关注降压药物的选择,促使更有效的降压达标

我国成人高血压患病率高达18.8%,全国有高血压患者约1.6亿.合理的药物治疗是降压达标的主要措施,如何进行正确选择成为摆在我们面前的难题.目前,降压药物主要包括利尿剂、β受体阻断剂、血管紧张素转换酶抑制剂、血管紧张素Ⅱ受体拮抗剂、钙拮抗剂和α受体阻断剂6类.因降压治疗的收益主要来自于降压本身,为了提高降压达标率及高血压患者的用药依从性,目前多主张低剂量联合治疗.     

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。     

降压治疗的决策思考

尽管降压药物有了很大发展,高血压的控制率仍很低下。降压治疗中还存在包括医生和患者两方面的许多误区。目前已取得的共识是:降压治疗的益处主要来自血压控制。因此,非常重要的是要达到血压的有效和长期稳定的降低。根据患者的年龄、基线血压、伴随的临床状况等,因人而异地选择副作用小、降压效果好的药物,提高顺应性是改善高血压控制率的关键。     

降压治疗的决策思考

尽管降压药物有了很大发展,高血压的控制率仍很低下.降压治疗中还存在包括医生和患者两方面的许多误区.目前已取得的共识是:降压治疗的益处主要来自血压控制.因此,非常重要的是要达到血压的有效和长期稳定的降低.根据患者的年龄、基线血压、伴随的临床状况等,因人而异地选择副作用小、降压效果好的药物,提高顺应性是改善高血压控制率的关键.     

关于血管紧张素转换酶抑制药＋β受体阻断药组合的重新审视

采取联合用药方案治疗高血压已成为近年来临床用药的总体趋势。临床用药情况调查结果表明,血管紧张素转换酶抑制药＋β受体阻断药的联合用药组合占有一定的使用率,分析两类药的降压作用以及对高血压常见并发症和对代谢、心率等的影响,可见这个组合是合理的。     

高龄老年高血压患者的降压治疗策略

80岁以上高龄老年高血压患者的降压治疗随着人口老龄化而越来越受关注.评估高龄高血压患者降压治疗的获益与风险,在循证医学基础上进行个体化治疗,依据全身情况和耐受程度调整血压控制水平,慎重选择药物,平稳缓慢降压,将使高龄高血压患者最大程度受益.     

高龄老年高血压患者的降压治疗策略

80岁以上高龄老年高血压患者的降压治疗随着人口老龄化而越来越受关注。评估高龄高血压患者降压治疗的获益与风险,在循证医学基础上进行个体化治疗,依据全身情况和耐受程度调整血压控制水平,慎重选择药物,平稳缓慢降压,将使高龄高血压患者最大程度受益。     

门诊抗高血压用药分析

通过对天津市某医院的高血压患者发病和用药情况进行调查,了解此医院血压用药特点及其合理性和局限性。结果显示,用药频度的前三类分别是钙离子拮抗剂（CCB）、血管紧张素Ⅱ受体拮抗剂（ARB）、血管紧张素转换酶抑制剂（AcEI）;用药频度的前三个药分别是硝苯地平控释片、厄贝沙坦、贝那普利;使用一种降压药物的处方占49．25％,...     

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。     

老年高血压降压不易达标及降压质量低的原因分析及对策

老年高血压降压不易达标或降压质量低,原因在于老年高血压的特殊性,如多发收缩期高血压、血压波动大、易发生体位性低血压、合并多脏器功能损害等。在老年高血压的治疗中,应充分认识其特殊性,开展健康教育、改善生活方式,正确选择降压药,在降压达标治疗的基础上,提高降压质量,最大限度降低患者靶器官损害,减少心血管终点事件的发生。     

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.     

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.     

Mythological Underpinnings of Feminine Development

In the manner of Oedipus Rex, the myth of Myrrha—a story about a daughter's initiation of sex with her father—promises to divulge insights about feminine development. Given parallels between these two myths, the author asks why Jung identified Electra rather than Myrrha as the feminine counterpart to Oedipus, and revisits Freud's and Jung's differing interpretations of the incest theme in personality development. To break open the metaphor of Myrrha's incest, the author analyzes a similar account of incest in the Old Testament story of Lot and his wife and finds that they share a theme of female bitterness related to wounding of the mother and its arresting effect on the daughter's maturation. The article then considers the Demeter-Persephone myth, a tale not of incest but rape in Persephone's initiation into womanhood. In contrast to Myrrha, Persephone's development unfolds with strong maternal support tempered by the opposing claims on her by the masculine. The article draws these stories together to illuminate the archetypal forces that drive feminine development as well as the human affairs that resist and complicate them. The article concludes with a case study of a client whose developmental “stuckness” follows the contours of the Myrrha myth.     

Alchemical dragons: Winnicott’s reaching towards the objective psyche

This paper was presented to the inaugural joint conference of The Society of Analytical Psychology and the West Midlands Institute of Psychotherapy in the autumn of 2020. It develops the author’s interest (2011, 2015, 2016) in Winnicott’s engagement with Jung by looking at the imagery of Michael Maier’s alchemical work of 1617, Atalanta Fugiens, through the lens of Matte Blanco’s bi-logic.     

In Memory of Anthony Stevens: A Career Retrospective with Emphasis on His Formative Role in the Archetype Debate

This paper celebrates the life and legacy of psychiatrist and Jungian author Anthony Stevens, who passed away at age 90 on July 13, 2023. It outlines Stevens's origins as a research fellow in Greece, where his work on infant attachment led to a lifelong dedication to establishing the biological and evolutionary foundation of psychiatry. It details his instrumental role in the debate about the theory of archetypes and describes the current state of the literature including the responses and reactions to Stevens's biological innatist position. The paper concludes with a career retrospective in which Stevens's major works are introduced and briefly described.