药物成瘾理论的新进展

成瘾过程伴随着一系列脑机能和心理机能的改变,但对药物滥用如何导致这些改变以及它们如何诱发成瘾却存在着不同的解释。近年来,由于认知心理学和认知神经科学研究技术在该领域的应用,研究者对药物成瘾过程的认知机能及其脑机制获得了新的认识,且基于对负性生活事件及外部压力在维持药物滥用及诱发复吸行为中的作用的测量学研究和动物实验研究而提出的成瘾理论为该领域的研究开辟了新的思路。本文重点评述了药物成瘾的认知加工模型和以压力或负性情绪为核心的相关理论模型及其研究,并提出进一步研究的方向。     

非肝病治疗药物导致慢性乙型肝炎病毒携带者肝损害现状分析

随着药物种类的增多,药物性肝病的发病率亦增加。由于乙型肝炎病毒携带者肝组织已存在不同程度的损害,比非乙型肝炎病毒感染者更容易发生药物性肝炎。因此,非肝病治疗药物导致慢性乙型肝炎病毒携带者肝损害应引起高度重视。     

Pharmacologic and Behavioral Withdrawal From Addictive Drugs

ABSTRACT— Recent theories suggest that drug withdrawal does not motivate drug use and relapse. However, data now show that withdrawal produces complex changes over time in at least two symptoms (i.e., negative affect and urges) that are highly predictive of relapse. Evidence suggests that falling levels of the drug in the blood and interruption of the drug self-administration ritual both affect these symptoms. Both of these forms of withdrawal motivate renewed drug use in addicted individuals.     

On anxiety-specific actions of tranquilizers

Abstract

This study examined the role of social support in the relationship between work demand and psychological distress (GHQ 12) in correctional officers (N=419), a high stress occupational group. Work demands were positively associated with strain. There was no evidence that social support buffered the negative impact of work demands. Rather, consistent with most previous research findings, support showed direct benefits and these were discussed in the context of worker participation and control. The hypothesis that officers high in negative affectivity, as measured by trait anxiety would show greater reactivity to work demands was not supported. However, trait anxiety appeared to inflate the relationship between work stressors (work demand and work support) and psychological distress supporting recent suggestions that the role of trait anxiety in occupational stress should not be disregarded. Trait anxiety combined additively with work demand to predict individual differences in psychological distress, however social support moderated the impact of trait anxiety on strain.     

致病性微生物耐药性严重化问题的思辨

致病性微生物耐药性严重化是一道世界性医学难题。微生物使出种种耐药的"招术",不只是其对药物作用的反应,更应看到是耐药内外因相互作用的结果,是其生物本性之使然。微生物的基本特性使其具备这种"能耐"。这些耐药性应存在一定的"原动机制",可以认定微生物的耐药性必然永远存在。人类社会必须构建长效的、与时俱进的防、抗致病微生物耐药性的卫生工作机制。     

由新药临床试验中的依从性问题引发的思考

本文就如何看待新药临床试验中的依从性问题提出了自己的看法：应用整体观、认识论的方法辩证地分析、处理依从性问题,以保证临床试验的顺利进行和质量可靠;文中通过实例并结合当前的医改背景,对临床医疗工作中的医患关系提出一些启发和看法,建议医务人员从自身出发重视患者的依从性。     

序贯疗法根除幽门螺杆菌

幽门螺旋杆菌（HP）感染是胃炎、消化性溃疡、胃癌和胃黏膜相关淋巴组织淋巴瘤的主要病因,根除HP具有重大的临床意义。随着抗生素耐药株HP逐年增加,HP根除率日益下降,因此出现了一种新的HP根除方案——10天或14天序贯疗法。此疗法指前5天或7天的诱导期中应用质子泵抑制剂（PPI）加一种抗生素的二联治疗,随后5天或7天应用PPI和两种抗生素的三联治疗。目前除少数研究外,绝大多数临床研究表明序贯疗法能够获得比传统的7天或10天三联疗法更高的HP根除率,其具体机制尚不明确。目前大部分相关的研究为单中心、样本量少,缺乏双盲对照,未能评估抗生素耐药性,尚待大样本、多中心、随机双盲对照的临床研究来进一步证实该疗法的有效性和安全性。     

围手术期抗菌药物合理使用与药品费用的相关性分析

通过对本地一所三级甲等医院进行的围手术期抗菌药物的干预对照研究,用SPSS软件对470个手术病例的调查资料进行了统计分析,加强抗菌药物的用药管理及进行用药干预,能在对住院时间和手术切口感染率无影响的同时,明显降低手术病例的药品费用,特别是抗茵药品的费用,减轻患者负担。     

What can we learn from psychoanalysis and prospective studies about chemically dependent patients?

Despite the common occurrence of drug abusers in the psychoanalytic clinic, contemporary literature on the subject, particularly among publications in the IJP, is sparse. This paper aims to review the most important psychoanalytic contributions on drug dependency in the past 100 years, then attempts to compare their postulations to the findings ofpertinent prospective studies. In these patients, a persistent symbiotic object relationship is found, which ties them to narcissistic functioning, where drug use is viewed in the light of both pleasure without object and omnipotently controlled need. The author also discusses the possible contribution of the mother and father in the genesis of this condition, focusing on the compromise of the paternal function as the deciding factor. The theoretical and technical implications of this approach are illustrated by clinical material.     

在西方医药审判中的一个亮点--科学哲学

科学证据不仅在司法审判中起着极其重要的作用,而且在科研成果的评价中也是不可取代的,但是在审判和科研成果评估中,对“科学是什么”这样一个更深层次的问题－科学哲学问题,历来没有得到应有的重视,通过美国止吐药本涤汀前后历时20年的审判历程,突出科学哲学在医药审判实践中的地位。