躯体变形障碍与美容整形术前心理评估

躯体变形障碍是一种并不罕见的精神障碍,其临床表现的特殊性使大多数患者以普通求术者的身份出现在美容整形科医生面前。然而,关容整形手术非但不能解决患者的心理问题,更可能引发复杂的医疗纠纷。基于躯体变形障碍在美容整形科呈高发生率的特点,文章对美容整形术前心理评估的必要性和现状进行分析,并列举了有效的评估工具以提高心理评估的准确性。     

躯体症状障碍的特点及综合诊疗原则

从美国精神疾病诊断与统计手册第三版（DSM-Ⅲ）的躯体形式障碍,到甚至更早的诊断名称为DSM-5的躯体症状障碍,这类疾病的名称一直在变化;学界对躯体化症状的分类和定义也一直存在争议.进行分类和诊断的主要目的是为了治疗.本文从躯体症状障碍相关概念的变迁及本质特点入手,分析、总结躯体症状障碍的心理行为特点及接诊和治疗原则,以期对广大临床工作者治疗工作的开展有所帮助.     

抑郁焦虑共病研究及其辩证思维

抑郁、焦虑障碍是临床上很常见的两种疾病,两者之间的症状具有重叠性,共病率很高;目前由于两者的病因和发病机制不太明了,很难做出全面系统的判断.对抑郁、焦虑共病现象采取辩证的思维方法、科学的研究方法,以期探讨共病现象的本质及其规律,为临床诊断、治疗、预防提供更全面、更有效的措施与方案.     

自伤行为的神经生理机制及共病障碍比较

自伤行为是危害公众心理健康的重大隐患。综合自伤行为的新近研究成果,情绪脑区、控制脑区、疼痛脑区、奖赏脑区、阿片类系统和多巴胺系统以及特定基因的异常共同参与了自伤行为。将自伤行为与自杀、成瘾、进食障碍和抑郁障碍进行比较,发现自伤行为与其共病障碍存在部分相似的发生机制。在此基础上尝试构建了自伤行为的认知神经机制假设模型,并就自伤行为神经生理机制的性别差异、发展特点及干预等提出研究展望。     

共病诊断在精神科应用的意义探讨

1　精神科诊断的特殊性和复杂性精神疾病的诊断,与其他各科相比更为复杂及困难,其原因可能与下述因素有关[1]。11　大多数精神疾病,尤其是精神分裂症等非器质性精神障碍,迄今病因未明,目前尚缺乏特异性的生物学指标。12　精神疾病不同于躯体疾病,除一小部分器质性精神障碍外,多数病种或病例在体格检查、神经系统检查及实验室检查中,并无特征性的阳性发现。13　由于慢性起病者居多,疾病潜隐且表现复杂多样,不典型病例的比例有增多趋势。并且两种及其以上疾病状态的混合存在,也为本科疾病的早期识别、确诊及鉴别诊断工作增加了难度。14　不同…     

创伤后应激障碍与物质使用障碍共病的病因学及其启示

创伤后应激障碍与物质使用障碍共病率高,现有的治疗方法疗效差,总结20年来创伤后应激障碍与物质使用障碍共病研究中病因学方面的新认识,通过对病因的哲学思考可以为今后的治疗方向提供一条思路:两病同治;应提倡药物治疗、认知干预和社会支持综合的治疗手段。     

心身障碍共病与慢性疼痛关联的结构模型

常见的心身障碍共病可以理解为一种新的精神疾病结构模型：情绪障碍、抑郁、焦虑及躯体化障碍等归为内化性疾病谱系的组成元素,物质滥用和反社会行为障碍归为外化性疾病谱系的组成元素。本文分析探讨评估慢性疼痛与这一模型的联系。社会心理和生物学的研究证据表明慢性疼痛与内化性障碍密切相关,提示内化-外化性疾病模型可以作为一个有效的研究架构,为探讨慢性疼痛与情感、抑郁焦虑及其他相关精神障碍的关联共病机制提供新的研究方向和新思路。     

中国的“身体沟通”和躯体症状障碍:一个文化和性别视角下的案例研究

传统医疗支援服务在治疗躯体形式障碍和躯体症状障碍(somatic symptom disorder,SSD)上收效甚微。这些患者经历着越注意身体的痛感越感到难受的恶性循环,他们对这些现象的负面解释导致自身形成关注于身体(身体形象,强化患者的自我意识/自我观察)的“担忧型认知风格”,导致身体感觉不适与过度唤醒。身体心理治...     

抑郁障碍和焦虑障碍治疗的神经心理机制——脑成像研究的ALE元分析

抑郁障碍和焦虑障碍是两种最常见的精神障碍。使用激活似然估计(activation likelihood estimation,ALE)元分析对抑郁和焦虑障碍患者治疗后出现的一致脑区激活改变进行评估,并考察不同条件下这一改变的差异。研究共纳入25篇文献,结果发现:(1)抑郁和焦虑障碍接受治疗后,枕下回(inferior occipital gyrus,IOG)等脑区激活增加;豆状核(lentiform nucleus)等激活减少。(2)a.心理治疗产生的脑激活改变为豆状核活动的减少;药物治疗则在于扣带回(cingulate gyrus)等活动增加,而楔前叶(precuneus)等活动减少。b.任务下成像治疗后激活增加的脑区为扣带回等,减少的脑区为楔前叶等;静息下成像,治疗后枕下回等激活增加,额内侧回(medial frontal gyrus,MFG)等激活减少。c.抑郁障碍治疗后的脑激活变化为扣带回等活动增加,楔前叶等活动减少;焦虑障碍在于前扣带回/额内侧回(anterior cingulate/MFG)活动减少。研究表明治疗会给抑郁和焦虑障碍带来一致的脑区激活改变;治疗方法、成像状态和障碍类型不同,治疗后脑区激活改变也存在差异。     

服刑人员创伤后应激障碍与心理健康问题的共病类型

目的：采用潜在剖面分析服刑人员创伤后应激障碍(PTSD)与心理健康问题的潜在共病类型,并探讨创伤类型对潜在类别的影响。方法：采用PTSD筛查量表和一般健康问卷对692名服刑人员进行调查。结果：(1)PTSD与心理健康问题的共病类型可分为四类,即“高PTSD-高健康问题”、“回避-一般健康问题”、“低PTSD-高健康问题”和“低PTSD-低健康问题”;(2)相比于无创伤个体,遭遇创伤个体产生心理健康问题的风险更高,部分个体还有可能产生PTSD症状;而且,遭受人际创伤还更可能导致“回避-一般健康问题”(3)男性服刑人员较高的创伤率可能导致其在“低PTSD-高健康问题”和“回避-一般健康问题”的发生风险更高。     

下丘脑异常与抑郁症

近年来的研究发现了抑郁模型动物或抑郁症病人下丘脑异常的大量证据, 诸如下丘脑体积及神经元数目的改变, 下丘脑-垂体-内分泌轴的改变, 下丘脑相关激素、受体及其基因、神经肽的改变, 下丘脑与其他脑区功能联系的改变等等。然而, 下丘脑与抑郁症关系的研究所获证据多来自动物实验、或临床间接指标(如病人外周血激素水平等), 或病人脑组织尸检, 缺乏来自病人活体下丘脑异常的直接证据。今后的研究可考虑运用影像学的手段更直接地探索抑郁症患者活体下丘脑的结构特征和功能特征, 以期发现抑郁症的生物学标记及其可靠性指标, 为抑郁症的客观诊断提供依据, 为揭示抑郁症病理机制提供线索。     

抑郁症早期识别方法研究

抑郁症早期识别技术至今仍未解决,需要厘清研究思路。回顾以往研究可梳理出三类方法,即：前驱症状法、易感性法、生物内表型法。前驱症状法是依据前驱期症状识别早期患者,但现象学指标的客观性和特异性较差;易感性法是依据家系或个体风险因素界定风险人群,但缺少纵向研究支持,很难直接用于预警;生物内表型法是寻找与疾病相关的潜在生物学标记,但多为临床期研究,不能确定其中哪些可作为前驱期征象。今后的研究可考虑整合三类方法,即利用家系高风险设计寻找生物内表型,并以此识别可靠前驱症状,构建更精确的风险预测模型。     

抑郁患者的注意偏向

抑郁患者的注意偏向是抑郁认知研究中的重要问题。该文从研究范式、注意偏向特点及理论解释等方面进行了探讨,在研究范式上有Stroop范式、点探测任务和线索–靶子范式等,在抑郁患者注意偏向的特点上有对象为临床患者、需要阈上刺激、刺激内容针对抑郁患者和刺激强度不能太弱等,在理论解释上有注意成分、注意聚焦变窄、认知负荷和唤醒水平等,并对将来的研究方向进行了探讨     

Common Genetic and Environmental Influences on Major Depressive Disorder and Conduct Disorder

The evidence for common genetic and environmental influences on conduct disorder (CD) and major depressive disorder (MDD) in adolescents was examined. A sample of 570 monozygotic twin pairs, 592 dizygotic twin pairs, and 426 non-twin siblings, aged 12-18 years, was recruited from the Colorado Twin Registry. For the past year data, there was a significant correlation between the genetic influences on MDD and CD and, for the lifetime data, there was a significant correlation between the genetic influences on MDD and CD, and a significant correlation between the nonshared environmental influences on MDD and CD. Our results suggest that some genetic factors will increase an individual's vulnerability to both MDD and CD in adolescence.     

Hoarding Disorder: Diagnosis,Assessment, and Treatment

Hoarding disorder (HD) is a newly added mental disorder in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013). In this article, the symptoms, characteristics, and features of HD are described, along with diagnosis and assessment strategies. The most efficacious treatments for counseling clients diagnosed with HD are also discussed.     

Executive Functioning in Children and Adolescents with Major Depressive Disorder

The present investigation examined neurocognitive functioning, focusing on executive functioning (EF), in 39 children and adolescents with Major Depressive Disorder (MDD) and 24 healthy control subjects all ages 8 to 17 years. The Wechsler Intelligence Scale for Children-Third Edition along with several measures of executive functioning including the Wisconsin Card Sorting Task, Trail Making Test, Controlled Oral Word Association Test, and the Stroop Color Word Test were administered. The neurocognitive profiles for the group of depressed children and adolescents were grossly intact as most scores on intellectual and EF measures fell within the average range and did not differ from the comparison group. Mental processing speed was decreased in the MDD versus normal control group and 27% of the depressed group performed below average on the Trail Making Test. This investigation provided a good base from which to compare future literature on EF in outpatients with early-onset MDD.     

Preferences Regarding Targeted Education and Risk Assessment in People with a Family History of Major Depressive Disorder

Genetic testing for susceptibility to major depressive disorder (MDD) is not available for clinical use at present. Given this, family history remains the best predictor for development of MDD, and family-history-based risk assessment and information about familial aspects of MDD may be useful to clients at increased risk for MDD attending for genetic counseling. This study uses a mixed-methods design to assess the information needs and preferences of people at increased familial risk for MDD. Telephone interviews were conducted with 23 individuals, who had at least one first-degree relative with MDD and were recruited through advertisements placed on depression education websites. The most preferred way to access depression information was via the internet (87 % of participants), although this preference may have been due to the internet-based recruitment method. The second most preferred dissemination strategy (56 %) was face-to-face delivery through a health professional, including genetic counselors. Individuals reported a need for information about etiology and development of MDD, reproductive decision-making, early detection of symptoms and risk-reducing strategies. Nearly all participants expressed an interest in risk assessment. The present study found evidence of a high level of interest for information targeted to people at increased familial risk for MDD. Genetic counselors are likely to be called upon increasingly to provide supportive counseling to assist clients at increased familial risk in interpreting and contextualizing such information once it becomes available.     

Aberrant Parasympathetic Stress Responsivity in Pure and Co-Occurring Major Depressive Disorder and Generalized Anxiety Disorder

Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are highly comorbid; we know little, however, about the shared physiological features of these disorders. In the present study, we examined whether aberrant parasympathetic stress responsivity represents a transdiagnostic process in MDD, GAD, and co-occurring MDD-GAD. Adult women diagnosed with MDD only, GAD only, and co-occurring MDD-GAD and never-disordered controls (CTLs) completed a standardized laboratory task that involved anticipating, confronting, and recovering from a social stressor. Participants’ levels of respiratory sinus arrhythmia (RSA) were measured to index parasympathetic responses. The three clinical groups combined (participants with MDD only, GAD only, and co-occurring MDD-GAD) exhibited a similar pattern of RSA responsivity that differed significantly from that of the CTL group. Specifically, whereas CTL participants exhibited a sharp decrease in RSA when confronting the stressor and a sharp increase in RSA when recovering immediately following the stressor, the clinical participants exhibited a blunted response pattern that involved weaker fluctuations in RSA when confronting and recovering from the stressor. There were no significant differences among the three clinical groups in RSA responses. Interestingly, clinical and CTL participants did not differ in self-reported fluctuations in negative emotional arousal. Finally, for clinical participants patterns of RSA reactivity to the acute stressor were associated differentially with trait rumination and worry as maladaptive forms of emotion regulation. These findings support the formulation that aberrant parasympathetic stress responsivity is a shared feature of MDD, GAD, and co-occurring MDD-GAD that is characterized by diminished reactivity to and recovery from stress.     

An Integrated Sleep and Reward Processing Model of Major Depressive Disorder

Major depressive disorder with comorbid sleep disturbance has been associated with negative outcomes, including lower rates of treatment response and a greater likelihood of depressive relapse compared to those without sleep disturbance. However, little, if any, research has been conducted to understand why such negative treatment outcomes occur when sleep disturbance is present. In this conceptual review, we argue that the relationship of sleep disturbance and negative treatment outcomes may be mediated by alterations in neural reward processing in individuals with blunted trait-level reward responsivity. We first briefly characterize sleep disturbance in depression, discuss the nature of reward processing impairments in depression, and summarize the sleep/reward relationship in healthy human subjects. We then introduce a novel Integrated Sleep and Reward model of the course and maintenance of major depressive disorder and present preliminary evidence of sleep and reward interaction in unipolar depression. Finally, we discuss limitations of the model and offer testable hypotheses and directions for future research.     

The Underlying Role of Negative Affect in the Association between PTSD,Major Depressive Disorder,and Generalized Anxiety Disorder

Clinicians and researchers have found differential diagnosis to be difficult, particularly for conceptually similar disorders. One category of particular interest has been distress or internalizing disorders, theorized to be related via an underlying construct of generalized distress or negative affect. The present study attempted to address the comorbidity of three distress disorders - posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and generalized anxiety disorder (GAD) - using latent analyses by controlling for the variance attributable to negative affect. The sample consisted of 265 trauma-exposed individuals who completed self-report measures of PTSD, MDD, GAD, and negative affect. Confirmatory factor analysis was used to test initial model fit. Next, the model was re-computed, controlling for negative affect by regressing negative affectivity at the item-level. Results indicated that a significant amount of variance within and between these diagnostic categories is attributable to negative affect at both the item- and factor-level. The hypothesis that MDD’s non-somatic/affective factor and the GAD factor would have the highest attenuations in factor loadings after controlling for negative affect was supported. Therefore, negative affect significantly influences the co-occurrence of PTSD, MDD, and GAD clinically, emphasizing the need for transdiagnostic interventions for trauma victims.