60例ICU产后抑郁的临床分析

目的对ICU病房产后抑郁的临床特点进行分析,并探讨其诱因及对策,以提高产后抑郁患者的生活质量。方法对60例ICU病房产后抑郁患者应用爱丁堡产后抑郁量表和Zung抑郁自评量表(SDS)进行评分,分析患者的抑郁情况,探讨产后抑郁症发生的原因,并对重症孕产妇患者给予有针对性的治疗和心理干预,观察临床效果。结果 60例中轻度抑郁10例,中度抑郁25例,重度抑郁25例,所有患者经有效的心理干预及部分药物治疗,抑郁状态均消失或得到缓解。结论产后抑郁症对母婴的健康影响很大,分析产后抑郁的临床特点、诱发因素,采取有针对性地治疗和心理干预等措施,对产后抑郁症者的健康恢复有重要作用。     

综合心理护理干预对多系统萎缩照料者心理状况与生活质量的影响

目的调查多系统萎缩照料者的心理状况与生活质量,干预以缓解其焦虑、抑郁情绪,提高其生活质量。方法将40例多系统萎缩照料者随机分为实验组20例和对照组20例,应用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评估2组心理状况;应用世界卫生组织生活质量测定量表简表(WHOQOL-BREF)中文版评估2组生活质量。对照组给予常规护理指导,实验组在此基础上进行综合心理护理干预,3个月后仍用上述量表评价干预效果。结果多系统萎缩照料者在干预前焦虑、抑郁阳性率60%;干预前2组间HAMA、HAMD、WHOQOL-BREF评分比较无显著差异;干预后实验组各量表评分改善程度显著优于对照组(P0.05)。结论多系统萎缩照料者存在焦虑、抑郁情绪,同时存在生活质量较差等的问题。综合心理护理干预可有效改善照料者的心理状况,提高其生活质量。     

首发儿童精神分裂症患者母亲抑郁症的调查

为探讨独生男孩首次患精神分裂症后,其母伴抑郁症状的临床特点,对38例患儿母亲进行症状自评量表（SCL－90）、抑郁自评量表（SDS）和汉密尔顿抑郁量表（HAMD）评定。同时选取年龄、文化程度、职业相匹配的38例健康独生男孩的母亲为对照。结果：研究组常伴有抑郁症状,三种量表总分均明显高于对照组（P＜0．001）。提示,对伴抑郁症状（患儿）母亲应予心理和抗抑郁药物治疗,对存在心身健康问题（患儿）母亲给予咨询、指导和社会心理支持。     

心理干预辅助治疗老年原发性高血压80例疗效观察

目的观察心理干预辅助治疗老年原发性高血压的疗效。方法将80例老年原发性高血压病人通过随机数字表法随机分为2组。干预组40例,给予卡托普利、硝苯地平,在此基础上再给予心理干预;对照组40例,只给予卡托普利和硝苯地平。2组均治疗3周并采用焦虑自评量表(SAS)和抑郁自评量表(SDS)测试病人治疗前后的焦虑、抑郁程度。结果心理干预3周后干预组患者SAS、SDS标准分与干预前比较有显著性差异(P<0.05),对照组无显著性差异(P>0.05)。结论原发性老年高血压患者在使用药物治疗的同时给予适当的心理干预有利于患者的身心健康,可有效缓解焦虑、抑郁情绪,提高临床疗效。     

加强供应室管理控制医源性感染

目的 探讨如何加强供应室的管理,并减少由此而产生的医源性感染.方法 严格执行<医院消毒供应室验收标准>,加强供应室人员的职业责任心,严格操作规程、消毒及供应流程,并与院领导共同督导并适当给予精神与物质鼓励.结果 通过学习与责任制度,提高了科室人员的工作热情,加强了工作责任心,降低了由此而引起的医源性感染.结论 科学的管理和人性的指导,可以很大程度的提高科室人员的工作热情与责任心,确保灭菌效果,提供安全的无菌物品,为医院治病救人打下坚实的基础.     

女性不孕症患者心理分析及护理干预

目的探讨女性不孕症患者心理状态,给予有效的护理干预措施,减轻患者心理压力。方法对符合不孕症诊断标准的180例患者分别于干预前后,采用焦虑及抑郁自评量表(HAD)测定其心理状态,对两次测定数据进行统计学分析处理。结果干预后病人心理状态评分明显低于干预前评分(P<0.01)。结论女性不孕症患者存在不同程度的焦虑和抑郁情绪,通过有效的护理干预,可帮助患者改善不良情绪,减轻病人的精神痛苦,提高治疗效果及患者生活质量。     

难治性抑郁还是老年期痴呆:一例病例报告（英文）

抑郁伴痴呆在老年人中日益普遍。本报告描述了一个78岁的女性患者,先前有过两次抑郁发作,本次存在抑郁症状(动力缺乏和情感淡漠)和典型的痴呆症状(记忆力和执行功能受损)。即使经过详细的临床检查和神经心理测量,仍然难以明确诊断是难治性抑郁症还是老年痴呆。经过8周的住院治疗,更改了原先以利血平为主的降压药,调整抗抑郁药并予心理治疗,患者的抑郁和焦虑症状改善,但大多数认知症状仍然持续存在。在出院后7个月的随访中,这些症状也没有变化。随后,她出现了晚期乳腺癌并开始化疗,此时她的抑郁症状和认知症状更加明显。我们认为,需要2~3年的随访才可以确定认知症状是抑郁症的残留症状还是新出现的痴呆表现(或两者皆是)。该病例表明对于同时有抑郁症状和痴呆症状的老年患者,不仅需要详细的临床检查和神经心理测试,而且要结合对治疗疗效的长期评估才能明确诊断。     

难治性抑郁还是老年期痴呆：一例病例报告

概述：抑郁伴痴呆在老年人中日益普遍。本报告描述了一个78岁的女性患者，先前有过两次抑郁发作，本次存在抑郁症状（动力缺乏和情感淡漠）和典型的痴呆症状（记忆力和执行功能受损）。即使经过详细的临床检查和神经心理测量，仍然难以明确诊断是难治性抑郁症还是老年痴呆。经过8周的住院治疗，更改了原先以利血平为主的降压药，调整抗抑郁药并予心理治疗，患者的抑郁和焦虑症状改善，但大多数认知症状仍然持续存在。在出院后7个月的随访中，这些症状也没有变化。随后，她出现了晚期乳腺癌并开始化疗，此时她的抑郁症状和认知症状更加明显。我们认为，需要2~3年的随访才可以确定认知症状是抑郁症的残留症状还是新出现的痴呆表现（或两者皆是）。该病例表明对于同时有抑郁症状和痴呆症状的老年患者，不仅需要详细的临床检查和神经心理测试，而且要结合对治疗疗效的长期评估才能明确诊断。     

肿瘤病人疼痛的心理护理

疼痛是一种常见现象，也是一种痛苦的感受，在肿瘤病人中，疼痛发生率在70％^[6]。癌性疼痛影响心理功能，并使患者焦虑、抑郁和自杀意念增加。对癌性疼痛病人进行正确的疼痛评估、诊断，制定恰当的心理护理措施，可以帮助其减轻痛苦，提高生活质量，使护理人员在癌痛控制中发挥独特积极的作用。     

肿瘤病人疼痛的心理护理

疼痛是一种常见现象,也是一种痛苦的感受,在肿瘤病人中,疼痛发生率在70%[6].癌性疼痛影响心理功能,并使患者焦虑、抑郁和自杀意念增加.对癌性疼痛病人进行正确的疼痛评估、诊断,制定恰当的心理护理措施,可以帮助其减轻痛苦,提高生活质量,使护理人员在癌痛控制中发挥独特积极的作用.     

Comparison of psychiatrists and psychologists in clinical practice

OBJECTIVE: The authors compared data from psychiatrists and psychologists in California to determine whether long-standing differences in clinical practice remain after the introduction of managed care and other changes in mental service delivery. METHODS: Responses from practicing clinicians in California who participated in the 1998 National Survey of Psychiatric Practice and the 2000 California Survey of Psychological Practice were compared on items related to patient caseload, practice profile, and insurance or reimbursement arrangements. RESULTS: Data from 97 psychiatrists and 395 psychologists were available for the study. Psychiatrists reported spending more hours on most aspects of practice and working more total hours per week than psychologists. The weekly caseloads reported by psychiatrists included a greater percentage of persons treated for psychotic conditions than did the caseloads of psychologists. Psychologists reported that their weekly caseloads included a greater percentage of persons treated for anxiety disorders, personality disorders, and other disorders. Psychiatrists reported receiving a greater average payment for services from public insurance, and psychologists reported treating a greater average percentage of patients who did not have insurance coverage. Significant differences in income sources and fee arrangements were observed, and the net reported income of psychiatrists was nearly 80 percent greater than that of psychologists. CONCLUSIONS: Long-standing differences in clinical practice patterns remain between psychiatrists and psychologists despite managed care staffing arrangements and treatment strategies that streamline the practices of both provider groups. The significant income and wage differences between psychiatrists and psychologists may be partly due to supply dynamics of the mental health workforce that adversely affect psychologists.     

Treatment choice after one antidepressant fails: a survey of northeastern psychiatrists

BACKGROUND: Because limited evidence exists to help clinicians choose the next step after a depressed patient fails to respond to an adequate trial of an antidepressant, I conducted a survey to explore psychiatrists' treatment choices. METHOD: I asked 118 northeastern psychiatrists what they would do next in response to a clinical vignette of an inpatient with DMS-III-R major depression who failed to respond to 4 weeks of nortriptyline at adequate blood levels. RESULTS: Lithium augmentation was chosen by more than a third (33.9%) of psychiatrists. Other choices, in order of decreasing frequency, were continuing nortriptyline for another 2 weeks (17.8%) and switching to either fluoxetine (16.1%), electroconvulsive therapy (11.0%), or a monoamine oxidase inhibitor (6.8%). Only one psychiatrist each chose thyroid augmentation or bupropion. CONCLUSIONS: The surveyed psychiatrists overwhelmingly preferred lithium augmentation over other strategies to manage treatment-resistant depression. Research on comparative strategies is lacking and urgently needed.     

Current use of depression rating scales in mental health setting

Objective

This study was to investigate the current use of depression rating scales by psychiatrists and clinical psychologists in Korea.

Methods

The questionnaires from many psychiatrists and clinical psychologists were included in the analysis. The questionnaire was composed of items about examining the percentage of patients clinically using depression rating scales, reasons for not use of them, the degree of satisfaction, the perceived agreement rate between the result of depression rating scales and doctor''s clinical interview in the evaluation of patients with depressive symptoms. Data were analyzed by χ² and independent t-test.

Results

The clinical use of depression rating scales was more frequent in the psychologists than in the psychiatrists. The purposes for using depression rating scales were assessed into six areas, there was no significant difference in between two groups, and both groups pointed out their purpose as rating of severity and screening. The reasons for not using scales were that their interview may be sufficient for diagnosis and assessment of depressive patients and they are not familiar with the use of depression rating scales. The psychiatrists usually prefer the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale and Symptom Checklist 90-Revision (SCL-90-R) in order of frequency, and the clinical psychologists are more likely to use the BDI, Minnesota Multiphasic Personality Inventory and SCL-90-R. Overall rate of satisfaction in the use of the scales was 67.29±14.45% and overall perceived agreement rate was 70.89±16.45%.

Conclusion

Currently used depression rating scales at the clinical practice were not various. Therefore, to heighten clinicians'' utility of these depression rating scales measures, either educational efforts or advertisements, or both, will be necessary to spread them wildly.     

The provision of psychological therapy to people with intellectual disabilities: an investigation into some of the relevant factors

Background Five factors are proposed as important in influencing the provision of psychological therapy to people with intellectual disabilities (IDs): the perceived effectiveness of psychological therapy, individual clinician competence, service resources (number of trained clinicians), the level of the client’s disability and the diagnostic overshadowing bias. Method A prospective questionnaire design was used. A survey style questionnaire was sent out to clinical psychologists (n = 412) and psychiatrists (n = 274) working in ID services in the UK. Responses were received from 133 psychologists and 90 psychiatrists. Results Perceived competence, the level of the client’s disability and the diagnostic overshadowing bias all appeared to be important factors. The perceived effectiveness of psychological therapy with this client group and service resources appeared less important than hypothesized. Conclusion Whereas the debates in research publications tend to focus on broad issues of effectiveness, clinicians themselves appear more concerned with their personal skill levels. The issue of the appropriateness of psychological therapies for people with more severe levels of disability remains largely unresearched.     

Open Supervision: Modelling psychotherapy supervision as a teaching method for first year psychiatric residents

The Open Supervision teaching method involves a therapist presenting process notes and correlated supervisory sessions of a terminated psychotherapy case to a group of trainees, accompanied by the therapist's former supervisor of that case. Open Supervision reduces the trainee's anticipatory anxiety about supervision by modelling the supervisory relationship, and by providing a realistic picture of the capacities and limitations of both supervisee and supervisor.     

Reflections on psychodynamic psychotherapy supervision for psychiatrists in clinical practice

Much has been written about psychotherapy supervision for trainees in psychiatry. Psychiatrists are also encouraged to receive supervision when dealing with difficult patients or when involved in personal events that have the potential to have an impact on their psychotherapeutic work. Nevertheless, a literature search, conducted through Medline, revealed few publications dealing with supervision of psychiatrists who conduct psychotherapy in clinical settings after completion of training. This article discusses the issues involved in psychotherapy supervision for the supervisor, supervised psychiatrists, and their practice settings and patients. The author first discusses the benefits of psychotherapy supervision for psychiatrists in clinical practice, including helping psychiatrists maintain and improve psychotherapeutic skills, assistance in dealing with patients who have complex or especially challenging problems (e.g., personality disorders, intractable depression, difficulties with compliance, complex psychosocial problems), addressing ethical concerns, boundary issues, and transference and countertransference, and helping psychiatrists deal with personal issues that may cause difficulties in providing psychotherapy or issues that arise in working with a multidisciplinary team. The author then reviews key issues related to the supervisory process, including group versus individual supervision, the role of the supervisor, different supervisory styles, and factors that can contribute to feelings of shame or vulnerability in the supervisee. The author also discusses different supervisory styles, clarifies the distinction between therapy and supervision, and discusses issues that arise in the supervision of experienced psychodynamic therapists. Barriers that may keep psychiatrists from seeking psychotherapy supervision are reviewed. Finally the author discusses the supervision of those acting as supervisors for other clinicians.     

Health professionals' recognition of co-occurring alcohol and depressive disorders in youth: a survey of Australian general practitioners, psychiatrists, psychologists and mental health nurses using case vignettes

OBJECTIVE: To examine whether health professionals who commonly deal with mental disorder are able to identify co-occurring alcohol misuse in young people presenting with depression. METHOD: Between September 2006 and January 2007, a survey examining beliefs regarding appropriate interventions for mental disorder in youth was sent to 1,710 psychiatrists, 2,000 general practitioners (GPs), 1,628 mental health nurses, and 2,000 psychologists in Australia. Participants within each professional group were randomly given one of four vignettes describing a young person with a DSM-IV mental disorder. Herein is reported data from the depression and depression with alcohol misuse vignettes. RESULTS: A total of 305 psychiatrists, 258 GPs, 292 mental health nurses and 375 psychologists completed one of the depression vignettes. A diagnosis of mood disorder was identified by at least 83.8% of professionals, with no significant differences noted between professional groups. Rates of reported co-occurring substance use disorders were substantially lower, particularly among older professionals and psychologists. CONCLUSIONS: GPs, psychologists and mental health professionals do not readily identify co-occurring alcohol misuse in young people with depression. Given the substantially negative impact of co-occurring disorders, it is imperative that health-care professionals are appropriately trained to detect such disorders promptly, to ensure young people have access to effective, early intervention.     

The administration of programs for infants and toddlers.

In this article, models for providing training in infant and toddler mental health are described. The goal has been to outline programs in enough detail that they may serve as models for persons who wish to develop infant psychiatry training and services within their academic division or their clinical program. From an administrative and fiscal perspective, developing training experiences in infant mental health has many advantages. Consultation experience and clinical experience with infants and young children are training requirements of the psychiatry Residency Review Committee. There is also a workforce shortage of child and adolescent psychiatrists and clinicians who can work with children, and there is an even greater shortage of child psychiatrists and psychologists who can work with very young children. This shortage allows a division chief or program director a particular opportunity to earmark core training funding for this underserved area and to partner with affiliated institutions and programs that can help fund these training efforts. The author's program was helped immensely by a private foundation grant, but for the first 20 years it was able to be self-sufficient through a commitment to training and reimbursement for clinical services. Currently, there seems to be an awareness on the part of community and public sector programs that they not only need to pay for trainee time but also must include administrative and faculty time. Finally, experience has defined major important principles of this work with infants, toddlers, and their families. First, training and clinical service must be provided within a context of knowledge and experience in child development. Second, the principles and knowledge of infant mental health must be used. Third, an understanding of relationship-based interventions provided within the context of reflective supervision and mentorship must be provided.     

Training the Next Generation of Geriatric-Focused Clinical Neuroscientists

It remains challenging to integrate clinical neuroscience into clinical practice. Hindrances at the training level (e.g., lack of qualified faculty and curriculum) contribute to this impasse. To help address this, we present a model of training in clinical neuroscience. We expand on a growing literature on incorporating neuroscience into psychiatry training by emphasizing two points. That is, 1) we propose a training model designed for the geriatric-minded clinician; and 2) that extends across several phases of education and career development. Considering the relevance of dementia to our population of interest, and the potential impact expertise in clinical neuroscience can have in elders with cognitive impairment, we provide relevant curriculum examples at various training stages. Clinical research, both as a practitioner and consumer, figures prominently into our training model. We discuss two mentoring programs, T32 fellowships and Research Career Institute in the Mental Health of Aging, as ways to engage geriatric psychiatrists early in their training and transition them successfully to post-residency clinical investigator positions. Although there is increasing opportunity for geriatric psychiatrists and other clinicians to become leaders in the field of neuroscience, this remains a work in progress; ours and others’ training programs continue to evolve based on input from trainers and trainees alike, as well as from the increasing literature on this important topic.     

Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals

OBJECTIVE: The aim of this paper was to compare the Australian public's attitudes towards people who have been treated for a mental disorder with the attitudes of general practitioners, psychiatrists and clinical psychologists. METHOD: The study involved a household survey of 2031 members of the Australian public and a postal survey of 872 general practitioners, 1128 psychiatrists and 454 clinical psychologists. Survey participants were presented with a vignette describing a person with schizophrenia or one with depression. They were asked opinions about the person's long-term outcome in various areas of life after receiving treatment. Participants were also asked whether they thought the person described would be discriminated against by others. RESULTS: Both the public and professionals rated outcomes as poorer and discrimination as more likely for the person with schizophrenia than for the one with depression. The professionals made more negative ratings than the public, although the clinical psychologists had similar attitudes to the public about depression. CONCLUSIONS: Compared to the public, health professionals rate long-term outcomes more negatively and discrimination as more likely. It is possible that these more negative attitudes are realistic, being based on greater knowledge of mental disorders. However, professional attitudes may be biased by greater contact with patients who have chronic or recurrent disorders. Either way, health professionals need to be aware of the effects that their negative attitudes might have on patients and the public.