强制戒毒与复吸率

探讨有效脱毒和降低复吸率的戒毒方法。方法··:应用美沙酮5d递减 ,续用可乐定5d ,进行脱毒治疗 ;脱毒后采取全封闭管理 ,采用集体上课、个别心理疏导等方法继续进行身心康复治疗90d ;回归社会后重点监控 ,定期回访。结果··:患者均安全脱毒康复 ;随访15个月 ,复吸率为22.2 % (113/508)。结论··:该法安全有效 ,复吸率较低。     

强制戒毒对象3例跟踪帮教体会

我所自1997年12月建所以来,始终贯穿生理脱毒、心理纠治、跟踪帮教环环相扣的戒毒模式,收到一定效果.实践证明,其中帮教工作更是提高防复吸率必不可少的重要环节,戒毒者自身远离毒品的主观因素、家庭、社会监督的力度起到了不容忽视的作用.     

强制戒毒所心理治疗理论及方法

脱毒治疗的实质是针对戒断综合征进行控制的抗戒断症状治疗 ,脱毒治疗过后 ,由于稽延性戒断症状的困扰 ,长期存在毒品渴求心理及吸毒环境的影响 ,随即普遍出现很高的近期复吸率[1] 。为降低复吸率必须进行海洛因临床脱毒后的康复治疗。康复治疗是综合应用各种技术和方法 ,使药物依赖者的躯体疾病及心理依赖得到治疗 ,最大限度地恢复其健全的人格和行为模式 ,提高生活自理能力、劳动和工作能力等。以便使他们能再充分地参加家庭和社会生活 ,重新回到工作岗位上去。所以 ,康复应该是以“全面康复”为主要原则 ,以“重返社会”为最终目的[2 ] …     

615例海洛因依赖者复吸原因调查与分析

目的··:了解海洛因依赖者脱毒后复吸的原因 ,寻求有效的预防复吸措施。方法··:采用《药物滥用复吸因素调查表》对615例海洛因依赖者脱毒后复吸的情况进行调查。结果··:在615例被调查者中 ,脱毒后出院3d内复吸的占21.79 % ;1个月内复吸的占52.36 % ;6个月内复吸的占93.50 % ;1a内复吸率高达97.89 %。自愿戒毒、强制戒毒与劳教戒毒出所后不同时间内的复吸率比较无显著性差异 (P>0.05)。难以抗拒的对药物的心理渴求是产生复吸的主要心理因素 (占86.99 % ) ;身体不适、失眠等稽延性戒断症状是产生复吸的主要生理因素 (占76.75 % ) ;毒友引诱是产生复吸的主要社会因素 (占75.94 % )。心理、生理、社会诸因素造成海洛因依赖者脱毒后不能保持操守。结论·· :脱毒后给予必要的对症治疗和坚持不懈的行为矫治 ,以及持之以恒的家庭关心、监督 ,社会帮教、扶持 ,政府部门监控、管制和严惩毒贩 ,清除毒源等综合治理 ,是降低复吸率的有效办法     

康复训练—海洛因依赖治疗中的重要环节

目的··:了解康复训练在海洛因依赖治疗后防复吸中的效果。方法··:随访调查分析72例经脱毒治疗后接受康复训练和352例同期脱毒后未接受康复训练的海洛因依赖者的复吸率。结果··:与仅脱毒而未经过康复训练的海洛因依赖者比较,接受康复训练者吸毒冲动及觅药行为明显减少,6个月时复吸率为93.1 % (对照组6个月的复吸率100 % )。结论··:康复训练在一定程度上能降低复吸率,是海洛因依赖治疗中的重要环节     

海洛因依赖者戒毒期间身心护理

吸毒人员均存在不同程度的心理障碍。有研究认为,在戒毒期间应重点进行身体脱毒治疗,将心理治疗放在脱毒之后,然而采用这种方式,非常事件发生率高,病人难以坚持治疗,复吸率高。为此,在戒毒期间,我们对戒毒者采用连续性身心护理,收到良好效果,其中有两名戒毒者保持５年未复吸。全部病例为在广东汕头市龙湖区强制戒毒所住院的戒毒者,共６４例,其中男５７例,女７例。使用的毒品全部为海洛因。使用方式以烫吸为主。末次吸毒量０．６６ｇ±ｓ０．５７ｇ。戒毒者入院后在脱毒的同时就采用《Ｚｕｎｇ抑郁和焦虑自评量表》和中国药物依赖性研究所…     

海洛因依赖者脱毒后复吸的原因及防复吸措失

在戒毒工作中我们体会吸毒者一旦染上毒瘾 ,彻底戒毒非常困难 ,防止复吸更难。本文就其复吸的原因及防复吸措施简要讨论如下。１复吸原因１．１脱毒后的后续照顾跟不上戒毒包括脱毒、康复和回归社会三个完整的过程。我国大部分戒毒所的工作仅停留在脱毒阶段。康复和回归社会两个过程则基本没有实施。然而 ,脱毒只能摆脱身体对毒品的依赖 ,不能解决诸如心理依赖等问题 ,加之脱毒出所后的后续照顾跟不上 ,这是造成复吸率居高不下的主要原因。１．２综合治疗手段不完善 ,戒毒质量不高吸毒成瘾除了用药物治疗及对症治疗外 ,还需要心理治疗和行为…     

建立门诊戒毒模式开展社区综合管理

目前中国有两种戒毒模式:强制戒毒(含劳教戒毒)和自愿戒毒,分属公安部门和卫生部门,各自为政.两者都采取封闭式管理,短期收治吸毒者,虽各有特色,但都不可能永远留住戒毒者.戒毒者回家后放任自流,很快就会复吸.最新调查显示,早期脱毒率接近100%,脱毒后2周复吸率达65.3%,1年后复吸率达94.7%[1].针对我国国情,尽快建立一套能广泛使用且行之有效的戒毒模式已成为当务之急.     

强制戒毒所复吸复戒人员的心理特点及矫治对策

近年来，随着我国禁毒斗争的深入，禁吸戒毒工作日益受到重视，强制戒毒人员逐年攀升，2004年，全国各地强制戒毒所满员收戒，宁波市公安局强制戒毒所收戒总量比上年翻了一番，创历史新高。由于强制戒毒时间只有3至6个月，强制戒毒期限内是以生理脱毒为主，心理戒瘾及社会帮教的后续措施没有及时跟上，因此，从戒毒场所回归社会人员复吸率居高不下。据大量文献资料表明，全国各地戒毒人员复吸率高达85％以上，     

打造平台 形成合力 创建社区防复吸帮教网络体系

"生理脱毒易,解除心理渴求难",在戒毒领域已成为共识.如何解决吸毒者对毒品的心理渴求,使其彻底摆脱毒品的羁绊是世界性难题.所谓心理渴求,是指毒品对吸食者大脑中特定的组织结构形成的破坏,而目前尚无有效方法使其恢复,从而导致绝大部分脱毒者无法遏制因心理依赖而产生的对毒品的渴求[1].面对生理脱毒后居高不下的复吸率[2],用什么方式,创造何种环境来抑制、减少吸毒戒断者的心理渴求是康复治疗中重要的环节,甚至是最为关键的环节.本文根据吸毒者心理渴求的现状,汲取我国现有的各种抑制心理渴求的经验,提出强制戒毒所要发挥自身优势,从人文关怀的角度考虑,在当地政府的统一领导和协调下,以社区为基本单位,获取社会支持,创建社区帮教网络体系,降低复吸率.     

Duration of imipramine therapy and relapse in panic disorder with agoraphobia

It has been suggested that maintenance treatment of patients who have remitted panic disorder with agoraphobia beyond the six months of acute phase imipramine treatment may decrease the risk of relapse. This study further explores the relationship between relapse and duration of imipramine treatment in this population.Fifty-one patients, all in remission at the end of six months acute phase open trial with imipramine 2.25 mg/kg/day and randomized to double-blind maintenance or placebo substitution, discontinued imipramine treatment eventually and were followed over a 12-month risk period: 27 during first year placebo substitution, 7 after 12 months of imipramine maintenance in placebo substitution, and 17 after variable durations of imipramine maintenance in open discontinuation. There were no behaviorally oriented interventions or instructions at any time during the acute and maintenance phases of treatment or during imipramine discontinuation.Duration of imipramine treatment, the method of discontinuation (open versus placebo substitution), or any of the 9 variables from the demographic, clinical, and open treatment domains that were entered in a Cox proportional hazard model did not predict relapse. The rate of relapse after only 6 months of treatment (10 out of 27, 37%) was identical to the rate of relapse after 12 to 30 months of treatment (9 out of 24, 37.5%).The results suggest a lack of specific protective effects beyond prophylaxis and underscore the difficulty in predicting relapse in fully remitted panic disorder with agoraphobia patients. Early detection of relapse in patients who discontinue treatment may be a viable alternative to prediction.     

Relapse after inpatient substance use treatment: A prospective cohort study among users of illicit substances

AimsThe main aim was to investigate the relative roles of mental distress and intrinsic motivation for relapse after inpatient substance use disorder (SUD) treatment, while adjusting for demographics and treatment variables.MethodsThe study is based on a prospective multicenter study with a baseline gross sample of 607 patients with SUD (response rate = 84%) admitted to an inpatient stay at one of five specialized SUD treatment centers in Norway. The analytical sample consisted of patients with illicit drug use (n = 374) who took part in a follow-up interview three months after discharge from inpatient treatment (n = 249) (retention rate = 67%). Data were collected using information from electronic medical records, a self-report questionnaire at treatment entry, and a follow-up interview.ResultsRelapse occurred among 37% of the sample by three-month follow-up. Results of multivariable analysis showed that younger age and having a psychiatric diagnosis were associated with an elevated relapse risk. Patients who received treatment at a short-term clinic (2–4 months), as opposed to a long-term clinic (>6 months) were also at increased risk of relapse, regardless of their length of stay. Reduced risk of relapse was predicted by having completed the inpatient treatment stay.ConclusionIdentifying the treatment needs of young patients and patients with co-occurring psychiatric diagnoses during and following inpatient SUD treatment may contribute to reduced post-treatment relapse rates. Further research is needed to illuminate the treatment-related factors that contribute to reduced risk of relapse after inpatient SUD treatment.     

综合康复治疗腰椎间盘突出症的疗效观察

目的：探讨综合康复治疗腰椎间盘突出症的临床疗效。方法：将本院2009年1月～2011年7月收治的腰椎间盘突出症患者100例,随机分为对照组与观察组,每组50例,对照组给予传统牵引、推拿以及卧床休息治疗;观察组在对照组基础上给予口服中药、针灸以及注射西药等综合康复治疗方法。评定两组患者的临床疗效,治疗前后采用Bridwell腰椎间盘突出症系统进行评分,随访1年,比较两组患者复发情况。结果：治疗后观察组的痊愈率以及总有效率均明显高于对照组（P〈0.05）;观察组的Bridwell评分明显高于对照组（P〈0.05）;观察组的1年内复发率明显低于对照组（P〈0.05）。结论：综合康复治疗腰椎间盘突出症的临床疗效确切,复发率低,临床症状改善明显,值得在临床中推广应用。     

自愿戒毒和劳教戒毒后复发因素的调查分析

目的:对自愿戒毒与劳动教养戒毒两种戒毒模式中海洛因成瘾者戒毒后复发因素进行调查分析,探讨戒毒防复发的策略与方法。方法:使用31项《阿片类物质依赖复发情况问卷》,对自愿和劳教戒毒患者两组人群进行复发因素的量表测评和问卷式调查。对其"躯体生理因素、心理因素、药物成瘾性因素和社会环境因素"4个因子结果,以及社会支持量表和抑郁症自评量表等结果进行统计学分析和比较。结果:影响海洛因成瘾戒毒复发的最主要的影响因素依次是"精神心理因素、社会环境因素、躯体生理因素和药物成瘾因素"。劳教戒毒组中"精神心理因素"和"社会环境因素"更加突出。结论:造成海洛因成瘾戒毒后复发的因素是多方面的,劳教戒毒较自愿戒毒的复发因素更为复杂,提示:海洛因成瘾者在接受药物治疗的同时,更要注重心理治疗和回归社会后帮教措施的落实。     

体外冲击波碎石配合中西医结合治疗泌尿系结石的临床研究

目的探讨泌尿系结石体外冲击波碎石后中药排石的临床疗效和1年后结石复发情况。方法筛选泌尿系结石直径≥10mm的患者780例,随机分为治疗组和对照组,每组各390例,两组患者均先行体外冲击波碎石后分别接受中西医结合和纯西医治疗,40d后观察两组患者的临床排石治愈率、疗程、1年后结石复发情况。结果治疗组肾结石、输尿管结石、膀胱结石治愈率均明显高于对照组,疗程缩短,复发率低（P〈0．05）。结论泌尿系结石经体外冲击波碎石后再行中西医结合治疗,排石治愈率高,使很多具备手术指征的患者可以通过碎石非侵入性治疗而治愈。降低手术治疗率,降低医疗风险,减轻医疗费用及患者的痛苦,具有创伤小、病程短、康复快、复发率低等优点,是治疗泌尿系结石的理想选择。     

溃疡性结肠炎复发相关因素探讨

目的:探讨溃疡性结肠炎患者复发率及其影响复发的相关因素。方法:选择2004年—2006年住院明确诊断的溃疡性结肠炎患者465例,分析其复发的年龄、性别以及复发的可能因素并对其进行随访。结果:465例患者中,111例患者失访,失访率为23.8%,354例进行了随访。其中1年复发率为15.8%,2年复发率为34.1%,5年复发率为54.5%。随访发现,性别、民族、超敏C反应蛋白(CRP)与溃疡性结肠炎复发有一定相关性,经统计学处理差异有统计学意义(P<0.05);初发部位、血沉与溃疡性结肠炎复发无明显相关性,经统计学处理差异无统计学意义(P>0.05)。总体维持治疗时间0～53(15.3±3.4)个月;复发患者维持治疗中,维持治疗方案复发比例由高到低依次为口服5-氨基水杨酸组(52.6%)、局部治疗组(49.6%)、口服柳氮磺胺吡啶组(17.6%)和口服免疫抑制剂组(12.1%)。结论:女性溃疡性结肠炎患者复发率高于男性,性别、民族、CRP及维持治疗方案与溃疡性结肠炎复发相关。     

Relapse rate of patients after healing of oesophagitis—a prospective study of alginate as self-care treatment for 6 months

In order to estimate the rate of symptomatic relapse and to identify factors associated with this relapse, 1030 patients were included in a multicentre study. All patients included had clinically and endoscopically healed oesophagitis (grade I (erosion, 57%), grade II (confluent erosion, 33%) or grade III (circular erosion, 9%)) after treatment with an H₂ blocker or omeprazole. Patients were given conservative advice and were told to take sodium alginate only in response to pain. Relapse was defined as pain justifying more than eight sodium alginate sachets over 48 hours or treatment with another drug, or the need for a new endoscopy. Forty risk factors were recorded initially and patients were seen every 2 months; they filled out diary-cards describing symptoms and drug consumption. Data were available for 883 patients during follow up. The cumulative percentage of patients without relapse at 6 months estimated by Kaplan Meier method was 76 ± 2 % (mean ± S.E.M.). Among these patients without relapse, 95% took less than two sachets per day. Only two factors were identified as associated with relapse—the grade of oesophagitis (P < 0.007), and the occurrence of stress during follow-up (P < 0.05). The percentage of patients free from relapse at six months was 85 ± 2% in patients with grade I oesophagitis, 69 ± 3% in patients with grade II, and 56 ± 6% in patients with grade III oesophagitis (P < 0.0001).     

A depot neuroleptic withdrawal study

A double-blind withdrawal trial in 41 chronic schizophrenic outpatients was carried out during 6 months. Depot neuroleptics (fluphenazine decanoate or flupenthixol decanoate) were compared with placebo to evaluate clinical and neurological effects during continued therapy and during withdrawal. The drugs were significantly more effective than placebo in preventing relapse and rehospitalization. In the placebo group 62% relapsed compared to 27% in the drug group. There was a weak and nonsignificant tendency to a higher relapse frequency in the flupenthixol group compared to the fluphenazine group. After withdrawal for 6 months, plasma levels for fluphenazine were detectable. Plasma levels for flupenthixol were not detectable after 9 weeks of withdrawal. The differences in the plasma levels may possibly explain the difference in relapse rate between the two depot neuroleptics. Furthermore, it was found that the patients who relapsed during fluphenazine treatment had a significantly lower plasma level of the drug than patients who did not relapse during treatment. The results from this study provide some information on the therapeutic levels of fluphenazine and flupenthixol in schizophrenic patients.