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.     

伊斯兰教临终关怀与癌性疼痛心理治疗的探讨

如何利用伊斯兰教的信仰关怀、情感关怀和死亡关怀“三关怀”,提高癌症患者临终关怀质量和癌性疼痛心理治疗效果,作者根据在宁夏回族地区癌症患者中开展临终关怀的五年实践体会,从临终关怀的宗旨和目的出发,探讨了伊斯兰教的临终关怀之信仰关怀、情感关怀和死亡关怀三种形式和内容,解释了癌性疼痛的原因、疼痛的主观和客观影响因素及心理治疗的常用方法和原则,总结了在宁夏回族地区开展临终关怀应用伊斯兰教的信仰关怀、情感关怀和死亡关怀”三关怀”与癌性疼痛心理治疗之间的关系。     

慢性疼痛与抑郁的心身医学整合观

生物医疗观对慢性疼痛患者的诊疗作用较差。慢性疼痛常因为心理应激、个性、行为和疾病状况而复杂化,增加了患者诊疗的难度。患者常因情感症状、生活压力,而失去信心,陷入无助地痛苦选择冲突中。应用一种系统的跨学科方法重建和保持医生的共情和患者的积极心理,采用疾病状态、生活经历、个性特征和行为模式的四种心身整合观点,综合评估抑郁和慢性疼痛患者。设计综合诊疗方案评定的痛苦作用,在方案制定的过程中认识到这四个观点彼此不同,相互补充,全面阐释影响患者痛苦的生物、心理和社会的多种原因。心身整合观点为设计合理的治疗方案提供了方法,提高了医生成功治疗慢性疼痛患者的可行性。     

Effects of psychological interventions for patients with osteoarthritis: a systematic review and meta-analysis

The aim of this study was to determine the effects of psychological interventions (e.g. cognitive restructuring, relaxation) on physiological and psychological health in osteoarthritis patients. A systematic literature search was done using PubMed, Embase, PsycINFO, Web of Science, China National Knowledge Infrastructure, and Wanfang Database through November 2016. Studies were included if they used a randomized controlled trial designed to explore the effects of psychological interventions in osteoarthritis patients. Two independent authors assessed the methodological quality of the trials using criteria outlined by Jadad et al. Meta-analysis was done with the Revman5.0. Twelve randomized controlled trials, including 1307 osteoarthritis patients, met the study inclusion criteria. Meta-analysis showed that psychological interventions could reduce the levels of pain [standard mean difference (SMD) ?0.28, 95% CI ?0.48, ?0.08, P-value 0.005)] and fatigue (SMD ?0.18, 95% CI ?0.34, ?0.01, P-value 0.04). In addition, psychological interventions significantly improved osteoarthritis patients’ self-efficacy (SMD 0.58, 95% CI 0.40, 0.75, P-value 0.00) and pain coping (MD 1.64, 95% CI 0.03, 3.25, P-value 0.05). Although the effects on physical function, anxiety, depression, psychological disability were in the expected direction, they were not statistically significant. In conclusion, the role of psychological interventions in the management of osteoarthritis remains equivocal. Some encouraging results were seen with regard to pain, pain coping, self-efficacy, and fatigue. We believe that more methodologically rigorous large-scale randomized controlled trials are necessary to answer this study question.     

La gestion des émotions et ses déficits,chez les personnes atteintes de douleur chronique : une revue systématisée des études relatives à l’alexithymie, à l’intelligence émotionnelle, à la régulation émotionnelle et au coping

The goal of this review is to synthesize the data of scientific literature on emotional management and its deficits in chronic pain. We used terms referenced in databases and MesH terms (of the United States National Library of Medicine) to perform a literature search in a powerful online search engine (EBSCOhost research databases). Four hundred and forty-nine papers, taken from international reviews and published of 1994 (because it is in the middle of the 1990s that this theme begins to be handle) to the end of January, 2015, are identified by a total 5 electronic databases with predefined keywords about emotions and chronic pain. Forty-six of which met the inclusion criteria, according to their title, their summary and their complete text. The findings suggest that some emotional management strategies and its deficits can maintain a vicious circle of negative emotional states with physiological and psychopathological consequences. Several studies show that alexithymia, emotional ambivalence and emotional suppression have a deleterious impact on pain, emotional distress (depression, anxiety) and disability. In spite of some contradictions concerning the nature of this effect (sensory or affective pain intensity or even duration of pain), it seems that alexithymia is a major variable implied in chronic pain. Inversely, experiential acceptance has a beneficial effect on psychological distress (depression, anxiety and stress). Emotional disclosure (of stressful or traumatic events) can decrease pain intensity but not disability and mental health. Likewise, emotional expression in daily life seems beneficial, but when the expression of the positive and negative feelings are distinguished, emotional expression of negative feelings increases pain, disability and distress. The whole of these findings emphasize the need to further research about emotional management in chronic non-cancer pain. It is necessary to identify and control the source of potential bias. Some hypotheses have been proposed to explain these findings. In the future, it would be interesting to use a multifactorial approach to investigate the interactions between various processes of emotional management in chronic pain patients.     

Memory of pain and affect associated with migraine and non-migraine headaches

The main aims of this study were to assess memory of pain and pain-related affect in headache sufferers and to compare the pain memories of individuals who suffer from migraines and those who experience non-migraine headaches. A total of 313 women participated in the study, 86 of whom had a diagnosis of migraine headache. The women rated their state anxiety about having a headache, the intensity and unpleasantness of headache pain, and their emotions while actually experiencing a headache. Either three or six months later, the participants were asked to recall their state anxiety, the intensity and unpleasantness of pain, and the emotions they had felt. Regardless of the length of recall delay or migraine diagnosis, participants accurately remembered both pain intensity and unpleasantness. Together, recalled anxiety, experienced pain and recalled positive affect were the most important predictors of memories for headache, accounting for 41% and 37% of the total variance in recalled pain intensity and unpleasantness, respectively. However, participants overestimated recalled positive and negative affect. The effect of recalled affect on memory of headache, together with the overestimation of recalled affect, suggests that although memory of headache is accurate, it is influenced by distorted memories of affect.     

多媒体技术在医患沟通中的临床应用实践——以胸外科患者为例

伴随着网络信息技术的飞速发展,医学卫生行业正在跨入信息化时代,本课题采用多媒体技术的多样性、集成性、交互性和实时性的特点,使用自制多媒体术前谈话课件进行医患沟通.通过将胸外科拟手术患者随机分为试验组及对照组,试验组采用多媒体课件进行医患沟通,对照组采用传统方式沟通,分别统计分析两组患者沟通质量满意度,来探讨多媒体技术在胸外科医患沟通中的临床应用.采用多媒体技术进行医患沟通可以显著提高患者满意度,值得在临床工作中进一步推广.     

Short‐term cognitive‐behavioral treatment in multicultural primary care of patients with longstanding backache

The efficacy of cognitive‐behavioral therapy in multi‐cultural primary care patients with longstanding backache is not evaluated. The purpose of this study was to investigate the outcome of a four weekly‐treatment given by primary care physicians regarding pain‐related worry, depression and severe pain and to determine which social, clinical or gender factors were associated with outcome.The study group consisted of 245 patients in consecutive order from 19 countries, 18 to 45 years, entering rehabilitation program because of longstanding backache. Prevalences of pain‐related worry and depression and severe pain was counted and compared before and after. Logistic regression was used to calculate the odds (OR; 95% CI) for persistent pain‐related worry and/or persistent depression and severe pain (VAS ≥ 50). The prevalences of pain‐related worry and depression were both significantly lower after treatment (pain‐related worry 83% before vs. 38% after; depression 43% before vs. 31% after). Also the number of patients scoring ≥ 50 VAS was a little, but significantly, fewer (68% vs. 61%). Use of interpreter doubled the risk of having persistent pain‐related worry (OR 2.1; 95% CI 1.1–4.1) but the risk was not significant regarding persistent depression (OR 1.8; 0.6‐5.4). The rating of VAS rating ≥ 50 after treatment was twice as high, OR 2.3 (95% CI 1.1–4.6) in the 38–45 year old age group. To conclude, a focus on pain ideas reduced pain‐related worry and depression in these patients with various sociocultural backgrounds and longstanding backache.