青年颈心综合征避免误诊为冠心病的临床诊疗策略

通过对临床收集的187例青年(≤45岁)颈心综合征患者的临床资料进行分析。探讨青年颈心综合征临床误诊为冠心病的原因及避免误诊的诊疗策略。目的在于帮助临床医师对青年颈心综合征进行识别,注意如何与冠心病心绞痛相鉴别,对防止病情延误,尽早明确诊断积极治疗,排除冠心病,减少诊疗费用及避免冠脉造影的风险意义很大。     

重症手足口病的早期识别与处理

手足口病(hand-foot-mouth disease,HFMD)是由肠道病毒[以柯萨奇A组16型(Coxsackievirus A16,CoxA16)、肠道病毒71型(Enterovirus 71,EV71)多见]引起的急性传染病,而重症多由EV71感染引起。由于EV71的高度嗜神经性,重症者可合并中枢神经系统(central nervous system,CNS)损害、急性肺水肿/出血等。现就重症手足口病的早期识别与处理进行简要综述。     

成人和婴儿麻疹临床特点和治疗

麻疹是一种急性呼吸道传染病,常见于6月～5岁儿童。近年来婴儿和成人麻疹患者在总患者数中所占比率表现出上升的趋势,容易造成误诊、漏诊。作为临床工作者,我们认为临床医生应充分认识到麻疹发病人群及年龄的改变,在临床工作中减少误诊,并为患者提供及时有效的治疗,对高危人群的有计划干预对于减低成人麻疹发病率有着重要作用。本文针对婴儿和成人麻疹的诊断和治疗进行了综述,试图提供参考。     

Pharmacological treatment effects on eye movement control

The increasing use of eye movement paradigms to assess the functional integrity of brain systems involved in sensorimotor and cognitive processing in clinical disorders requires greater attention to effects of pharmacological treatments on these systems. This is needed to better differentiate disease and medication effects in clinical samples, to learn about neurochemical systems relevant for identified disturbances, and to facilitate identification of oculomotor biomarkers of pharmacological effects. In this review, studies of pharmacologic treatment effects on eye movements in healthy individuals are summarized and the sensitivity of eye movements to a variety of pharmacological manipulations is established. Primary findings from these studies of healthy individuals involving mainly acute effects indicate that: (i) the most consistent finding across several classes of drugs, including benzodiazepines, first- and second- generation antipsychotics, anticholinergic agents, and anticonvulsant/mood stabilizing medications is a decrease in saccade and smooth pursuit velocity (or increase in saccades during pursuit); (ii) these oculomotor effects largely reflect the general sedating effects of these medications on central nervous system functioning and are often dose-dependent; (iii) in many cases changes in oculomotor functioning are more sensitive indicators of pharmacological effects than other measures; and (iv) other agents, including the antidepressant class of serotonergic reuptake inhibitors, direct serotonergic agonists, and stimulants including amphetamine and nicotine, do not appear to adversely impact oculomotor functions in healthy individuals and may well enhance aspects of saccade and pursuit performance. Pharmacological treatment effects on eye movements across several clinical disorders including schizophrenia, affective disorders, attention deficit hyperactivity disorder, Parkinson’s disease, and Huntington’s disease are also reviewed. While greater recognition and investigation into pharmacological treatment effects in these disorders is needed, both beneficial and adverse drug effects are identified. This raises the important caveat for oculomotor studies of neuropsychiatric disorders that performance differences from healthy individuals cannot be attributed to illness effects alone. In final sections of this review, studies are presented that illustrate the utility of eye movements for use as potential biomarkers in pharmacodynamic and pharmacogenetic studies. While more systematic studies are needed, we conclude that eye movement measurements hold significant promise as tools to investigate treatment effects on cognitive and sensorimotor processes in clinical populations and that their use may be helpful in speeding the drug development pathway for drugs targeting specific neural systems and in individualizing pharmacological treatments.     

Letting go of your dreams—Adjustment of child-related goal appraisals and depressive symptoms during infertility treatment

To examine the adjustment of child-related goal appraisals during infertility treatment and whether such adjustment contributes to depressive symptoms 178 (86 men, 92 women; age for women M = 33.92, SD = 0.34, for men M = 35.68, SD = 0.45) patients at an Infertility Clinic filled in child-related goal appraisal questionnaires six times: (1) before starting the hormone injections, (2) before the oocytes were retrieved, (3) after embryo transfer, (4) the day when the pregnancy test was done, and (5) two and (6) six months after the infertility treatment. At the first and last measurement times they filled in questionnaire on depressive symptoms. Appraisals concerning child-related goal changed in tandem with the treatment result, and goal adjustment had an effect on depressive symptoms.     

失眠症治疗的最新进展

失眠是睡眠障碍之一,主要表现为睡眠时间减少、入睡困难、入睡后易惊醒、醒后不易再入睡等。本文主要探讨了失眠的非药物治疗,包括睡眠约束,光疗法,认知治疗,松弛疗法和行为治疗。     

Anxiety sensitivity: a unique predictor of dropout among inner-city heroin and crack/cocaine users in residential substance use treatment

The present study examined the extent to which anxiety sensitivity (AS) at treatment entry was related to prospective treatment dropout among 182 crack/cocaine and/or heroin-dependent patients in a substance use residential treatment facility in Northeast Washington, DC. Results indicated that AS incrementally and prospectively predicted treatment dropout after controlling for the variance accounted for by demographics and other drug use variables, legal obligation to treatment (i.e., court-ordered vs. self-referred), alcohol use frequency, and depressive symptoms. Findings are discussed in relation to the role of AS in treatment dropout and substance use problems more generally.     

HIV/Aids: an encounter with death or a journey into life?

This is an account of a panel discussion. It focuses on an encounter with the HIV/Aids virus. Such an encounter may result in a descent into despair, hopelessness and ultimately death, or it may offer the opportunity of possible transformation of consciousness to embrace a life lived productively and meaningfully with a chronic but manageable disease. A picture is provided of the dire situation that exists regarding the HIV/Aids pandemic in South Africa. The HI-virus is compared to a malevolent trickster type energy that uses ingenious means to gain access to the host. It is an impersonal agent seeking only its own survival but if left untreated will ultimately result in the death of the host. Reference is made to characters in the musical, The Lion King, to illustrate that it is the willingness to suffer the painful emotions evoked following a diagnosis of being HIV-positive more consciously that allows for a transformation from despair and hopelessness to a life lived productively and meaningfully. Two of the panelists who are HIV-positive share their experiences of this process. One recounts how, living with Aids, his connections with others and human relatedness helped to restore his dignity and self-worth. The other relates how his willingness to state his status publicly allowed him to overcome the stigma and shame that are evoked when diagnosed as HIV-positive. This has allowed him to seek appropriate treatment with ARV's. He now lives with a chronic but manageable infection and leads a creative and significant life. The difficulties encountered regarding the prevention of HIV/Aids when attempting to change potentially destructive sexual behaviours in teenagers are discussed. An inspiring account of work in treating those that live with HIV/Aids under difficult circumstances is also discussed.     

Interdependent Group Contingency Management for Cocaine-Dependent Methadone Maintenance Patients

Contingency management (CM) for drug abstinence has been applied to individuals independently even when delivered in groups. We developed a group CM intervention in which the behavior of a single, randomly selected, anonymous individual determined reinforcement delivery for the entire group. We also compared contingencies placed only on cocaine abstinence (CA) versus one of four behaviors (CA, treatment attendance, group CM attendance, and methadone compliance) selected randomly at each drawing. Two groups were formed with 22 cocaine-dependent community-based methadone patients and exposed to both CA and multiple behavior (MB) conditions in a reversal design counterbalanced across groups for exposure order. The group CM intervention proved feasible and safe. The MB condition improved group CM meeting attendance relative to the CA condition.     

Splitting as a Focus of Couples Treatment

Current developments in neurophysiology and trauma have re-awakened interest in the reciprocal influences of the interpersonal and intrapsychic domains. Although object relations theory continues to guide clinical practice, its integration into models of best practice has been limited by a lack of empirical study. This paper examines the defense mechanism of splitting in couples from the theoretical, empirical and clinical perspectives in ways that allow for integration with research findings. It is proposed that splitting operates on a continuum from a specific response that is stimulated by anxiety, to a fundamental style of relating that is marked by emotional reactivity, impaired problem solving and relationship instability. Specific treatment interventions that integrate object relations and cognitive perspectives are summarized.