药物治疗的风险及其处理

造成药物治疗风险的因素包括药物因素、病情因素、患者因素、用药因素及管理因素等。通过对药物进行严格监管,对医药从业人员加强培训和教育,对民众开展科普教学和用药指导,可以降低药物治疗的风险。风险事件主要表现为用药差错、药物不良反应或药物治疗无效。在药物治疗中,首先必须时刻警惕和及时发现风险;其次需要全面评估风险,还要对疾病风险和药物治疗风险进行比较。应尽可能避免药物治疗的风险,对于必须承受的风险,需采取相应措施,减少风险事件发生的概率和严重程度。如果存在较大风险,务必同时设计处理风险事件的预案,并与患者及其家属保持良好的交流和沟通。     

直肠间质瘤致下消化道大出血1例报告

胃肠道间质瘤是一种发生于消化道的少见的间叶肿瘤,直肠间质瘤更为罕见,在直肠肿瘤中的发生率0．1％以下。直肠问质瘤的临床表现无特异性,与其他直肠肿瘤相似,随肿瘤逐渐增大可表现为排便习惯改变、便血、排便困难等。临床确定诊断困难。手术治疗是能够治愈直肠问质瘤的唯一方法。格列卫作为一线化疗药物对术前降期及改善预后都有良好疗效。本例患者因下消化道大出血入院,肿瘤近肛缘,术中病理考虑为直肠闻质瘤,完整切除肿瘤后行保肛术。术后应用格列卫,随诊3个月无复发、转移。     

焦虑障碍的系统式家庭治疗

焦虑障碍是最常见的心理障碍之一.其具有症状重、病程慢、复发率高、社会功能明显缺损等特点,给个人、家庭和社会造成了巨大的负担.家庭环境因素在焦虑障碍的发病、转归和预后方面都起到重要作用.本文介绍了国内外关于焦虑障碍患者家庭特点和家庭互动模式的研究结果.系统式家庭治疗作为一种家庭治疗模式,具有其独特的治疗理念和方法,国内外研究结果表明系统式家庭治疗用于焦虑障碍具有良好疗效.今后,还应该运用更加多元化的研究方法探讨中国焦虑症家庭动力学特点和家庭功能,并采用更加严格的随机对照设计,进一步证实系统式家庭治疗对焦虑障碍的治疗效果.     

TACE联合RFA序贯DC-CIK治疗小肝癌的研究进展

射频消融术（RFA ）、肝动脉化疗栓塞术（TACE）及 DC-CIK 治疗等非手术方法已成为治疗小肝癌的重要手段。RFA 及 TACE 直接杀伤肿瘤细胞,DC-CIK 治疗明显改善机体免疫功能。 TACE 联合 RFA 术后序贯 DC-CIK 治疗可取长补短,提高治疗的有效性、安全性及患者的远期疗效。本文主要对 DC-CIK 治疗、TACE 、RFA 治疗现状及联合治疗前景做一综述。     

伊斯兰教临终关怀与癌性疼痛心理治疗的探讨

如何利用伊斯兰教的信仰关怀、情感关怀和死亡关怀“三关怀”,提高癌症患者临终关怀质量和癌性疼痛心理治疗效果,作者根据在宁夏回族地区癌症患者中开展临终关怀的五年实践体会,从临终关怀的宗旨和目的出发,探讨了伊斯兰教的临终关怀之信仰关怀、情感关怀和死亡关怀三种形式和内容,解释了癌性疼痛的原因、疼痛的主观和客观影响因素及心理治疗的常用方法和原则,总结了在宁夏回族地区开展临终关怀应用伊斯兰教的信仰关怀、情感关怀和死亡关怀”三关怀”与癌性疼痛心理治疗之间的关系。     

Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia

In this study we compared the efficacy of virtual reality exposure combined with cognitive-behavioral therapy (VRET) to that of traditional cognitive-behavioral therapy (CBT) alone in reducing phobic symptoms in a sample of patients with long-term agoraphobia. The study was a between-subject design with three experimental conditions (VRET group, N = 30; CBT group, N = 30; and medication only group, N = 20) and repeated measures (pre-treatment, post-treatment, and six-month follow-up). All patients were receiving antidepressant medication. Results showed that all therapies were statistically effective both at post-treatment and six-month follow-up. The VRET group showed clinical improvement in most variables measured at follow-up. The CBT group showed the highest dropout rates. These results are discussed pointing out that VRET probably serves as an intermediate procedure for an efficient exposure to phobic stimuli. Besides describing the advantages of VRET for the treatment of agoraphobia symptoms in cost-benefit terms, the study also considered issues related to higher treatment adherence and motivation.     

Thoughts on representation in therapy of Holocaust survivors1

This paper presents the problems of representation and lack of representation in treating Holocaust survivors, through clinical vignettes and various theoreticians. The years of Nazi persecution and murder brought about a destruction of symbolization and turning inner and external reality into the Thing itself, the concrete, or, in Lacan’s words, ‘The Thing’. The paper presents two ideas related to praxis as well as theory in treating Holocaust survivors: the first is related to the therapist’s treatment of the Holocaust nightmare expressing the traumatic events just as they happened 63 years previously; the second deals with the attempt at subjectification, in contrast to the objectification forced by the Nazis on their victims.     

Self-Acceptance Group Therapy: A Transdiagnostic,Cognitive-Behavioral Treatment for Shame

Shame has broad importance to psychological problems. However, few interventions specifically address shame, and most of these have been designed to target shame in the context of particular disorders. Self-Acceptance Group Therapy (SAGT) was developed as a transdiagnostic shame-focused treatment, based on a cognitive-behavioral framework. SAGT is an 8-week treatment that involves psychoeducation and training in the use of cognitive and behavioral shame regulation and support-building skills in order to promote self-acceptance. After describing SAGT, the study presented used an open trial design to examine the utility of SAGT for addressing shame, self-acceptance, quality of life, and relevant psychological problems (e.g., depression, social anxiety). Twenty-four outpatients with elevated shame were assessed at pretreatment, posttreatment, and 1-month follow-up. By post-treatment, results revealed significant improvements in self-acceptance, shame, and borderline personality disorder (BPD) symptoms among treatment completers (n = 18), with all of these improvements maintained at follow-up. Additionally, significant improvements in quality of life, emotion dysregulation, depression, loneliness, and stress were observed at follow-up. Results provide preliminary support for SAGT’s utility in the treatment of shame and related pathology among diverse outpatients.     

Adapting Parent–Child Interaction Therapy for Deaf Families That Communicate via American Sign Language: A Formal Adaptation Approach

While our field has made positive strides in adapting psychotherapeutic interventions for diverse groups of people, considerable work is still needed in this area. We present our formal adaptation procedure for parent–child interaction therapy (PCIT) with Deaf persons. This includes a review of the cultural adaptation process for psychological interventions, including PCIT, as well as an introduction to Deaf culture. Details regarding the specific adaptation of PCIT for Deaf persons are outlined. We found that the utilization of a clear framework to guide the cultural adaptation process facilitated careful consideration of the numerous linguistic and cultural variables involved, while maintaining integrity of the treatment model. While the current focus was on adapting PCIT for Deaf families who communicate via American Sign Language, this framework can also be applied to other populations and/or interventions.