍÒ¡ÒÃ¡ŒÒÇÃŒÒÇÃØ¹áÃ§

¡ÒÃª‹ÇÂàËÅ×Í ¡ÒÃª‹ÇÂàËÅ×Í (µ‹Í)

1. ·‹Ò·Ò§µÖ§à¤ÃÕÂ´ µÑÇà¡Ãç§ ¡ÓËÁÑ´ËÃ×Í¨Ñº ¾¹Ñ¡à¡ŒÒÍÕéá¹‹¹ äÁ‹¼‹Í¹¤ÅÒÂ 2. ¤Ó¾Ù´ÃØ¹áÃ§ àÊÕÂ§´Ñ§ áÊ´§¤ÇÒÁ©Ø¹à©ÕÂÇ ËÂÒº¤ÒÂ 3. ÁÕ¡ÒÃà¤Å×èÍ¹äËÇ à´Ô¹ä»ÁÒµÅÍ´àËÁ×Í¹ ÇÔµ¡¡Ñ§ÇÅÁÒ¡ ¡ÃÐÇ¹¡ÃÐÇÒÂ 4. ·‹Ò·Ò§ËÇÒ´¡ÅÑÇ ¾ÃŒÍÁ·Õè¡ÃÐ·Ó ¡ÒÃÃØ¹áÃ§ à¾×èÍ¨Ð»‡Í§¡Ñ¹µÑÇàÍ§ 5. à¤ÂÁÕ»ÃÐÇÑµÔ·Ó¡ÒÃÃØ¹áÃ§ÁÒ¡‹Í¹ ËÃ×Íà¤Â ¶Ù¡·ÓÃŒÒÂ·ÒÃØ³ ËÃ×ÍÁÕªÕÇÔµ·Õè¢Á¢×è¹ ¤Ñºá¤Œ¹ 6. ¼ÙŒ»†ÇÂÍÒ¨ÁÒ¾ºá¾·Â� áÅÐºÍ¡á¾·Â�àÍ§ Ç‹Ò ¡ÅÑÇ¨Ð¤Çº¤ØÁµÑÇàÍ§äÁ‹ä´Œ

1. àÁ×èÍÊÑ§à¡µàËç¹ÅÑ¡É³Ð¾ÄµÔ¡ÃÃÁ·ÕèáÊ´§ÍÒ¡ÒÃ ¡ŒÒÇÃŒÒÇÃØ¹áÃ§ ¤ÇÃãËŒ¡ÒÃª‹ÇÂàËÅ×Í·Ñ¹·Õ äÁ‹»Å‹ÍÂ ãËŒÃÍµÃÇ¨¹Ò¹ àËÁ×Í¹¼ÙŒ»†ÇÂ·ÑèÇä» äÁ‹¤ÇÃ¾Ù´¢‹Á¢Ù‹ ·ŒÒ·ÒÂËÃ×ÍáÊ´§Ç‹Ò·‹Ò·ÕäÁ‹Ê¹ã¨ 2. ãËŒ¼ÙŒ·ÕèäÁ‹à¡ÕèÂÇ¢ŒÍ§ÍÍ¡¨Ò¡ËŒÍ§µÃÇ¨ãËŒËÁ´ ÍÂ‹ÒÂ×¹ ËÃ×Í »�´¡Ñé¹·Ò§ÍÍ¡¢Í§¼ÙŒ»†ÇÂ 3. àµÃÕÂÁ¾ÃŒÍÁ·Õè¨Ð¤Çº¤ØÁ¼ÙŒ»†ÇÂâ´ÂÁÕà¨ŒÒË¹ŒÒ·ÕèÃÑ¡ÉÒ ¤ÇÒÁ»ÅÍ´ÀÑÂ 3-4 ¤¹ ÃÍ¹Í¡ËŒÍ§ ¼ÙŒ»†ÇÂÁÍ§àËç¹ ä´ŒÇ‹ÒÁÕ¤¹·Õè¨ÐËÂØ´ÃÑé§à¢Òä´Œá¹‹¹Í¹ ¶ŒÒà¢ÒÁÕ ¾ÄµÔ¡ÃÃÁÃØ¹áÃ§ ËÒ¡¼ÙŒ»†ÇÂÁÕÍÒÇØ¸ËÃ×ÍÊ§ÊÑÂÇ‹ÒÁÕ ÍÒÇØ¸¤ÇÃµÃÇ¨ËÒáÅÐ»Å´ÍÒÇØ¸¡‹Í¹ 4. áÊ´§·‹Ò·Õ·Õèà»š¹ÁÔµÃµ‹Í¼ÙŒ»†ÇÂãËŒ¼ÙŒ»†ÇÂÁÕâÍ¡ÒÊ¾Ù´ ÃÐºÒÂ¤ÇÒÁÃÙŒÊÖ¡äÁ‹áÊ´§·‹Ò·Ò§·ŒÒ·ÒÂ ËÃ×Í¢‹Á¢Ù‹ ¤ÇÃÂ×¹Ë‹Ò§¨Ò¡¼ÙŒ»†ÇÂÍÂ‹Ò§¹ŒÍÂ 2-3 àÁµÃ µŒÍ§ ÃÑº¿˜§áÅÐà¢ŒÒã¨¼ÙŒ»†ÇÂ ¾Ù´¡Ñ¹ÍÂ‹Ò§µÃ§ä»µÃ§ÁÒÇ‹Ò àÃÒÍÂÒ¡ª‹ÇÂàËÅ×Íà¢Ò ¡ÒÃáÊ´§·‹Ò·Ò§µ×è¹¡ÅÑÇµ‹Í ¼ÙŒ»†ÇÂÂÔè§·ÓãËŒ¼ÙŒ»†ÇÂÃÙŒÊÖ¡äÁ‹ÁÑè¹¤§ÁÒ¡¢Öé¹ 5. µÍºÃÑº¢ŒÍàÃÕÂ¡ÃŒÍ§¢Í§¼ÙŒ»†ÇÂ àª‹¹ ¢ÍÂÒ ËÃ×Í¢Í ÍÂÙ‹âÃ§¾ÂÒºÒÅËÃ×ÍÍÒ¨àÊ¹ÍãËŒÂÒ·Õè¨Ð·ÓãËŒ¼ÙŒ»†ÇÂ ÃÙŒÊÖ¡ÊºÒÂ¢Öé¹

6. ¤ÇÃãËŒÁÕÞÒµÔ·Õè¼ÙŒ»†ÇÂ¤ØŒ¹à¤ÂÇÒ§ã¨ÁÒ¾Ù´ªÑ¡¹ÓãËŒ ÃÑº¡ÒÃÃÑ¡ÉÒ´ŒÇÂ 7. ãËŒÂÒ¤Çº¤ØÁÍÒ¡ÒÃä´Œ àËÁ×Í¹ã¹¼ÙŒ»†ÇÂâÃ¤¨Ôµ à©ÕÂº¾ÅÑ¹ 8. ¡ÒÃ¼Ù¡ÃÑ´¼ÙŒ»†ÇÂÍÒ¨¨Óà»š¹ã¹ºÒ§ÃÒÂ ¤ÇÃãªŒ ÊÒÂË¹Ñ§ËÃ×Í ¼ŒÒ¼×¹ãËÞ‹ÃÑ´á·¹àª×Í¡àÊŒ¹àÅç¡ æ ¤ÇÃá¡Œ¡ÒÃ¼Ù¡ÃÑ´·Ñ¹·Õ ·ÕèàËç¹Ç‹Ò¼ÙŒ»†ÇÂäÁ‹à»š¹ÍÑ¹µÃÒÂ µ‹Í¼ÙŒÍ×è¹áÅŒÇ ¡ÒÃÃÑ¡ÉÒ´ŒÒ¹ÂÒ 1. Haloperidol 5 -10 mg IM «éÓä´Œ·Ø¡ 30 ¹Ò·Õ ÍÒ¨Ã‹ÇÁ¡Ñº Diazepam 10 mg IV µÃÇ¨ ÊÑÞÞÒ³ªÕ¾¨Ã·Ø¡ 15 ¹Ò·Õ áÅÐ´ÙáÅã¡ÅŒªÔ´

Violent Patient


ยาทางจตทควรมไวในโรงพยาบาลชมชน

1. Antipsychotic 2. Hypnotics 3. Antidepressants 4. Mood Stabilizers 5. Anticholinergic

Drug

Chlorpromazine 100 mg.

Clozapine 25 mg.

Clozapine 100 mg.

Haloperidol 2 mg.

Haloperidol 5 mg.

Perphenazine 4 mg.

Perphenazine 8 mg.

Fluphenazine decanoate 50 mg./Amp

Haloperidol injection 5 mg./Amp

Diazepam 2 mg.

Diazepam 5 mg.

Dipotassium chlorazepate 5 mg.

Lorazepam 0.5 mg.

Clonazepam 1 mg.

Diazepam 10 mg./Amp

Amitriptyline 10 mg.

Amitriptyline 25 mg.

Fluoxetine 20 mg.

Nortriptyline 25 mg.

Lithium Carbonate 300 mg.

Sodium valproate 500 mg.

(Extended Release)

Sodium Valproate 200 mg.

Benzhexol 2 mg. ËÃ×Í 5 mg.

ÂÒ

โทร. 074-311319, 074-442477-8, 074-324868-9โรงพยาบาลจตเวชสงขลาราชนครนทรSongkhla Rajanagarindra Psychiatric Hospital โทร. 074-311319, 074-442477-8, 074-324868-9โรงพยาบาลจตเวชสงขลาราชนครนทรSongkhla Rajanagarindra Psychiatric Hospital

Refer case

¢Ñé¹µÍ¹¡ÒÃ»¯ÔºÑµÔ ¼ÙŒÃÑº¼Ô´ªÍº

Tel »ÃÐÊÒ¹¨Ôµá¾·Â� Ã¾¨.Ê§¢ÅÒÏ074-324868-9,311319,442477-8, 325037 µ‹Í 404 (Ë¹ŒÒËŒÍ§µÃÇ¨ã¹àÇÅÒÃÒª¡ÒÃ) ¹Í¡àÇÅÒÃÒª¡ÒÃÃÐººâÍ¹â´ÂÍÑµâ¹ÁÑµÔ

¨Ôµá¾·Â�µÍºÃÑº Refer/ãËŒ¤Ó»ÃÖ¡ÉÒá¡‹á¾·Â�âÃ§¾ÂÒºÒÅà¤Ã×Í¢‹ÒÂÏ

à¢ŒÒª‹Í§·Ò§´‹Ç¹à¾×èÍ¾º¨Ôµá¾·Â�

µÃÇ¨ÃÑ¡ÉÒâ´Â¨Ôµá¾·Â�

»¯ÔºÑµÔµÒÁ¢Ñé¹µÍ¹¡ÒÃ Admit

ÃÑºÃÑ¡ÉÒäÇŒã¹ Ã¾.

Ã¾.à¤Ã×Í¢‹ÒÂÏ

¾ÂÒºÒÅ OPD/¾ÂÒºÒÅµÃÇ¨¡ÒÃ

¨Ôµá¾·Â� Ã¾¨.Ê§¢ÅÒÏ á¾·Â�âÃ§¾ÂÒºÒÅà¤Ã×Í¢‹ÒÂÏ

Ã¾.à¤Ã×Í¢‹ÒÂ/ÞÒµÔ/¾ÂÒºÒÅ OPD

¾ÂÒºÒÅ OPD/àÇªÃÐàºÕÂ¹/¹Ñ¡ÊÑ§¤ÁÊ§à¤ÃÒÐË�

NO admit

admit

Flow Chart ระบบรบ Refer case จตเวชฉกเฉนจากโรงพยาบาลเครอขายฯ

¾ÂÒºÒÅÃÑº Tel. à¾×èÍ»ÃÐÊÒ¹§Ò¹¨Ôµá¾·Â�

Ã¾.à¤Ã×Í¢‹ÒÂÏ/ÞÒµÔ ¹Ó¼ÙŒ»†ÇÂ·ÓºÑµÃ/¤Ñ´¡ÃÍ§

¨Ôµá¾·Â�

á¾·Â� / ¾ÂÒºÒÅ»ÃÐ¨ÓËÍ¼ÙŒ»†ÇÂ

¾ÂÒºÒÅ OPD/àÇªÃÐàºÕÂ¹/¹Ñ¡ÊÑ§¤ÁÊ§à¤ÃÒÐË�

- ãËŒ Treatment- ãËŒ¤Ó»ÃÖ¡ÉÒ- ãËŒÂÒ¡ÅÑººŒÒ¹- Refer µ‹Í Ã¾.½†ÒÂ¡ÒÂ


Flow Chart ระบบรบ Refer case ผปวยจากโรงพยาบาลจตเวชฯ

ไปโรงพยาบาลเครอขายฯ

Refer case

¼ÙŒÃÑº¼Ô´ªÍº

«Ñ¡»ÃÐÇÑµÔ/¤Ñ´¡ÃÍ§¡Ã³Õ¼ÙŒ»†ÇÂ/ÞÒµÔµŒÍ§¡ÒÃÃÑºÂÒã¡ÅŒºŒÒ¹

ãËŒà¢ÕÂ¹ãº¤ÓÃŒÍ§¢Í»ÃÐÇÑµÔ

¾º¨Ôµá¾·Â�»ÃÐàÁÔ¹ÍÒ¡ÒÃ·Ò§¨Ôµ

ÊÃØ»»ÃÐÇÑµÔ¡ÒÃÃÑ¡ÉÒµÒÁáºº¿ÍÃ�Á

ÁÍº»ÃÐÇÑµÔãËŒÞÒµÔ¹Óä» Ã¾.à¤Ã×Í¢‹ÒÂà¾×èÍä»ÃÑººÃÔ¡ÒÃã¡ÅŒºŒÒ¹

Created by : Agift 081-6095492

àÇªÃÐàºÕÂ¹

¾ÂÒºÒÅ OPD

¨Ôµá¾·Â�

¨Ôµá¾·Â�/¾ÂÒºÒÅ OPD

¾ÂÒºÒÅ OPD áÅÐÞÒµÔ

¼ÙŒ»†ÇÂ/ÞÒµÔ ÁÒÃÑººÃÔ¡ÒÃ Ã¾¨.Ê§¢ÅÒÏ

¢Ñé¹µÍ¹¡ÒÃ»¯ÔºÑµÔ

Documents

แนวทางการดูแลผู้ป่วยจิตเวชในโรงพยาบาลชุมชน (รพ.จิตเวชสงขลาราชนครินทร์)