从惊恐障碍看生物心理社会医学模式的必要性和紧迫性

归属于精神医学研究范畴的惊恐障碍患者反复就诊于综合医院内科,频繁使用急救医疗服务,是误诊率最高的疾病之一.本文探讨了惊恐障碍患者去综合医院就诊的必然性和误诊误治的原因及危害性,提出了综合医院医师掌握该病诊治方法,由生物医学模式向生物心理社会医学模式转变的必要性和紧迫性.     

用生物心理社会医学模式指导疾病的诊治

惊恐障碍作为一种精神科疾病,由于伴有明显的躯体化症状,使大多患者首诊于综合医院非精神科,极易引起该病的误诊误治,同时也浪费了大量的卫生资源。针对这一情况,本期“临床决策研究”栏目中熊新英撰写的“从惊恐障碍看生物心理社会医学模式的必要性和紧迫性”,对于惊恐障碍就诊于综合医院误诊率高的原因及高误诊率导致的后果进行了分析,并提出了相应的对策。作者认为,惊恐障碍属于精神医学范畴,但由于此病患者多突然出现躯体化症状,使患者多到综合医院就诊,     

综合医院惊恐障碍高误诊率引发的思考

惊恐障碍是一种急性焦虑障碍,属精神医学研究范畴。但惊恐障碍患者却反复在综合性医院就诊。目前国内综合医院尤其是基层综合医院普遍未设置精神科,非专科医生对惊恐障碍的识别率又非常低,误诊率甚至高达100%。作者就综合医院惊恐障碍高误诊率的原因、对策、展望与期待、较为理想的就医途径和治疗方法做一探讨。     

综合医院惊恐障碍高误诊率引发的思考

惊恐障碍是一种急性焦虑障碍,属精神医学研究范畴.但惊恐障碍患者却反复在综合性医院就诊.目前国内综合医院尤其是基层综合医院普遍未设置精神科,非专科医生对惊恐障碍的识别率又非常低,误诊率甚至高达100%.作者就综合医院惊恐障碍高误诊率的原因、对策、展望与期待、较为理想的就医途径和治疗方法做一探讨.     

中医问诊的生物心理社会医学模式

问诊是中医临床诊查疾病的重要方法之一.在内容上,中医问诊涵盖了对患者生物、心理和社会因素的全面观察和分析;在方式上,中医问诊重视患者主诉,并对患者主动而有针对性地询问和沟通.中医问诊是医生与患者主动交流互动的平台,体现了现代生物心理社会医学模式,对当前医学模式转变和医患关系改善有重要的参考意义.     

在内科临床中落实生物心理社会医学模式

社会心理因素与内科疾病的发生、发展和治疗效果关系密切,临床工作中忽视社会心理因素的作用可能导致严重后果。内科医生应积极拓展自身的知识技能,继而把对社会心理因素的重视落在实处,体现在病历中。完整的病史采集又需要加强医患沟通,如此才能真正发现和解决患者的社会心理问题。     

从高昌妇女的健康长寿看我国古代中医理论中的生物心理社会医学思想

公元５世纪末～７世纪初,以汉族人为主体民族,以吐鲁番盆地为舞台的高昌王国割据一方达一个半世纪。汉代以来因各种原因陆续迁居此地的汉人,带动了一方的风气习俗,虽地处西域却一如汉地,特别是在魏晋战乱时期,这里相对比较安定,许多优良的传统风俗和习惯得以保存下...     

生物-心理-社会医学模式与社区医疗的科学定位

对生物-心理-社会医学模式与社区医疗的结合进行探讨,生物-心理-社会医学模式在社区医疗中的应用,尤其是其社会性、整体性、综合性、以人为本的思想无疑会给社区医疗带来全新的发展,促使社区医疗科学定位,转变服务模式.而社区医疗的发展也会促进生物-心理-社会医学模式在实践中的应用.     

生物-心理-社会医学模式与控烟及吸烟相关性疾病的防控

大量流行病学研究证实,吸烟是导致肺癌的首要危险因素。因此,控烟才是解决问题的根本途径。本文简述了吸烟的主要危害及目前我国吸烟的现状,在此基础上提出需要在生物-心理-社会医学模式的理论框架下全面考虑控烟及吸烟相关疾病的预防和管理。     

惊恐障碍药物心理干预的临床动态研究

惊恐障碍(panic disorder,PD)是综合医院常见的一种急性焦虑障碍,严重地影响患者的精神心理健康、社会功能和生活质量,并造成医疗资源的极大浪费.本研究通过动态比较药物与药物加心理治疗的疗效,为更合理的对惊恐障碍进行临床干预提供了一定决策依据.     

Children's Cognitive Responses to the Somatic Symptoms of Panic

The purpose of this study was to test Nelles and Barlow's (1988) hypothesis that spontaneous panic attacks are rare or nonexistent prior to adolescence as children lack the ability to make the internal, catastrophic attributions (i.e., thoughts of losing control, going crazy, or dying) characteristic of panic according to the cognitive model (Clark, 1986). Conceptions of panic attacks, including the understanding of symptoms and causes, and cognitive interpretations of the somatic symptoms of panic were examined in children from Grades 3, 6, and 9. A significant main effect for grade was found for conceptions of panic attacks, with third graders receiving significantly lower scores than sixth and ninth graders. However, the majority of all children, regardless of age, tended to employ internal (e.g., I'd think I was scared or nervous) rather than external (e.g., I'd think I was feeling that way because of the temperature or the weather) explanations of panic attacks. No significant grade differences were found for the tendency to make internal versus external and catastrophic versus noncatastrophic attributions in response to the somatic symptoms of panic. When presented with panic imagery in a panic induction phase, children, regardless of age, made more internal and noncatastrophic attributions. Finally, internal attributional style in response to negative outcomes and anxiety sensitivity were found to be significant predictors of internal, catastrophic attributions. The challenge that these findings pose to Nelles and Barlow's hypothesis, and their relevance for understanding children's cognitive interpretations of panic symptomatology are discussed.     

Health Perceptions and Anxiety Sensitivity in Patients with Panic Disorder

Separate lines of research indicate that patients with panic disorder display negative perceptions of physical health and elevated fear of autonomic arousal. Because health perceptions and anxiety sensitivity may be related, the present study evaluated the degree to which these constructs can be distinguished in patients meeting DSM-IV criteria for panic disorder (N = 44). Perceived health, anxiety sensitivity, and the clinical features of panic disorder were assessed at pretreatment and following 12 sessions of cognitive–behavioral treatment. Findings consistently indicated that perceived health and anxiety sensitivity can be meaningfully differentiated. Perceived physical health was only moderately associated with anxiety sensitivity, and each was uniquely associated with pretreatment symptomatology and posttreatment end-state functioning. Perceived physical health appears to be a clinically useful index in the overall evaluation of panic disorder and is readily distinguishable from anxiety sensitivity.     

Mismanagement of Panic Disorder in Emergency Departments: Contributors, Costs, and Implications for Integrated Models of Care

Panic disorder (PD) is associated with the rapid onset of fear-related symptomatology, often somatic in nature. As a result, individuals with the disorder often fear that they are experiencing a life-threatening emergency and present in hospital emergency departments (EDs). As the operating heuristics of EDs are geared toward identifying organic causes and allow only brief physician–patient contact, the diagnosis of PD is more often than not overlooked. Those with the disorder go on to incur enormous costs as they seek out an explanation for their symptoms. Efforts to alleviate this problem, including increased physician education and the development of screening instruments, have been largely unsuccessful. The continued misidentification and mismanagement of this disorder argues for greater incorporation of mental health professionals into the ED, allowing collaborative efforts that recognize the relationship between physiological and psychological aspects of panic.     

Intolerance of Uncertainty as a Contributor to Fear and Avoidance Symptoms of Panic Attacks

Panic disorder symptoms are persistent for 50–80% of cases even after treatment, resulting in experiences of disability and dissatisfaction in life. Previous research has focused on anxiety sensitivity (AS) and its dimensions as contributing to symptoms of panic disorder; however, recent research has suggested that intolerance of uncertainty (IU)—the tendency for a person to consider the possibility of a negative event occurring as threatening, irrespective of the actual probability of its occurrence—may also play a critical role. The current study was designed to assess the specific relationships between dimensions of IU (i.e. prospective IU and inhibitory IU) and the fear and avoidance symptoms associated with panic disorder. Participants included 122 community members (81% women) with a history of at least one panic attack who participated in a larger study on fear. Participants completed measures of AS, IU, and panic disorder symptoms. Correlation and regression analyses supported a significant and substantial relationship between AS, inhibitory IU, and panic disorder symptoms. Inhibitory IU accounted for relatively more variance in avoidance symptoms related to panic disorder than did the fears of physical sensations dimension of AS. As such, further investigation of the role of IU in panic disorder symptoms appears warranted. Comprehensive results, implications, and directions for future research are discussed.     

Manualized Treatment of Panic Disorder in a Medical Setting: Two Illustrative Case Studies

People who experience panic attacks (PAs) typically present to medical settings, concerned that their symptoms signify a life-threatening condition. Despite the efficacy of cognitive-behavioral therapy (CBT) for panic disorder (PD), medical practitioners seldom provide this type of treatment. Physicians may lack the time or expertise to impart such behavioral medicine interventions, while patients may find group or individual CBT too costly even when available. Researchers have begun investigating manualized CBT as a cost-effective alternative when traditional forms of this intervention are prohibited. This article describes two case studies in which women presenting to a medical clinic with PD were treated with 6 weeks of manualized CBT after pharmacotherapy was unsuccessful or unpalatable. Both patients exhibited reductions in panic and depressive symptomatology over baseline levels, along with increases in self-efficacy regarding their ability to manage future PAs. Improvements were maintained over 12 months, supporting continued use of manualized CBT as a supplement or alternative to pharmacological methods of treating PD in the medical setting.     

在新医学模式指导下预防碘缺乏病

碘缺乏病严重危害人类健康,是最大的、可预防的智力损伤因素。通过“社会动员”,推动防治碘缺乏病（ＩＤＤ）“轮子”运转,使我国消除ＩＤＤ事业有了巨大进步。目前存在的问题可能会影响到该事业的可持续发展。对此,提出一些建议。     

A New CBT Model of Panic Attack Treatment in Comorbid Heart Diseases (PATCHD): How to Calm an Anxious Heart and Mind

Treating anxiety comorbid with heart disease is challenging due to (a) diagnostic overlap between anxiety and heart disease, (b) the high risk associated with ignoring chest pain symptoms and delaying seeking medical attention, (c) that cognitive-behavioral therapy based on catastrophic misinterpretation of bodily symptoms requires adaption to incorporate the element of risk, and (d) that certain interoceptive symptom induction experiments may be harmful and are therefore fraught with liability. We describe Panic Attack Treatment in Comorbid Heart Diseases (PATCHD) that is based on enhancing coping skills, performing safe interoceptive exposures and supervised exercise, and countering avoidance to reduce panic attack frequency. Pre- and posttreatment data from 18 patients shows a significant reduction in cardiovascular hospital admissions and length of stay, panic attacks, general anxiety, and depression (all p < .05). Because of the complex nature of panic disorder comorbid with heart disease, health professionals should familiarize themselves with several necessary CBT adaptions.     

从医生和医院角度透视医患关系

医患关系一直以来都是临床医学实践的核心问题和基础,受多因素影响,包括患者、医生(医院)和社会.在医患关系不和谐的今天,如何以系统论方法,从医生和医院角度分析制约医患关系健康发展症结,是每个医生和医院管理者需认真思考和对待的问题.而发扬人文主义精神,坚持"以病人为中心"理念,是医生和医院缓解日益加剧的医患矛盾,从根本上改善医患关系的前提.