疑病者与疑似病者之比较研究

疑病者与疑似病者,在基础心理特征方面存在较大差异,也有一定的共性,两者都构成诊断结果,会给当事人带来心理上焦虑、不安等情绪。疑病者的心理问题是内生性的,与精神倾向及人格有关,疑似病者的心理问题是外生性的,与机体症状有关。疑病者与疑似病者的角色在一定条件下可以相互转化,疑病者在长期不良心境下可变为疑似病者,具有高神经质人格的疑似病者易转变为疑病者。在心理干预过程中,应该注意到这两者不同的特点,采取不同的措施。     

对颌骨骨折坚固内固定术患者心身感受的质性研究

了解颌骨骨折坚固内固定术患者不同阶段的心理和躯体感受,以便为其提供人性化的人文护理服务,使患者满意,使优质护理服务得到落实。采用立意取样法选取研究对象,对选取的31例颌骨骨折坚固内固定术患者采用质性研究中的现象学方法进行深度访谈,并对资料进行整理和分析。结果发现患者在三个阶段中的护理问题如下：（1）手术前;自我形象紊乱、功能障碍和焦虑。（2）手术后：舒适受到影响和愧疚感等。（3）出院时：渴求信息。本研究能规范颌骨骨折坚固内固定术患者人文护理的具体内容,改善其护理问题。     

“Transferring” and transference

This paper is part of my research into psychotic transference and is also related to the psychotic aspect of any adult or infantile patient in analysis. In my research, I studied the origin of the concept of transference in Charcot's time before Freud, and the transformation of this concept in psychoanalysis. Freud thought that psychotic patients were not able to establish a transference relationship, but some of his early papers show the opposite. In fact, Freud himself and then several other analysts were able to develop a personal experience regarding the possibility of contact and transferring feelings and delusional experiences in a therapeutic context – individual, group, or institution. I provide some clinical examples in this paper, as well as some theoretical, personal views regarding intrapersonal and interpersonal transference. Like Freud and Melanie Klein, I believe that transference starts with life, but that in psychoanalysis it has a particular meaning.     

The being a patient effect: negative expectations based on group labeling and corresponding treatment affect patient performance

Patient studies provide insights into mechanisms underlying diseases and thus represent a cornerstone of clinical research. In this study, we report evidence that differences between patients and controls might partly be based on expectations generated by the patients’ knowledge of being invited and treated as a patient: the Being a Patient effect (BP effect). This finding extends previous neuropsychological reports on diagnosis threat. Participants with mild allergies were addressed either as patients or control subjects in a clinical study. We measured the impact of this group labeling and corresponding instructions on pain perception and cognitive performance. Our results provide evidence that the BP effect can indeed affect physiological and cognitive measures in clinical settings. Importantly, these effects can lead to systematic overestimation of genuine disease effects and should be taken into account when disease effects are investigated. Finally, we propose strategies to avoid or minimize this critical confound.     

家属参与授权教育对老年原发性高血压伴同型半胱氨酸血症患者管理中的应用

探讨家属参与授权教育对老年原发性高血压伴同型半胱氨酸血症患者的干预效果.选取120名老年原发性高血压伴同型半胱氨酸血症患者,随机分成试验组和对照组,每组60名,两组均采取相同的药物治疗,给予常规的授权教育模式.试验组在此基础上给予家属参与授权教育模式,为期6个月.试验组与对照组比较,总胆固醇（TC）、甘油三脂（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、同型半胱氨酸（Hcy）及血压值低于对照组,差异有统计学意义（P＜0.05）;试验组的生存质量及满意度评分均高于对照组,两组差异有统计学意义（P＜0.05）.经过为期6个月的健康教育干预,这一模式取得了较好的效果.     

病耻感对于精神病患者的影响以及文化对策

本文分析三种类型歧视所造成的患者及其家属的痛耻感,论述我们应当如何利用适当的文化应对策略来消除歧视、减少病耻感,从而有效地克服病耻感对于患者及其家属的负面影响。文化差异与病耻感的形成直接相关,文化作为一个重要变量,影响着精神卫生问题以及相应的服务政策,深入研究和认识儒家文化的核心价值有助于减少对于精神病患者的歧视,帮助他们克服病耻感。中国道家文化推崇道法自然,无为而治,可以发展出有效的心理疗法,对于精神疾病是一剂对症的良药。     

Psychological support needs of patients with head and neck cancer and their caregivers: A qualitative study

Objective: The aim of this study was to explore the psychological support needs of patients with head and neck cancer (HNC) and their caregivers. The appropriate timing, length, format and content of sessions were also investigated.

Design: Eighty-three patients with HNC and 73 of their caregivers completed questionnaires at diagnosis. Follow-up questionnaires were mailed to patients six months later.

Main outcome measures: Free text-comments to open-ended questions in the questionnaires were analysed using an inductive thematic approach with coding and theme development directed by the content of responses. This was used to determine psychological support needs both at diagnosis and at six month follow-up.

Results: Patients described ‘just being there’, empathy, maintaining normality and practical support as helpful from family/friends. They desired information, honesty, positivity and empathy from clinical staff. Formal psychological support was desired by approximately 40% of patients and caregivers, particularly early after diagnosis and during treatment. Most participants desired face to face sessions, providing individualised information and coping strategies.

Conclusion: The results of this study suggest that psychological interventions for patients with HNC and their caregivers should be delivered early after diagnosis in face to face sessions, presenting honest and factual information about the disease and coping strategies.