精神疾病共病现象的辩证思考

由于大多数精神疾病的病因和发病机制不明,无特异性的生物学诊断指标,临床表现多样,有时很难用一种疾病解释.共病的概念应用于精神科临床,为精神科医生提供了一种辩证的诊断思维方法,对研究共病的本质和指导临床治疗都有重要的意义.     

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.     

Couple Therapy in the Presence of Mental Disorders

Abstract

Mental disorders and relationship discord commonly occur together and couples where one or both parties suffer from a mental disorder are commonly seen in couple therapy. Symptoms of mental disorders can usefully be conceptualized cybernetically and viewed as part of negative feedback loops that couples become trapped in without denying the potential contribution of biological or other types of knowledge. Most of the existing research focuses on couples and depression and couple therapy has been found to have efficaciousness as a treatment of depression especially when depression occurs along with relationship discord. There is less research on couple therapy and other mental disorders but general guidelines are offered that couple therapists can use with any of the mental disorders.     

Predictors of Suicidality Among Patients with Psychotic Disorders in a Partial Hospital Treatment Program

Individuals with psychotic disorders are at increased risk for suicidality. Demographic and clinical characteristics were compared in individuals with psychotic disorders reporting either high or low suicidality. Among this sample of 259 partial hospital patients, 116 (44.8%) were classified as high risk on the suicidality section of the Mini Neuropsychiatric Interview, and 143 (55.2%) were considered low risk. Bivariate analyses revealed that patients classified as high risk demonstrated greater depression severity, more relationship difficulties, greater emotional lability, and more substance use problems. A logistic regression model indicated that substance use was the most powerful predictor of higher levels of suicidality. Monitoring and intervention for substance use should be targeted as a particularly important aspect of treatment for acutely ill patients diagnosed with psychotic disorders.     

The Role of Hope in the Psychological Adjustment of Gastropareutic Patients Receiving the Gastric Pacemaker: A Longitudinal Study

Hope, depressive symptoms, anxiety, and physical quality of life (QOL) were assessed in three subgroups of patients receiving the gastric pacemaker. Patients (n = 22) completed questionnaires prior to pacemaker implantation and at 3 and 6 months post-surgery. The idiopathic subgroup reported a significantly greater degree of hope and less anxiety at 6-month follow-up, compared to the diabetes patients. The idiopathic patients also reported significantly less anxiety at 6 months than the postsurgical patients. Across all subgroups, there was an increase in hope and physical QOL, and decrease in depressive symptoms and anxiety, from baseline levels. There was a significant negative relationship between hope and both depressive symptoms and anxiety at baseline and 3- and 6-month follow-up. Presurgical hope level did not significantly predict depressive symptoms or anxiety after implantation. This study provides evidence that the pacemaker improves the physical and psychological health of gastropareutic patients; hope appears to play a role in the psychological adjustment of these patients.     

布托啡诺预处理对减轻精神病患者MECT肌痛的作用

探讨对精神病人无抽搐电休克治疗（modified electroconvulsive therapy,MECT）后肌痛的治疗效果。选择我院MECT病人120人次,随机分为对照组和治疗组,于异丙酚复合琥珀胆碱静脉麻醉下进行MECT。治疗组病人在麻醉前5min静注布托啡诺1mg,结果显示,布托啡诺预处理可有效减轻精神病人MECT后的肌痛程度。     

Factor Structure of the Illness Intrusiveness Rating Scale in Patients Diagnosed with Anxiety Disorders

The Illness Intrusiveness Rating Scale (IIRS) is a measure designed to assess the impact of illness on various domains of functioning (G. M. Devins, 1994). In anxiety disordered patients, illness intrusiveness ratings are higher than those of chronically ill medical patients, suggesting that the IIRS may have a different underlying structure in a sample of individuals with anxiety disorders. To examine this possibility, IIRS items were submitted to an exploratory and confirmatory factor analysis in 2 samples (total N = 294). These solutions were compared to solutions in chronically ill populations from a previous study. In the exploratory analysis, both a one-factor and a three-factor solution were identified, accounting for 42 and 61% of the variance, respectively. Confirmatory analyses showed adequate similarity between the three-factor structure of the IIRS from a medically ill population and the current three-factor structure, suggesting that elevated IIRS scores in anxiety disordered samples cannot be explained simply by a different structure of the instrument.     

Effectiveness of Dialectical Behavior Therapy for Treating Eating Disorders

This study evaluated the effectiveness of dialectical behavior therapy (DBT) for treating eating disorder episodes and co‐occurring depression symptoms among individuals diagnosed with eating disorders. Separate meta‐analytic procedures for between‐groups and single‐group studies were conducted and yielded large effect sizes, indicating that DBT may be efficacious for decreasing disordered episodes among women diagnosed with eating disorders; medium to large effect sizes were noted for treating depression symptoms. Implications for evidence‐supported practice and study limitations are discussed.     

关系精神分析的心身障碍治疗观

关系精神分析的临床治疗范围已涉及心身障碍患者。不同于古典精神分析的心身二元论, 关系精神分析的心身观认为心理与身体是一个统一体, 两者相互作用并紧密联系。关系精神分析师阿隆认为, 心身障碍患者的主要特征是分离现象, 分离现象有三种层次。关系精神分析以关系性的视角看待心身障碍, 认为其病因在于创伤性事件与养育失败, 其病理表现为身心不协调, 情感淡漠及躯体症状等。分析治疗的目标在于通过在共同参与的分析情境中, 建立分析师与患者安全与信任的关系, 提高患者自我反思能力、情感调节能力, 从而修复心身关系。     

Hope in a strengths-based group activity for individuals with chronic pain

While hope has been described as the ability to imagine a future in which one wishes to participate, individuals with chronic pain can have difficulty maintaining hope due to the pervasive impact of pain on multiple facets of their lives. This research examines client experiences of hope during a hope and strengths activity offered as part of a group treatment plan for individuals experiencing chronic pain. Entitled Being Hopeful in the Face of Chronic Pain, the group was developed in order to focus on hope and generative emotional experiences, experiences often lacking for individuals with chronic pain. The group activity being studied specifically addressed participants’ current strengths and strengths they hope-to-have-more-of. The study employed basic qualitative inquiry and utilized interpersonal process recall individual interviews to stimulate participant recall. Twelve participants (spanning three separate group offerings) individually discussed their personal experiences as they unfolded during a specific hope and strengths-focused activity. Participants described experiences during the group activity that fostered personal hope via perspective shifts, communion, comparison and connection with other group members. Findings are discussed in the context of current literature on hope, chronic pain, positive psychology and group interventions.     

焦虑障碍的虚拟现实暴露疗法研究述评

虚拟现实暴露疗法(VRET)是传统的行为疗法的一种转换形式, 也是经典的现实情境暴露疗法的替代性治疗形式。虚拟现实整合了即时计算机图形学、身体感觉传感、视觉成像技术, 给来访者提供近似真实的、可以沉浸(immersion)和交互作用的虚拟环境。研究者采用虚拟现实暴露疗法治疗幽闭恐怖症、恐高症、飞行恐怖症、创伤后应激障碍、惊恐障碍等焦虑障碍, 并且关注虚拟现实暴露疗法的认知机制以及心理生理机制。实验研究表明, 虚拟现实暴露疗法在治疗焦虑障碍时是有效的。被试经过治疗之后, 对情境的控制感和自我效能感提升, 消极自我评价降低, 对创伤事件的容忍力提高, 重新获得对情境的控制感。与心率指标相比, 皮肤电是预测虚拟现实暴露疗法治疗效果更好的指标。虚拟现实暴露疗法还处于实验验证阶段, 并没有应用到实际临床中, 需要更加规范的实验设计验证该疗法的认知机制以及心理生理机制。虚拟现实暴露疗法结合功能磁共振成像(FMRI)用于心理治疗, 会是未来发展的新方向。     

Aquinas and the Virtues of Hope: Theological and Democratic

A prominent political historian has recently identified unwarranted optimism and unwarranted pessimism as democracy's “dual dangers.” While this historical analysis highlights the difficulties that accompany democratic hope, our prevailing conceptual vocabulary obscures the resources needed to address them. This essay attempts to recover these resources by excavating insights from Thomas Aquinas, who supplies one of the most systematic accounts of hope in the history of religious and political thought. By appropriating the conceptual structure of Thomas's theological virtue of hope, this essay reconstructs a democratic virtue that perfects acts of hoping in fellow citizens to achieve democratic goods and thereby enables citizens to respond properly to difficulties that tempt presumption and despair.     

The Design and Evaluation of a Hope Enhancement Programme for Adults

The study evaluated the effectiveness of a hope enhancement programme for a group of adults and its impact on general psychological well-being. The intervention programme focused on participants' abilities to set feasible goals, planning ways to reach those goals (pathways) and increase determination and motivation (agency) to reach these goals. The workshop-format programme, consisted of six two-hour sessions conducted over five days. A pre and post-test design included an experimental group (n = 8), control group (n = 8) and ‘chat group’ (n = 8). Findings indicated that the programme increased hope levels of the experimental group as indicated by the Hope Scale and the Hopefulness Subscale of the Hunter Opinions and Personal Expectations Scale. Well-being also improved as indicated by a significant increase in sense of coherence along with a positive change in satisfaction with life. Recommendations for future research were made.     

Dimensions of Acculturation and Work Hope in International Students

Work hope is an emerging and important factor in the career development process of international students. In this study, the authors focused on the work hope of international students and examined its relation to dimensions of acculturation (i.e., dominant society immersion, ethnic identity, ethnic society immersion, individualism, and collectivism). A total of 340 international students completed an online survey. Results of a correlation analysis revealed associations in the expected directions. Multivariate regression analysis revealed that horizontal collectivism, horizontal individualism, and vertical collectivism had a significant and unique contribution in explaining work hope. Implications and recommendations for future research are discussed.     

The Moderating Role of Hope in the Relationship Between Maladaptive Perfectionism and Anxiety Among Early Adolescents

Abstract

The aim of the study was to examine correlations among maladaptive perfectionism, hope, and anxiety and the moderating role of hope in the relationship between maladaptive perfectionism and anxiety among early adolescents. The sample of the study consisted of 639 early adolescents (354 female/285 male; Mean_age = 12.8, SD_age = .65, range: 11-14). In line with this purpose, the cross-sectional model was conducted. The findings of the study showed that there were significant correlations among maladaptive perfectionism, hope, and anxiety. Moreover, the findings found that hope moderated the relationship between maladaptive perfectionism and anxiety. More specifically, the findings suggested that among early adolescents with lower hope, the relationship between maladaptive perfectionism and anxiety was stronger than those with higher hope.     

意识障碍患者撤销生命维持治疗的伦理困境

意识障碍领域中广泛存在着分类定义不清晰、诊断误诊率高、治疗缺乏有效性和康复不佳的临床问题。在意识障碍患者限制治疗的过程中,患者的最佳利益始终是一个未被讨论透彻的问题,西方医疗决策模式仍然存在一些缺陷且与我国存在显著差异。结合我国当下意识障碍患者医疗管理现状及医疗决策特点,提出可能的解决途径,如意识障碍患者多模态评估、分类管理、共同决策、预立照护计划。以期为意识障碍临床实践提供动力,并推进撤销意识障碍患者生命维持治疗的认识。

     

Hope and self-determination of young adults in the workplace

This longitudinal field study tested positive reciprocal longitudinal interactions between components of hope theory and the satisfaction of basic psychological needs in the work environment during 3 years of vocational training. The three annual questionnaire surveys of 414 trainees in young adulthood were analyzed with latent autoregressive cross-lagged models. The tested longitudinal models provided support for a positive reciprocal feedback process between hope and the satisfaction of the need for competency. The 1 year lagged effects between hope and the needs for autonomy and relatedness were not statistically significant, but synchronous relations did exist. The study suggested that perceived vocational competencies lead to increases in hope, while the trainees’ hope in turn also had positive effects on the development of perceived vocational competencies.     

Group Cognitive-Behavioral Therapy via Telebehavioral Health for Those With Psychotic Spectrum Disorders: A Case Series

Telebehavioral health emerged as an important practice during the coronavirus disease 2019 (COVID-19) pandemic as an opportunity for continued evidence-based mental health intervention, while minimizing exposure to coronavirus contagion. Though preliminary research suggests feasibility and positive outcomes of telebehavioral health practice for people with schizophrenia spectrum and other psychotic disorders, there is limited research about implementation and effectiveness of this practice (Kasckow et al., 2014). This case series highlights the transition from in-person to telebehavioral health practice of a Cognitive Behavioral Social Skills Training for Schizophrenia group due to the COVID-19 pandemic. This article summarizes: (a) the staff procedures needed to transition the group from in-person to telebehavioral health, (b) participant outcome data, (c) session attendance data, and (d) survey results from facilitators and participants about barriers and facilitators of the transition to telebehavioral health, and about how the virtual platform altered the therapeutic relationship and engagement. Participant outcome and engagement data suggest that, not only were two participants able to transition to telehealth and complete the program, but both participants also showed notable improvement in treatment engagement, goal progress, and skill acquisition. Surveys of six facilitators and one participant highlight how the transition to telebehavioral health had treatment advantages (e.g., therapeutic relationship, treatment engagement, group dynamics). Though survey results highlighted several implementation challenges in using the new virtual platform (e.g., technological connectivity, confidential space for engagement), no survey respondents reported that participation in this program resulted in harm to facilitators or participants. All facilitators and one participant agreed that the transition from in-person to virtual services was easy and reduced transportation barriers. Given the limited treatment engagement for this population (Lora et al., 2012) and the importance of early intervention to maximize clinical outcomes (Black et al., 2001; Bottlender et al., 2003), unanimous facilitator and participant report about improved patient attendance and participation in treatment after the transition to telebehavioral health was critically important. Though results of this case study are promising in suggesting telebehavioral health could be a viable modality for providing psychosocial treatment to people with schizophrenia spectrum and other psychotic disorders, more rigorous study is needed.     

Psychosocial Occupational Therapy Interventions for Substance-Use Disorders: A Narrative Review

The review was conducted to explore psychosocial interventions for adults with substance-use disorders. A refined literature focus was placed on articles published by occupational therapists, or articles published by an allied health professional, that discussed occupational therapy performing the intervention. Ten articles met inclusion criteria, all focusing on aspects of life skills training. Study results support the professions’ ability to enhance functional independence and occupational performance for individuals recovering from substance use. Further, a more controlled investigation is warranted to further define occupational therapy’s scope within substance-use disorder treatment.