反复胸闷胸痛伴心理精神障碍的诊疗进展

近年来,临床中关于反复胸闷胸痛患者的较高误诊率引起了广大医务工作者的重视,此类患者伴有的心理精神障碍往往被忽视,得不到合理的治疗,预后较差.本文主要讨论关于反复胸闷胸痛患者病因的鉴别、心理精神障碍引起胸闷胸痛的机制、胸闷胸痛与心理精神障碍的关系、“双心”医学诊疗模式以及反复胸闷胸痛的治疗进展,通过增强临床医生对“双心”医学的认识降低胸闷胸痛患者的误诊率、漏诊率,减少过度治疗,通过心血管医学和心理干预联合治疗,改善心血管疾病患者的预后、降低死亡率.     

PCI术前术后的心理障碍识别与处理

概述冠心病经皮冠状动脉介入治疗（PCI）术前术后患者合并心理障碍的较高发生率以及心理障碍对冠心病发生、发展及预后的影响,分析 PCI 术前术后患者出现焦虑抑郁等心理障碍的原因、产生机制及影响因素,强调心内科医生应及时识别 PCI 术前术后患者出现的心理障碍,并以“双心医学”方式对其进行心理精神医学及心血管专科医学治疗,同时对心血管专科医学治疗效果不明显的冠心病 PCI 患者,进行相关的鉴别诊断后也要进行心理精神医学的诊断和治疗,以便有利于 PCI 术患者的康复和预后,减少不必要的检查和治疗。     

One-year temporal stability and predictive and incremental validity of the Body,Eating, and Exercise Comparison Orientation Measure (BEECOM) among college women

This study examined the one-year temporal stability and the predictive and incremental validity of the Body, Eating, and Exercise Comparison Measure (BEECOM) in a sample of 237 college women who completed study measures at two time points about one year apart. One-year temporal stability was high for the BEECOM total and subscale (i.e., Body, Eating, and Exercise Comparison Orientation) scores. Additionally, the BEECOM exhibited predictive validity in that it accounted for variance in body dissatisfaction and eating disorder symptomatology one year later. These findings held even after controlling for body mass index and existing measures of social comparison orientation. However, results regarding the incremental validity of the BEECOM, or its ability to predict change in these constructs over time, were more mixed. Overall, this study demonstrated additional psychometric properties of the BEECOM among college women, further establishing the usefulness of this measure for more comprehensively assessing eating disorder-related social comparison.     

Short report: correlates of functional disability with disease activity in elderly patients with rheumatoid arthritis

Rheumatoid arthritis (RA) prevalence increases with age and old people are special patient population. The recognition of functional disability related to RA could be challenging in elderly patients because aging itself and potential co-morbid disease may also cause functional disability. In this study, we aimed to look at the correlation between disease activity and functional disability in elderly RA patients. Elderly RA patients, ≥65 years old at their routine visits were included in the study. The composite ‘disease activity score’ in 28 joints (DAS-28) was used to determine disease activity groups. Health assessment questionnaire (HAQ) scores were calculated to describe the functional disability and compared across the disease activity groups. Two hundred and fifty-eight RA patients with the mean age of 71 ± 5 (65–90) and a total disease duration of 8.4 ± 8.5 (.5–50) years were recruited. The proportion of patients with high and moderate disease activity was 70%. HAQ scores were significantly correlated with disease activity (p < .05). Functional disability estimated by HAQ was correlated with disease activity in elderly patients with RA     

Gut interpretations: how difficulties in emotion regulation may help explain the relation of visceral sensitivity with depression and anxiety among young adults with gastrointestinal symptoms

It is widely recognized that abdominal pain and discomfort are common problems in the United States and are often associated with negative quality of life. The prevalence of anxiety/depression elevations and disorders among persons with gastrointestinal disturbances (GI) is estimated to be at least two to three times the rate in the general population. Visceral sensitivity reflects anxiety about GI sensations and its accompanying contexts and often leads to worsening of sensations (e.g. bloating, upset stomach, diarrhea). Among individuals with GI symptoms, visceral sensitivity may be associated with interpreting common sensations as catastrophic which may be related to greater difficulties with emotion dysregulation (e.g. severe anxiety and depression). The current study evaluated the indirect association of visceral sensitivity via emotion dysregulation in relation to depression, anxious arousal, and social anxiety symptoms among 344 young adults with a current history of GI symptoms and problems. Results indicated an indirect effect of visceral sensitivity via emotion dysregulation. These findings provide novel empirical support for the association of visceral sensitivity with emotional distress symptoms among young adults with GI symptoms. Based on the results, targeting emotion dysregulation may be a promising health promotion tactic among young adults with GI symptoms and disorders.     

Support groups for parents with an adult child suffering from bipolar disorder

Confronted with the disconcerting behaviour exhibited by their children, parents of bipolar patients are in severe distress. Research focuses on the study of the ‘burden’ that the pathology puts on caregivers, owing to their experience of depression, sometimes combined with the presence of hostile attitudes and negative affects. In France, parents of adult patients encounter an initial specific difficulty: they are not systematically included in the care management system. Thanks to the initiative of an association of psychiatrists and psychoanalysts, the authors set up a psychoanalytic support group for the parents of ‘bipolar’ adults. The diagnosis of a bipolar disorder is established by a psychiatrist within a medical structure. Support groups for parents do exist in France, but their experiences have not led to scientific publications on this specific topic. Existing publications focus on other types of pathology and other therapeutic approaches. In this article, we will highlight how this type of psychoanalytic support group, with operating rules based on the theoretical work of Anzieu, can help parents of patients with bipolar disorders. Group participants accepted the principle of a research study that maintained their anonymity. We collected and analysed qualitative data from the first year of the group, so we highlight the specific difficulties of these parents, faced with chronic disease. The relevance of our qualitative study also resides in the data collected over a period of time, enabling us to see the progress made, and encouraging us to reflect on the place of psychoanalytic groups for parents, as well as on the care management of this pathology.     

Vulnerability of Individuals With Mental Disorders to Epistemic Injustice in Both Clinical and Social Domains

Many individuals who have mental disorders often report negative experiences of a distinctively epistemic sort, such as not being listened to, not being taken seriously, or not being considered credible because of their psychiatric conditions. In an attempt to articulate and interpret these reports we present Fricker’s concepts of epistemic injustice (Fricker, 2007, p. 1) and then focus on testimonial injustice and hermeneutic injustice as it applies to individuals with mental disorders. The clinical impact of these concepts on quality of care is discussed. Within the clinical domain, we contrast epistemic injustice with epistemic privilege and authority. We then argue that testimonial and hermeneutic injustices also affect individuals with mental disorders not only when communicating with their caregivers but also in the social context as they attempt to reintegrate into the general society and assume responsibilities as productive citizens. Following the trend of the movement of mental health care to the community, the testimonies of people with mental disorders should not be restricted to issues involving their own personal mental states.     

Autonomic and subjective responsivity to emotional images in people with dissociative seizures

People with dissociative seizures (DS) report a range of difficulties in emotional functioning and exhibit altered responding to emotional facial expressions in experimental tasks. We extended this research by investigating subjective and autonomic reactivity (ratings of emotional valence, arousal and skin conductance responses [SCRs]) to general emotional images in 39 people with DS relative to 42 healthy control participants, whilst controlling for anxiety, depression, cognitive functioning and, where relevant, medication use. It was predicted that greater subjective negativity and arousal and increased SCRs in response to the affective pictures would be observed in the DS group. The DS group as a whole did not differ from controls in their subjective responses of valence and arousal. However, SCR amplitudes were greater in ‘autonomic responders’ with DS relative to ‘autonomic responders’ in the control group. A positive correlation was also observed between SCRs for highly arousing negative pictures and self‐reported ictal autonomic arousal, in DS ‘autonomic responders’. In the DS subgroup of autonomic ‘non‐responders’, differences in subjective responses were observed for some conditions, compared to control ‘non‐responders’. The findings indicate unaffected subjective responses to emotional images in people with DS overall. However, within the group of people with DS, there may be subgroups characterized by differences in emotional responding. One subgroup (i.e., ‘autonomic responders’) exhibit heightened autonomic responses but intact subjective emotional experience, whilst another subgroup (i.e., ‘autonomic non‐responders’) seem to experience greater subjective negativity and arousal for some emotional stimuli, despite less frequent autonomic reactions. The current results suggest that therapeutic interventions targeting awareness and regulation of physiological arousal and subjective emotional experience could be of value in some people with this disorder.