冠心病伴焦虑抑郁的临床研究

冠心病是目前公认的心身疾病,心理社会因素与其发生、发展及预后关系密切,其中焦虑、抑郁尤为重要.近年来综合心理干预已引起临床医生重视,本文拟从焦虑、抑郁与冠心病的关系、对其预后的影响以及临床干预治疗现状和水平进行了综述.     

冠心病患者的抑郁和焦虑

许多临床研究表明,冠心病患者常发生抑郁及焦虑。而在严重精神症状（如抑郁或/和焦虑）者中有较高的冠心病发生率。抑郁增加冠心病患者的不良心血管事件发生率,影响预后。其机制有如下几个方面：对医疗措施及生活方式改变的依从性差、血小板功能异常、血管内皮功能紊乱以及心率变异性降低。选择性5-羟色胺再摄取抑制剂由于其较好的耐受性且无明显的心血管副作用而应用于冠心病合并抑郁及焦虑的药物治疗并改善患者的生活质量。但仍需要更大规模的临床研究以确定抑郁及焦虑对冠心病预后的影响。临床上应更加关注焦虑对冠心病的影响,进一步探讨焦虑能否作为冠心病的危险因素。     

555例危险行为高危青少年的心理干预：来自个体辅导和团体辅导的效果对照

对有较高风险发展为危险行为青少年的高危群体实施有针对性的心理干预是非常有价值的。本研究对青少年危险行为高危人群进行结构化的个体与团体心理干预,评估两种干预的即时效果和六个月的预后情况。采用《青少年健康相关危险行为问卷》等量表对16所中职院校的学生进行筛查,共555名学生参加本研究,被随机分为个体、团体和对照组并分别进行干预。结果发现：干预后,个体心理干预组被试的危险行为水平、心理健康以及抑郁和焦虑情绪均获得显著改善,并且6个月的预后效果依然明显,而接受团体辅导干预组仅在抑郁指标上有所改善,在危险行为评分、焦虑和心理健康水平上均没有明显的改善。研究认为,对危险行为易感青少年的心理干预应以经过良好设计的个体心理干预为主、团体干预为辅的方式进行。     

家庭累积风险与青少年心理健康的关系——心理资本的补偿效应和调节效应

对1473名初、高中生进行问卷调查,考察家庭累积风险与青少年心理健康的关系以及心理资本的补偿效应和调节效应。结果发现：（1）家庭累积风险负向预测生活满意度,正向预测焦虑/抑郁;（2）心理资本正向预测生活满意度,负向预测焦虑/抑郁;（3）心理资本只能调节家庭累积风险与焦虑/抑郁的关系,表现为心理资本缓冲家庭累积风险对青少年焦虑/抑郁的不利影响。因此,改善家庭环境和培养心理资本是提升青少年心理健康的重要途径,需注意心理资本的培育对焦虑/抑郁和生活满意度作用的差异。     

PCI术前术后的心理障碍识别与处理

概述冠心病经皮冠状动脉介入治疗（PCI）术前术后患者合并心理障碍的较高发生率以及心理障碍对冠心病发生、发展及预后的影响,分析 PCI 术前术后患者出现焦虑抑郁等心理障碍的原因、产生机制及影响因素,强调心内科医生应及时识别 PCI 术前术后患者出现的心理障碍,并以“双心医学”方式对其进行心理精神医学及心血管专科医学治疗,同时对心血管专科医学治疗效果不明显的冠心病 PCI 患者,进行相关的鉴别诊断后也要进行心理精神医学的诊断和治疗,以便有利于 PCI 术患者的康复和预后,减少不必要的检查和治疗。     

女性冠心病患者并发焦虑和抑郁的个性化干预效果评价及影响因素

评价女性冠心病患者伴焦虑抑郁的个性化干预效果并探讨影响因素.试验组进行个性化干预,对照组不做任何特殊处理.干预后试验组的焦虑自评量表和抑郁自评量表分数明显低于试验前(P＜0.01),而对照组无显著变化(P＞0.05);试验组的平均住院时间为11.36天,低于对照组的15.42天(P＜0.01);文化程度、公费比例、疾病认知和病程影响焦虑的干预效果,疾病认知和单身年限会影响抑郁的干预效果.采取个性化干预的综合治疗效果显著.     

抑郁和焦虑对经皮冠状动脉介入治疗患者的影响及对策

越来越多的冠心病患者接受经皮冠状动脉介入治疗,但是这些患者表现出的焦虑抑郁情绪对经皮冠状动脉介入治疗（PCI）围术期的影响却少有报道。研究发现,焦虑和抑郁对心脏事件发生后的恢复有不利的影响,而接受 PCI 治疗的患者情感障碍的发生率是比较高的。主要心血管事件与这些负面影响是相关联的,研究表明密切监测这些患者的情感状态可以明显改善临床预后。     

抑郁和焦虑与心血管疾病

抑郁焦虑与心血管疾病的关系最能体现身与心两者相互影响、不可分割的特点。但临床上,心血管疾病患者抑郁焦虑的诊疗率不足1％。这说明现有的诊疗理念和方式没有将心血管疾病和精神障碍联系起来,给患者全面全程的干预和管理。这样的缺陷不仅增加患者的痛苦和功能障碍,也增加心血管疾病的发病率和病死率,还增加患者及社会的医疗负担。本文结合临床经验,从心身一体的诊疗理念,谈谈抑郁焦虑与心血管疾病。     

心理护理干预对伴有焦虑/抑郁的COPD患者治疗周期及费用的影响

为了探讨心理护理干预对伴有焦虑/抑郁的慢性阻塞性肺病患者治疗周期及费用的影响,将100例COPD合并焦虑/抑郁的患者随机分为心理干预组和对照组,两组均给予常规药物治疗,干预组增加心理干预,结果显示与入院时比较,心理干预组HAD评分明显改善(P＜0.05),对照组HAD评分也存在差异,但差异无统计学意义(P＞0.05).与对照组比较,干预组住院治疗周期明显缩短(P＜0.05),住院费用显著减少(P＜0.05).因此心理护理干预能改善COPD患者心理障碍,减少住院周期和费用,对COPD患者是较好的辅助治疗方法.     

焦虑和抑郁动物模型的研究方法和策略

焦虑和抑郁障碍是严重威胁人们健康的精神疾病。焦虑和抑郁动物模型是通过一定的心理社会应激使动物产生明显的焦虑和抑郁情绪,模拟人类焦虑和抑郁障碍,以探讨其细胞、分子和基因水平机制。情绪障碍动物模型通常通过表面效度、结构效度和预测效度进行评价。目前的动物模型虽然存在一定的缺点,但已经为临床和科研提供了巨大帮助。     

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.     

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.     

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.