心理危机干预

当个体经历危机事件而无法应对时容易导致心理危机,此时需要进行科学的心理危机干预。本文围绕心理危机干预的理论、心理危机干预的模型进行简单综述,以帮助从业人员更好的提供心理危机干预。     

心理危机与远程心理干预

当个体经历危机事件而无法应对时容易导致心理危机,了解心理危机才能更好的进行科学的心理危机干预。本文围绕心理危机的定义,心理危机的种类、心理危机反应的阶段和远程心理干预进行简单综述,以帮助从业人员更好的提供心理危机干预。     

疫情应激个体干预“简快重建法”

新型冠状病毒疫情(COVID-19)爆发以来,心理应激干预需求激增。心理应激团体干预"简快重建法"自2008年创立以来,多次在重大事件心理应激干预中得到认可,并在个体辅导中发挥作用。为契合本次疫情的心理援助特点,按照国家卫生健康委员会《新型冠状病毒感染的肺炎疫情紧急心理危机干预指导原则》[1],在"简快重建"基本框架的理论与实践基础上,提炼出疫情应激个体干预"简快重建法"。通过一次干预中的四个环节(问题呈现、信息传递、应对探讨、总结提升),协助服务对象稳定状态,看到资源,获得支持,恢复适应性的心理社会功能。     

灾难性突发事件中救援军人心理危机影响因素及对策研究

灾难性突发事件中,面临紧急救援任务的压力和各种异常情境的刺激,救援军人的人格特质、认知模式、社会支持系统及其利用度、成长史等因素会影响其心理危机反应程度。应结合部队的实际,通过社会支持干预、认知模式干预、应对方式干预、心理自助成长干预等方法对易感官兵进行心理影响,尽量降低和避免军人在灾难性危机救援中的心理创伤,提高其危机应对能力。     

灾难性突发事件中救援军人心理危机影响因素及干预经验总结

灾难性突发事件中，面临紧急救援任务的压力和各种异常情境的刺激，救援军人的人格特质、认知模式、社会支持系统及其利用度、成长史等因素会影响其心理危机反应程度。应结合部队的实际，通过社会支持干预、认知模式干预、应对方式干预、心理自助成长干预等方法对易感官兵进行心理影响，尽量降低和避免军人在灾难性危机救援中的心理创伤，提高其危机应对能力。     

浅谈ICU患者家属心理护理

我院ICU 2008-2009年对351例住院患者家属进行了心理、行为护理干预.现将护理体会总结如下. 1 ICU患者家属的心理状态 应激是个体对环境威胁和挑战的一种适应和应付过程,其结果是可以适应和不适应的[1].     

心理危机干预方法研究进展

经历心理危机的个体存在严重的心理失调,甚至会出现心理障碍,及时对其进行心理危机干预,有助于个体心理健康的恢复。目前国际上有许多成熟的心理危机干预理论、模型和方法,本文对这些方法和模型进行综述。     

综合性心理干预对临退伍期军人情绪状况及相关因素的影响

目的 研究团体授课与个体心理干预相结合对临退伍期军人焦虑、抑郁情绪障碍、个性特征、应对方式及社会支持的作用,探讨改善临退伍军人情绪状况的有效干预模式,为降低临退伍军人情绪障碍的发生提供理论依据和实践基础.方法 退伍前半年随机整群抽取南京军区服役期军人3000人,分为研究组和对照组,干预期为6个月.研究组采用团体授课与个体干预相结合,对照组无心理干预.在退伍前半年(服役期)和退伍前两周(临退伍期)对其中确定退伍的军人(研究组416人,对照组396人)采用症状自评量表(SCL-90)、简易应对方式问卷、艾森克人格问卷(EPQ)、社会支持评定量表(SSRS)及自编一般状况调查表分别进行测评.结果 干预前,两组SCL-90抑郁、焦虑因子得分比较,差异无统计学意义(P>0.05);与干预前相比,研究组干预后抑郁、焦虑因子得分降低(P<0.01),对照组抑郁、焦虑因子得分升高(P<0.01);干预后,研究组抑郁、焦虑因子得分明显低于对照组(P<0.01).干预后研究组积极应对得分增高(P<0.01),消极应对得分降低(P<0.01);主观支持、客观支持及支持利用度得分较干预前增高(P<0.01);情绪障碍发生率(0.5%)较干预前(2.4%)降低(P<0.05);干预后,对照组临退伍军人情绪障碍发生率(4.8%)高于干预组(0.5%),差异有统计学意义(P<0.01).结论 团体授课与个体干预相结合的心理干预模式,可明显降低临退伍期军人情绪障碍的发生率,且对其应对方式及社会支持有明显的改善作用,值得在临退伍期军人中推广试用.     

对急危重病人家属应对危机能力的调查分析

目的通过对急危重病人家属应对危机能力的调查分析,帮助护士充分认识急危重病人家属应对危机的能力,积极有效地提供护理干预。方法对50例急危重病人家属进行访谈调查。结果家属常采用的应对方式包括直接采取行动,乐观的态度,寻求支持帮助,自我依赖,选择逃避等,但有效率较低,而最有效的是护士在家属应对过程中给予护理干预。结论护士通过建立护患之间的支持关系,帮助家属减少无效应对,协助处理家庭冲突,并积极开展护患家属研讨会和建立家庭温馨病房等措施,将有效地帮助病人家属应对病人危重时的危机状态,维持家庭功能,促进病人康复,减少病死率。     

精神分裂症的个体心理治疗

精神分裂症诊断单元的提出至今已有百年历史,但是对精神分裂症的病因还不清楚,许多治疗理论至今仍是假设[1].精神医学界从生物医学角度对精神分裂症做了大量研究,心理学界也从他们的视角对精神分裂症进行了漫长的探索.目前仍主张对精神分裂症综合干预和长期治疗,心理治疗是精神分裂症康复期的重要辅助治疗之一.本文主要从心理动力学派、亲附理论学派、认知行为心理学派的主要理论假设和技术出发对精神分裂症的个体心理治疗进行阐述.     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.     

Special Pharmacokinetic Considerations in Children

Summary: Pediatric patients have greater degrees of pharmacokinetic variability and unpredictability than adults. This variability results from the effects of pharmacogenetics, age and growth, prior and current comedication, and disease. Newborns with seizures have the least predictable dosage requirements, and their needs change as drug-eliminating mechanisms mature in the neonatal period. Infants have the highest relative capacities to eliminate antiepileptics of any age group and require the largest relative doses. In addition to age-related trends, children demonstrate the same drug-specific, pharmacokinetic phenomena that adults do, including nonlinear phenytoin elimination, nonlinear valproate binding, and autoinduction of carbamazepine. Intercurrent illness and drug interactions further modify the age-related pharmacokinetic patterns in children and make dosage requirements even more unpredictable. Recent studies have shown that febrile illness can affect drug elimination, sometimes decreasing drug levels by 50% or more. Intermittent treatment with benzodiazepines administered either orally or rectally can be an important adjunct and help minimize this type of problem for children with marginally controlled epilepsy. Intermittent benzodiazepines are also helpful for children who have febrile seizures and who need only occasional antiepileptic protection.