Survivors of Torture: Realities, Responsible Care, and Rehabilitation

This paper provides an overview of special issues and challenges for the psychiatrist providing care to a survivor of government sponsored torture. Case examples illustrate cultural concerns, issues of confidentiality, transference, dual loyalties, and provider responsibilities. The author hopes to stimulate interest in others to learn more about working with this challenging and rewarding group of patients.     

Why Do People Stay in Hateful Relationships? The Concept of Malignant Vindictiveness

Why do couples remain in hateful relationships? This article defines theoretically rigorous ways of viewing partners who stay together despite severe strife. A case presentation shows how a relationship of two people, each with his or her character structure and idealized image, creates interpersonal conflict because of opposing demands each makes on self and other. Such conflict requires radical defensive measures including alienation, idealization, and externalization that increase tensions. A vicious circle of malignant vindictiveness cements the relationship. Increasing implacability in the relationship is understood through Horneyan categories of interlocking idealized images, hurt pride reactions, and the externalizing process.

     

The Red Road to Wellness: Cultural Reclamation in a Native First Nations Community Treatment Center

This article explores how Native American cultural practices were incorporated into the therapeutic activities of a community-controlled substance abuse treatment center on a "First Nations" reserve in the Canadian north. Analysis of open-ended interviews with nineteen staff and clients-as contextualized by participant observation, program records, and existing ethnographic resources-yielded insights concerning local therapeutic practice with outpatients and other community members. Specifically, program staff adopted and promoted a diverse array of both western and Aboriginal approaches that were formally integrated with reference to the Aboriginal symbol of the medicine wheel. Although incorporations of indigenous culture marked Lodge programs as distinctively Aboriginal in character, the subtle but profound influence of western "therapy culture" was centrally evident in healing activities as well. Nuanced explication of these activities illustrated four contributions of cultural analysis for community psychology.     

Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial

Previous studies on Internet-based treatment with minimal to moderate therapist guidance have shown promising results for a number of specific diagnoses. The aim of this study was to test a new approach to Internet treatment that involves tailoring the treatment according to the patient’s unique characteristics and comorbidities.A total of 54 participants, regardless of specific anxiety diagnosis, were included after an in-person, semi-structured diagnostic interview and randomized to a 10 week treatment program or to a control group. Treatment consisted of a number of individually-prescribed modules in conjunction with online therapist guidance. Significant results were found for all dependent measures both immediately following treatment and at 1 and 2 year intervals. Mean between-group effect size including measures of anxiety, depression and quality of life was Cohen’s d = 0.69 at post-treatment, while the mean within-group effect size was d = 1.15 at post-treatment and d = 1.13 and d = 1.04 at 1 and 2 year follow-up respectively.The tentative conclusion drawn from these results is that tailoring the Internet-based therapy can be a feasible approach in the treatment of anxiety in a homogeneous population.     

Multiple family groups for adult cancer survivors and their families: a 1-day workshop model

With marked advances in early detection and aggressive multimodality treatment, many adult cancers are now associated with good prognoses for disease-free survival. A burgeoning literature examining posttreatment quality-of-life issues has highlighted the numerous challenges experienced by patients and families in the aftermath of cancer treatment, further underscoring a need for new family-based psychosocial support interventions for cancer survivors and their families. This paper describes the clinical protocol for one such intervention, a 1-day "workshop" version of a multiple family group (MFG) for head and neck cancer survivors and their families. Data are reported from our experiences in running five 1-day workshops. Families uniformly reported that they were highly satisfied with their MFG participation, leading us to conclude that the abbreviated 1-day MFG model we are advocating is a promising family-focused support intervention for cancer survivors and their families.     

肿瘤诊治相关肾损伤的防治决策

肿瘤患者在诊治过程中可能会引起肾脏损伤,如造影剂、化疗和靶向药物的使用等等。如何平衡肿瘤患者在诊治过程中的疗效及安全性,使患者能够接受并完成治疗,延长患者无进展生存和总生存,是肿瘤学界所面临的挑战。     

膀胱癌与尿流改道治疗策略

膀胱肿瘤是我国泌尿外科最常见的肿瘤,其中尿路上皮占95％。浸润性膀胱癌生物学行为高度恶性,治疗的主要方法是根治性膀胱切除术加盆腔淋巴结清扫术加尿流改道术。其被认为是标准的治疗方法。由于全膀胱切除术及尿流改道术常给患者带来生活质量的下降及精神上的压力,使患者很难接受这种手术。本文着重分析了患者的个体化治疗,应用辩证思维方...     

浅谈认知行为治疗在肥胖治疗中的研究与应用

肥胖的治疗方法多种多样,各自具有不同的针对性和疗效特点,如何选择是一个最佳的治疗方案这是一个富有争议的话题。近年来,在肥胖心理学研究成果的基础上,发展了一系列的认知行为治疗方法,也开始应用于肥胖的治疗之中。不少追踪研究表明,该方法对于肥胖的长期疗效较佳,表现出广泛的应用前景。     

对低危前列腺癌治疗策略的再认识及思考

前列腺癌被认为是老年男性中最常见的恶性肿瘤。近年来,PSA筛查技术的广泛使用提高了前列腺癌的检出率。但许多低危的非致命性的前列腺癌患者却承受着过度治疗所带来的毒副反应风险。作者就当前用于减少低危前列腺癌过度治疗的新策略进行描述,如观察等待和主动监测策略,并指出癌症的过度治疗是很普遍的现象。未来需要发展更多的对恶性肿瘤进...     

常见吸毒患者的临床麻醉处理

毒品滥用患者给医疗管理和临床工作带来诸多复杂性和特殊性。对吸毒患者围术期麻醉诊疗要兼顾所惠外科疾惠与毒品对吸食者的身心影响,有效地控制戒断症状和毒性反应,综合评估,辨证施为。