重视双心医学原创研究

心血管病患者的心理问题远高于普通人群,以抑郁、焦虑、躯体化等尤为常见,但国内外普遍存在高漏诊、低干预,且因机制不清,对于心血管疾病所伴发的抑郁目前尚无真正有效的治疗措施。由于不同种族和文化赋予了心理的特殊性,所以,我们需要重视基于国人的心血管疾病和心理疾患(双心)的原创研究,从而更科学地解决双心问题,加速双心医学(psychocardiology)的发展。     

反复胸闷胸痛伴心理精神障碍的诊疗进展

近年来,临床中关于反复胸闷胸痛患者的较高误诊率引起了广大医务工作者的重视,此类患者伴有的心理精神障碍往往被忽视,得不到合理的治疗,预后较差.本文主要讨论关于反复胸闷胸痛患者病因的鉴别、心理精神障碍引起胸闷胸痛的机制、胸闷胸痛与心理精神障碍的关系、“双心”医学诊疗模式以及反复胸闷胸痛的治疗进展,通过增强临床医生对“双心”医学的认识降低胸闷胸痛患者的误诊率、漏诊率,减少过度治疗,通过心血管医学和心理干预联合治疗,改善心血管疾病患者的预后、降低死亡率.     

导言：情感障碍对心血管疾病的影响不容忽视

随着我国人民生活水平的不断提高,心血管疾病发病人数,尤其是冠心病及高血压病逐年增加,人们的健康意识也越来越强,就诊患者症状表现的多种多样。心血管疾病中常伴有的社会及心理因素使心血管疾病的诊断与治疗更加复杂和多样化。20世纪80年代及21世纪初以来,心血管疾病的治疗手段也越来越多。在基本药物治疗的基础上,心血管疾病的介入治疗及外科手术治疗的病例数也迅速增加,并取得了良好的临床效果,改善了患者的预后,提高了患者的生活质量。但越来越多的心血管病患者同时患有心理障碍,两种疾病互为因果,互相影响,导致疾病恶化。二者共病率高,已成为严重的健康问题之一,并形成了一门新兴的学科即心理心脏病学（psychocardiology）或称双心医学。     

抑郁和焦虑与心血管疾病

抑郁焦虑与心血管疾病的关系最能体现身与心两者相互影响、不可分割的特点。但临床上,心血管疾病患者抑郁焦虑的诊疗率不足1％。这说明现有的诊疗理念和方式没有将心血管疾病和精神障碍联系起来,给患者全面全程的干预和管理。这样的缺陷不仅增加患者的痛苦和功能障碍,也增加心血管疾病的发病率和病死率,还增加患者及社会的医疗负担。本文结合临床经验,从心身一体的诊疗理念,谈谈抑郁焦虑与心血管疾病。     

老年人合并冠心病的血压控制

高血压病和冠心病是与年龄密切相关的心血管疾病.老年人(包括年龄在80岁以上的)同时存在此两种疾病的情况正在逐渐增加.流行病学研究已经证明,高血压和冠心病有密切的联系.老年高血压患者药物的选择仍有一定的争议,而在合并冠心病时合理治疗的临床研究也不多.本文根据目前循证医学资料提出了可用于老年高血压合并冠心病患者合适的降压策略和冠心病的药物治疗.     

PCI术前术后的心理障碍识别与处理

概述冠心病经皮冠状动脉介入治疗（PCI）术前术后患者合并心理障碍的较高发生率以及心理障碍对冠心病发生、发展及预后的影响,分析 PCI 术前术后患者出现焦虑抑郁等心理障碍的原因、产生机制及影响因素,强调心内科医生应及时识别 PCI 术前术后患者出现的心理障碍,并以“双心医学”方式对其进行心理精神医学及心血管专科医学治疗,同时对心血管专科医学治疗效果不明显的冠心病 PCI 患者,进行相关的鉴别诊断后也要进行心理精神医学的诊断和治疗,以便有利于 PCI 术患者的康复和预后,减少不必要的检查和治疗。     

用科学的证据和科学的管理指引心血管疾病的防治

心血管疾病的防治不仅仅是心血管医生的问题,还是一个在循证医学引领下的一个全民生活方式改变的问题,也需要多学科相关专业的联盟,涉及心血管疾病治疗规范的形成与普及,对于疾病发生、发展各个阶段的科学管理更是冠心病的防治效果的重要保障.本文针对心血管病冠心病预防的具体实施,从几方面打开了一个全新的视野.     

浅谈心血管疾病预防的重要性和可操作性

心血管疾病是人类死亡的主要病因,其危险因素包括吸烟、血脂异常、糖尿病、高血压、肥胖等.目前我国医务工作者限于治疗疾病,忽视疾病预防,这种模式过于被动,需要高昂的医疗支出.如果不做好心血管疾病的预防工作,将会极大影响国民经济增长.因此改善生活方式、预防心血管疾病发生,形成疾病预防模式就显得尤为重要,并具有可操作性.     

幽门螺杆菌感染与胃肠外疾病的关系

流行病学研究显示幽门螺杆菌可能与某些胃肠外疾病发生有关,根除治疗可能缓解缺铁性贫血、ITP、酒糟鼻等疾病的临床症状和实验室异常.从粥样硬化相关心血管疾病、血液系统疾病、皮肤病的研究结果看,尽管有证据显示该类疾病患者幽门螺杆菌感染率高于普通人群,但二者是因果还是伴随现象仍不得而知,同时尚无根除治疗远期效果的报道.对相关胃肠外疾病是否需要进行幽门螺杆菌检测和治疗尚无定论.鉴于流行病学研究的局限性和发病机制的不确定性,对二者关系应持慎重态度,避免对幽门螺杆菌检测和根除治疗的过度滥用.二者关系的阐明有待机制研究的进展.     

普通高中心理健康教育的家-校-医联动模式探索——以上海市青浦区第二中学为例

<正>《中国国民心理健康发展报告（2019-2020）》显示：2020年中国青少年的抑郁检出率为24.6%，其中轻度抑郁17.2%，重度抑郁为7.4%。面对频发的心理问题、心理障碍，尤其是精神类疾病，学生和家长通常会存在“病耻感”，不愿主动配合治疗，对心理诊疗、心理辅导不理解，产生抵触与反感情绪，使得心理工作较为被动。部分被医生确诊需要治疗的家庭，对于心理治疗、     

Extremes of self-esteem and narcissism and the experience and expression of anger and aggression

This study examined the level of self-esteem and narcissism as personality variables involved in the disposition to experience and express anger. Three hundred thirty-eight subjects were sampled across two higher education centres and one student teaching programme in the United Kingdom. It was reasoned that individuals with both high self-esteem and narcissism would report especially high tendencies to experience and express anger and aggression and that those with high self-esteem and low narcissism would report the lowest. These predictions were influenced by theories that emphasise the role of threats to high self-esteem in the production of aggression and violence. Results indicate that groups defined by their extreme scores on self-esteem and narcissism scales produced levels of anger expression in the predicted direction. The importance of considering extreme levels of self-esteem and narcissism (in conjunction with other factors) in an analysis of anger is discussed with reference to currently influential theories in the field. Aggr. Behav. 24:421–438, 1998. © 1998 Wiley-Liss, Inc.     

Social and Personal Determinants of Adolescent Use and Abuse of Alcohol and Marijuana

This article summarizes research on social and personal determinants of adolescent use and abuse of alcohol and marijuana to aid practitioners when designing interventions.     

Cognitive and Personality Characteristics of Masculinity and Femininity Predict Wayfinding Competence and Strategies of Men and Women

Bem (1974) reconceptualized masculinity and femininity as independent and orthogonal constructs that both men and women possess to varying degrees. This perspective was used as a starting point to investigate whether the contributions of gender-typed characteristics can help to account for commonly observed gender differences in wayfinding (the ability to identify one’s current location and successfully navigate to an unseen location in the environment) favoring men. We further divided gender-typed characteristics into cognitive and personality characteristics to assess their separate influence on wayfinding and explored whether gender-typed characteristics predicted self-reported use of masculine wayfinding strategies (i.e., orientation strategies) and self-reported wayfinding competence. Participants were 452 college women and men in a southern U.S. public university. They completed the Gender-Stereotypic Characteristics questionnaire (Diekman and Eagly 2000), a social comparison questionnaire (created by the authors), a wayfinding strategy questionnaire (Lawton 1994), and a wayfinding competence questionnaire (Hegarty et al. 2002). For both men and women, higher masculine cognitive characteristics significantly correlated with greater use of orientation wayfinding strategies typical of men. For men, both higher masculine and feminine cognitive characteristics predicted better overall wayfinding competence whereas for women, only higher masculine cognitive characteristics predicted better overall wayfinding competence. For both men and women, higher feminine personality characteristics predicted poorer wayfinding competence. These results demonstrated the importance of considering cognitive and personality characteristics of masculinity and femininity in explaining individual differences in wayfinding.     

Face aftereffects suggest interdependent processing of expression and sex and of expression and race

Bruce and Young (1986) proposed that functionally different aspects of faces (e.g., sex, identity, and expression) are processed independently. Although interdependent processing of identity and expression and of identity and sex have been demonstrated previously, evidence for interdependent processing of sex and expression is equivocal. Using a visual adaptation paradigm, we show that expression aftereffects can be simultaneously induced in different directions along anger–fear continua for male and female faces (Experiment 1) and for East Asian and Black African faces (Experiment 2). These findings for sex- and race-contingent expression aftereffects suggest that processing of expression is interdependent with processing of sex and race and are therefore problematic for models of face perception that have emphasized independent processing of functionally different aspects of faces. By contrast, our findings are consistent with models of face processing that propose that invariant physical aspects of faces and changeable social cues can be processed interdependently.