躯体形式障碍的优化诊治

躯体形式障碍是精神科常见的一种神经症,该病具有较高的发病率,占用了大量的医疗资源,但临床识别率和有效治疗率却相当低.围绕躯体形式障碍的特点及其优化诊治作一些探讨,利于提高社会和非精神科医生对该病的认识,减少医疗资源的过度消耗,使疾病得到早期有效治疗.     

躯体症状障碍诊疗策略

大多数躯体症状障碍患者往往就诊于非精神科,而许多医生尤其是非精神科医生对此病的认识不足、诊疗不当,导致了该病的迁延、医疗资源的消耗和医患矛盾的增加等问题。因此探讨适合广大医务工作者的躯体症状障碍诊疗策略显得十分重要。本文在回顾躯体症状及相关障碍诊断与治疗相关特点与问题的基础上探讨了相应的诊疗策略,并介绍了悦纳沟通在躯体症状障碍诊疗中的应用,以期在躯体症状障碍的诊疗和医患沟通等方面为广大临床工作者提供帮助。     

解读躯体症状——重新认识躯体症状障碍

大部分躯体症状障碍患者往往就诊于非精神科,而很多非精神科医生对此病的认识不足、诊疗不当,导致疾病的迁延、医疗资源的浪费和医患关系的恶化等问题。因此提高临床医生对躯体症状障碍的识别能力显得非常重要。本文提出传统思维模式存在的问题,从病理心理机制角度重新解读躯体症状,提出新的症状分类方法。有利于从躯体症状的解读中寻求诊断躯体疾病及精神疾病的方向,有利于提高非精神科医生对躯体症状障碍的识别能力,明确躯体症状障碍的诊疗方向,从根本上减少疾病的漏诊误诊率。     

用生物心理社会医学模式指导疾病的诊治

惊恐障碍作为一种精神科疾病,由于伴有明显的躯体化症状,使大多患者首诊于综合医院非精神科,极易引起该病的误诊误治,同时也浪费了大量的卫生资源。针对这一情况,本期“临床决策研究”栏目中熊新英撰写的“从惊恐障碍看生物心理社会医学模式的必要性和紧迫性”,对于惊恐障碍就诊于综合医院误诊率高的原因及高误诊率导致的后果进行了分析,并提出了相应的对策。作者认为,惊恐障碍属于精神医学范畴,但由于此病患者多突然出现躯体化症状,使患者多到综合医院就诊,     

用生物心理社会医学模式指导疾病的诊治

惊恐障碍作为一种精神科疾病,由于伴有明显的躯体化症状,使大多患者首诊于综合医院非精神科,极易引起该病的误诊误治,同时也浪费了大量的卫生资源.针对这一情况,本期"临床决策研究"栏目中熊新英撰写的"从惊恐障碍看生物心理社会医学模式的必要性和紧迫性",对于惊恐障碍就诊于综合医院误诊率高的原因及高误诊率导致的后果进行了分析,并提出了相应的对策.     

中国的“身体沟通”和躯体症状障碍:一个文化和性别视角下的案例研究

传统医疗支援服务在治疗躯体形式障碍和躯体症状障碍(somatic symptom disorder,SSD)上收效甚微。这些患者经历着越注意身体的痛感越感到难受的恶性循环,他们对这些现象的负面解释导致自身形成关注于身体(身体形象,强化患者的自我意识/自我观察)的“担忧型认知风格”,导致身体感觉不适与过度唤醒。身体心理治...     

躯体形式障碍的社会心理学分析

本研究对躯体形式障碍患者的社会心理特点进行调查分析.按照中国精神障碍分类与诊断标准第3版（CCMD-3）,试验组躯体形式障碍患者51例,在社区分层抽样51人作为对照组,用防御方式问卷、多伦多述情障碍量表进行测量.试验组不成熟型防御方式明显高于对照组,成熟型防御方式低于对照组,差异有统计学意义;述情障碍总分高于对照组,差异有统计学意义.情绪表达障碍、不成熟心理防御方式和社会文化因素共同作用形成了躯体形式障碍发病机制中的社会心理原因.在预防与治疗中需加强心理干预,以有效预防疾病的发生和提高治疗效果.     

躯体症状障碍的特点及综合诊疗原则

从美国精神疾病诊断与统计手册第三版（DSM-Ⅲ）的躯体形式障碍,到甚至更早的诊断名称为DSM-5的躯体症状障碍,这类疾病的名称一直在变化;学界对躯体化症状的分类和定义也一直存在争议.进行分类和诊断的主要目的是为了治疗.本文从躯体症状障碍相关概念的变迁及本质特点入手,分析、总结躯体症状障碍的心理行为特点及接诊和治疗原则,以期对广大临床工作者治疗工作的开展有所帮助.     

“器质性精神疾病”诊断的争议

“器质性精神疾病”诊断的争议湖北医科大学附属第一医院精神科（武汉４３００６０）陈振华,朱志先,刘铁榜,臧德馨在杨玲玲和左成业新编著的《器质性精神病学》一书中,器质性精神疾病包括脑部疾病所致精神障碍、躯体疾病伴发的精神障碍、中毒性精神障碍与物质依赖［１...     

氟伏沙明联合认知疗法治疗躯体形式障碍临床疗效分析

探讨氟伏沙明联合认知疗法治疗躯体形式障碍临床疗效。将60例躯体形式障碍患者随机分为研究组(氟伏沙明联合认知疗法)和对照组(仅用氟伏沙明治疗)各30例,观察8周。采用症状自评量表(SCL-90)躯体化因子评分、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)于治疗前、治疗第2周末、第4周末、第8周末评估临床疗效,用副反应量表(TESS)评定不良反应。结果,治疗8周后,研究组各项测查减分明显。氟伏沙明联合认知疗法治疗躯体形式障碍疗效优于单用氟伏沙明,疗效稳定,且不增加副作用。     

综合医院惊恐障碍高误诊率引发的思考

惊恐障碍是一种急性焦虑障碍,属精神医学研究范畴。但惊恐障碍患者却反复在综合性医院就诊。目前国内综合医院尤其是基层综合医院普遍未设置精神科,非专科医生对惊恐障碍的识别率又非常低,误诊率甚至高达100%。作者就综合医院惊恐障碍高误诊率的原因、对策、展望与期待、较为理想的就医途径和治疗方法做一探讨。     

进修人员在双向转诊中作用的研究

我国人口分布范围广,医疗资源主要集中在大、中城市,合理利用有限的医疗资源,解决看病难,看病贵,实现有效转诊,是我们当前面临的一个难题。研究显示：通过进修医生转诊率高,迅速,患者及家属满意率高;对符合转诊要求,需要下转的患儿100例通过进修人员下转患者率96％,直接下转率65％。由此可见通过进修医生对患者进行双向转诊效果...     

Pharmacotherapeutic options in the treatment of comorbid depression and anxiety

Although anxiety and mood disorders are listed as separate disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, they frequently coexist. They may be expressed phenotypically as comorbidities or as the provisional entity mixed anxiety-depressive disorder. Patients with both anxiety and depression are more symptomatic, use more health care resources, and have a worse prognosis than those with a single disorder. Recognizing and treating these patients are challenges for physicians because the symptoms of the two disorders often overlap. Administration of effective treatment, comprising both anxiolytic and antidepressant effects, can reduce patient distress and disability, as well as inappropriate utilization of medical services. Medications such as tricyclic antidepressants, selective serotonin reuptake inhibitors, nefazodone, venlafaxine XR (extended release) and mirtazapine, are highly effective in treating comorbid depression and anxiety. These newer agents now represent the pharmacotherapeutic treatments of choice for the comorbid conditions.     

从惊恐障碍看生物心理社会医学模式的必要性和紧迫性

归属于精神医学研究范畴的惊恐障碍患者反复就诊于综合医院内科,频繁使用急救医疗服务,是误诊率最高的疾病之一。本文探讨了惊恐障碍患者去综合医院就诊的必然性和误诊误治的原因及危害性,提出了综合医院医师掌握该病诊治方法,由生物医学模式向生物心理社会医学模式转变的必要性和紧迫性。     

Vulvar pain: a phenomenological study of couples in search of effective diagnosis and treatment

Vulvar vestibulitis syndrome (VVS), a vulvar pain disorder, continues to puzzle medical and mental health professionals due to its unknown etiology and lack of effective treatment. This study used transcendental phenomenology methodology to explore the experiences of couples in which the woman has a diagnosis of VVS. Sixteen in-depth semi-structured interviews were conducted with 13 heterosexual couples and 3 women. Four essences emerged: (1) In search of ... the medical journey required extensive searching for knowledgeable and respectful practitioners to provide treatment. (2) The process of developing a personal understanding of this disorder led many couples to question their role in causing and maintaining VVS. (3) Developing strategies for coping with painful intercourse led to three strategies: becoming non-sexual, using alternatives to vaginal sex, and altering or enduring painful intercourse. (4) Feelings of isolation were experienced as adapting to this chronic pain syndrome was often a lonely process. Clinical suggestions included: treating the couple, not just the woman with VVS; encouraging couples to broaden definitions about the importance and primacy of vaginal intercourse and suggest alternative sexual activities less likely to cause vulvar pain; developing shared meaning as a couple, and assisting couples in locating physicians and resources. Suggestions are relevant for couples with VVS and those with chronic health problems affecting sexual relationships.     

表情强度对自闭症儿童面部表情识别影响的实验研究

为探寻自闭症儿童在识别低强度（10%,30%）、中强度（40%,60%）和高强度（70%,90%）的愤怒和开心面部表情时,识别情绪类型的既有能力和差异。采用表情标签范式,用E-prime软件在电脑上呈现不同强度的3D合成面部表情刺激,分别对10名自闭症儿童、10名正常发育儿童和10名智障儿童进行了实验研究。结果发现,自闭症儿童在低强度表情时具有面部表情识别障碍,其对不同强度面部表情识别正确率显著低于智障儿童和正常发育儿童;自闭症儿童面部表情识别正确率与面部表情强度呈正相关,面部表情强度越大,自闭症儿童面部表情识别的正确率越高;自闭症儿童对低强度面部表情识别时,对开心表情的识别正确率高于愤怒表情,但是,在中强度和高强度面部表情识别时,存在显著的愤怒优势效应。     

Psychosocial treatments for social phobia

Increasing recognition of the prevalence and impairment associated with social phobia has spurred the development of effective psychosocial treatments for this disorder. Exposure-based interventions have the most empirical support. This article applies the tripartite model of anxiety to social phobia, describes state-of-the-art psychosocial treatments, and highlights studies on the comparative and combined efficacy of psychological and pharmacologic treatments. Clinical issues related to treatment implementation, limitations of extant psychosocial interventions, and suggestions for future research are also discussed.     

Psychosocial Interventions for Children with Early-Onset Bipolar Spectrum Disorder

Once considered virtually nonexistent, bipolar disorder in children has recently received a great deal of attention from mental health professionals and the general public. This paper provides a current review of literature pertaining to the psychosocial treatment of children with early-onset bipolar spectrum disorder (EOBPSD). Commencing with evidence of the emerging interest in this topic, we then focus on terminology, the rationale for studying EOBPSD in children, current research and clinical progress, possible explanations for the recent increase in recognition, and essential issues that form the foundation of effective psychosocial treatment. Next we explore areas of research with direct implications for psychosocial treatment. These include biological and psychosocial risk factors associated with bipolar disorder; and the psychosocial treatment of adult-onset bipolar disorder, childhood-onset unipolar disorder, and anger management in children. Following this, we discuss treatments being developed and tested for children with EOBPSD. Finally, we conclude with recommendations for future studies needed to move the field forward.     

Cognitive-Behavioral Therapy for Prolonged Grief in Children: Feasibility and Multiple Baseline Study

There is growing recognition of a syndrome of disturbed grief referred to as prolonged grief disorder (PGD). Although mostly studied in adults, clinically significant PGD symptoms have also been observed in children and adolescents. To date, no effective treatment for childhood PGD yet exists. We developed a 9-session cognitive-behavioral treatment for childhood PGD, combined with 5 sessions of parental counseling. In the present article, the content of this treatment is described. We also describe findings of a multiple baseline study among 6 bereaved children and adolescents. This study showed that the intervention coincided with reductions in symptoms of PGD and other self-rated and parent-rated symptoms. All participating children and parents gave favorable scores to the satisfaction about each session, the contact with their therapist, and the information they received, attesting to the feasibility of this treatment approach.