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。     

性心理障碍研究

性心理障碍泛指在两性性方面的心理和行为明显偏离正常,并以这类偏离为性兴奋、性满足的主要或唯一方式的一组心理障碍。ICD～10将性心理障碍分为三类：即性身分障碍,性偏好障碍以及性对象选择障碍。关于性心理学障碍的成因主要有,生物学因素、心理学因素以及社会因素。性心理障碍的治疗则有心理治疗（包括精神分析理论、行为主义理论以及心理疏导治疗法）、性治疗以及经验疗法。     

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。     

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.     

青少年网络成瘾的预防与干预研究

网络成瘾障碍(Internet Addiction Disorder,IAD)已成为影响青少年身心健康和正常学业表现的重要因素。针对青少年网络成瘾的心理预防与干预研究已开展逾十年,分析与总结显示,已有研究采用个体、团体等不同干预模式,采用认知行为、动机激发等不同咨询与治疗理论,对青少年网络成瘾行为的干预进行了大量探索;其中以团体干预模式及认知行为疗法为主导,并呈现多模式多理论相融合的趋势。借鉴已有研究的成果与不足,我们采用家庭治疗、认知行为、动机激发等多种咨询与治疗理论,结合心理需求网络满足优势等网络成瘾理论,形成了个体-家庭-学校的多水平预防与干预方案,并得到了实证研究的检验。今后的研究应进一步考虑青少年网络成瘾的生理因素,将生物-心理-社会三方面相结合形成系统性的网络成瘾预防与干预模式。     

焦虑障碍的虚拟现实暴露疗法研究述评

虚拟现实暴露疗法(VRET)是传统的行为疗法的一种转换形式, 也是经典的现实情境暴露疗法的替代性治疗形式。虚拟现实整合了即时计算机图形学、身体感觉传感、视觉成像技术, 给来访者提供近似真实的、可以沉浸(immersion)和交互作用的虚拟环境。研究者采用虚拟现实暴露疗法治疗幽闭恐怖症、恐高症、飞行恐怖症、创伤后应激障碍、惊恐障碍等焦虑障碍, 并且关注虚拟现实暴露疗法的认知机制以及心理生理机制。实验研究表明, 虚拟现实暴露疗法在治疗焦虑障碍时是有效的。被试经过治疗之后, 对情境的控制感和自我效能感提升, 消极自我评价降低, 对创伤事件的容忍力提高, 重新获得对情境的控制感。与心率指标相比, 皮肤电是预测虚拟现实暴露疗法治疗效果更好的指标。虚拟现实暴露疗法还处于实验验证阶段, 并没有应用到实际临床中, 需要更加规范的实验设计验证该疗法的认知机制以及心理生理机制。虚拟现实暴露疗法结合功能磁共振成像(FMRI)用于心理治疗, 会是未来发展的新方向。     

接纳承诺疗法在青少年心理健康促进中的应用与展望

接纳承诺疗法(ACT)是近20年新兴起的一种认知行为疗法,由接纳、认知解离、关注当下、以己为景、明确价值和承诺行动六个核心过程组成,共同促进个体心理灵活性的提升。ACT应用于青少年心理应激、抑郁、焦虑、神经性厌食症、慢性疼痛、危险行为、学习障碍等身心行为问题的辅助治疗,能有效缓解个体消极情绪、帮助个体恢复社会功能、提高生命质量。对ACT六大治疗过程的研究、试验方法和测评工具的发展、研究范围的扩大以及依据青少年特征对ACT进行适应性改编是未来研究发展的方向。     

情绪障碍及其干预:心理表象的视角

心理表象在多种情绪障碍中均表现出病理性特点。研究者基于心理表象主要对创伤后应激障碍、抑郁心境、双相障碍情绪和社交焦虑进行了心理病理学解释,尤其关注闪回和过度概化记忆等两种典型症状,并且重视心理表象在情绪症状维持中的作用。概括而言,研究者强调记忆形成与提取过程的异常、认知与行为的保护性策略的负强化、对事件及自我的认知偏差等三类因素对情绪障碍的致病作用。目前,针对或运用心理表象的干预与训练方法包括减少消极表象、改变消极表象内容、提高积极表象能力、提高记忆的具体性等四类。未来应注重侵入性表象的功能分析以及相关的心理病理学模型研究,并拓展干预与训练研究。     

一种以身体为导向的心理疗法:集中式运动疗法

集中式运动疗法是一种以身体为导向的心理疗法,其适应证范围包括常见的精神心理障碍和心身疾病。集中式运动疗法发源于体操练习,在不断地实践探索中注重感官体验与精神分析治疗相结合,发展至今已成为全德国医疗机构中普遍应用的治疗方式。集中式运动疗法将身体的运动和感知作为经验的基础,是基于心理发展理论、精神分析理论与学习理论的思想模型。通过反复探索两个环形控制回路——非言语回路(运动-感知)和言语回路(思考-交流)来达到治疗目的。通过对该疗法的介绍,以期能够提供新的思路,促进以身体为导向的心理疗法在我国的应用和发展。     

内源性抑郁症史者的自尊心操纵实验研究

实验组为45名缓解的内源性抑郁症患者(27男18女),对照组为15名缓解的双相障碍患者(8男7女),71名正常人(42男29女)。自尊心操纵实验研究表明,抑郁症组受挫折后自责以及将失败一般化的倾向强于正常人组,作者推测此种心理形成于青少年时代。双相障碍组总分与其它组无显著差异。个别项目表现出情绪不稳,将失败一般化以及较低的他责。     

Pharmacotherapy of seasonal affective disorder

Seasonal affective disorder is a common variant of recurrent major depressive disorder or bipolar disorder. Treatment with bright artificial light has been found to be effective in this condition. However, for patients who do not respond to light therapy or those who lack compliance, conventional drug treatment with antidepressants also has been proposed. Substances with selective serotonergic or noradrenergic mechanisms should be preferred over older antidepressants. Although there are a number of open and controlled studies evaluating different compounds, these studies were often limited by relatively small sample sizes. Furthermore, there are no studies specifically addressing bipolar seasonal depression. This article will review the published literature on pharmacotherapy of seasonal affective disorder.     

The use of antiepileptic drugs in bipolar disorders: a review based on evidence from controlled trials

Antiepileptic drugs (AEDs) have diverse psychotropic profiles. Some AEDs have proven to be efficacious in the treatment of mood disorders, especially bipolar disorder. Others are ineffective as primary treatments but may be useful adjuncts for mood disorders or comorbid conditions. Valproate (acute mania and mixed episodes), carbamazepine (acute mania and mixed episodes), and lamotrigine (maintenance to delay recurrence) have United States Food and Drug Administration indications for the treatment of bipolar disorder. This article provides an overview of data on the use of AEDs in bipolar disorder, including acute mania and depression, prophylaxis, and rapid cycling.     

The contemporary face of bipolar illness: complex diagnostic and therapeutic challenges

Manic depression, or bipolar disorder, is a multifaceted illness with an inevitably complex treatment. The current article summarizes the current status of our knowledge and practice concerning its diagnosis and treatment. While the prototypic clinical picture concerns the "classic" bipolar disorder, today mixed episodes with incomplete recovery and significant psychosocial impairment are more frequent. The clinical picture of these mixed episodes is variable, eludes contemporary classification systems, and possibly includes a constellation of mental syndromes currently classified elsewhere. Treatment includes the careful combination of lithium, antiepileptics, atypical antipsychotics, and antidepressants, but not all of the agents in these broad categories are effective for the treatment of bipolar disorder.     

Bipolar disorder in children and adolescents

There is increased recognition that bipolar disorder has an early age of onset. The prevalence of bipolar disorder in prepubertal children has not been determined, however the prevalence in adolescence is approximately 1%. Bipolar disorder in children poses a diagnostic challenge since the symptoms may differ from those in late adolescence and adulthood. Comorbid disorders, such as attention-deficit/hyperactivity disorder, further complicate both the diagnosis and course of the disorder. There is increasing evidence of the chronicity and severity of this disorder in youths. Bipolar disorder significantly disrupts a child's psychosocial development including impairments in academic functioning, family functioning, and relationship with peers. Although this disorder has significant morbidity in children and adolescents, there is a paucity of controlled studies to assess the efficacy and safety of mood stabilizers in the treatment of this disorder in youths. The treatment literature consists largely of case studies, retrospective chart reviews, and open-label studies. There is a compelling need for double-blind, placebo-controlled trials to determine whether commonly used medications to treat this disorder are significantly superior to placebo. Since many children in clinical practice require more than one psychotropic medication to adequately manage this disorder, studies of combination treatments are warranted. This review will provide an overview of the literature of bipolar disorder in children and adolescents, including discussion of the prevalence, diagnosis, epidemiology, course of the illness, and treatment issues.     

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.     

Transdiagnostic emotion regulation processes in bipolar disorder and insomnia

Research and treatment have traditionally adopted a 'disorder-focused' approach by targeting one specific disorder, aiming to understanding its cause, maintenance and treatment. The aim of the present study was to contribute to the burgeoning interest in examining common, or 'transdiagnostic,' processes across disorders. Three candidate transdiagnostic processes involved in emotion regulation - rumination, worry, and automatic negative thoughts - were examined in euthymic bipolar I disorder (n=21) and insomnia (n=19), and a non-clinical control group (n=20). Rumination and worry were endorsed to a larger degree by the bipolar and insomnia groups compared to the control group. However, while the bipolar group had more negative automatic thoughts than the control group, there were no significant differences in negative automatic thoughts between the bipolar and insomnia groups or the insomnia and control groups. These results suggested that rumination and worry, but not negative automatic thoughts, might be common across bipolar disorder and insomnia. However, these findings no longer remained significant when current symptoms of anxiety and depression were controlled for. Prospective and experimental studies are needed to test the extent to which these processes contribute to the etiology or maintenance of insomnia and bipolar disorder.     

Rapid Cycling

Rapid cycling is not a distinct disorder, but is a particularly severe form of bipolar disease. One in six patients with bipolar disease seen by psychiatrists either as an outpatient or as an inpatient suffers from four or more episodes per year. If at least four episodes occur within one year, this high-frequency phase is called ?rapid cycling“ (RC). Treatment for bipolar disorder with RC usually includes trialling mood stabilizers, such as lithium, anticonvulsants, and modern antipsychotics.In four out of five RC patients, treatment improves disease progression; however, some patients exhibit RC for many years.Specific studies have raised the suspicion that administering antidepressive therapy could facilitate an unfavorable course of bipolar affective disorder. The present case demonstrates disease progression and treatment attempts in a patient with distinct RC progression.     

Functional magnetic resonance imaging studies in bipolar disorder

Abnormalities in brain activation using functional magnetic resonance imaging (fMRI) during cognitive and emotional tasks have been identified in bipolar disorder patients, in frontal, subcortical and limbic regions. Several studies also indicate that mood state may be differentiated by lateralization of brain activation in fronto-limbic regions. The interpretation of fMRI studies in bipolar disorder is limited by the choice of regions of interest, medication effects, comorbidity, and task performance. These studies suggest that there is a complex alteration in regions important for neural networks underlying cognition and emotional processing in bipolar disorder. However, measuring changes in specific brain regions does not identify how these neural networks are affected. New analytical techniques of fMRI data are needed in order to resolve some of these issues and identify how changes in neural networks relate to cognitive and emotional processing in bipolar disorder.     

New anticonvulsant medication uses in bipolar disorder

Therapy of bipolar disorders is a rapidly evolving field. Lithium has efficacy in classic bipolar disorders whereas divalproex sodium and carbamazepine may have broader spectrum efficacy that includes non-classic bipolar disorder. In the last 10 years, a series of anticonvulsants have been approved for marketing in the United States. Gabapentin has indirect g-aminobuytric acid-ergic actions, is generally well tolerated, and appears to have anxiolytic, analgesic, and hypnotic effects. Lamotrigine has antiglutamatergic actions and is generally well tolerated (aside from rash in 1 in 10, and serious rash in 1 in 1,000 patients). Lamotrigine is indicated for maintenance treatment in bipolar disorder. Emerging evidence suggests lamotrigine may have utility in bipolar disorder patients with depression and treatment-refractory rapid cycling, as well as analgesic effects. Topiramate and zonisamide may allow both weight loss, while topiramate may have specific efficacy in bulimia, binge eating disorder, and alcohol dependence. Two small studies found oxcarbazepine had similar efficacy to lithium and haloperidol in acute mania. Phenytoin, an older anticonvulsant, may have adjunctive acute mania efficacy. Levetiracetam, a newer anticonvulsant, may be worth exploring and has minimal drug-drug interactions. None of these newer agents has been shown effective in a large placebo controlled trial for acute mania. Although the clinical profiles of these newer anticonvulsants do not appear to overlap markedly with divalproex and carbamazepine (except perhaps for oxcarbazepine), these novel agents may still offer important new options in relieving a variety of specific target symptoms in patients with bipolar disorder.     

Assessing the specificity of autobiographical memory in individuals at a trait-based vulnerability to bipolar disorder using a sentence completion task

Overgeneral autobiographical memory recall has been associated with the diagnosis of bipolar disorder, but the role of overgenerality in the vulnerability to bipolar disorder remains under-researched. While a previous study suggested that high-risk individuals for bipolar disorder recall emotionally negative memories in specific detail, this is in contrast to memory recall patterns noted in bipolar samples. The Autobiographical Memory Test (AMT) used in previous non-clinical studies has also been criticised for not being sensitive to overgenerality due to its repetition of specificity instructions and practice trials. The traditional AMT format may allow some individuals to override their trait-based tendencies to be overgeneral. The current study used a sentence completion task to assess memory specificity in groups of students at a low and high trait-based vulnerability for bipolar disorder. In contrast to previous research, high-risk individuals recalled fewer specific positive memories and greater numbers of overgeneral negative memories than low-risk individuals. These results support the notion that the vulnerability for bipolar disorder might be associated with similar recall biases as demonstrated in bipolar samples, and that the AMT might not be sufficiently sensitive to detect overgenerality in non-clinical groups. The implications of these findings and directions for future research are discussed.