功能性便秘

功能性便秘是常见的慢性便秘,罗马III提出了新的诊断标准。功能性便秘的一般治疗包括定期排便、增加活动、增加纤维素摄取,改变生活方式和调整情绪。慢传输型便秘的药物选择膨胀性泻药、渗透性泻剂、促动力剂、氯通道激活剂等。功能性排便障碍型患者可选择生物反馈治疗。治疗成功后应调节剂量,维持疗效。外科治疗应有严格的适应证。进一步研究结肠动力与排便生理,以提高对疾病的认识和提出有效的治疗。     

功能性便秘

功能性便秘是常见的慢性便秘，罗马III提出了新的诊断标准。功能性便秘的一般治疗包括定期排便、增加活动、增加纤维素摄取，改变生活方式和调整情绪。慢传输型便秘的药物选择膨胀性泻药、渗透性泻剂、促动力剂、氯通道激活剂等。功能性排便障碍型患者可选择生物反馈治疗。治疗成功后应调节剂量，维持疗效。外科治疗应有严格的适应证。进一步研究结肠动力与排便生理，以提高对疾病的认识和提出有效的治疗。     

生物反馈、肌肉放松与高血压

本文旨在了解生物反馈与高血压病的关系,以临床客观指标探索它们之间的差量。随意选择高血压病者39名,分为三个组:单纯生物反馈组,肌肉放松训练组以及生物反馈辅助肌肉放松训练组。经一个月训练结果表明:单纯生物反馈组收缩压与舒张压的疗效有非常显著性差异水平。肌肉放松组仅收缩压疗效有统计学意义,舒张压不呈现差异水平。生物反馈辅助肌肉放松训练组两种血压疗效与单纯生物反馈组类似。这说明单纯生物反馈在治疗高血压中起主要作用。肌肉放松有很强的局限性。     

当前有关生物反馈理论,疗效的争论及我们的看法

本文回顾了当前生物反馈理论及其治疗效果方面存在的重大争论,并且对各种理论观点作了较为全面的阐析。文中给出了更为合理的关于生物反馈和生物反馈疗法的定义,并指出了今后的研究方向。一、争论的要点美国生物反馈协会(BSA,Biofeedback     

生物反馈的历史和现状

1985年8月Alan H.Roberts在《AmericanPsychologist》上发表了《生物反馈——研究、训练和临床作用》一文。作者对生物反馈的历史、现状作了全面的评述。生物反馈作为治疗方法已有15年的历史,有很多关于这方面的论文问世。有些人将生物反馈等同于行为医学,并且,随着生物反馈的兴起,肌电器、皮温测量装置等仪器被广泛应用,而对它的实际价值至今却褒贬不一。     

生物反馈在治疗大学生情绪表述困难中的应用

生物反馈技术是高校健康咨询机构新兴起的一门应用技术。介绍了生物反馈在治疗大学生述情困难中的优点、程序以及皮电、心率反馈和脑电反馈的实施。     

K-ras基因与结直肠腺癌关系研究进展

肿瘤的发生涉及癌基因的激活及抑癌基因的失活,K-ras基因是与肿瘤形成关系较为密切的一种癌基因,其功能异常能够影响细胞的生长、增殖、分化和凋亡等。研究已发现K-ras基因的突变激活是结直肠癌变过程中的重要事件之一。本文拟对K-ras基因的生物学特性、对细胞信号转导的影响及在结直肠腺癌形成与治疗中的作用作一综述。     

K-ras基因与结直肠腺癌关系研究进展

肿瘤的发生涉及癌基因的激活及抑癌基因的失活,K-ras基因是与肿瘤形成关系较为密切的一种癌基因,其功能异常能够影响细胞的生长、增殖、分化和凋亡等.研究已发现K-ras基因的突变激活是结直肠癌变过程中的重要事件之一.本文拟对K-ras基因的生物学特性、对细胞信号转导的影响及在结直肠腺癌形成与治疗中的作用作一综述.     

儿童功能性躯体化症状研究述评

功能性躯体化症状(Functional-somatic Symptoms, FSS)是指无法用医学知识解释, 或经医学治疗后无改善的躯体不适症状, 多发于儿童和青少年群体, 常伴随焦虑、抑郁等心理障碍共同发生。儿童FSS的发病受多方因素的影响, 包括社会文化、年龄、性别、家庭环境、生理易感性等。各个心理学流派从不同视角提出了儿童FSS的心理理论模型。心理干预, 尤其是认知行为疗法和放松–生物反馈疗法对治疗儿童FSS有较好的效果。     

生物反馈疗法对大学生考试焦虑的治疗作用

探讨生物反馈疗法对大学生考试焦虑的治疗作用。在某大学随机抽取学生1500名,采用考试焦虑量表进行筛查,选取焦虑组和对照组各30名。利用生物反馈疗法进行干预,采用脑电α波相对功率、肌电和皮电导联进行检测,每周2次,持续4周。结果表明：1.经过4周的干预,焦虑组干预前后各生理指标存在差异;2.生物反馈疗法干预考试焦虑在疗效上存在性别差异。结论：生物反馈疗法能有效降低大学生考试焦虑水平,对其治疗取得良好的效果。     

Functional Gastrointestinal Symptoms in Children with Anxiety Disorders

This study examined the incidence and correlates of functional gastrointestinal symptoms in children with anxiety disorders. Participants were 6–13 year old children diagnosed with one or more anxiety disorders (n?=?54) and non-clinical control children (n?=?51). Telephone diagnostic interviews were performed with parents to determine the presence and absence of anxiety disorders in children. Parents completed a questionnaire that elicited information about their child’s gastrointestinal symptoms associated with functional gastrointestinal disorders in children, as specified by the paediatric Rome criteria (Caplan et al., Journal of Pediatric Gastroenterology & Nutrition, 41, 296–304, 2005a). Parents and children also completed a symptom severity measure of anxiety. As expected, children with anxiety disorders were significantly more likely to have symptoms of functional gastrointestinal disorders (FGID), compared to children without anxiety disorders. That is, 40.7 % of anxious children had symptoms of a FGID compared to 5.9 % of non-anxious control children. Children with anxiety disorders were significantly more likely to have symptoms of functional constipation, and showed a trend for a higher incidence of irritable bowel syndrome symptoms compared to non-anxious control children. Furthermore, higher anxiety symptom severity was characteristic of anxious children with symptoms of FGID, compared to anxious children without FGID symptoms and non-anxious control children. Also, children with anxiety disorders, regardless of FGID symptoms, were more likely to have a biological family member, particularly a parent or grandparent, with a gastrointestinal problem, compared to non-anxious control children. The high incidence of FGID symptoms in children with anxiety disorders warrants further research on whether gastrointestinal symptoms reduce following psychological treatments for childhood anxiety disorders, such as cognitive behavioural therapy.     

The use of antidepressants in functional gastrointestinal disorders: new uses for old drugs

Since their introduction 50 years ago, antidepressants have been used in a wide variety of settings involving gastrointestinal (GI) disease. In the 1950s, antidepressants were shown to have some efficacy for the treatment of peptic ulcer disease. This is most likely due to their antihistaminic and anticholinergic effects. Since then, more efficacious and more disease-specific treatments have become available. In the last 20 years, antidepressants have been increasingly used for the treatment of functional gastrointestinal disorders such as irritable bowel syndrome, noncardiac chest pain, and other functional GI disorders. This article will review the rationale for the use of antidepressant drugs for the treatment of functional GI disorders. The role of psychiatric comorbidity in functional GI disorders, the impact of antidepressants on GI motility and visceral sensation, and the ability of these agents to produce improvements in the global well-being and overall quality of life will be reviewed. Finally, guidelines for prescribing and barriers to a patient's acceptance of these agents will be discussed.     

Pain Catastrophizing and Clinical Outcomes Among Patients Receiving a Novel Cognitive-Behavioral Therapy for Irritable Bowel Syndrome: An Experimental Therapeutics Approach

Irritable bowel syndrome (IBS) is the most common gastrointestinal (GI) condition treated by GI and primary care physicians. Although IBS symptoms (abdominal pain, bowel problems) are generally refractory to medical therapies, consistent research has shown that they improve following cognitive-behavioral therapy (CBT). Notwithstanding empirical support for CBT, there is less research explicating the reasons for why or how it works. Like other pain disorders, the focus on change mechanisms for behavioral pain treatments has focused on pain-specific cognitive-affective processes that modulate pain experience, few of which are more important than pain catastrophizing (PC). The fact that PC changes are seen across treatments of differing theoretical and technical orientation, including CBT, yoga, and physical therapy, suggests that it may be a nonspecific (vs. theory-based) change mechanism akin to therapeutic alliance and treatment expectancy. Therefore, the current study examined change in PC as a concurrent mediator of IBS symptoms severity, global GI symptom improvement, and quality of life among 436 Rome III-diagnosed IBS patients enrolled in a clinical trial undergoing two dosages of CBT versus a nonspecific comparator emphasizing education and support. Results from structural equation modeling parallel process mediation analyses suggest that reduction in PC during treatment are significantly associated with improvement in IBS clinical outcomes through 3-month follow-up. Results from the current study provide evidence that PC may be an important, albeit nonspecific change mechanism, during CBT for IBS. Overall, reducing the emotional unpleasantness of pain through cognitive processes is associated with improved outcomes for IBS.     

恐惧记忆习得与消退的性别差异及其神经机制

大多数人在其一生中都会经历创伤事件,但只有少数人会发展成为创伤后应激障碍（PTSD）。焦虑障碍的易感性和保护因素成为一个重要议题。基于恐惧记忆习得与消退模型的研究发现女性个体表现出“易习得、难消退”的特点。在恐惧相关脑区的脑生理结构、功能/结构连接性、以及大脑可塑性的性别差异可能是该特征的根本原因。性激素作为一种焦虑障碍的保护因素,可以调节这种性别差异,这种调节效应可能是通过影响大脑结构形态（如神经细胞的形态和数量）、调控与记忆相关基因的表达（如HDAC4）而实现的。雌性激素水平的不稳定性可能是女性易感焦虑障碍的重要原因。未来对性别差异的深入研究将有助于推进个性化医疗。     

Psychische Faktoren gastrointestinaler Erkrankungen

The list of potential or proven associations between psychological and intestinal functions in healthy subjects and in patients with functional and organic bowel disorders demonstrates that although these associations are manifold they are to a large extent incompletely understood, primarily of academic interest and not yet ready to be integrated into everyday clinical practice. However, of immediate practical relevance are psychotherapeutic as well as psychopharmacological approaches. It is, however, required that clinicians, both medical and psychological, are aware of the mechanisms of regulation of intestinal functions through central (CNS) and peripheral (ENS) neural circuits.     

Pain perception in irritable bowel syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal discomfort or pain in the absence of detectable organic disease. IBS is common and is associated with a significant impairment in health-related quality of life. Enhanced perception of visceral stimuli ("visceral hypersensitivity") appears to be an important pathophysiological mechanism. Early IBS studies using functional brain imaging techniques suggest an alteration in central pain modulation circuits, rather than an increased sensitivity of peripheral visceral pain pathways. The frequent comorbidity with psychiatric disorders suggests the possibility of shared pathophysiological mechanisms and etiologic factors.     

Schematherapie

Schema therapy is a cognitive behavioral therapy (CBT) development mainly for the treatment of personality disorders and other chronic mental disorders. It is characterized by an integration of cognitive, emotional and behavioral intervention methods derived from different therapeutic approaches with an emphasis on a specifically supportive therapeutic relationship. The original approach focused mainly on early maladaptive schemas. Current developments, however, concentrate on the concept of schema modes, describing different schema-associated emotional states. The schema mode approach is also used for specific case concepts for personality disorders. Effectiveness of schema therapy has been shown for borderline personality disorder. Current studies investigate the effectiveness of schema therapy for patients with other chronic mental conditions and as a group therapy approach. This paper provides an overview about case conceptualization and treatment, presents main research findings and discusses open questions and problems.     

Causal models and the assessment-treatment relationship in behavior therapy

The relationship between causal models in behavior therapy and strategies for designing intervention programs on the basis of assessment data is considered. The evolution away from simple univariate causal models is noted and complex causal models for behavior disorders are stressed. However, complex causal models currently preclude empirically based functional analytic and keystone target behavior assessment strategies for intervention design. Future directions for intervention design involving a combination of diagnostic, functional, analytic, and keystone strategies and markers for causal paths are discussed.     

Cognitive Behavioral Treatment of Comorbid Anxiety Disorders and Social Difficulties in Children with High-Functioning Autism: A Case Report

A substantial proportion of children with high-functioning autism (HFA) or Asperger syndrome (AS) have one or more comorbid anxiety disorders. Because anxiety disorders exacerbate the social difficulties and other functional impairments caused by an autism spectrum disorder (ASD), there is a need for efficacious treatments to address the clinical needs of youth with this comorbid presentation. This article describes an evidence-based cognitive behavioral therapy (CBT) treatment manual enhanced to address the unique characteristics and clinical needs of children with ASD. A case study is presented in which CBT was utilized in the successful treatment of an 11-year-old girl with HFA. The intervention was effective in reducing anxiety and improving social and adaptive functioning. These findings suggest that an enhanced CBT approach may be a viable intervention for children with comorbid HFA and anxiety disorders that should be further evaluated.     

Psychosocial Occupational Therapy Interventions for Substance-Use Disorders: A Narrative Review

The review was conducted to explore psychosocial interventions for adults with substance-use disorders. A refined literature focus was placed on articles published by occupational therapists, or articles published by an allied health professional, that discussed occupational therapy performing the intervention. Ten articles met inclusion criteria, all focusing on aspects of life skills training. Study results support the professions’ ability to enhance functional independence and occupational performance for individuals recovering from substance use. Further, a more controlled investigation is warranted to further define occupational therapy’s scope within substance-use disorder treatment.