抑郁障碍患者心理治疗感受的质性研究

探索抑郁障碍患者在心理治疗前后及其过程中的内心体验.使用立意取样法选9倒抑郁患者,深入访谈法收集资料,Colaizzi法分析资料.结果显示:(1)发病前压力大,对心理治疗基本没概念;(2)心理治疗过程中喜忧掺半:既有正性的感受,又有负性的感受;(3)经济压力大;(4)对医院和学校不满;(5)对疾病有痛耻感.因此,社会需要加大心理卫生知识的普及,抑郁障碍患者需要深切的人文关怀,医生应努力为患者减轻病耻感,同时要注意其社会功能的恢复.     

抑郁障碍患者心理治疗感受的质性研究

探索抑郁障碍患者在心理治疗前后及其过程中的内心体验。使用立意取样法选9例抑郁患者,深入访谈法收集资料,Colaizzi法分析资料。结果显示:(1)发病前压力大,对心理治疗基本没概念;(2)心理治疗过程中喜忧掺半:既有正性的感受,又有负性的感受;(3)经济压力大;(4)对医院和学校不满;(5)对疾病有病耻感。因此,社会需要加大心理卫生知识的普及,抑郁障碍患者需要深切的人文关怀,医生应努力为患者减轻病耻感,同时要注意其社会功能的恢复。     

一例内观疗法结合叙事疗法提升双相情感障碍患者幸福感的个案报告

为探讨内观疗法结合叙事疗法对双相情感障碍患者人际关系问题的疗效,以1例双相情感障碍I型患者为对象,进行为期三周的干预,共计11次内观疗法和7次叙事疗法。采用90项症状自评量表（Symptom Check List 90,SCL-90）、总体幸福感量表（General Well-Being Schedule,GWB）、宗氏抑郁自评量表（Zung Self-Rang Depression Scale,SDS）、宗氏焦虑自评量表（Zung Self-Rang Anxiety Scale,SAS）对患者治疗前、治疗后以及出院后3个月的状态进行测评。11次内观疗法和7次叙事疗法干预后,患者GWB总评分从73分升至115分,SDS标准分从38分降至31分,SAS标准分持平为38分,SCL-90评分从103分降至91分;三个月后随访GWB、SCL-90、SDS、SAS评分分别为：112分、91分、41分、25分,测评分值与治疗后差别较小。内观结合叙事疗法让患者意识到过去生活中的问题所在,有助于改善患者人际关系、稳定情绪并提升幸福感。     

电子智能设备在双相障碍个体化监测中的运用进展

现有研究提示,基于监测或评估的治疗可以有效提高临床治愈和改善疾病结局。双相障碍个体化监测及评估在国外已从传统纸质记录方法发展至现在的基于移动医疗手段。技术发展日新月异,但国内该领域研究尚是空白。本文主要介绍了国外电子智能设备在双相障碍个体化监测中运用的进展,对于国内该领域研究及双相障碍临床诊治具有重要指导意义。     

社会认同对抑郁的影响及其理论解释

社会认同作为个体在群际和内群体层面的社会联结,总体上对抑郁产生了积极影响,表现为认同程度、认同重要性、认同群体数量以及认同变化的影响等4个方面。现有研究从需求、认知和行为层面探讨了社会认同影响抑郁的中介因素,并检验了身份认同动机和消极群体评价两个调节因素。社会认同视角下的4种理论分别从社会医治、心理资源、认同变化以及认同层次等不同角度解释了社会认同影响抑郁的心理机制。未来应厘清社会认同对抑郁的深层影响机制,重视社会认同影响抑郁的调节因素,及建构社会认同影响抑郁的能动-共生模型。     

神经性厌食症的生物-心理-社会模型

厌食症作为一种精神和躯体疾病严重危害个体健康。已有众多研究者从生物-心理-社会整体医学模型角度对厌食症进行了研究。厌食行为受到遗传基因易感性、中枢神经递质活性改变、人格特质、肥胖恐惧感、应激因素、"瘦"文化背景、家庭关系紊乱等的影响。未来应着力探讨神经内分泌与厌食症的因果关系并加强厌食症的预防、干预及治疗。     

性心理障碍与性犯罪的社会心理防治——从一例儿童恋物症的矫治谈性心理障碍的成因、危害性及其防治

古人云：“食色,性也。”性活动与饮食、睡眠一样,都是比较高等的动物之最基本的生存需要和生理本能。通过性活动的生殖功能,物种得以延续,而人类的种族同样也得到了繁衍,人类社会也才得以绵延和发展。但是,人类性活动的特征已经与其他动物有了非常本质的区别,因为它受到社会化过程的重大作用和影响,已不仅仅是一种简单的个体的生殖活动,而是在人类繁衍本能所驱动下的一种复杂的、带有强烈心理色彩的、具有多种社会效应和社会功能的人类的基本活动。也就是说,人类的性活动已不单纯是为了生殖和繁衍后代为目的动物性的本能活动,     

1例神经性贪食症共病双相情感障碍患者的综合护理报告

神经性贪食症（bulimia nervosa,BN）是一种较为常见且难以治愈的精神疾病,常共病其他精神障碍,从而导致病情复杂化,需从多角度进行综合性护理。文章介绍了以认知行为治疗（cognive behavioral therapy,CBT）为核心,结合精神科安全护理、用药护理、营养与进食管理和健康教育等综合护理措施,护理1例BN共病双相情感障碍的患者,取得了较好的临床效果。     

述情障碍成因的认知及社会机制

对述情障碍本质和形成原因的解释主要包括认知机制和社会机制两种, 认知机制认为, 述情障碍体现了在情绪认知加工上的缺陷, 主要涉及到情绪图式、心理理论和执行功能等方面; 社会机制认为, 述情障碍的产生与儿童早年的一些经历有关, 并在社会文化和社会关系中得到不断的强化, 主要涉及到社会文化、社会经济地位和家庭功能及环境等方面。未来研究要把研究视角进一步扩展到热执行功能、整合研究、提出系统的社会机制理论等方面, 在研究方法上, 注意测量工具和研究技术的进一步改进。     

网络成瘾的社会-心理-生理模型及研究展望

对于网络成瘾,目前还没有统一的诊断量表,相应的研究手段和研究方法也不够成熟,有关的理论解释更有待于进一步探讨。以众多实验和理论研究成果为基础提出的“社会-心理-生理”整合模型也许能更好地解释这一现象。网络成瘾者的大脑活动变化规律,网络虚拟情境的特征及其与上网行为、个性特征等的交互影响,以及网络交互过程中的情感交流和情感识别等问题,将是今后网络成瘾研究的重要课题。     

Responsiveness to Threat and Incentive in Bipolar Disorder: Relations of the BIS/BAS Scales with Symptoms

Over the past 10 years, theorists have suggested that bipolar disorder symptoms result from increases and decreases in the activity of the Behavioral Activation or Facilitation System (BAS or BFS) and the Behavioral Inhibition System (BIS). These neurobehavioral systems are thought to determine the intensity of affective and behavioral responses to incentives and threats. This study examined cross-sectional and prospective associations of self-reported BIS and BAS with mania and depression in a sample of 59 individuals diagnosed with Bipolar I disorder. Depression was tied to BIS, pointing to the importance of sensitivity to threats in depression. However, links between BIS and depression appeared state-dependent. BAS subscales did not correlate with manic symptoms in a state-dependent manner; however, BAS (total scale and reward responsiveness subscale) predicted relative intensification of manic symptoms over time. Thus, evidence suggests that BAS sensitivity may constitute a vulnerability to mania among persons diagnosed with bipolar disorder. Discussion focuses on the integrative potential of the BIS/BAS constructs for linking psychosocial and biological research on bipolar disorder.     

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.     

The Role of the Family in the Course and Treatment of Bipolar Disorder

ABSTRACT— Bipolar disorder is a highly recurrent and debilitating illness. Research has implicated the role of psychosocial stressors, including high expressed-emotion (EE) attitudes among family members, in the relapse–remission course of the disorder. This article explores the developmental pathways by which EE attitudes originate and predict relapses of bipolar disorder. Levels of EE are correlated with the illness attributions of caregivers and bidirectional patterns of interaction between caregivers and patients during the postepisode period. Although the primary treatments for bipolar disorder are pharmacological, adjunctive psychosocial interventions have additive effects in relapse prevention. Randomized controlled trials demonstrate that the combination of family-focused therapy (FFT) and pharmacotherapy delays relapses and reduces symptom severity among patients followed over the course of 1 to 2 years. The effectiveness of FFT in delaying recurrences among adolescents with bipolar disorder and in delaying the initial onset of the illness among at-risk children is currently being investigated.     

Perceived Genetic Risks for Bipolar Disorder in a Patient Population: An Exploratory Study

Thirty-one subjects with bipolar illness completed a questionnaire about genetic risk for bipolar disorder. Subjects estimated both quantitative and qualitative genetic risk for bipolar disorder for the following categories: general population, siblings, parents, spouses, and children. Results showed that quantitative risks were inflated when compared to qualitative risks and that subjects routinely overestimated the risk for developing bipolar illness. These findings suggest that genetic counseling may be useful for this population.     

Cognitive Factors that Maintain Social Anxiety Disorder: a Comprehensive Model and its Treatment Implications

Social anxiety disorder (SAD) is a common, distressing and persistent mental illness. Recent studies have identified a number of psychological factors that could explain the maintenance of the disorder. These factors are presented here as part of a comprehensive psychological maintenance model of SAD. This model assumes that social apprehension is associated with unrealistic social standards and a deficiency in selecting attainable social goals. When confronted with challenging social situations, individuals with SAD shift their attention toward their anxiety, view themselves negatively as a social object, overestimate the negative consequences of a social encounter, believe that they have little control over their emotional response, and view their social skills as inadequate to effectively cope with the social situation. In order to avoid social mishaps, individuals with SAD revert to maladaptive coping strategies, including avoidance and safety behaviors, followed by post‐event rumination, which leads to further social apprehension in the future. Possible disorder‐specific intervention strategies are discussed.     

社会焦虑与精神疾病--社会焦虑致抑郁性自杀现象透视

社会焦虑是指在社会成员中普遍存在着的一种心理紧张状态.社会焦虑现象容易导致社会成员的关系紧张,不利于社会人群的心理健康并促使社会问题的产生和恶化.因此,遏制社会焦虑利于有效防止精神疾病的发生和社会的安全运转.     

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.     

Effectiveness of Psychodynamic Treatment in Patients with Borderline Personality Disorder

There is some evidence that the efficacy of four types of psychotherapeutic psychotherapy (mentalized-based treatment, transference-focused psychotherapy, psychoanalytic psychotherapy, and cognitive-analytic therapy), is superior to treatment-as-usual. More controlled and randomized studies are needed in order a) to confirm the results of the relatively few investigations that were available, b) to examine the therapeutic relevance and usefulness of correlates and predictors of improvement and remission in borderline patients, and c) to examine possible fruitful combinations with other types of treatment.     

Attention Bias Modification Treatment for Adolescents With Social Anxiety Disorder

Social anxiety disorder (SAD) tends to emerge during the early teenage years and is particularly refractory to change even when standard evidence-based CBT treatments are delivered. Efforts have been made to develop novel, mechanistic-driven interventions for this disorder. In the present study, we examined Attention Bias Modification Treatment (ABMT) for youth with SAD. Participants were 58 adolescents (mean age = 14.29 years) who met diagnostic criteria for SAD and who were randomized to ABMT or a placebo control condition, Attention Control Training (ACT). We predicted that ABMT would result in greater changes in both threat biases and social anxiety symptoms. We also explored potential moderators of change including the severity of social anxiety symptoms, the level of threat bias at pretreatment, and the degree of temperament-defined attention control. Contrary to our hypotheses, changes in attention bias were not observed in either condition, changes in social anxiety symptoms and diagnosis were small, and significant differences were not observed between the ABMT and ACT conditions. Little support for the proposed moderators was obtained. Reasons for our failure to find support for ABMT and its potential moderators are explored and recommendations for changes in the ABMT paradigm are suggested.     

An Integrative Brief Treatment Approach for Obsessive-Compulsive Disorder

This article reports on the integrated application of cognitive therapy, transactional analysis techniques, and the behavioral technique of response prevention using self-instructional training and behavioral substitution in a brief therapy approach. These methods were applied in the case of a young man who presented with compulsions to perform repetitive and ordering rituals with the belief that it would prevent his girlfriend from becoming pregnant. A 21-year-old white male who had performed 3 to 5 hours of rituals daily for several years was able to eliminate the majority of his compulsive behaviors and reduce his level of anxiety after eight clinical therapy sessions. Results were maintained at 6-month follow-up. The clear precipitating factors and the unusual maintaining variables for the disorder in the client are described. The author discusses the case in light of current theoretical, therapeutic, and biomedical understandings of the disorder.