综合医院医学心理咨询门诊1879例分析

目的 研究综合性医院医学心理咨询的临床特点。方法 对复旦大学附属中山医院医学心理咨询门诊2004年1879例初诊患者的资料进行统计处理和分析。结果 综合性医院的医学心理咨询门诊来访者的问题,绝大多数属于医学问题（90．5％）,其中以神经症和情感障碍为主,分别为781例（41．56％）和666例（35．44％）。结论 综合医院医学心理咨询门诊的主要对象是神经症和情感障碍,治疗方面药物治疗与心理治疗的综合使用更有助于患者病情的缓解。     

青少年心理咨询门诊200例分析

上海市精神卫生中心与上海市虹口区教育局德育室于1988年联合创办了《虹口区青少年心理卫生指导站》,并附设心理咨询门诊。现分析其中早期来咨询,资料较完整的青少年200例(内男性155例、女性45例,年龄平均14.0±3.8岁)报道如下:     

综合医院精神医学心理咨询现状——140例综合分析

目的 对140例全面分析，探讨综合医院的精神医学心理咨询，看综合医院应有医学心理专业人员进行咨询的必要。方法 收集门诊、会诊病例140份，就诊1442人次，采用《中国精神障碍分类与诊断标准-3》（CCMD-3）诊断，对资料进行全面分析。结果 神经症发病率最高，女性发病高于男性，中青年及中等文化者占多数。结论 心理卫生咨询回归综合医院是现代医学发展的一种趋势，其研究及防治工作是医学临床的重要课题。     

精神专科医院心理咨询门诊1149例的资料分析

心理问题已令人瞩目,咨询人数成逐年上升,求助内容亦更加广泛。为此,我们对心理咨询门诊1149例的资料进行了分析,旨在了解本市及周边地区人们的接受心理咨询的情况。并作了如下分析。     

心理咨询门诊与精神科门诊不同年限初诊病例分析

目的　了解心理咨询门诊和精神科门诊就诊对象有何异同。方法　随机抽取 1999、2 0 0 1、2 0 0 3年一月份所有在上海市心理咨询中心和上海市精神卫生中心就诊的共 2 94 5个初诊病例 ,进行回顾性分析。结果　咨询门诊常见诊断依次为神经症、心境障碍、其它心理问题、精神分裂症 ,而精神科门诊常见诊断依次为精神分裂症、其它精神障碍、心境障碍、神经症 ,病种有显著统计学差异 (P <0 .0 1)。结论　精神科门诊就诊对象以精神病性障碍为主 ,而心理咨询门诊更多的是亚健康人群的心理问题 ,心理咨询门诊是传统精神科门诊窗口的延伸 ,它拓展了精神科服务范围     

心理咨询门诊与普通专科门诊抽样对照分析

目的调查本院心理咨询门诊与普通专科门诊就诊疾病谱的差异,了解两者在精神分裂症治疗上的差异以及对预后的影响。方法以1/20抽取1995～2002年间的门诊病例进行统计分析,其中心理咨询门诊病例79份,普通专科门诊病例143份。自行设计表格对就诊者的性别、年龄、初诊诊断和服药、住院情况进行统计,比较两者就诊疾病谱的差异,以及两者在精神分裂症治疗上的差异和对预后的影响。结果(1)心理咨询门诊就诊者以心境障碍和神经症为主(分别达25%和27%),普通专科门诊以精神分裂症为主(48%,t=14．66,P＜0．005)；(2)在精神分裂症的治疗上,心理咨询门诊第二代抗精神病药(SGAs)的应用率较高(50%vs 14%,P＜0．005),两处就诊者的预后也存在差异。结论心理咨询门诊与普通专科门诊在初诊中存在一定的分工；两者对精神分裂症治疗存在差异,这种差异可能直接导致精神分裂症的预后,我国有待建立规范的精神分裂症治疗指南；全社会对非重性精神疾病的重视程度仍有待加强。     

城市居民心理咨询知晓率的调查分析

目的 了解市民对心理咨询的认知、态度和行为,以利于更好地开展社区心理咨询工作,提高社区居民心理健康水平.方法 自编心理咨询知识调查问卷,采用抽样方法对某社区433名市民进行调查.结果 有86.6%的市民听说过心理咨询,对心理咨询有所了解;49.5%的市民觉得心理咨询就是用安慰和开解的方法帮助人;95.0%以上的市民认为心理咨询对象有正确的理解;遇到心理困惑时依次选择朋友、亲戚、父母,最后才是心理咨询员;对于心理咨询,首选的方式为综合医院心理门诊,其次是电话咨询;63.9%的市民认为心理咨询机构的设置很有必要;在咨询过程中,还有18.1%的市民不愿意将自己的内心秘密暴露给咨询师.结论 虽然多数市民对心理咨询持有积极肯定的态度与认知,但在寻求心理咨询帮助的行为上却是消极的,还存在许多误区,需要加大宣教,进一步提高市民对心理咨询的知晓度.     

咨询门诊与精神科门诊初诊精神分裂症病人的诊治情况比较分析

目的 了解心理咨询门诊和精神科门诊中初诊精神分裂症病人的诊治特点。方法 随机抽取1999、2000、2001年一月份所有在上海市心理咨询中心和上海市精神卫生中心就诊的共550例初诊精神分裂症病人，进行回顾性比较分析。结果 在3个月内疗效上两种门诊之间差异没有明显的统计学意义；常用抗精神病药平均剂量咨询门诊略高于精神科门诊；合并用药咨询门诊明显多于精神科门诊；精神科门诊需住院治疗的比例高于咨询门诊；咨询门诊常用的前三种药物依次为：利培酮、氯氮平、氯丙嗪，而精神科门诊则为氯丙嗪、利培酮、奋乃静。结论 心理咨询门诊与精神科门诊对精神分裂症的诊治模式上稍显不同，但疗效相仿。     

综合医院精神医学心理咨询676例临床分析

目的 了解综合医院精神科、心理咨询患的临床特点。方法 用《中国精神障碍分类与诊断标准-3》(CCMD-3)，将上海邮电医院2001年1月～2004年1月间精神科及心理咨询门诊、会诊676例患的年龄、疾病分布及治疗情况进行分析。结果 神经症发病率最高268例，占39．64％，器质性精神障碍151例，占22．33％。女性发病高于男性，60岁以上老年人占多数303例占多数44．82％，治疗有疗效77．1％。结论 综合医院开展精神科、心理咨询门诊是十分必要的，需要大力加强精神卫生服务能力。     

综合医院心理咨询门诊中的精神分裂症

作者分析了在本院心理门诊十年内收集到的７００例精神分裂症病人，其中男性居多，住城市者居多，１６岁至３０岁者居多，４０．７１％的病人首诊时无人陪诊，病程在１年内者为４１．４８％，仅３０．４３％的病人来诊前曾接受过专科诊治，咨询原因包括幻觉、妄想、淡漠、懒散等，治疗３周以上者９５．４５％取得了较好疗效。作者认为，综合医院心理咨询门诊在精神分裂症的二级预防中能起极为重要的作用，也能为其三级预防提供便利．     

上海市心理健康咨询机构及服务人员基本情况调研与分析

为贯彻实施《上海市精神卫生条例》,加强和规范本市心理健康咨询工作,根据上海市卫生局卫生监督专项执法检查要求,开展全市心理咨询机构及从业人员基本情况调研,以便了解、掌握本市心理咨询机构及从业人员的现状,为市卫生行政主管部门开展《上海市精神卫生条例》的监督执法检查做好准备。经调研,上海现有各级各类心理咨询机构100家,服务人员360人,文章根据资料显示与统计分析,初步掌握总体情况,并针对存在问题,提出对策建议。     

上海市心理健康咨询培训工作的探讨

目的 探讨培训心理健康咨询服务人员的必要性与可行性。方法 采用宏观调研与教学管理实践评估、资料收集相结合的方法。结果 (1)我市心理咨询从业人员接受规范培训的现状不容乐观,培训需求仍有很大空间;(2)首届培训班学员对教学过程的主观满意度75.56％～97.78％;(3)培训效果的客观测评示,专业知识掌握程度提升38.41％(均分从60.69到84.00,P<0.01)。结论 在目标管理的前提下,教学培训的过程管理十分重要;教育培训科应立足问题的及时发现和解决,以进一步贯彻《上海市精神卫生条例》。     

精神科与综合科医护人员心理健康水平状况调查

目的了解医疗机构医护人员心理健康状况,以及精神科与综合科医护人员之间心理健康水平有无差异。方法采用SCL-90症状自评量表及一般情况问卷,对我院及社区卫生服务中心在职医护人员共115人进行调查。结果受调查医护人员总体心理健康水平优于中国常模（P〈0.05）,社区卫生服务中心心理健康水平优于精神卫生中心（P〈0.05）。受调查医护人员24.35%存在不同程度的心理问题,不同工作年限之间有显著差异（P〈0.05）。结论医护人员的心理健康状况良好,可能与医护人员医学心理学知识的掌握与应用,处理心理压力源的效度提高有关。而精神科医护人员由于服务对象的特殊性及社会对精神科服务价值的低认可,导致心理压力过大,总体心理健康水平低于综合科。     

心理干预对精神分裂症患者亲属心理状况的影响

目的：探讨心理干预对精神分裂症患者亲属心理状况的影响。方法：采用焦虑自评量表（SAS）、抑郁自评量表（SDS）和自编精神分裂症健康知识调查问卷对83名精神分裂症患者的亲属进行调查,并对其进行为期4周的心理干预。结果：精神分裂症患者亲属心理干预前的SAS和SDS评分分别为（53.90±2.02）分和（61.40±1.07）分,显著高于全国常模的（41.90±2.60）分和（41.40±1.83）分（P〈0.05）;心理干预后患者亲属的SAS和SDS评分分别为（41.00±1.56）分和（41.50±1.08）分,较干预前有显著降低（P〈0.05）;干预后亲属对患者疾病相关知识的知晓度明显提高。结论：心理干预可有效改善患者亲属的心理状况。     

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.     

心理门诊20年患者就诊原因及人员结构分析

目的了解心理门诊20年患者（咨客）就诊原因及人员结构变化情况。方法对1989年9月～2009年8月20年就诊于心理门诊2839例患者的资料,以每5年为一阶段,并将人口学资料归纳为疾病、恋爱婚姻、工作学习、人际关系问题五大类。结果后10年较前10年就诊例数增加了2.45倍（823/2016,χ2=28.39,P〈0.005）。各种原因就诊的例数列前3位的为婚姻问题381例、神经症及相关睡眠障碍344例,非亲缘性人际关系问题278例;四大原因以疾病类就诊的例数最多（1092例）。前/后10年各种就诊原因同比增幅列前3位的为婚姻问题6%、升学就业问题4%、心身疾病和子女教育问题各2%;人口学资料增幅依次为离异者13.08%、再婚7.04%、丧偶4.63%、〉60岁为4.12%、〈25岁为2.9%、无业者为2.67%……。上述差异均有统计学意义（P〈0.05、0.025、01、005）。结论患有与心理因素相关疾病的人群仍是心理门诊就诊的0.0.主要对象,离异、再婚、丧偶、〉60岁接受咨询、治疗的人群亦在增加,因婚姻、就业等问题咨询人数呈逐年上升。心理门诊就诊人数增加可能与就业困难、竞争的压力及价值观的改变有关。     

The psychological management of depression.

This article reviews the effects of psychological treatments specifically developed for depression. Promising and durable results have been reported for cognitive and interpersonal psychotherapies but also for behavioral psychotherapy, which has generated less research interest so far. The therapeutic effects seem to be equivalent and at least comparable to pharmacotherapy in mild to moderate depression.     

The outcomes of interpersonal counselling on depressive symptoms and distress after myocardial infarction

Aims: Depression is not treated adequately after myocardial infarction (MI). This study evaluates the interpersonal counselling (IPC) implemented by a registered nurse on outcomes for depressive symptoms and distress in MI patients. Methods: We studied MI patients (n = 103) randomized into intervention group (n = 51) and control group (n = 52) in hospital and at 6 and 18 months after discharge using validated questionnaires, Beck's Depression Inventory (BDI) and the Symptom Checklist-25 (SCL-25). Results: During the 18-month follow-up, depressive symptoms decreased statistically significantly (P = 0.009) in the intervention group compared with the control group. In the IPC intervention group, depressive symptoms decreased from 37.3% to 20.4% at 6 months (P = 0.014), and to 16.7% at 18 months (P = 0.001), while distress decreased from 37.3% to 26.5% (P = 0.132) during the 6-month follow-up, and to 20.8% (P = 0.015). In the control group with normal care, the number of patients with depressive symptoms and distress varied slightly at the three measurements, from 30.2 to 39.6%. Conclusions: The number of patients with depressive symptoms and distress decreased in the intervention group and remained high in the control group. The progress of severity level of depressive symptoms was toward milder symptoms in the intervention group during the 18-month follow-up. This brief intervention that can rapidly be adopted may result in enduring benefits of clinical value.     

A psychological and psychiatric investigation of the adjustment of female scoliosis patients

Twenty-six women with an idiopathic scoliosis of a high degree (average curvature 105°) underwent a psychiatric investigation and a psychological evaluation made from both socio-psychological and personality-psychological aspects, the latter being covered by a projective test (Rorschach) and a gestalt-psychological test (Bénder). A synthesis was made of the different evaluations characterising the patients' experience of disability according to a 4-grade scale. This variable was then related to important somatic variables. The patients' superficial psychosocial adjustment was obviously very good. Only one woman had an invalid pension and the psychiatric contact of the material only moderately exceeded the figure for other women with the same age-distribution. However, the personality-psychological examination gave results indicating that adjustment was not always so good. Two case histories illustrate the discrepancy between a good superficial adjustment and a high-grade psychological handicap. The patients' lives were marked to a high degree by their deformity. The group was characterised by hypersensitivity and insecurity, with a tendency to dysphoric mood; the level of energy was high. Not unexpectedly, the psychological adjustment deteriorated with an increasing degree of deformity. Poor vital capacity also impaired adjustment.     

The influence of medical and psychological interventions on women's distress after miscarriage

OBJECTIVE: The aim of this study was to examine the impact of medical and psychological interventions on women's distress after early miscarriage. METHODS: This was a prospective study of women attending for a routine scan at 10-14 weeks of gestation and found to have a missed miscarriage. An intervention group of 66 women had medical investigations to ascertain the cause of miscarriage, and at 5 weeks after the scan, they all had a medical consultation to discuss the results of the investigations. These 66 women were randomly allocated into a group which received further psychological counselling (MPC, n=33), and a group which received no psychological counselling (MC, n=33). They were compared to a control group of 61 women who received no specific postmiscarriage counselling. All participants completed preintervention and postintervention measures and 4-month follow-up questionnaires. RESULTS: The scores on the outcome variables decreased significantly with time for all three groups. In group MPC, compared to controls, there was a significantly greater decrease over time in the levels of grief, self-blame, and worry and, compared to MC group, a significantly greater decrease in grief and worry. In group MC, compared to controls, there was a significantly greater decrease in self-blame. In the MC and MPC groups, those with an identified cause of the miscarriage had significantly lower levels of anxiety and self-blame over time than those with a nonidentified cause. CONCLUSIONS: Psychological counselling, in addition to medical investigations and consultation, is beneficial in reducing women's distress after miscarriage. However, absence of an identifiable cause of miscarriage led to the maintenance of the initial anxiety levels, which should have otherwise decreased with time.