Amitriptyline for PTSD in a torture survivor: A case study

The present study investigated the effect of amitriptyline on PTSD symptoms in a torture survivor 7 years after the trauma. After a pretreatment assessment period of 1 month, amitriptyline 150 mg nocte was started and assessments were carried out up to 8 months. An overall improvement of 70% was noted 6 weeks after the start of treatment. Improvement was most marked in depression, anxiety, and in social and work adjustment but less so in PTSD symptoms. Residual symptoms included nightmares, constricted affect, aggressive urges, startle response, and phobic avoidance. The drug effect was partial and likely to disappear on discontinuation. The limitations of drug treatment indicate the need for combined psychotherapy for lasting improvement. Evidence so far suggests that behavioral approach in the treatment of traumatic stress symptoms achieves more stable improvement.     

糖尿病视网膜病变行玻璃体切割术患者的焦点解决短程治疗干预

目的 探讨焦点解决短程治疗用于糖尿病视网膜病变行玻璃体切割术患者的护理干预效果.方法 将96例拟行玻璃体切割手术治疗的糖尿病视网膜病变患者随机分为对照组与观察组各48例.对照组给予眼科常规护理及心理护理,观察组在对照组基础上实施焦点解决短程治疗心理干预.采用焦虑自评量表、抑郁自评量表、视功能损害眼病患者生活质量量表及自制护理满意度量表对两组患者进行效果评价.结果 干预后观察组焦虑、抑郁评分显著低于对照组,生活质量及护理满意度显著高于对照组(均P＜0.01).结论 焦点解决短程治疗可改善糖尿病视网膜病变行玻璃体切割术患者负性情绪,提高其生活质量及护理满意度.     

青少年抑郁症患者聚焦解决模式护理干预效果评价

目的 探讨聚焦解决模式护理干预对青少年抑郁症患者的干预效果。方法 将60例青少年抑郁症患者按照病区分为对照组和干预组各30例。两组均行常规抗抑郁治疗,对照组住院期间实施常规护理;干预组实施聚焦解决模式护理干预。结果 干预后,干预组焦虑、抑郁评分,冗思反思量表评分、非自杀性自伤行为评分、自杀意念评分显著低于对照组;聚焦解决思维中资源利用与目标导向2个维度评分显著高于对照组（均P＜0.05）。结论 聚焦解决模式护理干预有利于改善青少年抑郁症患者焦虑抑郁情绪,降低其冗思水平,减少其非自杀性自伤行为及自杀意念,增强患者康复信心。     

Survivors of torture and organized violence: Demography and diagnosis

Sixty patients, with a history of torture or other repressive state violence, newly referred to two psychiatrists, were assessed using a standard instrument. Thirty one met the diagnostic criteria for posttraumatic stress disorder (PTSD) and 21 met the criteria for MDD. Relationships between these diagnoses and history of trauma, loss of health, and social losses were investigated. Sexual torture is associated with an avoidance reaction.     

The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: examination of comorbidity with anxiety and depression

Previous research has indicated a relationship between posttraumatic stress disorder (PTSD) and somatic complaints. We examined whether this relationship is a result of shared comorbidity with anxiety and depression. Local doctors interviewed a random, community sample of 526 tortured and 526 nontortured Bhutanese refugees living in U.N. refugee camps in Nepal. The interview covered demographics, torture, somatic complaints, and PTSD, depression, and anxiety measures. Number of PTSD symptoms, independent of depression and anxiety, predicted both number of reported somatic complaints and number of organ systems involving such complaints. Physicians need to screen for PTSD when survivors of extreme stressors present nonspecific somatic complaints.     

系统饮食治疗对老年抑郁症患者营养状况的影响

目的 探讨系统饮食治疗计划用于老年抑郁症患者的有效性. 方法 将87例老年抑郁症患者按入院时间分为观察组(47例)和对照组(40例).对照组入院后按一般护理常规,由护士给家属及患者讲解饮食治疗的重要性,指导家属自行为患者提供饮食.观察组按系统饮食治疗计划进行,患者入院后评价患者营养状况;其能量供给量按年龄、性别、体质量...     

Experiences of torture and ill-treatment and posttraumatic stress disorder symptoms among Palestinian political prisoners

The relationship between the nature and severity of experiences of torture and ill-treatment and posttraumatic stress disorder (PTSD) symptoms was studied in 550 male nonhelp-seeking Palestinian political ex-prisoners from the Gaza Strip. Results showed that the more a prisoner had been exposed to physical, chemical and electric torture, psychological ill-treatment, and sensory deprivation or bombardment, the more he subsequently suffered from intrusive reexperiencing, withdrawal and numbness, and hyperarousal. Existential problems were not related to torture experiences. Furthermore, duration of imprisonment, health problems during the imprisonment, harassment during arrest and after release, family, marriage and economic difficulties all predicted intrusive reexperiences of trauma. Also, ex-prisoners who continued to be harassed by military authorities and had economic problems suffered more from withdrawal, numbness, and hyperarousal than others.     

认知行为疗法对抑郁孕妇干预效果的Meta分析

目的评价认知行为疗法对抑郁孕妇的干预效果。方法检索有关认知行为疗法对抑郁孕妇干预效果的国内外随机对照研究,采用RevMan 5.2软件进行Meta分析。结果共纳入9篇随机对照研究,637例抑郁孕妇。认知行为疗法能降低抑郁孕妇产前抑郁[SMD=-0.66,95%CI(-1.01,-0.31),P=0.000]、焦虑[MD=-2.82,95%CI(-4.32,-1.33),P=0.002]、压力[SMD=-0.46,95%CI(-0.75,-0.17),P=0.002],能改善孕妇产后4个月内的抑郁症状[SMD=-0.52,95%CI(-1.02,-0.03),P=0.04],但对产后4个月后抑郁症状的改善效果不明显。结论认知行为疗法可能有助于改善抑郁孕妇产前抑郁、压力以及焦虑情绪,但对产后4个月后抑郁症状的改善效果尚不明确。     

Lipid-lowering therapy and violent death: Is depression a culprit?

Large-scale, controlled treatment studies of antilipidemic therapy have yielded consistent evidence of reduction in cardiovascular morbidity and mortality, but no reduction in total mortality. This counterhypothetical result appears to be due to a compensatory increase in cancer and violent death with treatment. ‘Violent death’ includes suicides, homocides and accidents. The present study took advantage of a dataset on 174 males undergoing coronary angiography which included presence/absence of an antilipidemic medication regimen and multiple measures of emotional distress/dysfunction to see if the two were associated. Self-reported depression on the Ketterer Stress Symptom Frequency Checklist (KSSFC) was higher in these angiographic male patients if they were on medical treatment for hypercholesterolemia than if they were not. Comparisons across antilipidemic groupings of a number of potential confounding/mediating variables revealed no systematic differences which can account for these results. While only correlational in nature, present results are consistent with the hypothesis that antilipidemic drug treatment induces emotional distress in males undergoing coronary angiography.     

Sexual torture of political prisoners: An overview

Not much is known about the repressive use of sexuality against political prisoners. It is important to gain a better understanding of the trauma involved in sexual torture for treatment purposes. On the basis of clinical experience with refugees from the Middle East, North Africa, and Latin America, and the collection of mainly unpublished material on the subject, a theory of the psychodynamics of sexual torture is proposed. It is claimed that this method of torture is especially traumatic, as it is characterized by a confusing and complex ambiguity containing both libidinal and aggressive components, against which the victim has difficulty maintaining a psychological defense. Hence, his or her core identity processes are threatened. Aspects of transcultural treatment are discussed, and it is stressed that there must be a reframing of the trauma story so as not to repeat the psychological pain of the torture and aggravate symptoms. The Testimony-Method is introduced as an important tool for reframing. If the refugee presents sexual symptoms, sexological treatment interventions are recommended.     

The theory of torture and the treatment of its survivors: An intervention model

Torture is analyzed as an institution which impacts on both the individual survivor and society at large. The authors provide formulations toward a comprehensive treatment approach for survivors of torture and political repression. Interventions are focused on four key areas: (a) restoring physical integrity; (b) promoting psychological reorganization; (c) examining the multiple losses involved in refugee or exile status; and (d) reintegrating the survivor into sociopolitical life. A critical element underlying these interventions is an awareness of and sensitivity to countertransference dynamics. The authors stress the need for a safe therapeutic environment in which the uncovering process can take place, and survivors can rebuild their sense of trust and security.This article was accepted for publication under the Editorship of Charles R. Figley.     

认知行为疗法对改善糖尿病患者抑郁及血糖的Meta分析

目的评价认知行为疗法改善糖尿病患者抑郁症状及血糖控制的效果。方法计算机检索中英文数据库有关认知行为疗法治疗糖尿病患者抑郁症状及血糖控制的随机对照试验,按照纳入和排除标准进行文献质量评价后,采用RevMan5.3软件进行数据分析。结果最终纳入11项研究,共计1 279例患者,Meta分析结果显示:认知行为疗法可改善糖尿病患者的抑郁症状,缓解患者的相关情绪困扰,减轻患者的焦虑情绪(均P<0.01)。然而,认知行为疗法在糖尿病患者的血糖控制,提高其自我效能、心理健康和生活质量方面无明显效果(均P>0.05)。结论认知行为疗法能够改善糖尿病患者的抑郁症状、缓解相关情绪困扰和焦虑情绪;但对于改善糖尿病患者的血糖控制,提高其自我效能、心理健康和生活质量方面无明显作用。     

恶性梗阻性黄疸介入治疗短期疗效影响因素的研究

目的：探讨影响恶性梗阻性黄疸经皮肝穿胆道引流（PTBD）联合胆道支架置入术（PTBS）短期疗效的相关因素。方法：分析2004年6月—2009年6月经PTBD和PTBS治疗的恶性梗阻性黄疸患者107例,参照胆红素下降程度和术后30 d内生存情况分为短期治疗有效（91例）和无效（16例）2组,应用卡方检验进行单因素分析,非条件Logistic进行多因素分析。结果：单因素分析显示患者年龄、性别、梗阻时间、梗阻部位、术前胆道感染和肝功能Child-Pugh评分、TBIL、HGB、Cr 9个因素与恶性梗阻性黄疸介入治疗预后相关。多因素分析示术前胆道感染、肝功能Child-Pugh评分≥9分、Cr≥111μmol/L是恶性梗阻性黄疸介入治疗的高危因素。结论：术前胆道感染、肝功能Child-Pugh评分≥9分、Cr≥111μmol/L与恶性梗阻性黄疸短期预后关系密切,对梗阻性黄疸介入治疗的术前评估有重要参考意义。     

护生短时简化正念训练应用的研究进展

对正念、短时简化正念训练的定义、形式和时长、应用效果进行综述,总结短时简化正念训练在缓解护生负性情绪、优化护生生理功能和促进护生临床能力培养等方面所具有的积极作用,提出短时简化正念训练的优势与不足,旨在为其在护理教育中的应用和推广提供参考。     

发散式冲击波治疗间盘源性下腰痛近期疗效观察

目的：评价发散式冲击波（RSWT）治疗间盘源性下腰痛的近期疗效。方法：对43例间盘源性下腰痛患者进行发散式冲击波治疗,配合适当的卧床休息和躯干核心稳定肌功能锻炼,比较治疗1w、2w及治疗结束后1月、3月随访时的患者的VAS疼痛评分及Oswestry功能指数的变化。结果：治疗后1w、2w、1月、3月不同时段所观察记录VAS疼痛分值及Oswestry功能指数均较治疗前明显下降,差异有显著性（P〈0．05）。结论：发散式冲击波可有效缓解下腰背部疼痛并能改善腰部功能,其近期疗效满意,值得推广并行进一步前瞻对照研究。     

颈动脉支架植入术中低血流动力学紊乱相关危险因素

目的分析颈动脉支架植入(CAS)术中低血流动力学紊乱(HD)的危险因素。方法回顾性分析121例接受CAS患者,根据CAS术中血压和心率变化评估有无HD;以单因素及多因素logistic回归分析筛选CAS中发生HD的危险因素。结果共42例发生HD(HD组),其中27例见于球囊扩张时,14例见于植入支架时,1例见于以封堵器封堵血管时;79例未见HD(非HD组)。单因素分析显示,组间患者年龄、颈动脉狭窄程度和部位(有无累及球部或分叉部)、血管斑块性质及球囊后扩张差异均有统计学意义(P均<0.05);多元logistic回归结果显示,年龄、狭窄部位、血管斑块性质及球囊后扩张均为HD的独立危险因素(P均<0.05)。结论CAS术中发生HD与患者年龄、颈动脉狭窄部位、血管斑块性质及有无球囊后扩张有关。     

老年人工股骨头置换术后综合抗骨质疏松治疗的近期疗效分析

目的探讨老年人工股骨头置换患者术后抗骨质疏松治疗方法,以提高其治疗水平。方法对14例人工股骨头置换术术后患者进行包括健康宣教、生活习惯调整、抗骨质疏松药物、物理治疗、康复运动治疗及家庭康复指导等的综合治疗,并测量患者术前、术后6个月骨密度及Harris评分。结果 14例人工股骨头置换患者治疗效果良好,骨密度由术前平均0.64±0.05g/cm2增加至0.65±0.05g/cm2,术前、术后骨密度变化无显著性差异(t=1.51,P=0.16),但有效阻止了骨折患者创伤后的骨量丢失;Harris评分由术前平均48.93±4.63分增加至90.79±2.94分,术前、术后评分具有显著性差异(t=37.75,P<0.05),Harris评分略高于国内同类研究。结论综合抗骨质疏松治疗有利于提高老年人工股骨头置换患者骨密度和生活质量。     

Cognitive trauma therapy for battered women with PTSD: preliminary findings

CTT-BW includes trauma history exploration, PTSD psychoeducation, stress management, psychoeducation about dysfunctional self-talk and self-monitoring of self-talk, exposure to abuse reminders, Cognitive Therapy for Trauma-Related Guilt (E. S. Kubany & F. P. Manke, 1995), and modules on assertiveness, managing contacts with former partners, self-advocacy strategies, and avoiding revictimization. Thirty-seven ethnically diverse women were assigned to Immediate or Delayed CTT-BW. PTSD remitted in 30 of 32 women who completed CTT-BW. Gains were maintained at 3-month follow-up. CTT-BW was efficacious across ethnic backgrounds. Issues related to disseminability of CTT-BW are discussed.     

The effects of single and repeated psychiatric occupational therapy on psychiatric symptoms: assessment using a visual analogue scale

The main aims of psychiatric occupational therapy are to improve daily activity, to enhance communication with others and to reinforce social adaptation. Also, substantial improvements in psychiatric symptoms have been reported, but the effects on psychiatric symptoms are yet to be established. In the present study, we investigated the effects of single and repeated administrations of psychiatric occupational therapy on psychiatric symptoms and determined whether the effects can be predicted. Our subjects were 215 inpatients or outpatients at our university hospital who participated in psychiatric occupational therapy. Five psychiatric symptoms (i.e. depressive mood, tension, irritability, anxiety and fatigue) were subjectively measured just before and just after each psychiatric occupational therapy by using a visual analogue scale (VAS). As a result, there was a significant short-term effect from single psychiatric occupational therapy, but there was no significant further improvement of any psychiatric symptom from repeated psychiatric occupational therapy. The VAS value at the beginning stage significantly predicted improvement of each psychiatric symptom. These findings suggest that single psychiatric occupational therapy can bring about a short-term effect, whereas repeated psychiatric occupational therapy cannot induce long-term effect (accumulated effect) on psychiatric symptoms, and that the improvement can be predicted by baseline psychiatric symptoms.