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It has long been accepted that psychological factors adversely influence efforts to optimise glycaemic control.These are often unrecognised in terms of clinical assessment and therefore under reported.This essay presents an introduction to psychological issues that interact with psychiatric co-morbidities and diabetesspecific distress,and a case scenario illustrating the interconnectedness of presenting problems and themes.In the way that we cannot separate carbohydrate counting,blood glucose monitoring and insulin doseadjustment in the understanding of a presenting problem such as poor control,so we cannot separate the concurrent thoughts,feelings,and behaviours.Each of these emotional aspects are self-managed either through avoidance,or by delayed disclosure and are frequently associated with poor health outcomes.There is a requirement for the healthcare team to be sensitised to these issues and to develop styles of communication that are empathic,reflective and non judgemental.A brief outline of evidence-based psychotherapy treatments is given.  相似文献   
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The Self-Beliefs related to Social Anxiety (SBSA) scale assesses maladaptive social-evaluative beliefs, a key aspect in models of social anxiety disorder (SAD) that is frequently measured in research and clinical contexts. The SBSA has been evaluated psychometrically in student samples, but not in a large sample of individuals diagnosed with SAD. The current study tested the psychometric properties of the SBSA in a sample of individuals with SAD pooled from several studies (total N = 284). Results showed that the optimal factor structure for the SBSA was a correlated three-factor model (high standard beliefs factor, conditional beliefs factor, unconditional beliefs factor). The SBSA total and its subscales (formed based on the factors) exhibited good internal consistency. In terms of construct validity, the SBSA total, the high standard beliefs subscale, and conditional beliefs subscale had stronger associations with a measure of social anxiety than with a measure of depression, although the unconditional beliefs subscale was similarly related to both measures of social anxiety and depression. In terms of discriminative validity, the sample of individuals with SAD had higher SBSA total and subscale scores compared with a sample of individuals without SAD (N = 32). These findings provide a psychometric evidence base justifying the use of the SBSA for the assessment of maladaptive social-evaluative beliefs.  相似文献   
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急性肾损伤(Acute Kidney Injury,AKI)向慢性肾脏病(Chronic Kidney Disease,CKD)的进展过程严重影响肾脏预后及患者生存质量,是目前研究热点之一,其中细胞周期停滞是AKI向CKD进展中一个重要的致病机制。其可能通过持续增加细胞因子及炎症因子生成和释放、上皮间充质转分化、细胞器应激/串扰、衰老激活、管周微血管稀疏等一系列适应性不良修复过程,加速AKI向CKD转变。故调控细胞周期有望成为预防、减缓甚至阻断AKI-CKD进展的新的靶点机制。  相似文献   
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Limb amputation may lead to chronic painful sensations referred to the absent limb, ie phantom limb pain (PLP), which is likely subtended by maladaptive plasticity. The present study investigated whether transcranial direct current stimulation (tDCS), a noninvasive technique of brain stimulation that can modulate neuroplasticity, can reduce PLP. In 2 double-blind, sham-controlled experiments in subjects with unilateral lower or upper limb amputation, we measured the effects of a single session of tDCS (2 mA, 15 min) of the primary motor cortex (M1) and of the posterior parietal cortex (PPC) on PLP, stump pain, nonpainful phantom limb sensations and telescoping. Anodal tDCS of M1 induced a selective short-lasting decrease of PLP, whereas cathodal tDCS of PPC induced a selective short-lasting decrease of nonpainful phantom sensations; stump pain and telescoping were not affected by parietal or by motor tDCS. These findings demonstrate that painful and nonpainful phantom limb sensations are dissociable phenomena. PLP is associated primarily with cortical excitability shifts in the sensorimotor network; increasing excitability in this system by anodal tDCS has an antalgic effect on PLP. Conversely, nonpainful phantom sensations are associated to a hyperexcitation of PPC that can be normalized by cathodal tDCS. This evidence highlights the relationship between the level of excitability of different cortical areas, which underpins maladaptive plasticity following limb amputation and the phenomenology of phantom limb, and it opens up new opportunities for the use of tDCS in the treatment of PLP.  相似文献   
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Williams syndrome (WS) is a neurogenetic disorder known for its “hypersocial” phenotype and a complex profile of anxieties. The anxieties are poorly understood specifically in relation to the social-emotional and cognitive profiles. To address this gap, we employed a Wechsler intelligence test, the Brief Symptom Inventory, Beck Anxiety Inventory, and Salk Institute Sociability Questionnaire, to (1) examine how anxiety symptoms distinguish individuals with WS from typically developing (TD) individuals; and (2) assess the associations between three key phenotypic features of WS: intellectual impairment, social-emotional functioning, and anxiety. The results highlighted intensified neurophysiological symptoms and subjective experiences of anxiety in WS. Moreover, whereas higher cognitive ability was positively associated with anxiety in WS, the opposite pattern characterized the TD individuals. This study provides novel insight into how the three core phenotypic features associate/dissociate in WS, specifically in terms of the contribution of cognitive and emotional functioning to anxiety symptoms.  相似文献   
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This study investigated whether early maladaptive schemas can explain the relation between attachment anxiety and avoidance dimensions and symptoms of psychopathology. For this purpose, 289 Flemish, Dutch‐speaking, late adolescents participated on a questionnaire study. Using a non‐parametric re‐sampling approach, we investigated whether the association between attachment and psychopathology was mediated by early maladaptive schemas. Results indicate that the association between attachment anxiety and psychopathology is fully mediated by cognitions regarding rejection and disconnection and other‐directedness. The association between attachment avoidance and psychopathology is partly mediated by cognitions regarding rejection and disconnection. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:
  • Our findings suggest that cognitive therapy might be useful in the treatment of attachment‐related psychopathology.
  • Our findings suggest that therapists should be wary for attachment‐related relapse.
  • Especially the cognitive schemas regarding expectations to be rejected or disconnected mediated the association between attachment anxiety and attachment avoidance dimensions and psychopathology.
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The Clark and Wells (1995) model of social anxiety disorder postulates that three types of maladaptive social self-beliefs (high standard, conditional, and unconditional beliefs) play a crucial role in the development of fear and avoidance of social-evaluative situations—i.e., the hallmark symptoms of social anxiety disorder. In this project, we examined associations between the three types of maladaptive social self-beliefs and fear and avoidance of social-evaluative situations in a nonclinical community sample (n = 389). We used network analysis to estimate functional relations among aspects of maladaptive self-beliefs, fear, and avoidance and computed two different network models, a graphical Gaussian model (GGM) and a directed acyclic graph (DAG). Each model estimates edges and the importance of nodes in different ways. Both GGM and DAG pointed to fear and conditional beliefs as especially potent bridges between maladaptive social self-beliefs and social anxiety in our nonclinical sample. Altogether, these results offer data-driven heuristics in the field’s larger, ongoing effort to illuminate pathways at play in the development of social anxiety. We situate this study within novel network approaches for developing theory-driven models and tests of the instigation and interactions of maladaptive social self-beliefs and social anxiety. However, because this is the first study to combine GGM and DAG in social anxiety research, we also discussed the caveats to this approach to help to usher the field forward.  相似文献   
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Maladaptive daydreaming (MD) is an excessive and vivid fantasy activity that interferes with individual's normal functioning and can result in severe distress. Research has shown that MD is a clinical condition associated with a number of personal, interpersonal and behavioral problems. Therefore, a need exists to differentiate MD from other mental activities that involve an excessive or otherwise problematic use of fantasy. These include, among others, daydreaming, mind wandering, dissociative absorption, fantasy proneness, sluggish cognitive tempo, lucid dreaming, and autistic fantasy. In this article, we examine the commonalities and differences between MD and these mental activities, to promote a better understanding of the MD phenomena and their specificity, and to foster the quality of its assessment in clinical settings. A clinical case study is employed to elucidate our analysis and to demonstrate the differential diagnosis of MD.  相似文献   
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