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。     

D型人格：心血管疾病的重要心理危险因素

D型人格（又称忧伤人格）是指经历消极情感与社会压抑的混合倾向。对于心血管疾病患者来说,这种心理危险因素与其生活质量下降、梗死复发甚至死亡等有着密切联系。作者总结了D型人格与心血管疾病关系的研究现状,阐述了D型人格对于识别早期高危患者的临床价值,探讨了神经内分泌学、免疫学及心理学等方面的机制,并评价了对D型人格进行心理干预的可行性。     

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。     

矛盾分析法在心血管疾病心理治疗中的应用

随着我国人口老龄化趋势的加快,心血管疾病患病率、病死率不断上升,并往往伴随异常的心理状态,在传统治疗基础上辅以心理干预,将会改善患者的生活质量和预后.矛盾分析法是运用对立统一规律,观察、分析社会现象,应贯穿于心血管疾痛心理治疗的全部过程.     

用现代医学模式看心血管疾病合并抑郁症的诊疗

随着社会进步,生活节奏日益加快,抑郁症及抑郁情绪已经悄无声息地蔓延开来,心血管疾病已成为城乡居民的第一位死因,分别为心理、生理疾病,从传统医学模式的角度看两者互不相干,但从生理-心理-社会的现代医学模式理解以及各种研究表明它们其实有着密切的联系。     

用现代医学模式看心血管疾病合并抑郁症的诊疗

随着社会进步,生活节奏日益加快,抑郁症及抑郁情绪已经悄无声息地蔓延开来,心血管疾病已成为城乡居民的第一位死因,分别为心理、生理疾病,从传统医学模式的角度看两者互不相干,但从生理-心理-社会的现代医学模式理解以及各种研究表明它们其实有着密切的联系.     

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。     

心理行为干预在降低抗精神病药源性肥胖中的作用

现今世界,肥胖已是一个世界性的问题,抗精神病药所致药源性肥胖也已成为困扰精神病患者的一大难题,它不仅容易引起糖尿病、心血管疾病等躯体疾病,同时也给患者造成了严重的心理负担.目前,对于肥胖的治疗主要集中在膳食结构调整以及运动方面,而心理干预作为一种新的肥胖干预治疗方法逐渐被人们所接受,越来越多的实践表明,心理行为干预是一种有效、可行的防治抗精神病药源性肥胖的方法,值得推广.     

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.     

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。     

Retraction Note: Globalization and vulnerable populations in times of a pandemic: A Mayan perspective

Understanding representations of disease in various art genres provides insights into how patients and health care providers view the diseases. It can also be used to enhance patient care and stimulate patient self-management. This paper reviews how cardiovascular diseases are represented in novels, films, and paintings: myocardial infarction, aneurysm, hypertension, stroke, heart transplantation, Marfan’s disease, congestive heart failure. Various search systems and definitions were used to help identify sources of representations of different cardiovascular diseases. The representations of the different diseases were considered separately. The Common Sense Model was used a theoretical model to outline illness perceptions and self-management in the various identified novels, films, and paintings. Myocardial infarction followed by stroke were the most frequently detailed diseases in all three art genres. This reflects their higher prevalence. Representations ranged from biomedical details through to social and psychological consequences of the diseases. Artistic representations of cardiovascular diseases reflect cognitions, emotions, and images of prevalent disease. These representations shape views and behaviour of ill and healthy persons regarding heart diseases. As these representations are amenable to change, they deserve further research, which may be instrumental in improving the quality of life of persons struck by cardiovascular diseases. Changing illness perceptions appears to be a method to improve self-management and thereby quality of life in patients with various cardiovascular diseases.     

华生关怀理论在慢性病患者护理中的应用探索

随着我国经济的发展,人群中疾病谱和死因谱发生了重大变化。以心脑血管疾病、恶性肿瘤为代表的慢性病已成为严重威胁人们健康的公共卫生问题。慢性病的主要特点是病程长,迁延不愈,反复发作,它对人的共同影响有：身体功能、心理、社会生活等的影响。护理理论家华生提出关怀护理理论,关怀必须是护理人员结合科学与人文知识在与患者的互动关系中按照关怀的10个要素来完成,目标是帮助患者达到身体、心理及心灵更高程度的协调。本文介绍了关怀理论的主要内容、慢性病的特点,并通过实际病例应用阐述了关怀理论在慢性病患者临床护理中的应用。     

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。     

Gender differences in cardiovascular and hypothalamic-pituitary-adrenal axis responses to psychological stress in healthy older adult men and women

Gender differences in the neuroendocrine and cardiovascular response to psychological stress may contribute to the gender differences in the prevalence of diseases associated with hypothalamic-pituitary-adrenal (HPA) axis reactivity such as cardiovascular disease (CVD), diabetes and hypertension. We measured plasma ACTH, cortisol, heart rate (HR), and blood pressure (BP) responses in 8 men and 8 women (55-75 years) exposed to the Matt Stress Reactivity Protocol (MSRP), a psychological challenge. The MSRP elicited significant increases in HR, systolic-, and diastolic BP, ACTH and cortisol (all p<0.01). Men had significantly greater cortisol and diastolic BP responses compared to women (p<0.05). Additionally, a positive correlation between the ACTH and cortisol responses was only found in the males (r=0.71, p<0.05). There were no group differences in HR, systolic BP, or ACTH responses. We conclude, that among older adults, men respond to psychological stress with greater increases in cortisol, compared to women. This greater activation of the HPA axis could translate into an elevated risk for CVD, diabetes and hypertension and may be related to the higher prevalence of these diseases in males. Gender differences in brain structures and/or cognitive processes may be responsible for these sexually dimorphic stress responses.     

Psychological risk factors in cardiovascular diseases

Recent research has shown that psychological risk factors play an important role in the pathogenesis of cardiovascular diseases. The so-called ‘coronary prone behaviour pattern’ predominates, an important part of which is the ‘Type A behaviour pattern’. This is characterized by a marked ambition, a constant feeling of being under pressure, due to latent aggression and to a striving to dominate. For cerebrovascular diseases the so-called ‘pressured pattern’ as a risk factor has been found to be typical which is comparable to the Type A behaviour. Psychological risk factors and their components are not equally important for different vascular diseases. Besides the explanation of the question as to how far psychological processes really are involved in the development of vascular diseases, the research on psychological risk factors serves as a foundation for psychosomatic theories.     

消化系统疾病与精神心理因素的辩证关系

消化系统疾病与精神心理因素相互影响,其相互作用呈现个体化差异,这与个体间的内环境以及外环境差别有关。主要病理生理学机制之一为"脑-肠轴"及"脑肠互动"学说。临床医生需要认识到二者之间辩证关系的普遍性和重要性,及时发现躯体症状背后潜藏的精神心理问题,综合运用各种心理干预和药物治疗手段。     

代谢综合征致病的诊疗思考

如果将心血管疾病喻为冰山一角,潜在水中的冰山是危险因素的话,那么代谢综合征(MetS)就是深藏于水中冰山的最底层,这一形象的比喻是人类长期与疾病作斗争中运用科学思维的总结。目前,MetS已被公认是心血管疾病的危险因素,是与糖尿病和心血管疾病密切相关的一种疾病,其发病率居心血管疾病危险因素之首。     

古埃及疾病医治理念透析

疾病医治理念是古埃及文明的重要组成部分。古埃及人针对不同类别疾病有着相应的医治理念：药物、魔法与意志是内科疾病的医治理念;河渠原理是医治外科疾病的理念;对于治疗心理疾病主要是寻求神灵的拯救;预防疾病的理念是保持圣洁。挖掘、梳理这些医治理念,可以加强医学史的学科建设,对某些疾病的治疗有参考价值。     

Type D personality as a prognostic factor in heart disease: assessment and mediating mechanisms

Type D personality, a synergy between negative affectivity and social inhibition, has established itself as a serious risk factor for morbidity and mortality in patients suffering from cardiovascular disease. In this review, we summarize studies on the validity of the assessment methods of Type D, emphasizing its role as an independent vulnerability factor in the progression of cardiovascular disease. We further present evidence on the physiological characteristics that accompany the 2 psychological traits negative affectivity and social inhibition and may mediate the relation between personality and prognosis in heart disease. Further research needs to determine the mechanisms by which Type D affects the course and outcome of cardiovascular disease as well as how Type D patients may benefit from psychosocial intervention.