哲学视野下脑卒中后心理障碍的辩证康复

脑卒中后的心理障碍不但影响患者的心理健康,还严重阻碍整个康复治疗的进程。心理疗法作为一种重要的心理障碍康复手段,其有效性已得到相关临床研究的证实。但如何根据临床具体情况选择适宜的心理疗法加速患者功能的康复,提高其生活质量和日常生活活动能力,最终帮助患者重返家庭和社会一直是临床关注的热点。为了更好地提高对卒中患者心理障碍的认识和干预,本文试从哲学的角度出发,结合各期心理障碍的特点,对脑卒中后心理障碍的康复作一论述。     

高压氧医学与康复医学的协同发展

随着医学理论与实践的不断创新和发展,中国也正在努力寻求一种具有中国特色的现代医学发展模式.高压氧医学与康复医学都是新兴的边缘交叉性学科,具有广阔的发展潜能和空间;然而,两者在快速发展的同时也突显了一些问题,如：后续动力不足、发展方向不明确等.本文从哲学中联系与发展的角度出发,通过机制探讨及发展趋势的分析,试图寻找两者共同发展的结合点,为推动康复医学与高压氧医学在临床工作中的继续向前发展提供一种借鉴与参考.     

People with severe and profound intellectual disability: Nurse carer experiences in a South African setting

We explored nurse carer experiences with people with severe and profound intellectual disability in a care and rehabilitation centre in South Africa. Informants were a convenience sample of 10 nurses (females = 7; males = 3; mean years of service = 7.8, SD = 4.8 years). They completed an unstructured interview on their care provision experiences. The data were thematically analysed using Tesch’s method of open coding. Findings resulted in the following three themes to characterise the nurse carer experiences: compassion, person-centred care, and importance of parent involvement. Compassionate and person-centred care is fundamental to the establishment of a therapeutic relationship between nurse carers and people with severe and profound intellectual disability.     

Memory rehabilitation for older adults: preserving independent living / Rehabilitación de la memoria para adultos mayores: preservación de la autonomía de vida

Abstract

Episodic memory problems are the hallmark of cognitive ageing in normal elderly people. Learning of new material is worse in pathological cognitive ageing, such as dementia and its preliminary states (mild cognitive impairment). Because episodic learning is crucial to preserve independent living in the elderly, rehabilitation programmes for everyday memory problems are welcomed. The scope of scientific interest has switched from treatment to prevention. We claim that lifestyle interventions are the most direct way to preserve cognition. We summarize evidence for changes in nutrition and exercise. In addition, psychological interventions for elderly people with normal or pathological cognitive ageing are available. Recent meta-analyses found lacking evidence of transfer to everyday life and long-term effects. We critically assess these meta-analyses. We propose theoretically derived experimental interventions relying on spared learning mechanisms. As an example we report visual-imagery training showing positive effects in a randomized control trial, using individual memory diaries on memory improvement.     

Context-Dependent Learning in People With Parkinson's Disease

Context-dependent learning is a phenomenon in which people demonstrate superior performance in the context in which they originally learned a skill but perform less well in a novel context. This study investigated context-dependent learning in people with Parkinson's disease (PD) and age-matched nondisabled adults. All participants practiced 3 finger sequences, each embedded within a unique context (colors and locations on a computer screen). One day after practice, the participants were tested either under the sequence-context associations remained the same as during practice, or the sequence-context associations were changed (SWITCH). Compared with nondisabled adults, people with PD demonstrated significantly greater decrement in performance (especially movement time) under the SWITCH condition, suggesting that individuals with PD are more context dependent than nondisabled adults.     

Work strain and the post-discharge adjustment of patients following a heart attack

Abstract

The role of work characteristics in determining return to work after an acute coronary event was examined. One hundred and forty nine patients were enrolled. One year post-discharge, 74 had returned to work. Work characteristics (decision latitude, and opportunity for social interaction at work), together with age, depression, and medical prognosis, correctly classified work status in 78% of cases. At 12 months post-discharge, patients who had not returned to work recorded significantly poorer levels of adjustment compared to those who had returned to work. A better quality of life is associated with a lower level of depression pre-hospitalization, ownership of a larger home, being male, and having a more positive work environment. The findings suggest that the pre-illness work environment of the patient is a factor influencing return to work, which needs to be considered in rehabilitation programmes.     

Quality-of-life after penile prosthesis placed at radical prostatectomy

Abstract

The clinical and psychosocial effects of immediate penile prosthesis implantation at the time of radical prostatectomy (RP) were investigated in 97 consecutive patients and 68 partners. Prosthesis recipients reported more frequent sexual contact, fewer marital problems and slightly fewer sexual functioning problems than the RP-alone patients. There were no group differences on any sociodemographic characteristics, on disease recurrence, on physical and psychosocial functioning, or on reported depression. Patients who chose the prosthesis did, however, evidence less of a link between depression and functional limitations and between depression and marital problems. They also had lower levels of agreement with their partners in reporting their own depression, as compared to the patients who opted for RP surgery alone. We conclude that the penile prosthesis was associated with an increased frequency of sexual contact, a reduction in reported marital problems, and stylistic differences between the two patient groups in dealing with affect.     

On applying cognitive psychology

Recent attempts to assess the practical impact of scientific research prompted my own reflections on over 40 years worth of combining basic and applied cognitive psychology. Examples are drawn principally from the study of memory disorders, but also include applications to the assessment of attention, reading, and intelligence. The most striking conclusion concerns the many years it typically takes to go from an initial study, to the final practical outcome. Although the complexity and sheer timescale involved make external evaluation problematic, the combination of practical satisfaction and theoretical stimulation make the attempt to combine basic and applied research very rewarding.     

Rehabilitative Beit Midrash as a means for advancing the community integration of Ultra Orthodox Jewish persons with severe mental illness

ABSTRACT

Religious Jews with severe mental illness often encounter barriers to involvement in religious activities in their community affecting their ability to become integrated into their community. Therefore, a study was conducted in Israel examining the contribution to community integration through a programme providing religious persons with mental illness an opportunity to participate in religious studies. An A-B research design was implemented among 42 Ultra-Orthodox Jewish persons with severe mental illness utilising a culturally-oriented structured instrument. The study showed that the opportunity for involvement in religious studies could advance the participants’ sense of social interaction in their community as well as their sense of psychological integration with other religious people. It also strengthened their confidence in their ability to further get involved in religious studies in the community. Rehabilitation services providing persons with severe mental illness an opportunity for involvement in religious studies can act as a springboard for advancing their community integration.     

Drawing to reconstruct: Pilot study on acknowledging prisoners' internal and external resources in a penitentiary institution

Since the first offender rehabilitation treatments, all theoretical approaches have been focusing on reducing risk factors that may influence recidivism, without satisfactory results. Recent resilience research has instead shown the important mediating or moderating role of protective factors and provided the theoretical principles for the Good Lives Model Comprehensive. This holistic model suggests the importance of integrating the reduction of risk factors with the reinforcement of protective factors in offenders' treatment programs. This combined action is considered the main condition through which offenders are motivated to change their life and develop a sense of agency on their current life conditions. This article presents a pilot study, aimed at analyzing the feasibility of a psychosocial intervention, based on graphic workshops. The purpose of the intervention is helping prisoners strive toward adaptation in jail, and facilitating the redesign of their life beyond bars. Drawing activities allowed prisoners to enhance their own internal and external resources, and recognize risk and protective factors that could influence their successful reintegration into society. The main limit of this study is directly linked to the setting of the penitentiary institution where the study was conducted, which is characterized by a high prisoners' turn over.