腰腿痛患者现病史的客观采集及其评价

腰腿痛患者的现病史采集比较困难,临床上经常引发混乱,甚至会被忽略.作者根据临床经验总结了一套相时系统和客观的分析思路.借此启发和提示临床医生临诊分析的主观能动性.作者还通过对现病史采集在医学发展史上的地位变化的回顾,提出了现代临床医学对患者症状特征进行归纳分析的重要性.     

On boredom: A close encounter with encapsulated parts of the psyche

The psychoanalytical literature has numerous scattered references to the analyst's experience of boredom, especially amongst writers working with primitive mental states. In the present paper, the author tries to gather some of these references in an attempt to integrate the various facets of this widespread phenomenon, and reflect on some clinical issues and dilemmas it raises. It is suggested that the experience of boredom in analysis may be a reaction to an encounter with a hidden, encapsulated part of the psyche, a bidimensional area of experience in which mental activity has been suspended, and experience remains meaningless. This is a barren area of lack, an encounter with the autistic core of the psyche. However, boredom may also be an experiential expression of despair, a re-living of primitive object relations with an emotionally non-existent primary object. Through bringing the emptiness and desolation into analysis, the individual makes room for the empty, blunt, dead inner object which resides within him, and that needs to be integrated into the psyche. This inner object is a vital part of the patient's inner world, part of his history, and can neither be erased nor filled in order to eradicate the emptiness. This is illustrated by clinical material from patients along the spectrum of autism, autistic reaction following trauma and autistic barriers in neurotic patients.     

The relationship between pain tolerance and trait aggression: effects of sex and gender role

The literature on pain and aggression has indicated that pain elicits aggression. However, research has generally examined pain as a situational variable and focused less on the dispositional ability of an individual to tolerate pain. The dearth of research on pain tolerance and aggression appears to contradict the existing theory on the aggression‐eliciting effect of pain, in that studies have found a positive relationship between pain tolerance and aggression. The purpose of this study was to determine whether the relationship between pain tolerance and aggression is moderated by sex and whether the positive relationship could be explained by masculine gender role conformity. A sample of 195 collegiate men and women completed trait measures and a laboratory assessment of pain tolerance. Results indicated that correlations between pain tolerance and trait aggression were significant and positive for men but not women. However, when men's conformity to masculine gender role was controlled for, the relationship between pain tolerance and trait aggression was nil and nonsignificant. Results are discussed in reference to socialization and maintenance of masculine status. Aggr. Behav. 35:422–429, 2009. © 2009 Wiley‐Liss, Inc.     

Relation of Self-Efficacy to Reported Pain and Pain Medication Usage During Labor

We studied the relationship of self-efficacy to reported labor pain and pain medication usage among 43 women. Self-efficacy ratings were judgments of confidence regarding successful completion of tasks involved in labor and delivery (e.g., doing breathing exercises) and in overcoming barriers (e.g., nonsupportive partner). Multiple regression analyses revealed that self-efficacy significantly contributed to predicting labor pain beyond other relevant variables (e.g., age, amount of menstrual pain), with barrier self-efficacy the strongest predictor. Results are discussed in the context of increasing women's confidence in overcoming barriers by incorporating relevant interventions in childbirth education.     

The medial amygdala: Serotonergic inhibition of shock-lnduced aggression and pain sensitivity in rats

Two aspects of the amygdaloid complex (corticomedial and basolateral) were examined with reference to serotonergic inhibition of shock-induced aggression. Fighting was significantly depressed by serotonergic stimulation (5-HT, 10 μg bilateral) in the corticomedial amygdala while serotonergic blockade (methysergide, 5 μg bilateral) in this region increased levels of fighting. No consistent effects were obtained with serotonergic manipulation of the basolateral amygdala. Further investigation revealed that the state of serotonergic activity in medial amygdaloid sites was associated with concomitant alterations in the animals' sensitivity to footshock. Results are discussed in relation to a) a general inhibitory role of serotonin in behavioural mechanisms and b) a dopaminergic-serotonergic balance for behavioural arousal involving medial amygdaloid nuclei.     

Money versus pain: experimental study of a conflict in humans.

Ten healthy human males volunteered to be subjects in an experiment in which they were to be paid to endure a painful sensation. This sensation was produced by isometric muscular contraction in the thighs. For each of six sessions the subjects received either a payment that was changed for each session (0.2, 0.5, 1.25, 3.125, 7.8125 French francs per 20 s) or a lump sum. At the beginning of a session, the subjects assumed a seated position against a wall, but without a seat, and the duration for which they could hold this position was the chief variable measured. Heart rate, blood pressure, and magnitude estimation of pain were also recorded periodically throughout each session. Pain was reported after a mean delay of 15 +/- 7 s (SE), and the magnitude estimates then increased linearly with time. The duration of maintaining the painful position increased linearly in relation to the logarithm of the increase in the amount of payment. Thus, utility of money decreased when pitted against pain.     

Differences in High and Low Anxiety Sensitive Women's Responses to a Laboratory‐Based Cold Pressor Task

Anxiety sensitivity (AS) has been linked to a variety of disabling chronic health conditions, including pain‐related conditions. A recent study has found that healthy women with high AS reported significantly higher levels of sensory and affective pain on an experimental cold pressor task compared to women with low AS. However, this study found no differences between AS groups for pain tolerance or pain threshold. In the present study, which was designed to replicate and extend these findings, 90 undergraduate university women were selected for inclusion in 1 of 2 AS groups (high or low) based on their screening scores on a 16‐item measure of AS. Participants were tested individually on a lab‐based cold pressor task using a variety of self‐report and observer‐measured variables. Data analyses revealed that, as expected, the high AS participants reported significantly more fear in response to the cold pressor on a relevant item of the McGill Pain Questionnaire – Short Form (SF‐MPQ) than did the low AS participants. Also as expected, the high AS participants reported more pain in response to the cold pressor on the Present Pain Index (PPI) of the SF‐MPQ than did the low AS participants. High AS participants did not differ from low AS participants on other aspects of the cold pressor response (e.g. pain threshold, pain tolerance, pain recovery). These results support the role of pain‐related fear as a mediating variable between AS and increased perceived pain intensity.     

情绪通路异常与认知情绪偏差:慢性痛与抑郁症共病的神经心理机制

慢性疼痛与抑郁症具有高度共病性,但迄今尚无成熟理论能够阐释二者共病的神经心理机制。对慢性痛与抑郁的脑机制研究提示,慢性痛和抑郁常常涉及到相似的情绪脑区活动的异常改变;与此相对应的是,行为学研究发现,疼痛患者与抑郁患者在加工疼痛或抑郁相关信息时表现出了模式相似的认知情绪偏差(CAB)。近年来,越来越多证据趋于一致,指出慢性痛和抑郁共有的情绪通路异常变化可能导致了相似的信息加工异常,是二者共病的神经心理基础,而认知情绪偏差则在行为上反映了这种变化,并且很可能是共病发生、发展及维持的重要因素。     

基于心理痛苦理论与决策树的中学生心理危机分类模型

中学生心理危机分类模型属于复杂数据模型，本文采用分类树算法探究家庭、校园、同伴和个体因素在中学生心理危机分类中的相对重要性差异，尤其是心理痛苦三因素对致死性危机的独特作用。结果显示：（1）中学生自杀危机和非致死性危机分类树的分类效果良好，自伤危机分类树的分类效果欠佳；（2）中学生自杀危机中，痛苦逃避最为重要，痛苦唤醒次之，之后为痛苦体验和学校满意度；（3）中学生自伤危机中，同伴问题行为最为重要，之后为父母陪伴和家庭监督；（4）中学生非致死性危机中，歧视知觉最为重要，之后为痛苦唤醒和同伴支持。提示中学生不同心理危机的促发机制存在差异，心理痛苦三因素模型在自杀分类模型中作用显著，但并非自伤危机和非致死性危机的关键变量。     

DECREASING BURNED CHILDREN'S PAIN BEHAVIOR: IMPACTING THE TRAUMA OF HYDROTHERAPY

We evaluated the effects of cartoon viewing with the use of a star feedback chart on two burned children's pain behavior during their physical therapy sessions. In addition, the degree to which the observational data corresponded with physical therapists' and mothers' ratings of the children's pain, fear, and cooperativeness was examined. Using a reversal single-subject design, the results showed that the children's pain behavior substantially decreased during experimental treatment sessions compared to their baseline levels. The rating scale data indicated that the physical therapist's and mother's rating of pain, anxiety, and cooperativeness were all correlated significantly with the observational data (p < .05). The contributions of respondent and operant conditioning to the occurrence and treatment of pain behavior in burned children are discussed.