在沪藏族中学生行为问题的干预研究

目的探讨对在沪读书藏族中学生行为问题综台干预的方法和有效性。方法采取个别心理咨询、集体咨询、生物反馈治疗对行为问题进行综合干预。结果进行三年的综合干预．抑郁、思维獐碍、攻击因子分明显降低，藏族中学生的行为问题明显减少。结论综合干预能有效地解决藏族中学生的行为问题。     

利培酮氯丙嗪对首发精神分裂症患者眼动分析NEF的影响

目的探讨眼动分析中凝视点数和反应性探索分析能否作为首发精神分裂症患者的诊断和治疗效果的客观依据以及这两种指标是否受不同抗精神病药物治疗的影响。方法将符合入组标准的53例精神分裂症患者随机分为氯丙嗪组24例、利培酮组29例进行治疗,疗程6w。随机抽取30例正常健康者为对照组,于患者组治疗前及治疗6w末测评三组眼动分析中凝视点数来分析其认知功能的改善情况。结果氯丙嗪组、利培酮组眼动分析中凝视点数评分均显著低于对照组(P<0.01),治疗6w末凝视点数评分虽有显著升高(P<0.01),但仍均显著低于对照组,差异均有极显著性(P<0.01)。结论凝视点数测评可作为首发精神分裂症患者诊断和判定疗效的客观依据,并且可能受药物的影响。     

Impaired family functioning in psychosis and its relevance to relapse: a two-year follow-up study

BackgroundThe aim of the present study was to investigate whether dysfunctional family functioning contributes to relapse over a two-year follow-up period in patients experiencing their first episode of psychosis (FEP) and chronic patients with psychosis.MethodsThe sample consisted of 100 remitted patients (50 FEP and 50 chronic) diagnosed with schizophrenia (82%) or bipolar disorder with most recent episode manic severe with psychotic features (18%) recruited from the Inpatient Psychiatric Unit of the University Hospital of Heraklion, Crete, Greece, and their family caregivers. Family functioning was assessed in terms of cohesion and flexibility (FACES-IV), expressed emotion (FQ), family burden (FBS) and caregivers’ psychological distress (GHQ-28). Relapse was defined as patient rehospitalisation due to acute psychotic exacerbation, while number, length, and type of hospitalisations were also evaluated.ResultsDysfunctional family functioning in terms of cohesion and flexibility was not found to be a significant risk factor for relapse in psychosis. High expressed emotion, as indexed primarily by increased levels of criticism rather than emotional over-involvement, was associated with increased risk of relapse and shorter time to relapse (HR = 0.48, 95% CI: 0.24, 0.98, p = 0.043). Similarly, high levels of family burden were related to shorter time to relapse (HR = 0.47, 95% CI: 0.23, 0.95, p = 0.037), whereas there was no significant difference in survival curves based on caregivers’ psychological distress. No significant interaction effect of illness chronicity was observed in the aforementioned associations.ConclusionThese findings highlight caregivers’ criticism and burden of care as long-term predictors of the course of psychosis from the early stages of the illness and later on. In contrast, unbalanced levels of cohesion and flexibility in the family, as well as caregivers’ high emotional over-involvement and psychological distress do not appear to be factors that contribute to patient relapse. Family psychoeducational interventions focusing at ameliorating caregivers’ negativity toward the patient, and easing the burden of care should be considered as means in reducing relapse.     

Structural insights into aberrant cortical morphometry and network organization in psychogenic erectile dysfunction

Functional neuroimaging studies have revealed abnormal brain dynamics of male sexual arousal (SA) in psychogenic erectile dysfunction (pED). However, the neuroanatomical correlates of pED are still unclear. In this work, we obtained cortical thickness (CTh) measurements from structural magnetic resonance images of 40 pED patients and 39 healthy control subjects. Abnormalities in CTh related to pED were explored using a scale space search based brain morphometric analysis. Organizations of brain structural covariance networks were analyzed as well. Compared with healthy men, pED patients showed significantly decreased CTh in widespread cortical regions, most of which were previously reported to show abnormal dynamics of male SA in pED, such as the medial prefrontal, orbitofrontal, cingulate, inferotemporal, and insular cortices. CTh reductions in these areas were found to be significantly correlated with male sexual functioning degradation. Moreover, pED patients showed decreased interregional CTh correlations from the right lateral orbitofrontal cortex to the right supramarginal gyrus and the left angular cortex, implying disassociations between the cognitive, motivational, and inhibitory networks of male SA in pED. This work provides structural insights on the complex phenomenon of psychogenic sexual dysfunction in men, and suggests a specific vulnerability factor, possibly as an extra “organic” factor, that may play an important role in pED. Hum Brain Mapp 36:4469–4482, 2015. © 2015 Wiley Periodicals, Inc .     

精神科患者保护性约束中知情同意的相关问题及对策

本文分析了精神科患者保护性约束中知情同意存在的问题和原因,并对我院实践方法进行了介绍,提出在保护性约束中只有遵循患者充分知情、理解、同意的原则,才能保证知情同意的实现。     

度洛西汀与氟西汀治疗躯体形式障碍对照研究

目的：探讨度洛西汀与氟西汀治疗躯体形式障碍的临床疗效和安全性。方法将80例躯体形式障碍患者随机分为两组,研究组口服度洛西汀治疗,对照组口服氟西汀治疗,观察6周。于治疗前后采用临床疗效大体评定量表、症状自评量表的躯体化、焦虑、抑郁因子评定临床疗效,副反应量表评定不良反应。结果治疗6周末,研究组显效率69．2％、总有效率89．7％,对照组分别为44．4％、75．0％,研究组显效率显著高于对照组（χ2＝4．70,P＜0．05）,总有效率高于对照组,但差异无显著性（χ2＝2．84,P＞0．05）。治疗各时段副反应量表评分均显著低于对照组（P＜0．01）。结论度洛西汀与氟西汀治疗躯体形式障碍疗效均显著,但度洛西汀治疗起效更快、疗效更显著、安全性更高、依从性更好。     

危机管理在精神科护理中的应用

目的：探讨精神科护理危机管理的作用。方法建立护理危机管理组织,制定精神科护理应急预案,加强护理人员应急处置能力的培训,加强护理质量管理。结果实施危机管理后护理纠纷发生率、护理人员受伤害发生率显著下降（χ2＝6．59、7．99,P＜0．05或0．01）,患者满意度显著提高。结论危机管理是精神科病房安全管理的一种有效方法。     

理性情绪疗法对精神分裂症后抑郁患者心理状态的影响

目的：探讨理性情绪疗法对精神分裂症后抑郁患者心理状态的影响。方法将84例精神分裂症后抑郁患者分为两组,每组42例。两组均予以精神科常规治疗及健康宣教,研究组在此基础上联合理性情绪疗法治疗。观察6周。于治疗前后采用自尊量表、自我接纳问卷、汉密顿抑郁量表评定干预效果。结果治疗后两组汉密顿抑郁量表评分均较治疗前显著降低（P＜0．05或0．01）,研究组显著低于对照组（ P＜0．05）;自尊量表、自我接纳问卷评分均较治疗前显著升高（P＜0．05或0．01）,研究组显著高于对照组（P＜0．05）。结论理性情绪疗法能显著改善精神分裂症后抑郁患者的抑郁情绪,提高其自尊水平及自我接纳程度。