糖尿病防治的几点认识

根据世界卫生组织的健康定义,健康是人的生理、心理和社会的协调一致,反之产生疾病。糖尿病在影响人们生理、心理健康的同时,影响着人们的生活方式、社会关系、收入和社会期望度。因此糖尿病的诊断和治疗必须考虑到患者的心理社会因素。临床医生应学会使用现代的生物心理社会模式,倡导正确的行为生活方式、落实连续性医疗服务、提高卫生服务整体效能、提供多方位社会支持、选择个体化的糖尿病治疗方案,针对性地进行糖尿病的防治。     

糖尿病防治的几点认识

根据世界卫生组织的健康定义,健康是人的生理、心理和社会的协调一致,反之产生疾病.糖尿病在影响人们生理、心理健康的同时,影响着人们的生活方式、社会关系、收入和社会期望度.因此糖尿病的诊断和治疗必须考虑到患者的心理社会因素.临床医生应学会使用现代的生物心理社会模式,倡导正确的行为生活方式、落实连续性医疗服务、提高卫生服务整体效能、提供多方位社会支持、选择个体化的糖尿病治疗方案,针对性地进行糖尿病的防治.     

叙事医学在慢性疼痛住院患者中的应用

本文旨在探索叙事医学以平行病历的形式在慢性疼痛住院患者中应用的可行性及效果。采用历史性对照研究,40例慢性疼痛患者为对照组,40例慢性疼痛患者为叙事组。叙事组在常规诊疗基础上,进行叙事医学访谈,并书写平行病历。比较两组患者在医患关系量表-患者评(PDRQ-9)总分,诊疗关系共情量表(CARE)总分及患者出入院时心理痛苦温度计(DT)得分。结果示:叙事组PDRQ-9总分(40.63±2.40)显著高于对照组(38.70±3.33)(P=0.004);叙事组CARE总分(43.23±4.86)显著高于对照组(39.40±8.75)(P=0.018);DT得分入院时没有显著统计学差异,出院时叙事组DT(1.68±1.41)得分显著低于对照组(2.73±2.04)(P=0.011)。因此叙事医学的临床践行,可以提高患者对医患关系满意度,患者感受到医生体会自己的程度较高,并能降低心理痛苦程度。     

心理疗法在针灸治疗中的应用

随着疾病谱和死亡谱的改变,生物医学模式逐渐地不能满足医学发展的需要,取而代之的是生物心理社会医学模式。现代医学模式全方位探求影响人类健康与疾病的因果关系,认为生物学、心理学及社会学因素是人类致病共同的重要因素。针灸是中国传统医学同时也是西方辅助与替代医学的重要内容。针灸医护人员应大力宣传针灸知识,应用生物心理社会医学模式去对待每一位患者。本文试述心理疗法如支持性心理治疗、认知行为疗法、放松疗法在针灸临床的应用,展现针灸心身同治的诊疗特点。     

无痛技术在侵袭性诊疗中的应用

大量住院患者及门诊患者均需实施一些侵袭性的诊疗措施,以便于疾病的诊疗,但由此给患者带来的心理及生理上的疼痛、痛苦却往往被忽视.在有些情况下,侵袭性诊疗给患者带来的痛苦甚至远远超过了疾病本身,而由此所致的机体功能紊乱则更为深远.因此,无痛技术在临床侵袭性诊疗中的应用更加体现当今医学人性化的服务,凸显医学的人文关怀.     

综合医院精神卫生实践方法之UPSCALE查房模型

综合医院精神卫生服务需求非常之高,门诊常见有躯体疾病合并精神心理问题或以躯体症状就诊的心理生理障碍患者。医学分科导致的医学学科割裂正使得各学科在独立处理这些患者时都面临困难。北京协和医院心理医学科魏镜医生探索建立的多学科的、生物心理社会医学模式为理念的、基于以患者为中心的医患关系和访谈模式的UPSCALE查房模型设计用于从形式到内容上都整合地去面对患者这个人和患者的症状,以有效地建立医患关系、实现对患者的有效治疗。其已在临床上显示有效性和可操作性。     

临床医学新趋势：语言作为一种治疗工具的复兴

在履践生物心理社会医学模式中,语言具有不可替代的重要作用。现代医疗设备和仪器的高度发达使医生逐渐脱离了患者;技术主体化倾向使医生的语言功能逐渐地退化,语言能力的欠缺不仅影响医患关系,也直接影响疾病的治疗效果。因此,履践语言的临床复兴,务必掌握语言的艺术、沟通的技巧,以建立和谐稳固的医疗环境和医患关系,良好的语言是缓解患者痛苦的有效良方,在当今诸多医学及复杂社会因素的影响下,语言作为一种治疗工具必将成为临床医疗的新趋势。     

临床疾病多学科协作综合治疗的思考

认识生物-心理-社会医学模式在当代医学发展中的重要作用.分析临床多学科协作的客观必然性和现实性.用哲学辩证思维方法看待多学科协作的重要性,提出多学科协作的思路和途径,注重患者的人文关怀,实现临床疾病综合治疗和临床工作"以人为本"的服务目标,提高临床诊疗水平和医疗服务质量.     

盆腔炎性疾病后遗症患者心理行为干预疗法探讨

盆腔炎性疾病后遗症是盆腔炎性疾病（pelvic inflammatory disease，PID）的遗留病变，主要改变是组织破坏、广泛粘连、增生及瘢痕形成等^[1]，令患者承受身心痛苦。经典的治疗方案很少强调对患者行为和心理的干预。而这些患者由于疾病不适的反复发作、病程延绵难愈，出现了一些心身疾病的症状，如神经衰弱、     

当前社会经济对过度医疗的影响

杜治政教授关于过度医疗的定义在国内理论界具有广泛的说服力,他认为过度医疗是由于多种原因引起的超过疾病实际需要的诊断和治疗的医疗行为或医疗过程.其判定标准:第一,诊疗手段是否超出疾病诊疗的根本需要;第二,是否符合疾病诊疗的规律和特点;第三,是否超出当时个人、社会经济承受能力和社会发展水平;第四,是否有利于患者的生理、心理的康复,而非损害[1].     

Culture,psychology and ecology: An interview with Theodore Roszak

Objectives: This study investigates the efficacy of a standard cognitive behavioral group-program for chronic pain, in comparison with the same group program that integrates an existential perspective at treatment conclusion, 3-month, and 6-month follow-up. Design: This study is a quasi-experimental clinical trial with two treatment groups. Methods: We included 113 patients suffering from chronic pain who had been accepted for treatment at an interdisciplinary pain center. In addition to the specific therapy program, the patients received intense interdisciplinary treatment. Outcome measures include both pain-related disability and pain severity. Repeated-measures analyses of variance (ANOVAs) were used to test statistical significance, followed by tests of simple contrasts with pre-treatment as a reference-point. Results: Results indicated that the integration of an existential perspective leads to significantly lowered pain-related disability than the classic cognitive behavioral group-program. Additionally, existential aspects seem to be particularly important for patients with a spiritual orientation. The findings from this study support the importance of considering specific existential aspects in the cognitive-behavioral approach in treating chronic illness.     

Cost-Effectiveness and Health Care Utilization in a Multidisciplinary Pain Center: Comparison of Three Treatment Groups

Recent literature supports the efficacy of multidisciplinary pain management in treating persons suffering from chronic pain. However, the components of multidisciplinary pain management need to be evaluated in terms of effects on patients' quality of life as well as saving of future health care dollars. Therefore, cost-effectiveness of three treatment groups was compared by examining treatment outcome, posttreatment health care costs, and posttreatment health care visits. Results revealed that patients receiving both medical and psychological treatment (multidisciplinary pain management) exhibited the largest improvements in functional capacity, while being the least costly after their treatment program had ended. In contrast, patients who received only medical treatment exhibited significant deterioration in outcome after their treatment ended, and consumed substantially more posttreatment health care dollars.     

Individual Therapy via the Phenomenon of Hope for Treating Chronic and Complex PTSD

Evidence-based treatment (EBT) supports different types of cognitive-behavioral therapy (CBT) for treating post-traumatic stress disorder (PTSD). Yet, a growing body of evidence shows a high therapy dropout rate and non-response rate among PTSD patients, especially patients with complex PTSD. A different, short-term therapeutic approach is therefore needed which combines CBT and psychodynamic therapy (PDT) because it is better for patients with chronic and/or complex PTSD to work with clarified stages and an end of treatment in mind. The patient's mental structure is conceptualized as a continuum, and functional problems are regarded as stemming from cognitive structures and unresolved developmental conflict. The five phases of the phenomenon of hope model proposed in an earlier article—a connection phase; an agency and pathway phase (developing a goal-oriented decision-making pattern and learning to plan toward goal achievement); a reconstruction phase; a phase of processing the conflict characteristic of PTSD by utilizing the natural power of hope; and a summary and separation phase—advance a short-term therapy that combines CBT and PDT techniques. This integrated therapy is based on notes that were kept relating to the case study of a chronic PTSD patient.     

Automatic processing of pain: the change of implicit pain associations after psychotherapy

This study explores the utility of a pain IAT for the assessment of dysfunctional cognitive beliefs in chronic pain patients before and after a cognitive behaviour therapy. A patient group suffering from chronic pain (N=25) treated with a 4-week cognitive behavioural psychotherapy is compared with an untreated healthy control group (N=27) at two points in time. In addition, both groups completed a self-esteem questionnaire (Rosenberg-scale) and a self-esteem IAT. In the clinical group a questionnaire assessing self-reported pain cognitions was administered. The pain IAT was able to differentiate between chronic pain patients and healthy controls before the treatment. Most important, pain-related implicit associations could be shown to change over the course of treatment in the clinical group of chronic pain patients. Results provide first evidence for an application of the IAT in chronic pain research.     

干扰素治疗慢性乙型肝炎管理策略初探

在慢性乙肝抗病毒治疗中干扰素作为一线治疗取得了一定的疗效。在治疗过程中通过选择合适的慢性乙肝患者、监测疗效、确立个体化的疗程和剂量、及时监测不良反应和恰当的处理和最大限度的提高患者的依从性可使干扰素的疗效达到最大化。     

A Couple-Based Psychological Treatment for Chronic Pain and Relationship Distress

Chronic pain impacts individuals with pain as well as their loved ones. Yet, there has been little attention to the social context in individual psychological treatment approaches to chronic pain management. With this need in mind, we developed a couple-based treatment, “Mindful Living and Relating,” aimed at alleviating pain and suffering by promoting couples’ psychological and relational flexibility skills. Currently, there is no integrative treatment that fully harnesses the power of the couple, treating both the individual with chronic pain and the spouse as two individuals who are each in need of developing greater psychological and relational flexibility to improve their own and their partners’ health. Mindfulness, acceptance, and values-based action exercises were used to promote psychological flexibility. The intervention also targets relational flexibility, which we define as the ability to interact with one’s partner, fully attending to the present moment, and responding empathically in a way that serves one’s own and one’s partner’s values. To this end, the intervention also included exercises aimed at applying psychological flexibility skills to social interactions as well as emotional disclosure and empathic responding exercises to enhance relational flexibility. The case presented demonstrates that healthy coping with pain and stress may be most successful and sustainable when one is involved in a supportive relationship with someone who also practices psychological flexibility skills and when both partners use relational flexibility skills during their interactions.     

青少年脊柱侧弯的临床诊治进展

青少年特发性脊柱侧弯（AIS）既对患儿及家庭所造成的痛苦,也对患者家庭和国家财政都造成沉重的经济负担,引发各国及各级政府的高度关注。但是,随着对AIS了解的深入,质疑和犹豫也逐渐产生。本文回顾当前关于AIS的临床和基础研究结果,发现其中许多研究结论都充满了临床悖论。本文还通过总结作者单位的临床经验,提出的AIS诊治新原则。该原则利用脊柱对于AIS的充分代偿能力,改变聚焦于纠正脊柱畸形的传统理念,尽量维护脊柱的代偿平衡,同时避免对AIS患儿的歧视性宣传,避免诱导其发生心理自卑感。通过借鉴“代偿稳定、阴阳自和”等中医哲学理念可以在AIS等脊柱损伤退变性疾病的临床诊治过程中为患者争取最为实效的临床利益。     

急诊医生和人文关怀

急诊科倡导人文关怀是非常必要的,当代医学模式已从生物医学转变为生物-心理-社会模式,从而更重视对人的关怀,急诊医生每天面对的是急危重症,不仅要有精湛的医术、临危不乱的心态,同时在治疗抢救过程中还要有一颗仁爱之心,生命至上的信念,应当突出“人本思想”,体现“人文关怀”,尊重生命,关爱健康,减轻痛苦,尊重患者的权利和隐私,体现人道主义精神。急诊医生只有富于人文修养,方能建立良好的医患关系,有利于减少医疗纠纷,提升医院的竞争力。     

Addressing Shared Vulnerability for Comorbid PTSD and Chronic Pain: A Cognitive-Behavioral Perspective

Posttraumatic stress disorder (PTSD) frequently co-occurs with other conditions and symptoms that can complicate assessment and treatment. Of these, chronic musculoskeletal pain and related avoidance behaviors are amongst the most common and, unfortunately, the most often overlooked. In this paper we discuss issues that warrant consideration in developing and implementing a treatment plan that may maximize chances of successful outcome for GH, a patient with PTSD and chronic pain. Assessment strategies used in arriving at a case formulation are presented and, based on the emerging state-of-the-art, a tentative cognitive-behavioral treatment program targeting shared vulnerability for PTSD and chronic musculoskeletal pain is presented. Issues pertinent to anticipated treatment outcome are also discussed.     

Social problem‐solving,perceived stress,depression and life‐satisfaction in patients suffering from tension type and migraine headaches

This study aimed at investigating social problem solving, perceived stress, depression, and life‐satisfaction in patients with tension type and migraine headaches. Forty‐nine migraine and 42 tension type headache patients (n = 91) consenting to participate were compared to a total of 49 matched healthy control group. Participants filled in a questionnaire consisting self‐report measures of problem solving, perceived stress, depression and life satisfaction. They were also asked about headache duration, frequency, pain severity, psychiatric treatment and sense of control in one's life. T‐tests, chi‐square, analysis of variance, logistic regression analysis and Pearson product moment correlation coefficient procedures were used to analyze the data. Tension type headache patients reported having had more frequent headaches than the migraine patients but migraine patients reported having had more intense pain than the tension type headache patients. Instances of psychiatric treatment were more common among tension type headache patients than the migraine and the control group. Compared to the healthy controls, headache patients displayed a deficiency in problem solving, higher levels of perceived stress and depression. Levels of problem solving skills in headache patients were related inversely to depression, perceived stress and the number of negative life events but problem solving skills of headache patients was related positively to life‐satisfaction. The findings from this study suggested that cognitive behavioral problem solving therapy or training might be a viable option for reducing levels of stress and depression, and to increase life‐satisfaction in patients suffering from primary headache.