高血压脑出血微创治疗及手术时机的决策探讨

为了比较幕上高血压脑出血传统开颅与微创治疗的效果及其并发症,并对其手术时机进行探讨,对30例传统开颅组和104例微创治疗组进行对比研究.结果显示,术后6个月微创治疗组致残率及肺部感染发生率较传统开颅组明显为低(P<0.05);早期(8h～24h)手术死亡率较超早期(<8h)明显为低(P<0.05).因此,微创治疗能够有效降低高血压脑出血患者的致残率和术后并发症的发生率,其手术时机适宜选择在早期.     

高血压脑出血微创治疗及手术时机的决策探讨

为了比较幕上高血压脑出血传统开颅与微创治疗的效果及其并发症,并对其手术时机进行探讨,对30例传统开颅组和104例微创治疗组进行对比研究。结果显示,术后6个月微创治疗组致残率及肺部感染发生率较传统开颅组明显为低(P0.05);早期(8h～24h)手术死亡率较超早期(8h)明显为低(P0.05)。因此,微创治疗能够有效降低高血压脑出血患者的致残率和术后并发症的发生率,其手术时机适宜选择在早期。     

Counselling Older Adults Living in Residential Aged Care Settings: Four Illustrative Case Studies

The role of psychologists and other mental health professionals in long‐term care settings is undefined in Australia. Graduate psychology students receive little training in clinical geropsychology, and residential aged care providers do not routinely employ psychologists within such settings. Further, despite high rates of depression, neurocognitive problems, and other mental health problems, residents are rarely referred for evidence‐based psychological treatment. This article presents four case studies showing how psychology services may be employed in such settings within the context of a postgraduate psychology placement programme. These case studies emphasise the importance of engagement, the use of flexible and individualised treatment approaches, and the involvement of family and professional carers in the provision of psychological services. Psychology services in residential settings can have a positive impact on the care of older adults and their families.     

Assessing Outcome in Cognitive Behavior Therapy for Child Depression: An Illustrative Case Series

Recent meta-analytic data suggest a need for ongoing evaluation of treatments for youth depression. The present article calls attention to a number of issues relevant to the empirical evaluation of if and how cognitive behavior therapy for child depression works. A case series of 6 children and a primary caregiver received treatment—individual CBT for the child and behavioral parent training involving the caregiver and caregiver–child dyad. The effects were generally promising and illustrate how selection of inclusion criteria, measures, measurement intervals, and informants can alter conclusions. These areas warrant attention in studies of child depression and are important not only in interpreting treatment outcome data but also for conducting sound clinical practice.     

Manualized Treatment of Panic Disorder in a Medical Setting: Two Illustrative Case Studies

People who experience panic attacks (PAs) typically present to medical settings, concerned that their symptoms signify a life-threatening condition. Despite the efficacy of cognitive-behavioral therapy (CBT) for panic disorder (PD), medical practitioners seldom provide this type of treatment. Physicians may lack the time or expertise to impart such behavioral medicine interventions, while patients may find group or individual CBT too costly even when available. Researchers have begun investigating manualized CBT as a cost-effective alternative when traditional forms of this intervention are prohibited. This article describes two case studies in which women presenting to a medical clinic with PD were treated with 6 weeks of manualized CBT after pharmacotherapy was unsuccessful or unpalatable. Both patients exhibited reductions in panic and depressive symptomatology over baseline levels, along with increases in self-efficacy regarding their ability to manage future PAs. Improvements were maintained over 12 months, supporting continued use of manualized CBT as a supplement or alternative to pharmacological methods of treating PD in the medical setting.     

3 Culture and Ego-Ideal in Suicide: An Adult Case

A case is presented in which the patient's self-expectations, arising from his ego ideal, were violated by a conflict with his wife, who came from a different culture and did not share his marital and family values. When she left him he was devastated, not only by the loss of his family, but by the destruction of his ideal vision of himself as a husband and father. A dangerous suicide attempt followed. The psychodynamic formulation of the case and the treatment that followed from it are discussed.     

Adult Attachment Interview and Psychoanalytic Perspective: A Single Case Study

In this single case study we present a female patient diagnosed with a narcissistic personality disorder and a borderline organization. The interplay between attachment and psychoanalytic perspective will be focused. The analyst describes his impressions of the initial interview with the patient and essential steps during treatment. The patient was interviewed with the Adult Attachment Interview and classified as “insecure preoccupied” with an “unresolved state of mind” concerning loss and abuse. The analyst was asked to comment the AAI's essential characteristics of this patient. We discuss converging and diverging aspects of clinical and attachment interpretation in this single case.     

Selective Mutism in Children: Comparison to Youths With and Without Anxiety Disorders

Fifteen children with selective mutism (SM), 15 children with anxiety disorders (AD) without selective mutism, and 15 children without anxiety disorders or selective mutism (CN) were compared to examine the relationship between selective mutism and anxiety. Data were collected from children (age 4–10 years), parents, teachers, and clinicians. Results indicated that children with SM closely resemble children with AD. All children with SM received a diagnosis of social anxiety disorder and 53% received a diagnosis for an additional anxiety disorder. In addition, the SM and AD groups differed substantially from controls with respect to parent- and teacher-rated internalizing behavior problems. No differences among the groups were found with respect to parent-and teacher-reported externalizing behavior problems. The results are consistent with prior research emphasizing the association between selective mutism and anxiety disorders, and suggest that selective mutism may be conceptualized, assessed, and treated as an anxiety-related problem.     

高血压中等量脑出血微创抽吸与内科治疗的对比研究

对比研究微创穿刺血肿吸除与内科保守治疗中等量高血压脑出血患者的临床效果.对82例高血压中等量脑出血患者行回顾性分析,随机分为研究组(微创穿刺吸除)和对照组(内科保守),对比两组患者的临床疗效、并发症及死亡情况.研究组临床有效率(92.68％)明显优于对照组(70.73％)(P＜0.05);研究组在并发症发生率(7.32％)与病死率(2.43％)方面显著低于对照组(29.27％,14.53％) (P＜0.05).微创穿刺血肿吸除治疗高血压中等量脑出血可提高疗效、降低并发症发生率及病死率.     

Expanding Treatment Options for Children With Selective Mutism: Rationale,Principles, and Procedures for an Intensive Group Behavioral Treatment

Children with selective mutism (SM) experience significant challenges in a variety of social situations, leading to difficulties with academics, peers, and family functioning. Despite the extensive evidence base for cognitive-behavioral interventions for youth anxiety, the literature has seen relatively limited advancement in specialized treatment methods for SM. In addition, geographic disparities in SM treatment expertise and the roughly 6-month duration of some of the supported SM treatment protocols can further restrict the accessibility and acceptability of quality SM care. Intensive group behavioral treatment (IGBT) for SM was developed to expand the portfolio of evidence-based SM treatment options by offering brief, but high-dose, expert SM intervention in a group format for youth ages 3–10 years that can be completed in 1 week. In this article, we outline IGBT for SM program, which has already received initial support in a waitlist-controlled trial. Our presentation is organized around the five main components of the treatment model: (1) individual “lead-in” sessions, (2) camp (i.e., all-day group sessions for children held in a simulated classroom setting, with an emphasis on graduated exposures and structured reinforcement), (3) parent training, (4) school outreach, and (5) booster treatment, as needed. We conclude with a discussion of clinical considerations and future directions for further IGBT refinement and evaluation.     

Treatment of Posttraumatic Stress Disorder Following an Armed Robbery: A Case Study Testing the Transportability of Trauma-Focused Cognitive-Behavioural Therapy to Urban Africans

John, an urban African male who developed posttraumatic stress disorder (PTSD) following an armed robbery at the petrol station where he worked, was treated with 12 sessions of Trauma-focused cognitive behaviour therapy. Intervention involved a combination of psychoeducation, prolonged imaginal exposure, cognitive restructuring and behavioural assignments. This article is a systematic case study of his treatment which included a comprehensive narrative and tracking of progress by means of the Posttraumatic Diagnostic Scale. John responded well to the treatment, finding it acceptable and credible and remained free of PTSD symptoms at 15 months follow up. It is argued, based on the principles of Elliott's Hermeneutic Single Case Efficacy Design, that there is evidence from within the narrative that it was the treatment that led to remission of symptoms. This case study demonstrates the cognitive, emotional and behavioural processes underlying John's PTSD, which fits with those extensively described in the research literature, and that this evidence-based treatment developed in a westernised context is transportable to work with urban Africans.     

Anxiety and Stress in Children Following an Earthquake: Clinically Beneficial Effects of Treatment with Micronutrients

This study examined the effects of micronutrients on children with clinically elevated stress and anxiety 23–36 months after experiencing a natural disaster (a major earthquake). A single-case multiple-baseline design allocated 14 children (7 males, 7 females; aged 8–11 years; 10 with formal anxiety-disorder diagnoses) randomly to 1, 2 or 3 week baselines. Participants then took eight capsules/day of a micronutrient formula (EMPowerplus) during an 8-week open-label trial. Assessment instruments were the Children’s Global Assessment Scale (CGAS), the Screen for Child Anxiety-Related Emotional Disorders (SCARED), the Pediatric Emotional Distress Scale (PEDS), and the Revised Children’s Manifest Anxiety Scale (RCMAS). Symptom severity declined slightly in baseline for some children and declined much more during intervention for all children. Effect sizes at end of treatment were ?1.40 (RCMAS), ?1.92 (SCARED), +1.96 (CGAS), and ?2.13 (PEDS). Modified Brinley plots revealed decreases in anxiety and improvements in overall functioning for 10 out of 11 completing participants. Side effects were mild and transient. The study provided evidence that treatment with a dietary supplement containing micronutrients reduced children’s post-disaster anxiety to a clinically significant degree. Future placebo-controlled randomized-controlled trials and treatment-comparison research is recommended to determine if this is true of anxiety in general.     

Integrating Web-Based Applications into Aged Care: Two Case Studies and Discussion

In anticipation of the growing need for adequate mental health care for older adults in residential aged care facilities, psychologists are challenged to overcome several barriers that impede the uptake and delivery of their services in such settings. Information and communication technologies (ICT) have strong potential to overcome some of these barriers by supporting the delivery of evidence-based psychosocial treatments for common psychogeriatric issues. This paper presents two case studies that illustrate when and how psychologists can use various ICT applications (e.g., tablet devices, web-based applications) integrated with cognitive behavioural and reminiscence-based therapies. Both case studies demonstrate that ICT can effectively support the therapeutic alliance, enhance therapeutic engagement, and individualize treatment delivery to accommodate the needs of elderly patients. It is hoped that these case studies will encourage clinicians to consider using ICT to augment therapy with their elderly patients.     

The Adult Attachment Interview and self-reports of attachment style: an empirical rapprochement

Although 10 studies have been published on the empirical overlap of the Adult Attachment Interview (AAI) and measures of self-reported attachment style, results in this literature have been inconsistently interpreted in narrative reviews. This report was designed as a rapprochement of the AAI and attachment style literatures and includes 3 studies. Study 1 (combined N = 961) is a meta-analytic review showing that by J. Cohen's (1992) criteria (mean r = .09), the association between AAI security and attachment style dimensions is trivial to small. Study 2 (N = 160) confirms meta-analytic results with state-of-the-art assessments of attachment security and also examines attachment dimensions in relation to the Big 5 personality traits. Finally, Study 3 is an investigation of 50 engaged couples that shows that developmental and social psychological measures of attachment security predict somewhat distinct--though theoretically anticipated--aspects of functioning in adult relationships.     

Adult shyness: the interaction of temperamental sensitivity and an adverse childhood environment

This article examines the relation between adult shyness and sensory-processing sensitivity and posits a new model in which the interaction of sensitivity and adverse childhood environment leads to negative affectivity (with the highly sensitive being more impacted), which in turn leads to shyness. Consistent with this model, two questionnaire studies (Ns = 96 and 213) supported three hypotheses: (a) sensory-processing sensitivity interacts with recalled quality of childhood parental environment to predict shyness, (b) sensory-processing sensitivity interacts in the same way with childhood environment to predict negative affectivity, and (c) the interaction effect on negative affectivity mediates the effect on shyness. Hypothesis 2 was tested and supported in an additional questionnaire study (N = 393) and also in an experiment (N = 160) that manipulated negative contemporaneous experience as an analog for adverse childhood environment.     

Adult age differences in episodic memory: further support for an associative-deficit hypothesis

This study further tested an associative-deficit hypothesis (ADH; M. Naveh-Benjamin, 2000), which attributes a substantial part of older adults' deficient episodic memory performance to their difficulty in merging unrelated attributes-units of an episode into a cohesive unit. First, the results of 2 experiments replicate those observed by M. Naveh-Benjamin (2000) showing that older adults are particularly deficient in memory tests requiring associations. Second, the results extend the type of stimuli (pictures) under which older adults show this associative deficit. Third, the results support an ADH in that older adults show less of an associative deficit when the components of the episodes used are already connected in memory, thereby facilitating their encoding and retrieval. Finally, a group of younger adults who encoded the information under divided-attention conditions did not show this associative deficit.     

Adult age differences in memory performance: tests of an associative deficit hypothesis

An associative hypothesis to explain and predict older adults' deficient explicit episodic memory performance was outlined and tested. The hypothesis attributes a substantial part of older adults' deficient memory performance to their difficulty in merging unrelated attributes-units of an episode into a cohesive unit. Although each of the components can be memorized to a reasonable degree, the associations that tie the attributes-units to each other grow weaker in old age. Four experiments are reported that provide (a) a converging validity to the hypothesis by demonstrating this associative deficit for both interitem relationships and intraitem relationships and (b) a discriminant validity to the hypothesis by contrasting and testing competing predictions made by the associative hypothesis and by alternative hypotheses. The implications of these results to older adults' episodic memory performance are discussed.