冠心病患者的抑郁和焦虑

许多临床研究表明,冠心病患者常发生抑郁及焦虑。而在严重精神症状（如抑郁或/和焦虑）者中有较高的冠心病发生率。抑郁增加冠心病患者的不良心血管事件发生率,影响预后。其机制有如下几个方面：对医疗措施及生活方式改变的依从性差、血小板功能异常、血管内皮功能紊乱以及心率变异性降低。选择性5-羟色胺再摄取抑制剂由于其较好的耐受性且无明显的心血管副作用而应用于冠心病合并抑郁及焦虑的药物治疗并改善患者的生活质量。但仍需要更大规模的临床研究以确定抑郁及焦虑对冠心病预后的影响。临床上应更加关注焦虑对冠心病的影响,进一步探讨焦虑能否作为冠心病的危险因素。     

Treatment of Assaultiveness

Summary

Assaultiveness and abusiveness have a psychology that must be addressed in therapy; they are not merely the product of “bad attitudes” or social roles, nor can they be narrowly defined as the robotic imitation of action. Perceptions and feelings about the world of intimate relationships both sustain and are sustained by abusive actions. These provide points of intervention for cognitive behavioral therapy (CBT). Given the tendency to shame easily, abusive men must not be confronted too quickly or too strongly. On the other hand, given their well-established denial system and tendency to minimize the consequences of their abusiveness, some confrontation must occur. Hence a “Zen” line of least resistance must be found between the opposites of acceptance and confrontation. Treatment outcome studies indicate moderate success for cognitive behavioral treatment (CBT) for batterers. Treatment is less successful with men who have personality disorders, especially psychopathy.     

EDITORS' INTRODUCTION

ABSTRACT

Transsexualism implies that an anatomically normal individual feels that he or she is actually a member of the opposite sex. Treatment usually includes real-life experience along with hormone therapy and sex reassignment surgery. Voice modification surgery may be necessary, as pass ability in general is still in a large extent dependent on the aspects of voice in transsexual people. Often male-to-female patients report being addressed in telephone conversations as their genetic gender, which is experienced as a disability. The purpose of this study was to evaluate the impact of voice on the quality of life in transsexuals.

In order to detect the disability caused by a voice disorder, the validated assessment method the Voice Handicap Inventory (VHI) was used. An additional question about the way patients were addressed in a telephone conversation was added.

As part of a study describing general health in transsexual persons, done at the Ghent University Hospital Belgium, a total of 48 patients were evaluated. In female-to-male transsexuals the median scores were very low, suggesting testosterone treatment led to an acceptable voice alteration. A higher serum LH level was significantly correlated with higher total, functional and emotional VHI scores. In male-to-female transsexuals the scores were significantly higher than those of the female-to-male transsexuals, but still there was no indication of a real disability/handicap. The extra telephone question was scored higher suggesting male-to-female transsexuals did experience a disability caused by their voice. From this study it is concluded that the VHI values did not demonstrate a handicapping effect.     

注意偏向训练对社交焦虑的干预：方法、效果与机制

社交焦虑障碍是最普遍且难于治疗的精神障碍之一。大量研究发现, 注意偏向训练可以有效缓解社交焦虑。研究者从自我报告、结构化评估、生理记录等方面考察发现, 接受了注意偏向训练的社交焦虑个体其注意偏向、生理唤醒和脑神经活动发生变化并且社交焦虑症状有所缓解。注意偏向训练对社交焦虑的干预机制可能是因为训练提升了个体对威胁性刺激的注意解除能力。今后的研究可以进一步明确注意偏向训练干预社交焦虑的效果与机制, 拓宽评估注意偏向训练效果的手段, 并探索其对社交焦虑干预的长期效果和对其它心理疾病的作用。     

Treating Symptoms of Borderline Personality Disorder Through Narrative Therapy and Naltrexone

Abstract

Borderline Personality Disorder (BPD) is characterized by instability in interpersonal relationships, volatile perceptions of self-image and affects, and marked impulsivity, presenting in various contexts. Current BPD treatments are individual-centered, coping skills based, with a reduced emphasis on identifying etiology and systemic components. Narrative therapy focuses on deconstructing and reauthoring personal stories. A clinical case study shows narrative therapy to be efficacious, however, sometimes psychotherapeutic interventions alone are inadequate in managing these symptoms. Medication can serve as a useful adjunct in addressing self-injurious behaviors, suicidal ideation, and dissociation. Researchers further discuss the integration of naltrexone into treatment of BPD symptoms.     

Expectancy bias mediates the link between social anxiety and memory bias for social evaluation

Social anxiety (SA) involves a multitude of cognitive symptoms related to fear of evaluation, including expectancy and memory biases. We examined whether memory biases are influenced by expectancy biases for social feedback in SA. We hypothesised that, faced with a socially evaluative event, people with higher SA would show a negative expectancy bias for future feedback. Furthermore, we predicted that memory bias for feedback in SA would be mediated by expectancy bias. Ninety-four undergraduate students (55 women, mean age = 19.76 years) underwent a two-visit task that measured expectations about (Visit 1) and memory of (Visit 2) feedback from unknown peers. Results showed that higher levels of SA were associated with negative expectancy bias. An indirect relationship was found between SA and memory bias that was mediated by expectancy bias. The results suggest that expectancy biases are in the causal path from SA to negative memory biases for social evaluation.     

Distress and Avoidance in Generalized Anxiety Disorder: Exploring the Relationships with Intolerance of Uncertainty and Worry

Theory and research suggest that treatments targeting experiential avoidance may enhance outcomes for patients with generalized anxiety disorder (GAD). The present study examined the role of experiential avoidance and distress about emotions in a treatment-seeking sample with a principal diagnosis of GAD compared with demographically matched nonanxious controls and sought to explore their shared relationship with two putative psychopathological processes in GAD: intolerance of uncertainty and worry. Patients with GAD reported significantly higher levels of experiential avoidance and distress about emotions compared with nonclinical controls while controlling for depressive symptoms, and measures of these constructs significantly predicted GAD status. Additionally, experiential avoidance and distress about anxious, positive, and angry emotions shared unique variance with intolerance of uncertainty when negative affect was partialed out, whereas only experiential avoidance and distress about anxious emotions shared unique variance with worry. Discussion focuses on implications for treatment as well as future directions for research.     

Orientations of psychotic activity in defensive pathological organizations

The author reviews some clinical experiences of the treatment of personality disordered patients suffering from internal domination of ego functioning by a defensive pathological organization. In particular, the function and purpose of perverse, sadistic attacks by the organization on the ego are considered and questions pertaining to technique are raised. It is suggested that different forms of sadistic, subjugating activity by pathological organizations may denote differences in intent borne of the type and severity of the psychopathology of the individual. Patients with severe narcissistic psychopathology for whom object contact has become associated with the arousal of intense psychotic anxieties seem more likely to be subjected to an invasive, annihilatory imperative by the pathological organization, the purpose of which appears to be to obliterate the experience of contact with any differentiated object, to avoid emotion and to use coercion to enforce a primitive identification by the ego with the psychotic organization in the mind. Certain patients with less severe narcissistic psychopathology, yet for whom object contact can also be associated with the arousal of psychotic anxieties due to intense or persistent conflict with the object, sometimes expressed as organized sadomasochistic clinging to a punishing and punished object (for example, in certain borderline or depressed patients) exhibit sadistic attacks that serve less to annihilate object contact and more to intrusively control and punish the object. Observations of these phenomena have been made by a number of psychoanalysts in recent decades and these contributions are discussed. This paper is addressed primarily to the implications for technique with such patients, particularly a need for triangulation of their experiences of oppression in order to loosen the controls over the ego by the pathological organization.     

Alexithymia in Young people’s academic career: The mediating role of anxiety and resilience

Alexithymia prevents people from understanding and adopting verbal language to describe and regulate one’s emotions. Recent studies have found that alexithymia symptoms also impact on young people’s academic achievement. Nevertheless, it is worth investigating risk and protective roles played by students’ academic anxiety and resilience, respectively. The authors expected that students’ anxiety and resilience mediated the effect of alexithymia symptoms on students’ academic burnout and performance. A sample of 257 university students answered self-report questionnaires about alexithymia, academic anxiety and resilience, and academic burnout and performance. Mediation analyses were performed by the structural equation model. Anxiety acted as a mediator between alexithymia and academic burnout and performance. Furthermore, resilience mediated the effect of alexithymia on burnout, but not on academic performance. The study provides support for preventing alexithymia consequences on young people’s academic career by reducing their anxiety and promoting academic resilience. Implications of intervention programs were discussed.     

Sensory Processing Differences in Children Diagnosed With Tourette's Disorder

The objectives of this research were to determine whether sensory processing differences existed in children between the ages of 5 and 10 years diagnosed with Tourette's disorder and to examine whether further differences existed if these children had an additional diagnosis of Attention Deficit Hyperactivity Disorder. The Short Sensory Profile was completed by caregivers for 75 children with Tourette's disorder, 47 who were also diagnosed with Attention Deficit Hyperactivity Disorder. Differences in sensory processing were identified in the total sample. More significant differences were found in the group of children with dual diagnoses, especially in the area of auditory processing.