重型颅脑损伤围术期亚低温治疗路径——循证医学指导下的治疗抉择

早期动物实验研究表明亚低温能减轻脑损伤后的继发性损害,促进神经功能恢复,然而对其临床疗效不同研究结果不完全一致。本文应用循证医学思想,检索和评价国内外文献,为重型颅脑损伤患者制定了围术期亚低温实施方案。随访结果表明,亚低温可改善患者预后。     

Functional analysis and treatment of the delusional statements of a man with multiple disabilities: a four-year follow-up

Although delusional statements in people with intellectual disabilities and traumatic brain injury can be treated using behavioral interventions, none have demonstrated long‐term treatment effects. In the current study, a functional analysis demonstrated that delusional statements were maintained by attention. Differential reinforcement of alternative behavior and extinction of delusional statements resulted in near elimination of delusional statements and an increase in nondelusional statements. Follow‐up at 6 months, 1, 2, and 4 years indicated that treatment gains were maintained with continued staff training.     

临床外伤性视神经病变过度医疗的探讨

外伤性视神经病变是一类严重损害视功能的疾病,临床治疗上普遍存在着过度治疗的问题。原因是多样的,治疗标准不统一是主要原因。依据循证医学的成果,对临床外伤性视神经病变现阶段存在的过度医疗进行分析探讨,并提出了医者针对外伤性视神经病变过度医疗应采取的措施,获得最优化的诊疗方案。     

The concept of psychical trauma: A bridge in interdisciplinary space1

The concept of trauma currently occupies a central position in interdisciplinary dialogue. Using the concept of psychical trauma as a bridge, the author attempts an interdisciplinary dialogue with psychiatry, biology and neuroscience. Beginning with the concept of psychical trauma in Freud, the author reviews the evolution of Freud's thinking, and links it with the ideas of Ferenczi and post‐Freudian psychoanalytical authors. From a different framework, he considers the present state of research on post‐traumatic stress disorder in current psychiatric nosography and attempts an interdisciplinary approximation to the concept of psychical trauma. Interesting ideas like the traumatic situation, trauma spectrum and psychopathological spectrum emerge, which enable a better understanding of the concept of psychical trauma through its relatedness, as a bridge connecting a broad psychopathological range extending from normality to psychosis. The ensuing possible relative loss of nosographical rigour is more than compensated by the resulting increased understanding and enlarged therapeutic possibilities. In the second part of the paper, the author attempts a dialogue with neuroscience, taking into account new advances in current research on emotion and memory, and making them compatible with the psychoanalytical concept of trauma. In this sense, the paper underlines the importance of emotion and crucially of memory, regarded as a fundamental axis of the subject explored in this paper. Here a substantial distinction which is pertinent for analytical work appears: declarative memories versus non‐declarative or procedural memories. In a concluding discussion the author argues that, taking into account the implications of these current notions regarding a number of theoretical and technical aspects, psychoanalysis currently holds a privileged position, both in its potential for prevention and regarding the treatment of patients, in so far as, through interdisciplinary dialogue, psychoanalysis can be receptive to and be enriched by the contributions of other disciplines, just as it enriches them with its own contributions.     

Confronting Bluebeard: totalitarian regimes in childhood and in the collective psyche

Beginning with the story of Bluebeard, the author considers how traumatic overwhelm can occur in everyday childhood situations of a psychically murderous quality; for example, a nanny’s totalitarian regime may be invisible to parents ruled by collective social and cultural norms. A child who is remote from mother and idealises a father embodying a powerful patriarchal system may remain naïvely dependent in marriage and unable to cope with the realities of human aggression. The paper describes analytic work with a woman who had suffered repeated breakdowns and needed to relinquish a fragile, socially constructed identity in order to establish her own true orientation.     

Benchmarking Treatment Effectiveness of Community‐Delivered Trauma‐Focused Cognitive Behavioral Therapy

It is critical for urban youth with post‐traumatic stress disorder (PTSD) living in poverty to have access to evidence‐based interventions for their traumatic stress. However, there is limited research on the effectiveness of these interventions when provided in urban, community settings. The objectives of the current study are to (a) evaluate the effectiveness of trauma‐focused cognitive behavioral therapy delivered from 2013 to 2016 in 15 behavioral health agencies on youth (N = 114) PTSD as well as  general mental health symptoms and  functioning, and (b) benchmark these clinical outcomes against other published efficacy and effectiveness trials. Effectiveness data are from the Philadelphia County Community Behavioral Health System, a system that has invested significantly in the training and ongoing support of clinicians providing high‐quality trauma services to youth since 2012. From baseline to last assessment, youth PTSD symptom severity (d = 0.34), PTSD functional impairment (d = 0.38), and overall mental health problem severity (d = 0.29) improved. The effect sizes of  improvements were smaller than effect sizes observed in efficacy and effectiveness studies. This study is the first benchmarking study of TF‐CBT and provides preliminary findings with regard to the effectiveness, and transportability, of TF‐CBT to urban community settings that serve youth in poverty.     

When Conflict Traumas Fragment: Investigating the Sociopsychological Roots of Turkey’s Intractable Conflict

This article investigates the historical processes contributing towards the specific development of Turkey after the 1920s that in turn established the main contours of Turkey's conflict with the Partiya Karkerên Kurdistanê (PKK). It first argues that the traumatic conflict memories of the Turkish leadership (1918–35) influenced its individual‐level patterns of actions. These memories were used by the leadership to consolidate its imagined national agency in Turkey. The leadership perceived the traditional‐conservative groups as ontological insecurity sources, jeopardizing this agency. It second claims that Turkey's military apparatus is designed to silence these ontological insecurity sources. Finally, it claims these developments informed the ways in which the PKK's narratives of rebellion were constructed. Empirically, it problematizes the impact of the Ottoman Empire's collapse on the Turkish elites. Then, through a discourse analysis of elites' speeches and legal documents, it traces their anxieties to the Ottoman Empire's traumatic end. This article contributes to the trauma literature on ontological security and the emotions literature in International Relations in two ways. It first explores the particular national context in which traumatic memories are shaped and in turn articulated through emotional performances. Secondly, it shows the interplay between sociopsychological processes of security and agency making.     

Three fragments on trauma and time

How does trauma influence a client and a therapist’s experience of time in time-limited therapy? The therapist must first work to understand and remain responsive to the different registers of time now operative following the traumatic event. This paper contends that in the immediacy of trauma, hallucinatory wish-fulfilment oblivious to the structuring conditions of time and space appears to dominate. In chronic traumatic states, time appears to circle in a narrow compass, buffering between a cluster of moments surrounding and including the moment of traumatic rupture – as if struggling to re-establish a secure connection with linear time. The three clinical fragments presented attempt to describe different experiences of traumatic bereavement and the felt movement of time within them. The death of another confronts us not only with their loss but with our own mortality – the time we have lived and the time we have left. It is not surprising, therefore, that an individual's otherwise fluid transitions between different temporalities are disturbed in the aftermath of traumatic bereavement. The therapist’s capacity to regulate tempo when the client’s subjective experience of time is dysregulated offers an important means of containment. The aim of the therapist working with the traumatically bereaved client is to develop collaborative understanding to get thinking moving again and to gradually help the client unpin time, moving it beyond the confines that it occupies in trauma.     

创伤事件的痛苦程度对创伤后成长的影响：核心信念挑战的作用

采用创伤事件终身经历问卷—学生版、核心信念量表、创伤后成长评定量表,对3所大学进行问卷调查,探索具体创伤事件痛苦程度与创伤后成长(PTG)的关系,并检验核心信念挑战在其中的中介作用。结果发现：(1)家人患病或死亡类的创伤事件痛苦程度可负向预测PTG,并以核心信念挑战为中介;(2)目睹他人或自身相关的创伤事件痛苦程度和自身受虐待类的创伤事件痛苦程度可正向预测PTG,并以核心信念挑战为中介;(3)自然灾害类的创伤事件痛苦程度和家庭冲突类的创伤事件痛苦程度与核心信念挑战和PTG都无显著相关。因此不同领域的创伤事件痛苦程度引发创伤后成长的可能性不同。     

The moderating role of early traumatic experiences on the association of schizotypal traits with visual perception

The findings on the association of schizotypal traits with the perception of visual illusions are scarce and inconsistent and have not taken into consideration potential effects of childhood traumatic experiences, a risk factor for schizophrenia-spectrum conditions. Thus, the present study addressed the question of potential moderating effects of early traumatic experiences on the association between different aspects of schizotypal traits with the perception of the Müller-Lyer and Navon's Hierarchical Letters (NHL) illusions. The study revealed that (a) increased suspiciousness was associated with increased liability to the Müller-Lyer illusion, when the exposure to traumatic events was high, whereas the opposite pattern was true when the exposure to traumatic events was low; (b) negative schizotypy was associated with more accurate global perception, and high disorganized schizotypy was associated with superior accuracy when target letters were present during the NHL illusion, when early traumatic experiences were at lower levels; and (c) high negative, disorganized, and total schizotypy were associated with lower accuracy when target letters were present in the NHL paradigm, when early traumatic experiences were at higher levels. The findings of the study suggest that early traumatic events differentially moderate the relationship between various aspects of schizotypal traits and visual perceptual processing.