心理咨询门诊106例来访者临床资料分析

目的 分析心理咨询门诊来访者临床资料及相关因素。方法 统计分析2003年1月至2004年1月间本院心理咨询门诊所接诊的来访得的全部临床资料，共计106例。结果 临床诊断依次为神经症、精神病、躯体疾病、人格障碍、正常咨询、性问题。结论 心理咨询门诊来访者以神经症病人为主，占45．28％，心理咨询医生应加强心理治疗的学习和掌握，综合医院开展会诊一联络精神病学是必要的。     

综合医院2000例“神经症”的诊断分析

作者就综合医院各科门诊转入的2000名“神经症”患者,根据国际疾病分类及许—钟二氏拟定的神经症诊断标准,并采用心理诊断量表重新进行了诊断分类。结果发现,在这些患者中共包括有21种不同的疾病,其中,神经衰弱仅占15%。在讨论中,作者着重指出,焦虑症、隐匿性抑郁症、特别是社交障碍、心身病以及早期分裂症的诊断问题。最后强调了在综合医院内开设精神卫生门诊的重要性。     

深圳市综合医院精神科院际会诊498例回顾分析

目的了解深圳市综合医院精神科院际会诊的现状及临床特点。方法对2009年1月~2013年12月间深圳市各级综合医院邀请深圳市康宁医院进行的498例次精神科院际会诊患者的一般人口学资料、躯体疾病情况、会诊后精神科诊断及处置情况、邀请院际会诊医院等级及患者所在科室分布情况进行回顾性分析。结果邀请精神科院际会诊的综合医院以三级医院(65.3%)居多;共涉及23个科室,其中神经内科(17.9%)、骨外科(10.2%)占前两位;会诊后精神科诊断以器质性精神障碍为主,占32.9%,其次为精神分裂症、分裂型障碍和妄想性障碍,共占28.7%,而心境障碍占16.1%,神经症、应激相关的及躯体形式障碍占13.5%。结论深圳市综合医院对精神卫生服务的需求逐年增加,三级及以上综合医院应在加强会诊-联络精神医学工作的同时,考虑开设精神卫生相关专科及配备相应的精神专科处置床位,及时处理院内各科患者的精神心理问题。     

综合医院呼吸科住院患者精神科联络会诊结果分析

目的了解和探讨综合医院呼吸科住院患者精神科联络会诊的特点。方法对2年中申请精神科会诊的130例综合医院呼吸科患者,通过病史收集和精神检查,依照ICD-10进行诊断,并电话随访疗效。结果 2年内会诊患者130例,会诊率3.6%;常见的会诊原因分别是焦虑(24.6%)、抑郁(20%)、气促/咳嗽/胸闷/胸痛(16.2%)、烦躁/兴奋/行为混乱(16.2%);前4位的会诊诊断分别是适应障碍(25.4%)、焦虑障碍(16.9%)、器质性精神障碍(16.1%)、心境障碍(15.4%);处理措施以非典型抗精神病药和安全性高的SSRI药物为主。会诊后疗效很好和有效的比例分别为32.3%、59.0%。结论综合医院呼吸科的精神科会诊患者多以轻型精神障碍为主,内科医生及时识别患者的精神障碍和申请会诊有助于患者的临床治疗。     

综合医院663例精神科会诊患者的特点分析

目的了解北京某综合医院住院患者精神科会诊的临床特点。方法选取2010年至2011年北京某大型综合医院精神科所有住院患者共663例次,对人口学资料、会诊率、会诊科室、申请会诊原因、精神科诊断、治疗和转归进行分析。结果 2010年和2011年的会诊率分别为0.35%和0.41%,会诊率前三位的科室分别为神内(2.3%)、肾内(1.3%)、心内(0.9%)。申请精神科会诊数量最多的科室为神内、呼吸、消化、肾内科,分别占14.6%,11.6%,10.9%,10.3%。申请会诊主要原因有精神病发作、焦虑和抑郁,分别占37.2%、13.4%、12.8%,会诊后精神科的主要诊断为谵妄(31.1%)、心境障碍(23.1%)、神经症性障碍(13.0%)。精神科医师的主要处理建议为应用抗精神病药物(94.5%),护理和行为建议(59.7%),预防自杀或冲动(12.0%)。结论有必要加强精神科联络服务,提高非精神科医师对精神障碍的识别和处理能力。     

温州某综合医院心理科神经症患者人格特征调查分析

目的调查分析温州地区一家综合医院心理门诊神经症患者的人格特征。方法采用艾森克人格问卷,对本院心理门诊1143例神经症患者进行测试,并分析测定结果。结果就诊者中典型内向以及内向倾向者居多;典型情绪不稳及不稳定倾向者占64%,其中以典型内向以及内向倾向者居多。精神质和神经质因子均高于常模,而内外向和掩饰程度因子均低于常模;男性的精神质因子高于女性,掩饰程度低于女性,差异有统计学意义。情绪不稳定的731例中E维度性别分布接近,神经质和内外向因子性别分布接近,差异无统计学意义。Spearman相关分析:精神质与掩饰程度呈中等负相关,神经质与掩饰程度呈弱负相关,精神质与神经质呈正相关。结论综合医院心理门诊神经症患者中内向者多于外向者;以情绪不稳定者居多。孤僻,人际关系差,情绪不稳定,性格内向者更容易出现心理问题。     

整合心理疗法治疗32例强迫性神经症

目的探讨整合心理疗法对强迫性神经症的临床疗效。方法选取我院2009～2011年心理门诊就诊的强迫性神经症患者32例,予整合心理疗法治疗16周,疗效以痊愈、显著进步、进步和无效评定,所有患者治疗前后进行SCL-90评分。结果痊愈12例,显著进步11例,进步6例,无效3例。总体有效率71.87%。治疗前后SCL-90中躯体化、抑郁及恐怖的因子分有显著性差异(P<0.01),强迫、人际关系、焦虑及敌对有显著性差异(P<0.05),而偏执和精神病性的因子分变化不明显(P>0.05)。结论整合心理疗法对强迫性神经症的有较好的临床疗效。     

心理干预联合谷维素治疗更年期综合征的临床疗效观察

目的:观察心理干预联合谷维素治疗女性更年期神经症的临床疗效。方法:选择更年期神经症患者40例,随机分为两组:联合组和单药组,每组各20例。单药组:单纯口服谷维素治疗,联合组:心理干预联合谷维素治疗。疗程为6周。治疗前后用HAMD、HAMA的减分率统计疗效。结果:联合组有效率为80.0%,单药组有效率为40.0%,差异显著,有统计学意义(P<0.05)。联合组HAMD及HAMA减分较单药组更明显,差异显著(P<0.05)。结论:心理干预联合谷维素治疗女性更年期神经症疗效确切,值得临床借鉴。     

综合性医院医学心理咨询病例分析

目的研究综合性医院医学心理咨询的特点。方法对我院2005年4月～2005年9月在南昌大学第二附属医院开设的医学心理咨询门诊患者的资料进行统计、分析。结果综合性医院医学心理咨询者以神经症和情感障碍为主,分别为73例(45.34%)和44例(27.33%)。结论综合性医院医学心理咨询的主要对象是神经症和情感障碍,做好这些病人的咨询和治疗工作,不但可解除病人的痛苦,也有利于医学心理咨询工作的健康发展。     

黛力新联合心理护理治疗女性更年期神经症的临床疗效

目的:观察黛力新联合心理护理治疗女性更年期神经症的临床疗效。方法:选择更年期神经症患者44例,随机分为两组:联合组和单药组,每组各22例。单药组:单纯口服黛力新治疗,联合组:心理护理联合黛力新治疗。疗程为6周。治疗前后用HAMD、HAMA的减分率统计疗效。结果:联合组有效率为77.3%,单药组有效率为45.5%,差异显著,有统计学意义(P<0.05)。联合组HAMD及HAMA减分较单药组更明显,差异显著(P<0.05)。结论:心理护理联合黛力新治疗女性更年期神经症疗效确切,值得临床借鉴。     

心理疏导对新发2型糖尿病后出现心理问题患者血糖漂移及其依从性的影响

目的探讨心理疏导对新发2型糖尿病后出现心理问题的患者血糖、血糖漂移及其治疗依从性的影响。方法入组患者随机分为疏导组和对照组（分别为39例和38例）。疏导组给予常规治疗及心理疏导,对照组仅给予常规治疗,分别监测两组患者入组时、入组后半年及2年时血糖最高值、最低值、日平均血糖值、以及血糖最大漂移幅度,同时监测糖化血红蛋白,并观察其对治疗依从性的影响。结果与对照组相比,疏导组入组后半年和2年时,血糖最高值、最低值、日平均血糖值、血糖最大漂移幅度及糖化血红蛋白均较对照组下降,且差异具有统计学意义（P〈0.05或P〈0.01）。与对照组相比,疏导组入组后半年（除心理问题外）和2年时各指标均得到改善,且差异具有统计学意义（P〈0.05或P〈0.01）。结论心理疏导对新发2型糖尿病后出现心理问题的患者,具有改善其血糖、血糖漂移及依从性的效应。     

Cocaine in the Brain

Abstract

Three types of individual drug abuse counseling were investigated in a private methadone clinic in order to replicate and extend previous work on node-link mapping techniques (two dimensional graphic approaches for visualizing problems and solutions). Standard counseling, enhanced counseling with free-form maps (f-maps), and enhanced counseling with both f-maps and guide-maps (g-maps) were compared at six and 12 months of treatment. Also assessed were differential effects of these counseling conditions on clients with low and high levels of behaviors related to attention deficit hyperactivity disorder (ADHD; low-problem versus high-problem clients). Dependent variables included the number of scheduled sessions attended per month, counselor ratings of session characteristics (e.g., powerful, valuable), client psychological status ratings (i.e., self-esteem, depression, and anxiety) and treatment retention (i.e., the number of months clients remained in treatment). Findings replicate and extend prior work indicating the positive impact of using nodelink maps in individual drug abuse counseling. Particular benefits were found for clients with high levels of ADHD-related problems.     

Node-link mapping in individual counseling: treatment impact on clients with ADHD-related behaviors

Three types of individual drug abuse counseling were investigated in a private methadone clinic in order to replicate and extend previous work on node-link mapping techniques (two dimensional graphic approaches for visualizing problems and solutions). Standard counseling, enhanced counseling with free-form maps (f-maps), and enhanced counseling with both f-maps and guide-maps (g-maps) were compared at six and 12 months of treatment. Also assessed were differential effects of these counseling conditions on clients with low and high levels of behaviors related to attention deficit hyperactivity disorder (ADHD; low-problem versus high-problem clients). Dependent variables included the number of scheduled sessions attended per month, counselor ratings of session characteristics (e.g., powerful, valuable), client psychological status ratings (i.e., self-esteem, depression, and anxiety) and treatment retention (i.e., the number of months clients remained in treatment). Findings replicate and extend prior work indicating the positive impact of using node-link maps in individual drug abuse counseling. Particular benefits were found for clients with high levels of ADHD-related problems.     

Drug-related emergency department visits and hospital admissions.

The incidence and causes of drug-related hospital admissions and visits to an emergency department were evaluated. A retrospective chart review was conducted to identify drug-related visits and admissions for all patients who visited the emergency department of a 517-bed tertiary-care institution during a four-month period. Drug-related illnesses were classified as adverse drug reaction (ADR), overdose or abuse, noncompliance, drug interaction, or toxicity. Patient data included demographic characteristics, medication history, serum drug concentrations, length of hospital stay, and hospital admission charges. Of 10,184 patients who visited the emergency department, 293 (2.9%) had drug-related illnesses; 71 (24%) of these patients were admitted. The drug classes most commonly involved were drugs of abuse (23.2%), anticonvulsants (17.1%), antibiotics (12.6%), respiratory drugs (8.9%), and pain medications (8.9%). The most common category of drug-related illness was overdose or abuse (35%) followed by noncompliance (28%), ADR (28%), toxicity (8%), and drug interaction (1%). The average length of stay for patients who were admitted was 5.8 days, and the average cost of admission was $8888. Drug-related illnesses accounted for 2.9% of hospital admissions and visits for patients in the emergency department. The most commonly identified drug-related illnesses were overdose or abuse, noncompliance, and ADRs; the drug classes most commonly implicated were drugs of abuse, anticonvulsants, and antibiotics.     

Injection frequency mediates health service use among persons with a history of drug injection

Drug injectors are known to have high rates of hospital and emergency room (ER) use. We hypothesized that out-of-treatment injection drug users (IDUs) have higher rates of health service use than methadone-maintained persons, and that heroin injection frequency mediates health service use among drug injectors (IDUs). HIV-negative individuals with a history of drug injection were recruited from a needle exchange program (NEP) and a methadone maintenance treatment program (MMT) in Providence, RI. ER visits, outpatient visits, and hospitalizations in the last 6 months were the dependent variables with number of heroin injections the hypothesized mediator variable. The 472 participants were predominately male (60.6%) and white (82%) with a mean age of 37. NEP clients were more likely than MMT clients to visit an ER (39.2% vs. 29.8%; P=0.03). NEP participants were somewhat more likely to report a hospital admission (16.0% vs. 10.6%; P=0.08). Relative to non-injecting MMT participants, the odds of visiting an ER were 1.80 and 1.67 times higher for subjects recruited through NEP and actively injecting MMT participants, respectively. Additionally, subjects recruited through NEP (OR=2.2) and actively injecting MMT participants (OR=2.3) were over twice as likely to report a hospital admission than non-injecting MMT participants. Each increase of one heroin injection per day increased the expected odds of injection-related infection by a factor of 1.92. NEP clients are more likely to have ER visits and hospitalizations than methadone clients. We describe a pathway by which injection frequency influences health service use.     

Association of pharmacist counseling with adherence, 30-day readmission,and mortality: A systematic review and meta-analysis of randomized trials

Objective(s)To determine the association of pharmacist medication counseling with medication adherence, 30-day hospital readmission, and mortality.MethodsThe initial search identified 21,590 citations. After applying the inclusion and exclusion criteria, 62 randomized controlled trials (RCTs) (49 for the meta-analysis) were included in the final analysis. Data were pooled using a random-effects model.ResultsThe participants in most of the studies were older patients with chronic diseases who, therefore, were taking many drugs. The overall methodologic quality of evidence ranged from low to very low. Pharmacist medication counseling versus no such counseling was associated with a statistically significant 30% increase in relative risk (RR) for medication adherence, a 24% RR reduction in 30-day hospital readmission (number needed to treat = 4.2), and a 30% RR reduction in emergency department visits. RR reductions for primary care visits and mortality were not statistically significant.ConclusionThe evidence supports pharmacist medication counseling to increase medication adherence and to reduce 30-day hospital readmissions and emergency department visits. However, higher-quality RCT studies are needed to confirm or refute these findings.     

心理干预对酒依赖患者焦虑抑郁情绪的影响

目的探讨心理干预对酒依赖患者焦虑抑郁情绪的影响。方法对200例酒依赖患者采用焦虑自评量表、抑郁自评量表进行焦虑抑郁状态筛查,共筛查出合并焦虑抑郁状态者120例,随机分为干预组80例和对照组40例,两组均予安定替代治疗缓解症状,干预组在此基础上联合心理干预治疗,观察8周,采用焦虑自评量表、抑郁自评量表评定焦虑抑郁状态,对评定结果进行对比分析。结果干预组心理干预后焦虑自评量表、抑郁自评量表评分均较心理干预前有显著下降,且均显著低于对照组（P〈0.01）。结论酒依赖患者有严重的焦虑抑郁障碍,心理干预能有效减轻酒依赖患者的焦虑抑郁情绪,提高生活质量,缓解患者对酒的渴求及心理依赖,避免复饮。     

Student-Led discharge counseling program for High-Risk medications in a teaching hospital in Saudi Arabia: A pilot study

Discharge counseling by pharmacists reduces adverse medication events, emergency department visits, and readmissions. Studies indicate that pharmacy students in advanced pharmacy practice experiences (APPE) can deliver effective medication-related activities. An open label randomized controlled trial was conducted in adults discharged on warfarin, insulin, or both. Pharmacy students performed medication reconciliation, structured medication counseling, and follow-up calls 72-hours post-discharge. The usual care arm received traditional education. The primary outcome was the 30-day readmission rate post-discharge. Ninety-eight patients on high-risk medications were randomized to intervention (n = 51) or usual care (n = 47). The 30-day hospital readmission rate was lower in the intervention group (8/51, 15% vs. 11/47, 23%); (p = 0.48). There was no statistical difference in the time to first unplanned health care use (hazard ratio = 0.49 (95 %CI, 0.19–1.24), or the time-to-first clinic visit post-discharge (p = 0.94) between the two arms. Students identified 26 drug-related problems during reconciliation. Patients in the intervention arm reported high satisfaction with the service (mean 3.94; SD 0.11). Involving APPE students in the transition of care activities presents an excellent opportunity to minimize pharmacists' workload while maintaining patient care services.     

Treatment-naive active alcoholics have greater psychiatric comorbidity than normal controls but less than treated abstinent alcoholics

BACKGROUND: Most alcoholism research in the U.S. uses convenience samples of treated alcoholics. The findings from treated samples have traditionally been applied to all alcoholics, including the 75% of alcoholics who are untreated. Improper generalization from select samples to an entire population is called 'Berkson's fallacy'. We compared untreated versus treated alcoholics, in order to ascertain whether both groups belonged to the same population with regard to psychiatric comorbidity. METHODS: We compared psychiatric comorbidity in 1) active treatment-naive alcoholics (TNA; n=86) 2) treated long-term abstinent alcoholics (TAA; n=52) and 3) non-alcoholic controls (NAC;n=118). We examined lifetime and current diagnoses, lifetime symptom counts, and psychological measures in the anxiety, mood and externalizing disorder domains. RESULTS: TNA did not differ from NAC in psychiatric diagnosis rates, were abnormal compared to NAC on all psychological measures, had more externalizing symptoms than NAC, and showed a strong trend for men to have more symptoms in the mood and anxiety domains. TAA compared to TNA had higher diagnosis rates (all domains), symptom counts (all domains), and psychological measures of deviance proneness, but were comparable to TNA on anxiety and mood psychological measures. CONCLUSIONS: The abnormal thinking (psychological measures) in TNA (versus NAC) does not extend to behavior (symptoms) to the degree that it does in TAA. These results underline the importance of the use of subdiagnostic measures of psychiatric comorbidity in studies of alcoholics. The finding of lesser comorbidity in TNA versus TAA confirms the presence of Berkson's fallacy in generalizing from treated samples to all alcoholics.