接受不同术式的直肠癌患者的心理评估比较

对在吉林大学第一医院接受186例直肠癌手术患者进行术前及术后的心理评估.术前第一天和术后第七天分别用汉密顿抑郁量表(HRSD)对病人进行心理评估,接受腹会阴联合根治术(Miles手术)的患者术前有明显抑郁情绪,而术后无缓解,接受经腹直肠癌根治术(Dixon手术)的患者术前有一定抑郁情绪,术后明显缓解.单纯结肠造口患者术前抑郁情绪较重,术后加重.     

一例严重心理咨询的案例报告

赵某，女，20岁，大二学生，因身体出现问题而产生抑郁情绪。经心理测验SCL-90的抑郁因子分明显较高，SDS标准分76分。精神检查：意识清晰，思维正常，有明显的抑郁情绪。心理评估：情绪抑郁，认知存在偏差。经诊断为严重心理问题采用贝克认知疗法与求助者中心疗法，经过10次心理咨询后抑郁情绪缓解，认知能力得到改善。SDS简易量表测评结果为54。对咨询效果进行了回访、跟踪与评估，属成功咨询案例。     

腹腔镜与开腹手术治疗直肠癌术后早期肠梗阻的疗效分析

对比分析腹腔镜与开腹手术治疗直肠癌术后早期肠梗阻的疗效。选择我科收治的直肠癌根治术患者120例,随机分为腹腔镜手术组60例和开腹手术组60例,观察对比两组患者围手术期因素及术后早期并发症情况。腹腔镜手术组术中出血量、术后腹部胀痛时间、术后排气时间、术后进食时间及术后早期肠梗阻发生率明显低于开腹手术组,但其手术时间明显长于开腹手术组(P0.05)。腹腔镜手术是直肠癌术后早期肠梗阻的独立保护因素(P0.05)。直肠癌术后早期肠梗阻的发生与术式的选择有着密切的关系;与开腹手术相比,腹腔镜手术治疗直肠癌术后肠梗阻发生率减少。     

一例抑郁情绪心理咨询的案例报告

徐华,女,23岁,研究生在读,未婚。因"不想上课,到图书馆就头疼"前来咨询。既往无重大疾病史。性格温和、善解人意、合群。家中排行老二。SDS:总分为64分。精神检查:意识清,思维正常,有明显的抑郁焦虑情绪,求治心切。心理评估:1)抑郁情绪。2)挫折事件的非理性归因。采用合理情绪疗法,经过四次心理咨询后抑郁情绪明显缓解,能够正常上课。SDS测试结果在正常范围之内。     

腹腔镜直肠癌根治性切除术后胃肠功能恢复的临床研究

为探讨直肠癌腹腔镜手术的临床应用和术后胃肠功能恢复情况,选取笔者所在科室86例直肠癌手术患者进行对比研究,观察围手术期相关指标及并发症情况。结果显示腹腔镜组手术时间较开腹组长,但对比分析无明显差异,术后胃肠功能恢复时间少于开腹组(P0.05)。分析对比术前、术后血清胃动素与胃泌素,腹腔镜组无明显差异,而开放组术后胃动素和胃泌素都有了显著降低,有统计学意义(P0.05)。在术后并发症发生率,腹腔镜组少于开腹组(P0.05)。因此,腹腔镜直肠癌根治性切除术安全可行,胃肠动力恢复快,有利于维持血清胃动素和胃泌素的平衡,减少并发症的发生。     

肠梗阻导管治疗结直肠癌根治术后早期低位小肠梗阻综合征的临床疗效

探讨肠梗阻导管治疗结直肠癌根治术后早期低位小肠梗阻综合征的临床疗效。选择结直肠癌根治术后早期低位小肠梗阻综合征患者28例,随机分成采用肠梗阻导管的研究组(n=11例)和采用鼻胃管的对照组(n=17例)。观察两组患者腹部胀痛改善程度、肠梗阻缓解时间、腹部立位片气液平面消失时间、腹围消减程度。所有患者均置管成功。研究组早期低位肠梗阻缓解率100%(11/11)。研究组腹部胀痛改善程度、肠梗阻缓解时间、腹部立位片气液平面消失时间、腹围消减程度均明显优于对照组,其差异有统计学意义(P0.05)。研究组随访6个月无一例低位肠梗阻综合征复发。肠梗阻导管治疗结直肠癌根治术后早期低位小肠梗阻综合征疗效确切,能够显著改善患者临床表现,值得临床推广。     

复方泛影葡胺在直肠癌Miles术后低位小肠梗阻治疗中的应用

评价复方泛影葡胺在直肠癌Miles术后低位小肠梗阻治疗中的作用。选择直肠癌Miles术后低位小肠梗阻患者32例,随机分成对照组和研究组,其中16例对照组经造口置入一次性吸痰管灌肠治疗,其余16例研究组在吸痰管灌肠治疗基础上联合经口服用复方泛影葡胺治疗。观察两组患者的腹围变化、肠梗阻缓解时间、住院时间及影像学肠管直径变化,并观察其疗效。研究组直肠癌Miles术后低位小肠梗阻缓解率为100%(16/16),并成功接受了保守治疗。研究组患者的腹围缩小程度、肠梗阻缓解时间、住院时间及影像学肠管直径缩小程度明显优于对照组,其差异有统计学意义(P0.05)。研究组随访6个月无一例肠梗阻复发或再手术治疗。经造口置入一次性吸痰管灌肠治疗联合经口复方泛影葡胺治疗直肠癌Miles术后低位小肠梗阻是安全、经济、有效的方法,不仅能缩短住院时间及住院费用,也能避开接受手术之苦,值得临床推广。     

直肠癌保肛术后患者心理灵活性的现象学研究

对15例直肠癌保肛术后患者进行半结构式访谈,运用现象学方法进行资料分析与提炼,以深入了解直肠癌保肛术后患者的心理灵活性现状,探索影响心理灵活性的因素。研究发现直肠癌保肛术后患者心理灵活性的影响因素可归纳为知识缺乏、价值感降低、情绪痛苦、生活方式改变和社会支持五个方面。医护人员应借鉴和发展有针对性的干预措施,不仅能为患者提供照护,更能与患者共同管理疾病和帮助患者发展适应性能力,最终提高患者的心理灵活性,减轻心理应激。     

持续性闭式吸引技术在腹腔镜中低位直肠癌手术烟雾消除中的临床应用

探讨持续性闭式吸引技术在腹腔镜中低位直肠癌手术过程中能量器械使用而产生的烟雾消除效果。选取2015年1月~2017年6月笔者所在医院收治的100例中低位直肠癌患者,根据入院顺序分为对照组和研究组各50例,两组均实施腹腔镜直肠癌根治术,对照组经戳卡侧孔排烟法,研究组在术中应用持续性闭式引流技术,比较两组患者手术疗效及术后近期并发症情况。手术疗效的观察指标中,发现研究组与对照组相比术中出血量少、手术时间短、手术耗材成本低、术后住院时间短,差异有统计学意义(P0.05)。术后近期并发症指标观察中,发现研究组术后出血或术后吻合口瘘发生率明显少于对照组,差异有统计学意义(P0.05)。持续性闭式吸引技术能快速消除腹腔镜中低位直肠癌手术过程中产生的烟雾,不会影响腹腔内恒定的气腹压,保持清晰的手术视野,从而确保手术能安全、顺利地进行,还能减轻高额微创手术费用的负担,值得临床推广应用。     

腰椎间盘突出症患者MED术前心理状态调查与分析

为了研究腰椎间盘突出症患者行MED微创治疗前的心理状况,对442例行MED手术治疗的患者应用焦虑自评量表（SAS）、抑郁自评量表（SDS）进行术前心理评估。结果显示MED微创治疗前患者SAS、SDS测量分明显高于常模组。患者性别、年龄、婚姻状况、文化程度、病程长短等都与心理状况的改变相关。有34.9%的患者SAS得分和36.7%的患者SDS得分显示阳性。因此,临床骨科医师应重视心理因素的作用,在MED术前应对患者进行心理状况评估,并对心理状况较差的患者进行术前干预,才能取得更好的临床疗效。     

血清Cys C的检测对肾移植术后患者肾功能评价的临床意义

探讨分析血清胱抑素C（Cys C）水平在肾移植术后患者肾功能监测中的应用价值.对25例肾移植成功患者在术前、术后第1、3、5、7、10天的血清Cys C、Scr、β2-MG、BUN水平进行动态监测,同时随机抽取健康体检者中的20例作为对照组.发现移植组的Cys C、Scr、β2-MG、BUN水平在术前均明显高于健康对照组（P＜0.01）.这四项指标在手术后第一天都有所下降,且术后第1、3、5、7、10天的水平都比术前低（P＜0.01）.四项指标与GFR的关系均为显著性负相关（P＜0.01）,其中血清Cys C与GFR的相关性最好.Cys C、Scr、β2-MG、BUN检测后的ROC曲线下面积分别是：0.937、0.838、0.798、0.772,其差异都具有统计学意义（P＜0.05）.血清Cys C优于Scr、β2-MG、BUN,在肾移植患者术后的动态监测中具有重要的临床应用价值.     

Depression in a Cancer Patient Population

The main goal of this study was to examine depression and its components in cancer patients as compared with healthy control subjects and psychiatric inpatients. The participants were 54 cancer patients (28 females with breast cancer, 26 males with prostate cancer), 59 healthy controls (33 females, 26 males), and 75 psychiatric patients (27 females, 48 males). Participants were administered the Beck Depression Inventory (BDI) and the State Trait Personality Inventory (STPI) Depression scales. Cancer patients had higher overall depression scores than did healthy controls as measured by BDI, but the difference was due primarily to the significantly higher scores of the cancer patients on the BDI Somatic–Performance subscale. No differences were found on the BDI Cognitive–Affective subscale. Cancer patients also scored significantly higher than healthy controls on the State-Trait Personality Inventory (STPI) State Depression (S-Dep) scale because of higher Euthymia subscale scores. The psychiatric inpatients scored significantly higher than the other groups on all measures of depression. The findings of this study suggest that cancer patients may be erroneously labeled as depressed because of somatic–performance difficulties they may experience, which are similar to symptoms of depressed individuals. In addition, it is essential to delineate the various components of depression in evaluating cancer patients.     

The experimental model and treatment of neurotic depression

Learned helplessness is at present widely accepted as a model for depression. Depression, however, is a symptom-complex that has many causes. Three general causal categories are distinguished—normal, neurotic and endogenous. Neurotic depressions comprise the main clinical category whose causation is primarily external.

This paper shows that neurotic depression is evidently a function of conditioned anxiety response habits that finds a paradigm in experimental neuroses, not in learned helplessness. Both experimental and clinical neurotic depressions are overcome by deconditioning anxiety.

In a sample of 25 cases treated by the deconditioning of anxiety, 22 recovered from their depressions; and the recoveries were found to have endured in the 19 of them who were followed up for at least 6 months.     

Self-reported inability to cry as a symptom of anhedonic depression in outpatients with a major depressive disorder

To ascertain whether self-reported inability to cry would be associated with symptoms of anhedonic depression, the 21-item Beck Depression Inventory-II was administered to 1,050 outpatients diagnosed with a DSM-IV-TR major depressive disorder. 219 (21%) patients reported on the BDI-II Crying item that they were unable to cry, and 831 (79%) patients reported they were able to cry. Only BDI-II Loss of Interest was significantly associated with the inability to cry after the other BDI-II symptoms were controlled for using a multiple logistic-regression analysis. The inability to cry was discussed as an indicator of anhedonic depression.     

Does Problem Focused Coping Buffer the Effects of Trait Anxiety on Depressive Symptoms of Chronic Urticaria Patients?

The present study examined the moderating role of problem-focused coping in trait anxiety—depressive symptoms' relationship in patients with chronic urticaria (CU). Eighty-eight CU patients, who applied to an outpatient clinic of Clinical Immunology and Allergic Diseases, filled out a questionnaire set including State-Trait Anxiety Inventory, Ways of Coping Inventory, and Beck Depression Inventory. The results suggested that CU patients high on trait anxiety reported more depressive symptoms, and the ones using more problem-focused coping (PFC) strategies reported less depressive symptoms. Also, PFC strategies moderated trait anxiety-depressive symptoms relation. Accordingly, PFC strategies did not lead to any significant difference in CU patients who were low on trait anxiety in terms of the level of depressive symptoms. However, CU patients with high trait anxiety experienced significantly less depressive symptoms if they used more PFC strategies. The findings were discussed in the light of the relevant literature.     

Impact of anxiety and depression on the physical status and daily routines of cancer patients during chemotherapy

The evolution of symptoms, emotional state and daily routines in patients with breast cancer and lung cancer during treatment with intravenous chemotherapy (CT) is described and the influence of anxiety and depression on these variables is analyzed. 66 patients, 29 with breast cancer and 37 with lung cancer, were evaluated before starting treatment, and after completing the first, second and last cycle of CT using the Hospital Anxiety and Depression Scale (HADS), rating scales and interview. Less than 30% of the patients showed clinical anxiety or depression according to the HADS. Throughout the treatment, tiredness, fatigue and nausea increased significantly and work and leisure activity decreased. Concern about the future of relatives and insomnia increased significantly over time in patients with breast cancer whereas they decreased in patients with lung cancer. By introducing the HADS scores as covariates, it was found that most differences are due to the time factor and the type of cancer. During treatment with CT, emotional disturbances do not seem to have significant impact on the symptoms and changes in daily life reported by cancer patients.     

Animal-Assisted Therapy with Farm Animals for Persons with Psychiatric Disorders: Effects on Anxiety and Depression,a Randomized Controlled Trial

This study examined the effects of Animal-Assisted Therapy with farm animals during a 12 weeks' intervention on anxiety and depression among psychiatric patients by using a randomized controlled trial with a follow-up investigation at 6 months. Ninety adult patients were included, with 41 completers in the treatment group and 28 in the control group. Anxiety measured using Spielberger State Anxiety Inventory did not decrease significantly during the intervention for the treatment group but was significantly lower at follow-up compared with baseline (p = 0.002) and with the end of the intervention (p = 0.004). There was no significant change for the control group. Depression measured using Beck Depression Inventory was significantly lower at follow-up compared with baseline for both groups, but there were no significant differences between the groups.     

Frequent Assessment of Negative Symptoms Does Not Induce Depressed Mood

Use of real-time data collection is rapidly expanding in the medical sciences and questions have been raised as to whether frequent ratings of disease symptoms could evoke depressed mood. This study investigated the effect of an intensive momentary assessment protocol on depressed mood. Community rheumatology patients (N = 105) were recruited to participate in a 30-day momentary assessment protocol of pain and fatigue. Patients were randomly signaled and completed approximately 6 ratings per day and at bedtime. Beck Depression Inventory-II scores were obtained prior to and at the completion of the protocol. Thirty-six percent of patients were classified initially as mild to severely depressed, and 31% percent at the end of the protocol. Depression scores were significantly lower following the protocol (p < .001). Whereas 10% of patients shifted into a more depressed category at the end of the protocol, 20% shifted into a less depressed category. These findings suggest frequent assessment of pain and fatigue may not induce depressed mood, and may in some instances be associated with a small reduction in depressed mood.     

抑郁症患者识别情绪词时执行功能实验研究

为了研究抑郁症患者识别汉语情绪词时的执行功能特征,采用神经扫描仪STIM刺激反应系统记录16名抑郁症患者和18名正常对照组执行四类Go／No go汉语情绪词识别作业时的反应时和正确率,抑郁自评量表(SDS)评价抑郁严重程度,自动思维问卷(ATQ)评价负性认知偏差程度。结果发现,识别正／负性词时抑郁症组反应时均明显延长,正确率明显降低。组内方差分析显示,随着情绪词识别作业难度增加,正常对照组正／负性词反应时缩短,正确率逐渐提高,且不受双重作业任务的影响。抑郁症组则表现为反应时延长,正确率变化不明显。重复测量多因素方差分析显示。词性、作业、组别间因素对反应时的主效应均有显著性意义;组别间因素对正确率的主效应均有显著性意义。抑郁症患者SDS、ATQ分与反应时、正确率相关无显著性。提示抑郁症患者区分正负性汉语情绪词时存在执行功能障碍。     

Desperation and other affective states in suicidal patients

Data collected from 26 therapists who were treating patients when they died by suicide were used to identify intense affective states in such patients preceding the suicide. Eleven therapists provided comparable data on 26 patients they had treated who were seriously depressed but not suicidal. Although the two groups had similar numbers diagnosed with MDD, the suicide patients showed a significantly higher total number of intense affects in addition to depression. The acute affective state most associated with a suicide crisis was desperation. Hopelessness, rage, abandonment, self-hatred, and anxiety were also significantly more frequently evidenced in the suicide patients.