探索产科领域的百慕大之谜

妊娠肝内胆汁淤积症(ICP)往往在妊娠晚期发生胎儿猝死,但机制尚不清楚.孕妇和胎儿体内高浓度胆汁酸水平是ICP的显著临床特点.胆汁酸对实验动物心肌细胞具有毒性作用.深入研究胆汁酸对胎儿心脏的毒性作用,有可能揭示胎儿死亡之谜.     

Homelessness as psychological trauma. Broadening perspectives.

Most mental health literature on homelessness has focused on characteristics that may be risk factors for homelessness. The authors of this article argue that homelessness itself is a risk factor for emotional disorder and use the construct of psychological trauma--focusing on social disaffiliation and learned helplessness--to understand the potential effects of homelessness. Psychological trauma is likely among homeless individuals and families for three reasons. (a) The sudden or gradual loss of one's home can be a stressor of sufficient severity to produce symptoms of psychological trauma. (b) The conditions of shelter life may produce trauma symptoms. (c) Many homeless people--particularly women--become homeless after experiencing physical and sexual abuse and consequent psychological trauma. Research suggests that negative psychological responses to traumatic events can be prevented or mitigated by a supportive and empowering posttrauma environment. The implications of trauma theory for improving the psychosocial conditions of homeless people are discussed.     

Motivation to Pursue Genetic Testing in Individuals with a Personal or Family History of Cardiac Events or Sudden Cardiac Death

Genetic testing is becoming increasingly available for cardiac channelopathies, such as long QT syndrome and Brugada syndrome, which can lead to sudden cardiac death. Test results can be used to shape an individual’s medical management and to identify at-risk family members. In our qualitative study, all participants had a personal or family history of a diagnosed cardiac arrhythmia syndrome or sudden cardiac death. Open-ended interviews were conducted individually and in focus groups. Interviews were audio recorded, transcribed verbatim, and analyzed using a qualitative grounded-theory approach. Of 50 participants, 37 described their motivations for pursuing genetic testing for long QT syndrome or another cardiac channelopathy. Participants’ motivations included: to find an explanation for a family member’s sudden death, to relieve uncertainty regarding a diagnosis, to guide future medical management, to allay concern about children or other family members, and to comply with recommendations of physicians or family members. Perceived reasons not to pursue genetic testing included denial, fear, and lack of information. The genetic counseling and informed consent process can be enhanced by understanding and addressing an individual’s internal and external motivations either for or against pursuing genetic testing.     

关注心房颤动的临床治疗决策

心房颤动发生率很高,我国为0．77％,估计有1000万患者。房颤分类为初发房颤、阵发性房颤、持续性房颤和永久性房颤。房颤病因众多,包括高血压病、心肌病、心衰、甲亢及冠心病等。房颤危害严重,房颤引发卒中高出5倍,房颤促进或加重心衰,房颤增加痴呆2倍。房颤增加病死率,严重降低患者生命质量。房颤治疗决策主要恢复正常窦性心律,并预防其复发和控制心室率与抗凝治疗预防血栓事件。     

Meriwether Lewis: Was it Suicide?

Even 200 years following the conclusion of the Lewis and Clark Expedition, questions remain about whether Meriwether Lewis' death was a suicide. The purpose of this article is to consider this issue by examining historical evidence from a psychological perspective. A risk factor model for suicide assessment (Sanchez, 2001) is employed to evaluate the nature of Lewis' historical, personal, psychosocial environmental, and clinical risk factors as well as protective factors. The authors conclude that though there is some evidence to support a theory of murder, Lewis was at a high suicide risk at the time of his death, and that the preponderance of the evidence indicates that he died by his own hand.     

Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C): A Review of Molecular and Clinical Literature

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is heritable cardiomyopathy that may result in arrhythmia, heart failure, and sudden cardiac death (SCD). Approximately 50-60% of ARVD/C patient will have an identifiable pathogenic mutation in one of seven genes associated with the cardiac desmosome and other cardiac pathways. Genetic counseling remains complicated, however, because of great variable expressivity and reduced penetrance, even within members of the same family. Diagnosis of ARVD/C is made by meeting a set of major and minor diagnostic criteria, revised in 2010. Despite this, misdiagnosis is a chronic problem. Management of ARVD/C is aimed at reducing risk of sudden death/arrhythmias and preventing progression of disease. Strenuous physical activity is increasingly recognized as a significant risk factor in disease presentation and progression and is an important factor in preventative management. Anticipation of the psychosocial implications of this disease is also an important aspect of patient management. This review presents an overview of the clinical diagnosis, management, as well as disease mechanism and genetics of this rare cardiomyopathy.     

Dying but not killing: donation after cardiac death donors and the recovery of vital organs

Michael Potts, Paul A. Byrne, and David W. Evans are critical of donation after cardiac death (DCD). Contrary to the authors' assertion that the removal of vital organs is the proximate cause of death, the eventual fulfillment of the neurological criteria of death is solely dependant on the rate of brain cell death in the absence of circulation. Consistent with the "dead donor rule," DCD is not the cause of death.There are also procedural mechanisms to address the potential conflicts of interest that concern the authors. Rather than being prohibited, DCD may be an ethically justifiable exception to the rule that organ donors must be dead prior to organ recovery.     

Sudden Death of the Therapist: The Effects on the Patient

While the termination phase of psychoanalytic psychotherapy has been discussed in the literature, the effects on the patient of a forced termination following the therapist's death have seldom been investigated. In this paper, two groups of patients (N = 35) were compared: those who experienced a planned termination and those who experienced a sudden termination as a result of their therapist's death. Data were gathered by means of detailed questionnaire and formal psychological assessment (i.e., the Grief Experience Inventory). Responses were also solicited from therapists who treated patients subsequent to the original therapist's death. Results indicate that patients forced to terminate due to the therapist's unexpected demise experienced significantly more intense grief reactions with regard to feelings of anger, despair, depersonalization, and somatization. The nature of the transference relationship with the original therapist at the time of the latter's death appeared to influence the subsequent therapeutic relationship as well. The authors present recommendations and practical guidelines concerning therapists' responsibility to their analytic patients to make reasonable accommodations in the event of their unexpected death.     

Impediments to DNA Testing and Cascade Screening for Hypertrophic Cardiomyopathy and Long QT syndrome: A Qualitative Study of Patient Experiences

This paper reports data from a qualitative study of patient experiences of DNA testing and cascade screening for hypertrophic cardiomyopathy and long QT syndrome, cardiac conditions that place sufferers at risk of sudden death. The paper particularly focuses on potential impediments to testing and screening. Semi-structured interviews were undertaken with a purposive sample of 27 people in the UK who had undergone testing. In the context of the uncertainties that can characterize experiences of these disorders, the majority of participants in this sample embraced testing and screening as a way of providing health information for themselves or their relatives (particularly children). There was nevertheless evidence of ambivalence about the value and impact of the DNA test information which could influence participants’ dispositions toward testing, and play into dilemmas about family communication. Other concerns arose in relation to communicating about these disorders, decisions to involve elderly relatives and pressures relating to family responsibility. The evidence of ambivalence provides insight into why some people may be resistant to testing, screening and sharing information. The findings about communication processes indicate potential areas of concern for the cascading process.     

Are the fruits of research available to all? The effects of sex and academic rank on reprint-sending behavior

There is considerable evidence in the psychological literature that perceived status often has a major effect on behavior. The primary purpose of the present study was to examine the effects of two status variables in an academic setting by monitoring reprint-sending behavior. Reprints were requested from 1,200 authors of psychological articles by men and women of varying academic rank. Neither sex nor academic rank of requester had any significant effect on the total number of responses returned. However, male requesters received responses significantly faster than did female requesters. In addition, subsequent analyses indicated that reprint requests were more likely to be honored by male authors than by female authors.     

Brain mechanisms in fatal cardiac arrhythmia.

Intravenous injection of histamine to rabbits was used as a prototype in an investigation of the mechanism of sudden death due to anaphylaxis and other causes. The "dive" reflex, bradycardia due to activation of the ophthalmic branch of the fifth cranial nerve, was induced in thirty-seven of the animals while they inhaled a very small amount of cigarette smoke. Associated with the resulting bradycardia were lowered blood pH and increased serum content of lactic acid and potassium and increased peripheral arterial constriction with elevation of diastolic blood pressure. Intravenous injection of 1 ml of histamine in the presence of the dive reflex induced potentially fatal ventricular arrhythmia, but no cardiac disturbance when administered while the dive reflex was inactive, thereby strongly suggesting that sudden death in anaphylaxis may involve an overzealous response to a normally protective neural reflex.     

Brain mechanisms in fatal cardiac arrhythmia

Intravenous injection of histamine to rabbits was used as a prototype in an investigation of the mechanism of sudden death due to anaphylaxis and other causes. The “dive” reflex, bradycardia due to activation of the ophthalmic branch of the fifth cranial nerve, was induced in thirty-seven of the animals while they inhaled a very small amount of cigarette smoke. Associated with the resulting bradycadia were lowered blood pH and increased serum content of lactic acid and potassium and increased peripheral arterial constriction with elevation of diastolic blood pressure. Intravenous injection of 1 ml of histamine in the presence of the dive reflex induced potentially fatal ventricular arrhythmia, but no cardiac disturbance when administered while the dive reflex was inactive, thereby strongly suggesting that sudden death in anaphylaxis may involve an overzealous response to a normally protective neural reflex.     

Conceptualizing changes in behavior in intervention research: the range of possible changes model

An international movement has focused on identifying evidence-based interventions that were developed to change psychological constructs and that are supported by controlled studies. However, inconsistent findings within individual intervention studies and among multiple studies raise critical problems in interpreting the evidence, and deciding when and whether an intervention is evidence-based. A theoretical and methodological framework (Range of Possible Changes [RPC] Model) is proposed to guide the study of change in intervention research. The authors recommend that future quantitative reviews of the research literature use the RPC Model to conceptualize, examine, and classify the available evidence for interventions. Future research should adopt the RPC Model to both develop theory-driven hypotheses and conduct examinations of the instances in which interventions may or may not change psychological constructs.     

Clinical events in coronary patients who report low distress: adverse effect of repressive coping

OBJECTIVE: Coronary artery disease (CAD) patients who report low distress are considered to be at low psychological risk for clinical events. However, patients with a repressive coping style may fail to detect and report signals of emotional distress. The authors hypothesized that repressive CAD patients are at risk for clinical events, despite low self-rated distress. DESIGN: This was a prospective 5- to 10-year follow-up study, with a mean follow-up of 6.6 years. At baseline, 731 CAD patients filled out Trait-Anxiety (distress), Marlowe-Crowne (defensiveness), and Type D scales; 159 patients were classified as "repressive," 360 as "nonrepressive," and 212 as "Type D." MAIN OUTCOME MEASURES: The primary endpoint was a composite of total mortality or myocardial infarction (MI); the secondary endpoint was cardiac mortality/MI. RESULTS: No patients were lost to follow-up; 91 patients had a clinical event (including 35 cardiac death and 32 MI). Repressive patients reported low levels of anxiety, anger and depression at baseline, but were at increased risk for death/MI (21/159 = 13%) compared with nonrepressive patients (22/360 = 6%), p = .009. Poor systolic function, poor exercise tolerance, 3-vessel disease, index MI and Type-D personality--but not depression, anxiety or anger--also independently predicted clinical events. After controlling for these variables, repressive patients still had a twofold increased risk of death/MI, OR = 2.17, 95% CI = 1.10-4.08, p = .025). These findings were replicated for cardiac mortality/MI. CONCLUSION: CAD patients who use a repressive coping style are at increased risk for clinical events, despite their claims of low emotional distress. This phenomenon may cause an underestimation of the effect of stress on the heart. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

Self-Help Books: Some Ethical Questions

Self-help books may be a useful resource to counselors in their work with counselees. They may contribute, however, to the development of psychological problems or prevent people from seeking help when needed. The Utopia promised by self-help books may be a pathology in its own right as marketing experts “hype” a book beyond any reasonable evidence of its efficacy. Ethical questions are raised as well as action suggestions for authors, professional counselors, and professional organizations.     

Perspectives and research on the positive and negative implications of having multiple racial identities

Much attention has been directed toward understanding the impact having a multiracial background has on psychological well-being and adjustment. Past psychological research has focused on the challenges multiracial individuals confront in defining a racial identity. The implication is that these challenges lead to outcomes that are psychologically detrimental. However, evidence to support this assertion is mixed. The authors review qualitative and quantitative empirical research examining multiracial individuals' identity development, depression, problem behaviors, peer relationships, school performance, and self-esteem, finding support for detrimental outcomes only in studies sampling clinical populations. Studies on nonclinical samples find that multiracial individuals tend to be just as well-adjusted as their monoracial peers on most psychological outcomes. Earlier assertions of maladjustment may have been due to reliance on qualitative research that sampled clinical populations. Other implications and future research are discussed.     

Death thoughts mediate ostracism mood reduction: The moderating role of marital status

Ostracism is known to cause psychological distress; however, it remains unclear why ostracism evokes this response. Two experiments tested empirically whether fear of death mediates ostracism distress (mood) and whether marital status moderates this role. A total of 345 participants played Cyberball with two other ostensible players. After the game, accessibility of death-related thoughts was assessed by a word completion task, and a mood questionnaire was used to measure their distress. Death thoughts fully mediated ostracism distress. Marital status moderated this mediation effect in that no moderation was observed in married participants, suggesting that marriage may buffer death anxiety. The discussion centers on the ways in which these findings contribute to the ostracism and terror management literature by providing empirical evidence that death thoughts mediate ostracism distress, and the moderating effects of marriage on this mediation effect.     

Measuring grief after sudden violent death: Zeebrugge bereaved at 30 months

The Expanded Texas Inventory of Grief was used to measure the intensity of grief reactions in those bereaved by the Zeebrugge Disaster 30 months on. “View of Life” items were also included. The ETIG scores reported confirm the view that those bereaved by disaster or other sudden death score higher than those affected by bereavements which are expected. Further, the scores of the bereaved, who did not experience the impact, are somewhat higher than the scores of the survivors, who did, on all the measures used. The ETIG as a whole correlates highly with measures of general psychological symptoms and intrusive and avoidant trauma reactions, although there are indications that each measure relates to different areas of symptoms. There is strong support for the idea that avoidance and denial are central to prolonged grief reactions as well as to post-traumatic reactions. “View of Life” items did not correlate with other measures and seem to have little value in predicting psychological symptoms. The use of these items, which appear in later revisions of the scale (TRIGVOL) may indicate that this particular version has reduced clinical utility. A short form of the ETIG is suggested.     

Life review in pastoral counseling: background and efficacy for use with the terminally ill

Research continues to confirm that sharing one's life story through the process of life review enhances psychological well-being and increases life satisfaction. Although researchers have outlined techniques and activities that may be used in life review with older adults, little work has focused on the use of life review methods with terminally ill patients. Additionally, researchers have suggested that life review can take on the form of a spiritual assessment; and that such spiritually oriented life reviews may enhance a sense of meaning and foster reconciliation as one approaches dying. In this article, the authors provide a brief review of the research on and the practice of life review. Further, by merging concepts of life review with systematic theology, they offer a sample instrument--using the example of one faith framework--with which pastoral caregivers can better approach the spiritual needs of patients and facilitate a less traumatic death in the terminally ill.