对心理障碍心因的辩证思考

在分析心理障碍的原因时 ,我们不仅要考虑心理动力学模式、行为主义模式、认知心理学模式、人际关系模式等心因模式所提及的致病源 ,而且也应该注意确定病因变化及因果关系的方法。1　因素维度分析生物心理社会医学模式认为疾病的发生、发展与转归都与生物因素、心理因素和社会文化因素有关 ,但对具体的某一障碍来说 ,三者所起的作用和交互作用的方式不同。相对心理障碍而言 ,生物因素主要是指遗传和脑器质性因素 ,而社会文化因素主要是指社会文化情境中的压力和应激。心理社会因素是上述模式所提及的致病源。由于存在多种不同病因 ,我们确…     

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。     

心血管疾病患者心理评估及干预措施

本文概述了常见心血管疾病的患者合并心理障碍的发生率、发病机理以及心理障碍对心血管疾病发生、发展及预后的影响,分析了心血管疾病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心血管疾病患者出现心理障碍的重要性,探讨对心血管专科治疗效果不明显的心血管疾病患者合并心理障碍的鉴别诊断,并以"双心医学"方式对其进行心理干预及药物治疗,减少不必要的检查和治疗,以便有利于心血管疾病患者的康复和预后。     

儒家文化与中国人健康心理的交互建构

中国传统文化的主体是儒家文化,文化与健康心理之间存在着相互作用、相互建构的关系。儒家文化与中国人的健康心理的交互建构作用主要表现在三个方面:一是心理问题躯体化,即文化心理与躯体症状的交互建构; 二是心理问题道德化,即文化心理与德行标准的交互建构; 三是心理问题生活化,即健康心理与伦理规范的交互建构。它们既是中国人健康心理与行为的典型表现特征,也是儒家文化与中国人的健康心理和行为交互建构的结果。心理健康、道德健康、伦理健康三者之间是一个相互作用、相互建构、协调发展的完整体系。中国心理健康服务要充分发挥心理健康理论的建构特性和行动特征,促进心理健康服务理论与实践协调发展。     

心内科处理心理障碍患者治疗方案的可行性分析

为了探讨在心内科治疗心理障碍患者的可行性,我们应用汉密尔顿量表评估400例到心内科就诊的患者,对诊断为焦虑或抑郁状态的患者分为两组(心内科干预组,心理科治疗组),随访半年,观察焦虑或抑郁状态的缓解情况.结果显示,本研究共入选符合心理障碍诊断者71例,占就诊人数的17.75%.到心理科治疗患者30例,在心内科门诊治疗患者41例,半年随访评估,治疗有效率分别为16.7%和79.4%(16.7%VS 79.4%,P<0.05).因此,在心内科门诊对就诊的心理障碍患者进行治疗,是一种可行的方案.     

心内科处理心理障碍患者治疗方案的可行性分析

为了探讨在心内科治疗心理障碍患者的可行性,我们应用汉密尔顿量表评估400例到心内科就诊的患者,对诊断为焦虑或抑郁状态的患者分为两组（心内科干预组,心理科治疗组）,随访半年,观察焦虑或抑郁状态的缓解情况。结果显示,本研究共入选符合心理障碍诊断者71例,占就诊人数的17．75％。到心理科治疗患者30例,在心内科门诊治疗患者41例,半年随访评估,治疗有效率分别为16．7％和79．4％（16．7％vs79．4％,P〈0．05）。因此,在心内科门诊对就诊的心理障碍患者进行治疗,是一种可行的方案。     

新时代青少年羞怯对同伴侵害的影响：依存型和独立型自我建构的作用

本研究的主要目的是考察羞怯对同伴侵害的影响及潜在机制。1036名青少年(52%是男孩; M = 12.97 岁, SD = .76)完成了自评问卷。结果发现：(1)羞怯显著地正向预测青少年的同伴侵害;(2)自我建构调节了这一关系,依存型自我建构对羞怯个体的同伴问题具有保护作用,而独立型自我建构具有破坏作用;(3)性别对这一关系的调节作用并不显著。这些发现强调了在羞怯的适应功能研究中考虑文化的个人层面因素的重要性。     

哲学视野下脑卒中后心理障碍的辩证康复

脑卒中后的心理障碍不但影响患者的心理健康,还严重阻碍整个康复治疗的进程。心理疗法作为一种重要的心理障碍康复手段,其有效性已得到相关临床研究的证实。但如何根据临床具体情况选择适宜的心理疗法加速患者功能的康复,提高其生活质量和日常生活活动能力,最终帮助患者重返家庭和社会一直是临床关注的热点。为了更好地提高对卒中患者心理障碍的认识和干预,本文试从哲学的角度出发,结合各期心理障碍的特点,对脑卒中后心理障碍的康复作一论述。     

儿童反应性依恋障碍：病源、诊断与干预

反应性依恋障碍是一种儿童社会心理障碍, 不仅存在于福利院儿童中, 还存在于一般家庭儿童中, 其病因可能与个体早期的依恋关系、基因遗传和认知加工能力有关。反应性依恋障碍的诊断依据主要有DSM-Ⅳ、DSM-5和RDC-PA, 标准评估包是其目前主要的评估工具, 但目前对反应性依恋障碍的干预还处于探索阶段。未来的研究可尝试在反应性依恋障碍的本土化研究, 诊断评估、脑神经机制及综合化治疗干预方面深入展开。     

绘画是人们最适宜的心灵表达方式--绘画在心理治疗中的应用及其作用机理

绘画作为一种心理治疗方法有其独特作用,不仅可以处理人们的情绪和心理创伤问题,而且可以使心理障碍患者的自我形象、自尊或自我概念、社交技能等得到提升,促进语言的发展与认知功能的改善.机理是,绘画是人们最适宜的心灵表达方式,它作为一种人类心理意象的主要表现形式,发展象征性的语言,能触及人所不知的心灵感受,并能创造性地将它们整合到人格里,直至发生治疗性的变化.     

Cultural variations in the understanding and treatment of psychiatric disorders: India and England

Although much has been made of the nation of cultural specificity of mental illness, this paper argues that mental illness is a universal human experience. However, the types of disorders, the incidence and the severity of disorders may vary markedly across cultures. To understand mental illness and identify it across cultures, it is necessary to examine the problem against the backdrop of the dominant value systems which prevail in any culture at a given point in time. There are salient value systems to which most cultures subscribe, which in turn influence our understanding, diagnosis and treatment of mental illness and consequently the allocation of resources and the provision of care within the community. The different valueorientations between Western and Eastern cultures have a strong bearing on the problems of diagnosis and on the treatment of mental disorders, which in many instances are the outgrowth of the available resources and the acceptance of traditional arrangements unique to each culture.     

传统中国文化处理心理健康问题的三种思路

近年来 ,从中国文化的角度进行心理健康问题的研究越来越多 ,但是从文化整体的角度对这一问题的研究尚嫌不够。本文认为 ,虽然传统中国文化没有现代心理学意义上的心理健康的说法 ,但是由于人的存在的共同性 ,传统中国文化客观上具有处理心理健康问题的功能。这表现为三种思路 :信仰—养性的思路 ,养生—治身的思路 ,迷信—功利的思路。它们各自对心理健康有自己的见解和做法。文章分析了这三种思路的基本情况和特征 ,并进一步讨论了它们对当代心理健康研究的启发     

Child and adolescent development: common mental disorders according to age and gender

Despite the increase in the incidence and prevalence rates of children and adolescents' mental disorders, there are few works performed with large and representative samples of children and adolescents with psychopathological symptoms. The present work analyses 588 participants referred by first care pediatricians to a specialized unit for children and adolescents' mental health. As a result of the study, a statistically significant relation was found between age and diagnosis: a larger incidence of behavioral disorders, communication disorders, elimination disorders, pervasive developmental disorders, impulse-control disorders from 0 to 5 years; behavioral disorders and attention deficit hyperactivity disorder (ADHD) were more common from 6 to 11 years, behavioral and anxiety disorders were more likely at 12 to 15 years; and, lastly, behavioral disorders were more prevalent from 16 to 18 years. With respect to gender, there was a significant relationship with diagnosis: boys had more behavioral disorders, whereas girl had more anxiety disorders. To conclude, a relationship between mental disorders and developmental achievements could be indicated in the younger group. Additionally, externalizing disorders in boys and internalizing ones n girls were more prevalent across all ages.     

The cultural approach of ethnopsychiatry: A review and critique

Ethnopsychiatrists have consistently maintained that the perceptions, inclinations, and behavior of mentally ill persons are never a simple reflection of their illness: the mentally ill tend to behave in some ways in some cultural contexts and in other ways in others. This pathoplasticity shows, we are told, that abnormality is, primarily, the manifestation of a phenotype, not a genotype. Hence, any diagnosis and treatment of the affected individual must be grounded in some knowledge of the environment within which he or she functions. Postulating the existence of such an intimate and harmonious connection between psychopathology and social conditions, however, overlooks a pivotal distinction: while it is true that local norms and values can and do affect most neurotic presentations, those same standards have at best a marginal influence on psychotic reactions. Some pathogenic features are so overwhelming that they will be expressed in any environment. Accordingly, I conclude, we shall have progressed significantly in our understanding of the nature of mental disorders once we begin to associate neuroses with culture and psychoses with biology.     

Selling Sanity Through Gender: The Psychodynamics of Psychotropic Advertising

This paper provides a brief visual history of the ways women patients, and specifically women patients whose marital status is identified in conjunction with their “illness,” have been constructed as abnormal in the images of advertisements designed to promote psychotropic medications to an audience of psychiatrists. The advertisements I discuss come from the two largest circulation American psychiatric journals, The American Journal of Psychiatry and Archives of General Psychiatry, between the years 1964 and 2001. I use the ads to focus on two concomitant narratives. On one hand, I show how the advertisements situate the rise of “wonder drugs” in the context of an era described as the “golden age of psychopharmacology,” during which time drug treatments helped revolutionize the diagnosis and treatment of anxiety, depression, and other outpatient mental illnesses in the United States. On the other hand, the advertisements also illustrate the ways in which these new scientific treatments could not function free of the culture in which they were given meaning. In the space between drug and wonder drug, or between medication and metaphor, the images thus hint at the ways psychotropic treatments became imbricated with the same gendered assumptions at play in an American popular culture intimately concerned with connecting “normal” and “heteronormal” when it came to defining the role of women in “civilization.”     

Mental Health Clinicians' Beliefs About the Biological, Psychological, and Environmental Bases of Mental Disorders

The current experiments examine mental health clinicians' beliefs about biological, psychological, and environmental bases of the DSM-IV-TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians' beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having clinicians list what they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena.     

兰恩存在精神病学的心理治疗观

兰恩是20世纪英国著名的存在主义精神病学家,在反对传统精神病学诊疗观的基础上,提出了独特的存在精神病学的心理治疗观。在精神疾病的诊断上,兰恩主张从存在主义——现象学的视角来理解精神疾病,要从一个人的环境或背景中来理解他的行为。在精神疾病的心理治疗上,兰恩强调通过改变患者的生存环境来促进其自我恢复。     

Test-Retest Reliability of the Spanish Version of the Diagnostic Interview Schedule for Children (DISC-IV)

The test-retest reliability of the Spanish Diagnostic Interview Schedule for Children (DISC-IV) is presented. This version was developed in Puerto Rico in consultation with an international bilingual committee, sponsored by NIMH. The sample (N = 146) consisted of children recruited from outpatient mental health clinics and a drug residential treatment facility. Two different pairs of nonclinicians administered the DISC twice to the parent and child respondents. Results indicated fair to moderate agreement for parent reports on most diagnoses. Relatively similar agreement levels were observed for last month and last year time frames. Surprisingly, the inclusion of impairment as a criterion for diagnosis did not substantially change the pattern of results for specific disorders. Parents were more reliable when reporting on diagnoses of younger (4–10) than older children. Children 11–17 years old were reliable informants on disruptive and substance abuse/dependence disorders, but unreliable for anxiety and depressive disorders. Hence, parents were more reliable when reporting about anxiety and depressive disorders whereas children were more reliable than their parents when reporting about disruptive and substance disorders.     

精神疾病共病现象的辩证思考

由于大多数精神疾病的病因和发病机制不明,无特异性的生物学诊断指标,临床表现多样,有时很难用一种疾病解释.共病的概念应用于精神科临床,为精神科医生提供了一种辩证的诊断思维方法,对研究共病的本质和指导临床治疗都有重要的意义.