Rapid tranquilization: An audit of Irish mental health nursing practice

Rapid tranquillization is a pharmacological intervention sometimes employed in mental health care for the management of acute behavioural disturbance. It is a form of restrictive practice, which, along with seclusion and restraint, is a conventional and controversial intervention in the therapeutic management of risk in mental health settings. This study surveyed mental health nurses practice in rapid tranquillization. A self‐report questionnaire was utilized which addressed aspects such as definitions of rapid tranquillization, presence of rapid tranquillization policy, types of incidents where it is used and postintervention monitoring. The results demonstrate that rapid tranquillization is an intervention used in the management of acute behavioural disturbance in various mental health settings in Ireland. Respondents showed a basic understanding of rapid tranquillization as an intervention; however, some areas reported not having a specific rapid tranquillization policy. There was some evidence of a variation in postrapid tranquillization monitoring of psychiatric/mental health and physical health. Service user debriefing following rapid tranquillization was reported to be common; however, the content of this was not elaborated on. In the light of variations in practice, specific training and the development of rapid tranquillization policies are recommended.     

调理气血阴阳运行治疗顽固性失眠

中医认为,失眠的病因病机涉及脏腑、气血、阴阳等方面。阴阳失调、营卫不和、心失所主、肝失疏泄,均可因影响人体气机、血脉、阴阳的正常循行,从而出现寤寐规律失常而致失眠。顽固性失眠的临床治疗以通血脉、调阴阳、行气血为法。应用血府逐瘀汤使气血阴阳正常运行,并通过临证化裁、服药方法的变通而增强疗法。     

疏肝理气、健脾安神法治疗失眠肝郁脾虚型

目的 观察自拟疏肝理气、健脾安神方剂治疗失眠症(肝郁脾虚型)的临床疗效.方法 将72例失眠患者随机分为2组,治疗组36例给予自拟疏肝理气、健脾安神方剂治疗;对照组36例给予安神胶囊治疗,疗程8周,观察2组睡眠状况的改善情况.结果 2组患者临床疗效比较:治疗组治愈率为36.1%,对照组治愈率为22.2%,2组临床治愈率比较,差异有统计学意义(P<0.05),提示治疗组疗效明显优于对照组.2组患者PSQI积分比较:2组患者经治疗后,治疗组评分显著低于对照组,差异有统计学意义(P<0.05),提示治疗组疗效明显优于对照组.结论 自拟疏肝理气,健脾安神方剂治疗肝郁脾虚型失眠能有效改善睡眠及临床症状.     

从神论治眩晕中医理论探微

历代医家将眩晕病的病因责之于风、火、痰、虚、瘀及外感六淫等,并将其不断发展、完善,逐步形成了从风论治、从痰论治、从火论治等多种学术流派。尽管中医古籍中尚未明确记载眩晕病从神论治理论,但诸医家在遣方用药中已有所体现。围绕眩晕病"病位在心脑、从神论治"的新假说进行挖掘和整理,进一步阐述眩晕病的病机和治法,以期为临床诊治提供新思路。     

Event sequencing of forced intramuscular medication in England

ACCESSIBLE SUMMARY: ? In many countries staff are allowed to inject psychiatric inpatients against their will with psychotropic medication. ? This study, conducted in England, found such injections were given to 9% of patients, usually in response to aggressive behaviour or medication refusal. ? In most cases the forced injections ended a crisis, but the study concludes that there are opportunities for staff to use alternative approaches. ABSTRACT: In most inpatient psychiatric care systems it is permissible in certain situations for staff to forcibly inject patients with psychotropic medication. The aim of this study is to describe what precedes and follows a coerced intramuscular injection within a nursing shift. Data were collected on the sequence of conflict (aggression, absconding, etc.) and containment (seclusion, restraint, etc.) for the first 2 weeks of 522 acute admissions on 84 wards in 31 UK hospitals. Injections were given to 9% of patients. Aggression, regular medication refusal and pro re nata (PRN) medication refusal preceded injections. The giving of coerced medication concluded most crises. Coerced medication effectively resolves crises in the short term. Staff should offer oral PRN as an alternative, unless this is unsafe. Where only verbal violence has occurred staff should try to resolve the crisis without enforcing medication. More research on the best way to respond to inpatients' medication refusal is required.     

国医大师张琪从瘀辨治不寐

张琪教授重视从瘀辨治不寐,首辨有无瘀血,次辨瘀血形成的原因,再辨瘀血的程度。情志失调可影响肝之疏泄,血行不畅,心失所养,则发为不寐,治宜疏肝活血、宁心安神,方以逍遥散或龙胆泻肝汤合血府逐瘀汤加减;痰瘀互结,或化火扰动心神,使心神不安,或阻滞脉络,导致心脉失养,则发为不寐,治宜化痰祛瘀、和中安神,方以二陈汤或黄连温胆汤合桃红四物汤加减;心脾气血两虚,无力推动血液运行以濡养心脉,则发为不寐,治宜补益心脾、养血安神,方以归脾汤合血府逐瘀汤加减;若阴虚,或阳气相对偏盛,或津亏不足以载血,血脉瘀阻化火灼津,则发为不寐,治宜滋阴降火、凉血安神,方以黄连阿胶汤合血府逐瘀汤加减;脾胃不和,或气血亏虚导致脉络不通,形成瘀血,或气机升降失常,血液运行受阻,则发为不寐,治宜调和脾胃、化瘀安神,方以保和丸或黄芪建中汤合血府逐瘀汤加减。     

毛德西治疗不寐八法

毛德西教授治疗不寐八法:阴血不足、热扰心神者,养阴血、清热安神,方以酸枣仁汤加减;心肾不交、水火不济者,交通心肾、清心安神,方以交泰丸加减;痰浊蒙窍、气机逆乱者,化湿理气、开窍醒神,方以十味温胆汤加减;气血亏虚、心神失养者,健脾益气、养血安神,方以归脾汤加减;血脉瘀滞、心神不安者,活血祛瘀、行气安神,方以血府逐瘀汤或癫狂梦醒汤加减;肝失疏泄、气机郁结者,疏肝理气、解郁安神,方以疏调汤加减;邪热内踞、扰乱心神者,清热祛邪、镇静安神,方以柴胡加龙骨牡蛎汤加减;阴虚火旺、热扰心神者,滋阴清热、泻火安神,方以黄连阿胶汤加减。     

肝心同治法治疗功能性消化不良伴焦虑抑郁状态30例

目的观察疏肝健脾合养心安神方治疗功能性消化不良(functional dyspepsia,FD)伴有焦虑抑郁状态的疗效。方法将90例FD伴焦虑抑郁状态的患者随机分为疏肝组、疏肝养心组和疏肝黛力新组,分别治以中药疏肝健脾方、中药疏肝健脾方+养心安神方,及中药疏肝健脾方+黛力新,治疗前后观察3组患者脾胃症状评分,采用36条目生活质量简表(36-item short form health survey questionnaire,SF-36)评价患者治疗前后的生活质量,采用汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评价患者治疗前后的焦虑抑郁水平。结果疏肝养心组、疏肝黛力新组在改善FD患者脾胃症状,降低HAMA、HAMD评分,改善SF-36各维度评分方面显著优于疏肝组(P0.05,或P0.01);疏肝养心组与疏肝黛力新组疗效比较,差异无统计学意义(P0.05)。结论疏肝健脾方合养心安神方可明显改善FD伴焦虑抑郁状态患者的脾胃症状,并可改善焦虑抑郁症状,提高生活质量。     

王化良教授治疗心律失常经验总结

王化良教授在临床中灵活辨证治疗心律失常,首辨虚实,分清主次,标本同治,取得较好的疗效,体现了中药治疗心律失常的有效性。