《中国高血压防治指南》2005年修订版要点解析

指南是依据流行病学和大规模随机临床试验的最佳证据而修订的.指南的要点是:从110/75mmHg开始,人群血压水平与心血管病发生危险呈连续相关;正常高值血压(120～139mmHg/80～89mmHg)应改善生活方式以预防高血压发生;2002年调查我国有1.6亿高血压患者,但知晓率、治疗年和控制率很低;降低高血压患者的血压水平是预防脑卒中及心脏事件的根本.     

如何看待老年高血压的降压目标值

卒中及心血管事件的发生,随着高血压患者血压的增加而升高。降压治疗对预防卒中及心血管事件(包括心力衰竭)是有效的。过去的几十年来,降压治疗给不同亚组人群都带来了不同的益处。但是,正如不同时期的临床诊疗指南所强调的那样,对于老年人,尤其是80岁以上,获益的临床证据还不充分。老年高血压患者多有其他伴发或并发症,不仅需用降压治疗,还应有伴发疾病的特殊处理。在这一人群最佳的目标血压是最大治疗获益时的血压。2014年中国专家建议指出,对于≥65岁的高血压患者,降压目标为150/90mmHg以下,如可以耐受,收缩压可控制在140mmHg以内,对于80岁及以上者不应低于130/60mmHg。     

近年高血压患者血压控制及药物应用的变化

了解近几年各种高血压药物应用的变化情况。2005年入选门诊或住院的50岁~80岁的高血压患者163名,每4年随访1次,历时8年。入选患者平均年龄(64.42±7.86)岁,男性40.49%;三次监测(2005年,2009年,2013年)的平均血压分别为(164.98/91.98±20.92/12.90)mmHg,(141.77/80.85±14.11/11.65)mmHg和(141.77/77.63±11.78/12.07)mmHg。高血压药物的应用三次问诊分别为ACEI 12.27%,14.29%和7.63%;ARB 2.45%,11.11%和28.81%;β受体阻滞剂31.90%,30.95%和30.51%;钙拮抗剂48.47%,64.29%和61.86%;利尿剂25.15%,19.84%和13.56%。近年高血压的控制水平提高;药物的应用情况主要变化在血管紧张素转化酶抑制剂(ACEI)的应用大幅下降而血管紧张素受体拮抗剂(ARB)明显增加,应引起注意。另钙拮抗剂仍然是应用比例最高的药物。高血压患者近年规律运动的意识明显提高。     

高血压的催眠心理疗法

高血压病又称原发性高血压,是指反复持久的精神紧张和情绪激动而导致大脑皮层功能紊乱,并以交感神经兴奋性增高,全身小动脉痉挛,血压持续增高至160/95mmHg或以上为主的临床症候群。这是一种公认的心身疾病。 一、临床表现 高血压病可分为缓进性(良性)和急进性(恶性)两种。缓进性高血压病较为多见,患者多在40岁以上,病程发展较慢,舒张压波动于95～120mmHg之间,可达一二十年以上而不发生严重症状,比较常见的早期症状为头痛、头晕、耳鸣、失眠、注意力不集中、烦躁及全身无力等。急进性高血压病较为少见,患者多为青年,病程发展很急,血压显著升高,尤其是舒张压可持续在130～140mmHg以上,并迅速出现心、脑及肾方面的症     

心理社会因素与高血压临床

一般认为,当成人静坐时的血压超过160/95mmHg时,可称为高血压(hypertension);当血压在140-195/90-94mmHg之间,可称为边界型高血压(borderline,hypertension)。根据这一标准,美国估计有2400万成年人,即成人的15-27％的患有高血压,外加1700万边界型高血压。     

心血管病患者择期介入手术前后焦虑抑郁及影响因素分析

探讨择期介入治疗心血管病患者术前术后焦虑抑郁水平及其影响因素。连续调查我院心内科行择期介入治疗的住院患者100例,分别于术前及术后记录患者静息血压和心率,填写贝克抑郁量表、状态焦虑量表、自制担心评定量表、SF-36生活质量调查问卷;SPSS 17．0软件对焦虑抑郁影响因素进行了统计分析。介入患者术后血压（141．2＆#177;10．6）mmHg /（75．1＆#177;11．9）mmHg 较术前（145．4＆#177;18．0）mmHg/（79．8＆#177;12．2）mmHg 显著下降,心率（72．1＆#177;11．6）次/分也较术前（78．2＆#177;12．9）次/分显著降低;术前患者普遍存在焦虑情绪（43．4＆#177;8．4）,焦虑水平与学历、血压及心率均呈正相关（P＜0．05）,与年龄、生活质量呈负相关（P＜0．05）;介入术后患者焦虑水平显著下降（41．2＆#177;7．6,P＜0．03）;抑郁水平在手术前后无明显变化。本结果提示择期介入治疗心血管病患者术前存在明显焦虑,焦虑水平与年龄、学历、血压、心率及生活质量密切相关。     

正确认识高血压患者应用阿司匹林的出血问题

高血压作为一种全球性的心脑血管疾病,会导致多器官损害,其患者发生心肌梗死、心绞痛、脑卒中等血栓栓塞性事件的几率远远高于血压正常者,因此防止心脑血管事件的发生是高血压治疗中的一个重要目标。多项大型临床研究证明,阿司匹林可以有效预防高血压患者心脑血管事件发生,同时也增加了出血的危险。本文将探讨如何正确认识高血压患者应用阿司匹林的出血问题,并如何将出血的危险降低到最小。     

近年来中国抑郁症高发的社会因素分析

心脑血管疾病已超越恶性肿瘤成为人类的头号“杀手”。发生心脑血管疾病的风险与血压水平正相关,高血压患者发生心脑血管意外的可能性远高于血压正常者。高血压的发病原因非常复杂,可能是多种因素综合作用的结果。摄盐过多可能是现代社会高血压发病率较高的重要因素。本文试图从人类进化角度揭示长期高盐饮食导致高血压的历史根源,进一步阐明限盐在高血压防治中的重要性。     

重视限盐在高血压防治中的作用

心脑血管疾病已超越恶性肿瘤成为人类的头号"杀手".发生心脑血管疾病的风险与血压水平正相关,高血压患者发生心脑血管意外的可能性远高于血压正常者.高血压的发病原因非常复杂,可能是多种因素综合作用的结果.摄盐过多可能是现代社会高血压发病率较高的重要因素.本文试图从人类进化角度揭示长期高盐饮食导致高血压的历史根源,进一步阐明限盐在高血压防治中的重要性.     

高血压合并糖尿病患者的降压目标及治疗

高血压合并糖尿病是冠心病致死的危险因素。有效地控制血压可以显著地降低糖尿病病人心血管事件的发病率与病死率。高血压糖尿病病人的血压控制目标为〈130／80mmHg。为了达到这一血压水平,糖尿病病人的降压治疗包括合理的非药物治疗与药物治疗。在药物治疗中应选用血管紧张素转换酶抑制剂、血管紧张素受体拮抗剂、钙离子拮抗剂和小剂量利尿剂,并且注意联合用药。     

Together – apart: in touch in a time of separation

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst’s internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.     

The Possibility of Meaning in Human Evolution

Science undermines the certitude of non-naturalistic answers to the question of whether human life has meaning. I explore whether evolution can provide a naturalistic basis for existential meaning. Using the work of philosopher Daniel Dennett and scientist Ursula Goodenough, I argue that evolution is the locus of the possibility of meaning because it has produced intentionality, the matrix of consciousness. I conclude that the question of the meaning of human life is an existentialist one: existential meaning is a product of the individual and collective tasks human beings undertake.     

Phenotypic plasticity and archetype: a response to common objections to the biological theory of archetype and instinct

Since Jung’s death in 1961, scholars have attempted to integrate growing biological science data into Jungian concepts such as the collective unconscious, instincts and the archetypes. This enterprise has been challenging due to persistent false dichotomies of gene and environment occasionally arising. Recent works by Roesler (2022a, 2022b) for example, have raised objections to the biological theory of archetypes, but the objections are plagued by such dichotomies. The concept of phenotypic plasticity, however, helps to both avoid this problem as well as bridge the gap between competing theories into a more integrated model with solid biological foundations.     

When is it time to stop? When good enough becomes bad enough

This article draws on Winnicott’s concept of the good enough mother to discuss how to know whether a therapeutic situation is good enough to continue or bad enough to end. This dilemma is explored in terms of clinical syndromes, such as anorexia and pathological gambling, but focuses mainly on analyst-initiated endings, which are termed the ‘Casablanca dilemma’, based on an amplification of the ending of the film Casablanca. The author goes on to discuss such one-sided endings, drawing on interviews with 40 analysts and therapists about their clinical experience. A typology of bad enough endings is presented. The psychological differences between a good enough analysis as opposed to a bad enough one are explored through the ideas of Winnicott and Neumann.     

Kann Es Ein Argument Für Den Skeptizismus Geben? Das Epistemische Problem Der Irrtumsmöglichkeit

Summary  Is there any argument for scepticism? The epistemic problem of the possibility of error. Arguments for scepticism rest on the assumption that knowledge claims are fallible. For this reason the concept of knowledge appears to be questionable. Since it is necessary to distinguish doubts from possible doubts, the arguments for scepticism appear to be unconvincing. If we take it into account that we know something that is immune to doubt, we should draw the conclusion that, contrary to scepticism, knowledge claims have to be compatible with being fallible. Thus any knowledge claim is capable of being doubted.     

The transcendent function in Spitteler’s Prometheus and Epimetheus

In August 2020, John Beebe and Steve Myers met via Zoom to discuss their differing interpretations of psychological typology and the different sources within Jung’s writings that influenced their books: Integrity in Depth: Energies and Patterns in Psychological Type (Beebe), and Myers-Briggs Typology vs Jungian Individuation (Myers). The discussion centred on Spitteler’s epic poem Prometheus und Epimetheus, which forms the basis of chapter V of Psychological Types. This is both the largest chapter and one of two chapters that Jung highlighted in the Argentine foreword as containing the essence of the book. Jung’s book is primarily about the transformation of personality rather than the categorization of people. Although it contains a critical psychology that deconstructs the nature of consciousness, that is only one half of the book and a stepping-stone to the other half, which is the reconciliation of opposites with particular emphasis on the relation of consciousness and the unconscious. Jung assumed that readers were already familiar with Prometheus und Epimetheus, an understanding of which sheds light on the nature of the transformation that Jung described – the development of a new attitude towards attitude itself.     

Chapter 6: Biblical Foundations for a Practical Theology of Aging

SUMMARY

This article reviews Biblical sources pertaining to the elderly, particularly the frail elderly. Founded on these sources, implications for elderly with Alzheimer's Disease and other forms of dementia are addressed through a personal perspective informed by writings of Christian mystics.     

Seeing in the Dark: A View into Dissociation and Healing

In this paper, I will explore the role of art-making, the experience of trauma and dissociation, and the process of working with self-states from an analytic and creative frame. Relevant literature on dissociation, trauma, and the use of art will be discussed. A case involving my work with an adolescent girl who had experienced sexual abuse from a family member will be shared, with an emphasis on the meaningful role images played during the therapeutic process. Both Jungian and psychoanalytic models of conceptualizing and working with dissociation are included, following Donald Kalsched’s (2013) recommendation for a “binocular stance” to treatment, including both a focus on the inner, intrapsychic world and the interpersonal, relational realm, and how art images both illuminated and expressed these realms. Within the therapeutic process, art images allowed the therapist a view into the client’s unconscious process, and created a meeting ground for dissociative barriers to be gradually seen, felt and known, by both therapist and client. The experience of dissociation, in images and in session, provided a reference point for myself and my client, Taylor, to develop a shared understanding and a framework for growth.