治疗师角度下双相障碍强化门诊干预项目的疗效相关因素分析北大核心CSCD

目的探讨治疗师角度下双相障碍强化门诊干预项目（intensive outpatient program for bipolar disorder, IOP-BD）的疗效相关因素。 方法2016年6月至2017年4月在上海交通大学医学院附属精神卫生中心招募新近缓解的双相障碍患者进行IOP-BD干预,共有3组团体治疗,每次团体治疗结束后对10名治疗师进行半结构式访谈并录音。采用主题分析方法进行分析,将访谈录音转录为逐字稿并进行编码分析,再将结果反馈给治疗师以确定结果的可靠性。结果团体成员个体因素和治疗过程相关因素会影响双相障碍患者IOP-BD的疗效。治疗师认为那些积极参与并能有所反馈,内心真正接纳自己罹患双相障碍且病程短、家属调节能力强的患者获益更多;治疗过程中治疗师节奏的把握和引导也会影响疗效,而这些与其专业背景有关。结论治疗师需要有足够的经验掌握好治疗节奏,并对参与程度低、病程长、不接纳自己患病等的患者加以引导,增加IOP-BD疗效。     

功能性肢体无力诊断与治疗

功能性肢体无力是临床常见的功能性运动障碍,其诊断主要基于病史、神经科检查和阳性体征,易漏诊或误诊,治疗需在多学科诊疗模式下进行诊断解释、物理治疗和心理治疗。本文对功能性肢体无力的临床表现、诊断与鉴别诊断、治疗进行综述,以提高临床诊断率和治疗率,改善患者预后。     

Neurology：步幅管理辅助外骨骼改善慢性卒中患者的步行能力

正卒中后物理治疗应该高度重视提高患者的步行能力。动力机器人外骨骼(powered roboticexoskeletons)是一种有希望的工具,有助于为患者提供高剂量、高强度以及渐进性治疗方案,并且在治疗过程中实现更大的步行训练量,同时还能减轻治疗师的工作负荷。由本田研究与开发有限公司(Honda RD     

双肺移植后胸科物理治疗1例

摘要：肺移植是目前公认的治疗终末期肺病的一种方法。肺移植后的患者需要多学科的交叉治疗来获得最佳的治疗效果,胸科物理治疗是肺移植后综合治疗方案当中极其重要的一部分。文章个案分析了2007-08四川大学华西医院胸外科和康复与针灸医学中心双肺移植患者1例,以对国内移植后患者的物理治疗进行分析探讨。患者的物理治疗分为3个阶段,第1阶段为移植后当天及移植后第1天,即撤离机械通气之前,患者仍然需要呼吸机辅助呼吸且卧床静养;第2阶段为患者撤离呼吸机至停留ICU,患者继续接受多种监护,仅能完成床边的一些简单运动;第3阶段为患者从ICU转入隔离病房至康复出院,患者能在脱离监护及胸科物理治疗师指导下完成强度更大,时间更长的运动。35 d后患者康复出院,效果满意。 关键词：肺移植;康复;胸科物理治疗;早期活动     

急性脊髓损伤的循证治疗

目的：对1例急性脊髓损伤患者进行循证治疗,总结评价治疗急性脊髓损伤的最佳证据。 方法：系统检索美国国家指南交换中心NGC（2000/2011）、Cochrane 图书馆（2011 年第1 期）、TRIP Database(2000/2011)、PubMed（1966/2011）中治疗急性脊髓损伤的相关研究,依据循证医学倡导的最佳研究证据、医师的临床经验和患者的意愿相结合制定治疗方案。 结果：共纳入34篇研究文献,包括1篇临床指南,22篇系统评价和11篇随机对照试验。目前的证据表明：对于急性脊髓损伤的患者,不推荐使用任何神经保护类药物;推荐早期手术;使用物理方式和注射低分子量肝素来防止静脉血栓的发生;功能性电刺激和针灸对急性脊髓损伤患者的功能恢复有促进作用。实验中未给予患者任何神经保护类药物,于伤后6h进行颈椎手术,术后应用低分子量肝素和物理措施预防血栓形成,每日进行呼肌功能锻炼,同时给予功能性电刺激和针灸治疗。经过3个月的随访,证实此方案适合该患者。 结论：应用循证医学的方法为急性脊髓损伤的患者制定个性化治疗方案,能显著提高治疗效果和预后。     

中国脑血管病防治指南(节选)

第三章 卒中单元 一、概念 卒中单元（stroke unit）是指改善住院卒中患者的医疗管理模式，专为卒中患者提供药物治疗、肢体康复、语言训练、心理康复和健康教育、提高疗效的组织系统。卒中单元的核心工作人员包括临床医师、专业护士、物理治疗师、职业治疗师、语言训练师和社会工作者。基于以上概念，可以将卒中单元概括为以下特点：（1）针对住院的卒中患者，因此它不是急诊的绿色通道，也不是卒中的全程管理，只是患者住院期间的管理。（2）卒中单元不是一种疗法，而是一种病房管理系统。（3）这种新的病房管理体系应该是一种多元医疗模式（muhidisciplinary care system），也就是多学科的密切合作。（4）患者除了接受药物治疗，还应该接受康复治疗和健康教育。但是，卒中单元并不等于药物治疗加康复治疗，它是一种整合医疗（integrated care）或组织化医疗（organized care）的特殊类型。（5）卒中单元体现对患者的人文关怀，体现了以人为本。它将患者的功能预后以及患者和家属的满意度作为重要的临床目标，而不像传统的理念仅强调神经功能的恢复和影像学的改善。     

2011年新加坡卫生部：卒中及短暂性脑缺血发作临床实践指南

本指南的首要目标是协助个体诊所、医院科室及医院管理人员针对以下方面制定规范:①评估、完善检查并迅速处置短暂性脑缺血发作(transient ischemic attack,TIA)或急性卒中(除外蛛网膜下腔出血)惠者。②TIA或急性卒中后的二级预防及危险因素控制。本指南的次要目标是提出落实指南内容及临床实践审查的具体方法。制定本指南的工作组由新加坡卫生部组建,包括相关专业的卫生保健专业人士、家庭医生、护士、作业治疗师及一位非专业的病患协助者(patient advocate,一种职业、协助患者了解诊断、选择治疗等)。本指南参考了苏格兰院际间指南协作网(Scottish Intercollegiate Guidelines Network,SIGN)有关卒中患者管理的临床实践指南,并进行了更新、修改以符合本地需要。最终指南由以临床证据为基础的推荐意见组成,涵盖了评估、检查及迅速处置惠者、二级预防、康复和转诊等方面。本指南已经由专业机构评估、认定,最终版本下发至新加坡所有医疗执业人员,以期改进卒中及TIA患者的诊疗水平,同时也提出了改进临床诊疗质量的具体措施。     

下肢骨折致膝关节功能障碍患者骨密度与早期康复训练的关系

背景：将骨密度检测同康复治疗相关联将有益于患者及康复治疗师及时了解康复进程，为康复治疗师制定或修改康复方案提供更好的依据。但目前国内有关康复治疗对人体骨密度影响的报道相对较少。 目的：观察综合康复训练对下肢骨折致膝关节功能障碍患者骨密度的影响，并比较其性别差异。 方法：选择天津医院康复科下肢骨折致膝关节功能障碍行内固定或外固定患者80例，随机分为康复组与对照组。康复组在术后4周开始进行早期康复治疗，包括主动、被动运动训练及不同物理治疗，持续20周；对照组在术后24周内未进行系统的康复训练。术后4，24周双能X射线检测股骨颈、L2~4、Ward区骨密度，并测量患者膝关节活动度。 结果与结论：无论是否进行早期运动康复训练及锻炼，下肢制动患者股骨颈、L2~4以及Ward区骨密度均下降，但康复组与对照组骨密度下降程度不同，康复组各部位骨密度的减少量均低于对照组(P < 0.01)，关节活动增加程度明显大于对照组(P < 0.01)，说明运动康复训练可以有效地减少下肢骨折患者康复期间骨矿物质的丢失，减少局部骨密度下降量，有效预防和改善失用性骨质疏松的情况，并且早期运动康复对下肢骨折所致膝关节功能障碍患者骨密度的影响并无明显的性别差异。     

脑卒中康复治疗技术发展史

脑卒中是引起感觉运动障碍最常见的神经系统疾病,严重影响患者生活质量。康复治疗能够显著改善脑卒中患者生活质量。祖国传统医学在治疗脑卒中及其相关症状方面历史悠久;第二次世界大战以来,西方医学开始广泛出现针对脑卒中患者功能恢复的康复治疗技术。本文以时间顺序为主线重点介绍脑卒中康复治疗技术的发展概况,以帮助康复医师和治疗师根据脑卒中患者的个体差异选择最佳康复治疗技术,恢复受损功能。     

伽玛刀治疗功能性泌乳素腺瘤患者内分泌改变及疗效分析

目的 评价伽玛刀治疗功能性泌乳素(PRL)腺瘤的疗效及患者内分泌的改善程度.方法 回顾性分析135例应用伽玛刀治疗的功能性PRL腺瘤患者的临床资料,按照治疗剂量分为3组,A组:中心剂量50～60 Gy(含50 Gy),边缘剂量:20～30 Gy;B组:中心剂量40～50 Gy,边缘剂量15～25 Gy;C组:中心剂量30～40 Gy,边缘剂量12～20 Gy;比较3组患者的临床资料和伽玛刀治疗后PRL水平的改变. 结果 伽玛刀治疗后患者临床症状部分缓解90例(66.7%),全部缓解35例(25.9%),无变化10例(7.4%);3组患者的年龄、性别及肿瘤大小差异均无统计学意义(P<0.05),经不同剂量伽玛刀治疗后患者PRL正常率不同,差异有统计学意义(F=8.604,P=0.000),两两比较结果显示伽玛刀中心剂量和边缘剂量较高时,PRL正常率较高. 结论 伽玛刀治疗功能性PRL腺瘤,在控制肿瘤的同时改善内分泌功能,可以作为临床治疗功能性PRL腺瘤的方法之一.     

Treatment goals of depressed outpatients: a qualitative investigation of goals identified by participants in a depression treatment trial

Treatment goals and preferences of depressed patients are important, but they are rarely empirically studied. Although clinicians are likely to discuss goals with individual patients, research that clarifies overall patterns in the treatment goals of depressed patients could be useful in informing new interventions for depression. Such research could also potentially help address problems such as poor adherence and psychotherapy drop-out. In this preliminary qualitative investigation, we examined treatment goals established by depressed outpatients in the context of a trial of behaviorally oriented psychotherapy. The treatment goals that were most commonly articulated included improving social and family relationships, increasing physical health behaviors, finding a job, and organizing one's home. These results underscore the fact that, in addition to improvement in the symptoms of depression, functional improvements are viewed as key treatment goals by depressed individuals.     

Functional cognitive-behavioural therapy: a brief, individual treatment for functional impairments resulting from psychotic symptoms in schizophrenia.

This paper describes a novel cognitive-behavioural approach to treating psychotic symptoms--functional cognitive-behavioural therapy (FCBT)--which was developed with the primary aim of remediating social functioning deficits in patients with residual psychotic symptoms. In FCBT, symptom-focused cognitive-behavioural therapy (CBT) interventions are delivered in the context of working on functional goals: a premise of FCBT is that the therapeutic alliance and patient motivation are enhanced by linking interventions to life goals. The paper outlines the rationale for expanding existing approaches to target social functioning impairment and uses case illustrations to exemplify particular phases of treatment as well as specific CBT interventions. Results from a pilot study of FCBT are summarized, together with suggestions for new research directions.     

The impact of deep dysgraphia on graphemic buffer disorders

This article describes an investigation into the residual writing skills of a severely dysgraphic patient (DA). We found that they were powerfully influenced by a number of lexical variables (lexicality, frequency, imageability, length and geminates). His error pattern was characterized by semantic, lexical, substitution, deletion errors and fragment responses that preserved the first letter. Thus, DA's written spelling was characterized by both deep dysgraphic and graphemic output buffer effects. It is proposed that this pattern of performance represents a new"putative functional syndrome."     

Utility of the sickness impact profile in Parkinson's disease.

The Sickness Impact Profile (SIP) is a questionnaire consisting of 136 items grouped into 12 categories and two dimensions (physical and psychosocial). To characterize its utility in Parkinson's disease (PD), we administered the SIP to 44 consecutive clinic patients with PD. Compared to 44 age- and sex-matched control subjects, PD patients had their greatest dysfunction in the categories of mobility, communication, and home management. The two items that PD patients most commonly endorsed were, "I am having trouble writing or typing" (75%) and, "My sexual activity is decreased" (61%). In general, these treated PD patients had greater dysfunction in the psychosocial than physical dimensions. Two simple PD-specific scales correlated well with the physical dimension score but less so with the psychosocial dimension, suggesting that the SIP assesses more functional domains than the PD-specific scales used. The SIP holds some promise as a broad measure of functional status in PD patients.     

The anterior superior parietal lobule and its interactions with language and motor areas during writing

Past neuroimaging studies of writing demonstrate activation foci in several regions of the posterior parietal cortex (PPC). The present study aimed to dissociate the role of the superior parietal lobule (SPL) from the other PPC regions using functional magnetic resonance imaging (fMRI) and functional connectivity. First, parametric event-related fMRI permitted the categorical comparison of experimental writing conditions with control conditions that were carefully chosen to match the experimental conditions in terms of variables extraneous to the motor act of writing, such as visual stimulus characteristics, and generating and retrieving verbal information. A selective focus of increased activation in the PPC restricted to the rostral part of the SPL (area PE) in the left hemisphere was demonstrated. Subsequently, functional connectivity analysis showed that area PE flexibly interacts with different language areas depending on the linguistic demands of the writing task. Activity in area PE correlates with the left angular gyrus, a region implicated in reading, when the writing is in response to words that are read; in sharp contrast, when the writing is in response to pictured objects, then area PE correlates with the supramarginal gyrus, a region involved in the articulatory and phonological loop, as well as with prefrontal regions that are involved in the retrieval and selection of semantic information. The results suggest that area PE serves as a critical interface between posterior cortical regions in the left hemisphere involved in language processing and the central motor and sensory regions that are directly involved in the control of movement.     

The treatment capabilities of psychiatric emergency services

The author describes the treatment capabilities of a psychiatric emergency service. Psychiatric emergency facilities have become an integral part of general hospitals and the mental health system, and are used increasingly by patients. The author defines the treatment goals of psychiatric emergency care as, (1) symptomatic relief, (2) maintenance of ongoing treatment, and (3) referral and facilitation for entering treatment. The treatment techniques include an integration of psychologic, pharmacologic, and physical management principles. The qualities needed by an emergency service clinician to work in such a setting are described. Implications for training and research are discussed.     

Healing Through Writing: Insights from Research

Over the past two decades, a growing body of research has demonstrated that writing about traumatic or stressful events or experiences has a positive impact on physical and psychological health. This paper reviews the research findings related to expressive writing and health, in clinical as well as non-clinical populations. Research findings comparing the health benefits of vocal and written disclosure of traumatic experiences are addressed. Possible pathways or mechanisms through which expressive writing affects health are discussed. Finally, major issues that need serious attention from researchers in this area for future research are suggested.     

Anxiety in the pediatric medical setting

The relationship between pediatric anxiety disorders and physical health is not well-understood, but appreciation of the importance of this relationship is growing. Significant functional impairment may accompany a chronic physical health condition such as asthma, diabetes, or epilepsy, and anxiety may complicate the course. In addition, physical disease can present with symptoms of anxiety, and anxiety disorders may present or be associated with physical symptoms such as functional abdominal pain, headache, and fatigue. This article describes anxiety and its association with physical disease, outlines assessment, and presents a treatment overview including psychotherapy and pharmacotherapy.