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.     

September 11th,an attack at the limits of thought

The paper deals with imagination and its failures from a psychoanalytic perspective. We offer a definition of imagination failures and suggest how they can be interpreted as an opportunity to learn from experience. In order to show that the topic has a concrete and not only speculative significance we consider the public report on September 11 as a case study. The report was published by the National Commission on Terrorist Attacks Upon the United States after a long investigation of the facts and circumstances relating to the September 11 attacks. The document has been the object of strong criticisms, as we argue in the paper. Both the document and some of the critiques that it received focus, however, on significant aspects of the debate about imagination, such us the fragility of imaginative thought, its dependence on unconscious desires and its plurality of outcomes: a plethora of imaginaries can in fact be developed at any time, from the same set of information about reality. We comment on these aspects and reinterpret them from a Bionian perspective. The concepts of ‘unthinkability’, ‘imagination failure’ and ‘depressive position’ are used to inform the necessity of dealing with an evolving and conflictual geopolitical scenario. Particular attention is paid to the proposal of ‘routinizing, even bureaucratizing, the exercise of imagination’ within the institutions that deal with National Defense. This possibility is discussed in depth in order to suggest how it may be concretely implemented. In conclusion, a strong case is made for the usefulness of psychoanalytic reflection in the arena of relationships among countries, with particular emphasis on the new terrorist challenges.     

166例冠心病患者活动平板试验中室性心律失常的分析

探讨冠心病患者冠状动脉狭窄程度与室性心律失常的关系,用Mar-quette Case16型活动平板系统测试,采用改良的Bruce方案。结果显示,偶发室早在单支狭窄和多支狭窄中无明显差异,恶性室性心律失常发生率在多支狭窄中较单支狭窄明显增高。冠心病患者出现的恶性室性心律失常提示病变严重或预后较差。     

PCI术后患者的血糖管理

经皮冠状动脉介入治疗(PCI)已成为冠心病治疗及急性心肌梗死(AMI)血运重建的有效手段。取得令人满意的效果,而被临床广泛接受和应用。在冠心病患者中糖代谢异常发生率显著高于一般人群。有研究显示高血糖是引起冠状动脉支架再狭窄的独立危险因素。因此糖尿病患者PCI术后必须进行严格的血糖管理。根据目前研究结果,可能血糖目标定为餐前血糖7.8mmol/L,且随机血糖10.0mmol/L较为合适。     

成就动机和性别对风险倾向的预测作用

研究通过对等同绝对值(CE)的比较将冒险倾向转换为可以量化比较的变量,旨在探讨成就动机和性别在经济获益和损失的各种概率情景下对冒险倾向的预测作用。结果发现,高低成就动机组并没有表现出冒险倾向的显著差异。进一步的相关分析发现,成就动机中的回避失败维度与获益情景下的冒险倾向相关显著,而追求成功维度与各个情景下的相关都不显著。以回避失败维度聚类得到的高低回避失败组,体现出来的冒险倾向趋势显示高回避失败组的被试在获益低概率、获益中等概率、获益高概率、损失低概率、损失中等概率和损失高概率6种情景下都更加回避冒险,而且两组等同绝对值中位数的差异在获益中等概率和获益高概率两种情况下达到显著。另外,冒险倾向的性别差异只在损失中等概率和损失高概率两种情景中达到显著,这两种情况下都是女性更冒险,这与传统的女性更保守的刻板印象不同。     

应激干预对不同行为类型大学生心率血压手指温度的影响

探讨应激干预对心率、血压、手指温度的影响及不同行为类型的差异。被试为河北师范大学本科生72人(A、B型各36人),应激干预为音乐放松、腹式呼吸和静坐休息,实验包括基线期-干预期-应激期-恢复期四个阶段,在观看紧张性影片前进行应激前干预,记录被试的心率、血压、手指温度。结果发现,就缓解应激所产生的交感神经活动增强来说,音乐放松效果较好,腹式呼吸也明显优于自然休息;行为类型（A、B）和应激干预大多表现出来交互作用;个体生理反应的性别差异与生理指标有关,基线值的性别差异较大时,男女生的生理数据不宜混合在一起,基线值相差不大时,可以用相对值（如变化值或变化率）进行统计处理。说明行为类型（A、B）对于应激而言是一种微调变量,在自然休息状态或者低应激水平下作用更明显,应激水平较高时,行为类型的调节作用会显著降低;不同应激干预适用不同行为类型个体     

自尊对大学生失败后情绪状态的影响

以117名大二学生为被试,采用2×2两因素混合设计检验了自尊对大学生失败后情绪状态的影响。结果表明:(1)无论失败前还是失败后,低自尊组都比高自尊组有更多的抑郁、焦虑情绪;(2)无论高自尊组还是低自尊组,失败后都比失败前有更多的抑郁、焦虑反应;(3)自尊水平与情绪测量时间没有显著的交互作用;(4)高自尊组和低自尊组在失败后的情绪变化幅度上没有显著差异。     

X线伤害:先天性心脏病介入治疗知情同意的盲点

随着先天性心脏病介入治疗快速发展,受X线照射的患儿日益增多。而X线照射的危害并未受到临床医生的重视,家属也没有充分的知情同意。     

儿童的内隐特质观与社交失败后反应的关系

以160名儿童为被试考察儿童内隐特质观与社交失败后反应的关系。结果表明:(1)随着年龄增长,儿童越来越积极地应对社交失败;(2)社交失败后,越赞同固存观儿童提出的积极群体加入策略比例越低而消极策略比例越高;越赞同发展观儿童提出的积极策略比例越高而消极策略比例越低;(3)持固存观儿童比持发展观儿童更倾向将社交失败归因于自己,自我评价也更为消极,但两者在社交坚持性、未来社交预期等方面无显著差异。     

超滤在小儿体外循环心脏手术中应用的临床决策

体外循环(CPB)技术的运用,使心脏直视手术的安全开展成为可能,但是体外循环可造成患者心肺功能的损伤,这种表现对心肺尚未发育成熟的婴幼儿的影响尤为严重。超滤已经成为低体重和危重患儿体外循环心脏手术中的一项重要技术,对患儿术后心肺功能的改善起着重要的作用。不同的超滤技术有各自的优缺点,需要我们在临床工作中合理应用。