系统性红斑狼疮病因病理与防治的思考

系统性红斑狼疮(SLE)是一种临床表现有多系统损害症状的慢性系统性自身免疫病.虽然对SLE的病因、病理的研究有了较大的进展,但SLE的治疗并不理想,目前仍然有约10%的患者在发病5年内死亡.从哲学角度对SLE的病因、病理与防治中存在的问题进行了综合分析,并为SLE的临床实践和进一步研究提供了思路.     

SLE患者焦虑抑郁影响因素调查分析

为了探讨SLE（systemic lupus erythematosus）即系统性红斑狼疮患者焦虑抑郁心理影响因素,应用Zung焦虑自评量袁（Self—rating anxiety scale,SAS）和抑郁自评量表（self—rating depression scale,SDS）,对36例系统性红斑狼疮患者进行检测,辅以自行设计因素调查表进行相关因素调查。结果显示,SDS和SAS均分为49．70±11．3和42．13±8．9,与国内常模比较,差异有统计学意义,P〈0．01。单因素分析显示：对疾病的恐惧感、对病情了解程度、治疗效果、药物副作用、家庭经济状况、家庭支持、婚姻关系、睡眠质量、担心事业受影响、躯体症状的反复出现、社交娱乐活动受限、担心医护不精心12项因素与SLE患者抑郁焦虑状态的发生显著相关,P〈0．01。证明SLE患者抑郁焦虑心理与对疾病的恐惧感、治疗效果、家庭经济状况、睡眠质量等因素相关,这为心理干预提供了依据。     

从系统论的角度看系统性红斑狼疮分类标准的变迁

系统性红斑狼疮是一种复杂的自身免疫性疾病,本文试从系统论中的整体性、层次性、动态性、目的性原理来阐述SLE分类标准的变迁,揭示系统性思维对于正确把握SLE分类标准的重要性,临床诊疗决策中系统论的运用具有重要意义.     

酒精性肝损伤的防治思考

酒精性肝损伤已成为继病毒性肝炎后的主要肝损伤病因,因此酒精性肝病的防治已经成为重要的医疗课题。其病因、发病机制、病理改变及治疗等有其独特的特点,用哲学的方法对其进行科学、全面的分析,可有助于对该病的认识和研究,指导我们从总体考虑,更为合理、有效地防治酒精性肝损害。     

略論我国病理心理学現况

近几年来,我国病理心理学工作者在和精神病学工作者富有成效的协作之下,展开了临床心理診断、心理治疗和其他病理心理研究的一系列工作,积累了一些科学資料,初步取得了一些成果。中国心理学会1963年学术年会上,有关病理心理問題的論文已有20篇之多,而过去的大会論文却很少涉及这方面的問題。二十篇論文的內容涉及对資产阶級唯心主义在病理心理学中的流派的批判和分析,神經症、精神病的病因、診断和治疗的病理心理学实驗研究。中国心理学会各地方学会也有不少精神病学工作者参加了組織工     

关于病灶与证象两种疾病观的比较

中医和西医对人体和疾病的认识方法不同 ,分别建立了各自的病理学体系 ,西医的病理学基础是病灶 ,中医的病理学基础是证象。病理学的不同 ,导致中西医对病因、病机、临床表现、诊断、治疗以及预后判断的全方位认识差异。1　病因病灶即指机体结构发生的异常改变 ,这是西医进行病理判断的基础 ,有灶即有病 ,无灶便无病。因此病因便是导致病灶出现的原因 ,如果找不到致使病灶发生的原因 ,那么该病便被称为病因不明疾病。在这里 ,因果关系是进行病理判断的根本原则 ,而直接原因更是被格外看重 ,间接原因和多重原因相对而言不被西医病理学注意。…     

神經衰弱的自觉症状与皮肤电现象

問題我国近年来对神經症病因与发病机制的研究有不少报告,但对症状的心理生理分析則比較少。在病理心理学方面有关皮肤电現象的工作,早年的研究者多企图发現各类疾病的特征性曲綫。欧德格的实驗強調了症状的分析。我們也曾提出了类似的看法,并指出必須从病人当时的病理心理状态来考虑曲綫的特点。     

女性绝经进程与抑郁易感性

采用系统论观点对女性围绝经期的生物学改变进行分析,并在此基础上对该时期抑郁症易感性增加的原因进行探讨,指出绝经进程的系统性特征,对大脑皮层、下丘脑、垂体等中枢神经系统结构和卵巢等外周器官的功能改变和失调进行多层次、关联性、动态性分析,对围绝经期抑郁症病因的进一步研究具有重要意义。     

中医药临床实践的价值

把现代病因病理医学作为参照物,通过比较,指出中医的证是病人的全身综合反应状态,是病因病理医学之外的另外一个临床医学范畴。状态与病因病理是人类疾病的两个不同方面。从单纯状态病,西医难治和不治的疾病,常见病的治疗,中医药的近期疗效和远期疗效等方面阐述了中医药的临床价值。     

中医药临床实践的价值

把现代病因病理医学作为参照物,通过比较,指出中医的证是病人的全身综合反应状态,是病因病理医学之外的另外一个临床医学范畴.状态与病因病理是人类疾病的两个不同方面.从单纯状态病,西医难治和不治的疾病,常见病的治疗,中医药的近期疗效和远期疗效等方面阐述了中医药的临床价值.     

系统性红斑狼疮误诊的反思

系统性红斑狼疮是一种极为复杂的自身免疫性疾病,临床表现变化多端,早期误诊率高。对1328例系统性红斑狼疮误诊病例进行分析,剖析了该病的本质及特征,并探讨导致误诊的原因,提出了预防误诊的对策,以期提高对本病的早期诊断。     

Do Cognitive Therapy Skills Neutralize Lifetime Stress to Improve Treatment Outcomes in Recurrent Depression?

Cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but not all patients respond. Past research suggests that stressful life events (SLE; e.g., childhood maltreatment, emotional and physical abuse, relationship discord, physical illness) sometimes reduce the efficacy of depression treatment, whereas greater acquisition and use of CT skills may improve patient outcomes. In a sample of 276 outpatient participants with recurrent MDD, we tested the hypothesis that patients with more SLE benefit more from CT skills in attaining response and remaining free of relapse/recurrence. Patients with more pretreatment SLE did not develop weaker CT skills, on average, but were significantly less likely to respond to CT. However, SLE predicted non-response only for patients with relatively weak skills, and not for those with stronger CT skills. Similarly, among acute-phase responders, SLE increased risk for MDD relapse/recurrence among patients with weaker CT skills. Thus, the combination of more SLE and weaker CT skills forecasted negative outcomes. These novel findings are discussed in the context of improving CT for depression among patients with greater lifetime history of SLE and require replication before clinical application.     

Cognitive and Emotional Abnormalities in Systemic Lupus Erythematosus: Evidence for Amygdala Dysfunction

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder characterized by the production of autoantibodies. Approximately 30-50?% of patients produce autoantibodies directed against N-Methyl-D-aspartic acid receptors (NMDARs). Once they have gained access to brain tissue, these autoantibodies bind to the NR2A subunit of the NMDARs and synergize with glutamate to cause excitatory, non-inflammatory cell death or alter neuron function. Both humans with SLE and animal models of SLE have shown structural and functional damage to the amygdala. The amygdala is a brain region important for processing the emotional relevance of stimuli in the environment. It also serves to modulate perception, attention, and memory to facilitate the processing and learning of relevant stimuli. Research has linked amygdala damage to deficits in emotional memory and emotional behavior. Individuals with SLE often exhibit emotional dysregulation, such as lability and depression; however, the behavioral impact of possible amygdala dysfunction has yet to be studied in this population. The purpose of this review is to 1) examine possible associations between SLE, anti-NMDAR antibodies, amygdala damage, and emotional processing deficits and 2) to identify the clinical, social, and treatment implications for individuals with SLE who suffer from deficits in emotional processing.     

The influence of subjective life expectancy on retirement transition and planning: A longitudinal study

This study examines the construct of subjective life expectancy (SLE), or the estimation of one's probable age of death. Drawing on the tenets of socioemotional selectivity theory (Carstensen, Isaacowitz, & Charles, 1999), we propose that SLE provides individuals with their own unique mental model of remaining time that is likely to affect their retirement planning and decision making. Longitudinal data from 1908 participants showed that SLE measured at Time 1 predicted mature-aged workers' intended retirement age and the extent that they were engaged in retirement preparation 12 months later at Time 2. Furthermore, a shorter SLE at Time 1 increased the odds of actual retirement by Time 2 after controlling for a set of known predictors of retirement. In contrast, a longer SLE at Time 1 increased the odds that a Time 1 retiree had returned to paid work by Time 2. The discussion highlights ways in which SLE can inform financial and vocational counselling for late career decision-makers.     

糖皮质激素治疗系统性红斑狼疮中“度”的把握

系统性红斑狼疮是一种与遗传、免疫、种族、环境等因素有关的侵犯多系统结缔组织的全身性自身免疫性疾病。该病多器官受累,症状重且复杂,病情反复缓解和发作,故本病的治疗是一个长期的过程,需要终身治疗。糖皮质激素在系统性红斑狼疮的治疗中为最关键的药物,糖皮质激素的剂量、合理运用及“度”的掌握是治疗疾病成败的关键。     

Personality Predicts Health Declines Through Stressful Life Events During Late Mid‐Life

Personality predicts the occurrence of dependent stressful life events (SLE; i.e., events reliant, at least in part, on an individual's behavior). This process, termed stress generation, contributes to psychiatric outcomes, but its role in physical health is unknown. Data were included from 998 participants (aged 55–64) in the St. Louis Personality and Aging Network (SPAN) study. Assessments occurred every 6 months for 18 months. Neuroticism, impulsivity, and agreeableness were measured with the Revised NEO Personality Inventory. Dependent (e.g., divorce) and independent (e.g., family death) SLE occurring within 6 months following baseline were assessed with the List of Threatening Experiences and confirmed by interviews. Health problems occurring within a year after SLE were the outcome. Analyses examined whether neuroticism, impulsivity, and agreeableness indirectly predict the onset of new health problems through exposure to dependent SLE. Each personality trait was associated with dependent, but not independent, SLE. Only dependent SLE predicted new health problems. Each personality trait indirectly predicted the onset of new health problems through dependent SLE. Findings suggest that personality‐driven stress generation influences physical health during late mid‐life. Addressing personality in interventions may reduce the occurrence of SLE, in turn decreasing health risks.     

A brief assessment tool for body image in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) may adversely affect body image in multitude ways. Development and validation of a brief and valid SLE specific body image tool were undertaken. Eleven items were identified on interview of 21 SLE patients for the Body Image Lupus Scale (BILS v1.0). The tool was administered to 70 SLE patients. Based on analysis, feedback, and refinement of items, the final iteration BILS v1.2 with five items was administered to 233 SLE patients along with validated body image measures (Situational Inventory of Body Image Dysphoria and Body Image Quality of Life Inventory) and health-related quality of life measures for a subsample. The BILS scores' had an internal consistency reliability of .94. It correlated with both the referent body image measures, and with health-related quality of life. It differentiated participants by health status and disease activity. Test-retest reliability estimates exceeded .90. These results support the psychometric properties of BILS.     

Stressful life events and suicidal behaviour in countries with different development levels: Nicaragua,El Salvador,Chile and Spain

This paper presents a study conducted on 709 Latin American undergraduates from four countries with different development levels (Nicaragua, El Salvador, Chile and Spain). The intention of this paper is to value the differences in the number and characteristics of stressful life events (SLE) suffered by the participants. Another purpose is to confirm the relation between SLE and suicidal conduct in Spanish cultural contexts, through the study of a multicultural sample of Spanish‐speaking university students, and finally, to isolate the SLE that allow predicting a later suicidal conduct to a greatest extent. The information was collected by means of a self‐applied questionnaire. The results indicate a greater presence of SLE among those who live in countries with lower development levels and among those who have attempted committing suicide. It is observed that the fact of having suffered certain SLE—physical or sexual mistreatment, excessive alcohol or drug consumption and having left home during childhood or adolescence—aid in the prediction of later suicidal conducts in the studied samples. Copyright © 2010 John Wiley & Sons, Ltd.     

Suicide attempts and stressful life events among female victims of intimate partner violence living in poverty in Nicaragua

This article describes a study of 136 female intimate partner violence victims living in poverty in Nicaragua. The paper aimed to analyze the relationship between experiencing stressful life events (SLE) and perceived social support with suicide attempts, and to evaluate the differences in the SLE experienced by female suicide attempters versus non‐attempters. The results showed the existence of a high level of SLE among the interviewees, and that women who have attempted suicide have experienced substantially more of these events. Experiences of violence and less social support were especially related to suicide attempts among the interviewees.