酒依赖患者复饮原因调查与分析

目的:探讨导致酒依赖患者复饮的原因,以便提供有针对性的干预,避免或减少复饮.方法:应用自设问卷对85例酒依赖患者进行调查,对常见复饮原因进行分析.结果:复饮原因有:应激事件占90％;诱惑占82％;负性情绪占75％;戒酒决心动摇占72％;愉快情绪占70％;睡眠障碍占67％;心理渴求占52％;错误的认知占34％;空虚无聊占28％;躯体不适占15％;侥幸心理占10％.结论:酒依赖患者复饮的原因较多,其中应激事件、诱惑、负性情绪、戒酒决心动摇、愉快情绪、睡眠障碍、心理渴求为主要原因,需要提供有针对性的干预以减少复饮.     

酒依赖患者妻子情感体验的质性研究

目的:探讨妻子对丈夫病态饮酒行为的情感体验及其在诊断、治疗、康复过程中真实的心理感受.方法:采用立意取样法选取16例酒依赖患者的妻子,运用深入访谈法收集资料和Colaizzi法分析资料.结果:经分析萃取出4个主题:①对丈夫酒依赖行为的无能为力感；②缺乏酒依赖相关知识,导致就医延迟,得不到早期干预；③对病耻感的体验与感知较强；④对酒依赖治疗和复发预防缺乏正确认识.结论:酒依赖患者的妻子存在无能为力、病耻感,缺乏酒依赖相关知识,需要获得有效的情感支持及专业技能.     

内观疗法治疗酒依赖及随访

目的 :探讨内观疗法治疗酒依赖患者的疗效及复发率。方法 :采用明尼苏达多项人格调查测试了 2 3例酒依赖患者 ,并与全国常模对照 ,住院期间应用集中内观 ,出院后定期随访 ,认真操练 ,使患者保持内心体验。结果 :通过随访治疗 ,3个月有 1 7例完全戒酒 ,6个月有1 3例完全戒酒。结论 :内观疗法是一种治疗酒依赖较为有效的方法。     

护理干预提高肿瘤患者PICC置管术的依从性

目的 了解基层医院肿瘤患者对经外周静脉植入中心静脉置管术(PICC置管术)的依从性.方法 对237例无禁忌证的恶性肿瘤患者进行问卷调查,寻找影响PICC置管术依从性的主要因素,实施针对性护理干预措施.结果 237例中,46例患者拒绝PICC置管术.其主要原因有:担心经济承受能力有限;担心长期携管会给生活带来不便;担心出院后的管道维护;担心置管技术不成熟等.实施护理干预后置管率由实施护理干预前2007年的4.55%上升到2008年的34.18%.结论 行之有效的护理干预明显提高基层医院肿瘤患者对PICC置管术的依从性.     

心理疗法对酒依赖患者戒酒的影响

目的:研究心理疗法对有酒依赖症的患者的戒酒情况的干预效果。方法:选取2010年1月～2012年12月来我院接受戒酒治疗的患者63例,均为住院治疗,将其随机分组,分别为33例实验组和30例对照组。对对照组实行常规药物治疗,实验组在对照组的基础上采用心理疗法。经过为期两个月的治疗,在其后的随访中了解两组酒依赖情况和复饮率,比较分析。结果:在其后的随机访问中实验组有1例未获得成功随访,对照组有4例发生此类情况。故实际纳入对比分析的病例为32例实验组和26例对照组。随访中调查的复饮率数据:对照组为77%,实验组为25%,实验组明显优于对照组,比较差异具有统计学意义(P<0.05)。结论:心理疗法对酒依赖患者戒酒有较好疗效,值得在实际临床中推广。     

男性酒依赖者的青少年子女情感体验的质性研究

目的:探究男性酒依赖者的青少年子女的内心体验。方法:运用立意取样法和深入访谈法,对16例男性酒依赖患者的12-18 a青少年子女进行半结构式访谈,将获得的资料用Giorgi法进行分析,萃取出主题内容。结果:经分析,萃取出4个主题内容:(1)对父亲饮酒行为的强烈厌恶感;(2)父亲病态饮酒行为带来的病耻感;(3)对父亲病态饮酒行为的无能为力感;(4)对家庭问题的企图逃避感。结论:男性酒依赖者的青少年子女面临心理卫生问题,应引起公众关注;建议为该群体提供有效的情感支持和应对技能。     

反复住院精神分裂症患者的用药依从性分析

目的:探究反复住院精神分裂症患者的用药依从性现状、影响因素与对策。方法:回顾性调查、分析我院152例反复住院精神分裂症患者的用药依从性。结果:精神分裂症患者院外维持治疗期能长期完全依从的仅占21.05%,有47.37%的再住院患者因自行停药或减药导致复发或病情加重,11.18%的患者住院期间有拒药、藏药行为。结论:影响精神分裂症患者用药依从性包括疾病、药物、心理和错误认知等因素,应对其进行干预,以提高疗效、减少复发。     

血液透析合用呋喃唑酮治疗酒依赖28例

目的 :用血液透析 ( HD)快速、安全的戒酒后再用呋喃唑酮行厌恶疗法〔1〕,并简要分析 HD戒酒原理。方法 :对符合 CCMD-2 -R酒依赖诊断标准的共 37例患者均用两次 HD戒酒 ,辅以抗焦虑、抗抑郁剂药物治疗。前 9例远期复饮率较高 ( 5 5 .6 % ) ,后 2 8例合用呋喃唑酮一个疗程行厌恶疗法 ,并随访。结果 :2 8例患者中仅 3例复饮 ,且酒量减少 80 %～ 85 % ,成功率89.3% ,有效率 1 0 0 %。结论 :血液透析对于打断酒依赖的物质基础、改善戒断症状、安全舒适的戒酒、近期疗效等均较好。但不能改善心理渴求 ,合用厌恶疗法则解决了复饮问题     

吞咽康复训练联合正性激励护理对脑梗死后吞咽障碍的影响

目的 观察吞咽康复训练联合正性激励护理对脑梗死后吞咽障碍依从性、病耻感及吞咽障碍的影响。方法 选取2020年10月至2022年3月于该院就治的脑梗死后吞咽障碍患者90例，按随机数字表法分为观察组与对照组各45例。对照组接受单一吞咽康复训练护理，观察组接受吞咽康复训练联合正性激励护理干预。比较两组干预前后病耻感、吞咽功能及吞咽康复训练依从性。结果 干预后观察组慢性病病耻感量表、标准吞咽功能评价量表评分低于对照组，吞咽康复训练依从率[95.6%(43/45)]高于对照组[80.0%(36/45)]，差异均有统计学意义(t=18.78、12.26，χ²=5.07,P <0.05)。结论 采用吞咽康复训练联合正性激励护理干预脑梗死后吞咽障碍，可改善患者病耻感、提高康复训练依从度，取得更佳吞咽功能恢复成效。     

851例住院酒相关精神障碍患者的临床特征及治疗转归

目的 :探讨酒依赖和酒相关精神障碍的流行病学特点、临床特点、治疗和转归。方法 :收集 1991年 - 2 0 0 1年北京安定医院全部诊断为酒依赖和 或酒相关精神障碍的住院病历 ,制定调查记录表格 ,对调查纪录结果进行汇总、分析。结果 :诊断为酒依赖和 或酒相关精神障碍的住院病历 85 1份 ,占我院总住院人数的 3 33% ( 85 1 2 5 5 4 0 )。自 1996年 ,住院构成比有所增加 ,分别为 :1997年 4 2 7% ( 93例 ) ,1998年 4 0 8% ( 90例 ) ,1999年 3 89% ( 82例 ) ,2 0 0 0年 4 0 2 % ( 94例 )和 2 0 0 1年 4 0 3% ( 10 3例 )。男∶女 =93 4 5∶1。发病年龄为 4 1 38a±s 8 5 6a。诊断为戒断综合征4 5 8例 ( 5 3 82 % ) ,震颤谵妄 12 5例 ( 14 6 9% ) ,伴幻觉 2 85例 ( 33 4 9% ) ,伴妄想 2 14例 ( 2 5 15 % )。治疗措施主要为 :地西泮替代治疗、抗精神病药物治疗、抗抑郁治疗和匿名戒酒互助 12步法治疗。临床完全缓解的占 6 0 % ( 5 16例 ) ,好转占 35 % ( 2 91例 ) ,死亡 1% ( 5例 )。结论 :酒相关精神障碍住院比率近 5a有逐年增加的趋势。住院诊断以戒断综合征、酒相关幻觉妄想症为主     

Characteristics of male medical patients referred for alcoholism treatment

Purpose: Medically ill alcoholics are frequently encountered in medical practice, yet little is known about this subgroup of alcoholics. Anecdotal evidence suggests that current treatment methods may be ineffective in some of these patients, and that many of them resist referral to treatment programs. In this pilot study, we sought to characterize this group, in order to determine whether further research was indicated. Basic Procedures: In the Minneapolis VA Medical Center, we conducted a retrospective chart review of 61 alcoholics from 3 groups of alcohol-dependent patients: medical inpatients who accepted transfer to treatment, medical inpatients who refused transfer, and ambulatory patients requesting treatment. The groups were compared on demographic, physical, psychological, and laboratory characteristics, and on compliance with medical appointments. Most Important Findings: As might be expected, inpatients were older and sicker than ambulatory patients, but also demonstrated fewer nonmedical complications of alcoholism. On psychological testing, those who transferred were more likely to exhibit anxiety and depression, while the ambulatory patients were more antisocial. Inpatients who transferred differed from those who refused in having fewer previous treatments and less severe medical illness and in showing more compliance with medical recommendations in general. Principal Conclusions: These findings raise the possibility that these groups may significantly differ from one another, and suggest that further research on the characteristics of medically ill alcoholics is indicated. Improved characterization could potentially lead to more effective treatment approaches.     

Treatment effectiveness as judged by successfully and unsuccessfully treated alcoholics.

Thirty-seven successfully and 46 unsuccessfully treated male alcoholics were asked to judge the effectiveness or ineffectiveness of six treatment methods routinely offered by a state hospital. For each treatment method, the total frequencies of judgments of most and least helpful, respectively, were as follows: detoxification (16%, 14%), lectures (16%, 20%), group therapy (54%, 7%), individual counseling (26%, 6%), work therapy (17%, 22%) and family therapy (13%, 14%). The two groups of subjects differed significantly in the frequencies of treatment methods judged to be "least helpful", but not in the frequencies of "most helpful" treatment. The similarity between the judgments of successfully and unsuccessfully treated alcoholics might reflect the positive effects of previous treatment in the unsuccessful group.     

Cognitive Style,Personality Traits,and Treatment Attrition Among Alcoholics

The relationships among cognitive style, personality characteristics, and treatment attrition were examined. The Group Embedded Figures Test (GEFT), Clinical Analysis Questionnaire (CAQ), and Minnesota Multiphasic Personality Inventory (MMPI) were administered to 78 inpatient alcoholic male veterans. Multiple linear regression analyses indicated that the GEFT and CAQ shared 24% common variance; second-order CAQ factors of Depression, Independence, and Extraversion contributed significantly. The GEFT and MMPI shared 16% common variance. Field-independent alcoholics demonstrate less psychopathol-ogy, more independence, and tend to be more introverted than field-dependent alcoholics. Cognitive style did not differ among four treatment attrition groups. Implications for treatment are discussed.     

A double-blind, placebo-controlled pilot trial of quetiapine for the treatment of Type A and Type B alcoholism

BACKGROUND: Atypical antipsychotics may be useful in the treatment of alcohol dependence. Human trials suggest that atypical antipsychotics may reduce alcohol craving and consumption, especially among patients with comorbid psychopathology. Therefore, these medications may be more useful for treating more severely affected alcoholics, such as patients with Type B alcoholism. Type B alcoholics are characterized by an early age of onset of problem drinking, high severity of alcohol dependence, increased psychopathology, and treatment-resistance. Quetiapine is an atypical antipsychotic with a favorable side effect profile, and may be a promising medication for the treatment of alcohol dependence, particularly Type B alcoholism. METHODS: Male and female alcoholics (33 Type A and 28 Type B) were included in a 12-week, double-blind, placebo-controlled trial. After detoxification, patients were randomized to receive quetiapine (n = 29), 400 mg/d at bedtime, or placebo (n = 32). The primary outcome measure was the quantity and frequency of alcohol consumption, measured by the timeline follow back. RESULTS: Forty-seven patients (77%) completed the trial, with no significant between-group differences in treatment retention. Nine quetiapine-treated patients (31%) maintained complete abstinence compared with 2 placebo-treated patients (6%) (chi(2) = 6.3, P = 0.012). There was a significant interaction between quetiapine and alcoholic subtype. As predicted, quetiapine- versus placebo-treated Type B alcoholics had significantly fewer days of drinking and fewer days of heavy drinking. Alcohol craving was also significantly reduced in quetiapine-treated compared with placebo-treated Type B alcoholics. Among Type A alcoholics, quetiapine provided no advantage over placebo in improving drinking outcomes. CONCLUSIONS: Quetiapine may be effective for the treatment of alcohol dependence, particularly in the more complicated Type B, early-onset alcoholics.     

A one-year follow-up of men alcoholics given disulfiram

A total of 348 consecutive primary alcoholics entering an alcoholism treatment program comprised Group 1 (172 men who were offered disulfiram and agreed to take it) and Group 2 (176 who were eligible to take the drug but refused). Information was gathered at the time of intake into the program through personal interviews with patients and two resource persons. The clinical course in the 12 months after discharge was determined by follow-up interviews with patients and one resource person. The two groups were demographically similar at intake and there were no significant differences in outcome. However, at intake those men who agreed to take disulfiram and subsequently did well were more affluent, more likely to be married and less likely to have spent time in jail prior to treatment, and drank less often than those men who refused. Thus, although agreeing to take disulfiram was not associated with an improved outcome overall, men with more social stability and less pervasive problems may be the ones most likely to benefit from the drug.     

幽门螺杆菌根除方案DUE评价模式的建立与应用

目的：建立本院幽门螺杆菌根除方案的药物利用评价（Drug use evaluation,DUE）标准,为合理治疗幽门螺杆菌提供依据。方法：根据建立的幽门螺杆菌（Hp）根除治疗方案的DUE标准,采用回顾性方法,对本院2019年1月～12月行Hp检测的患者,从用药指征、用药过程、用药结果进行评价与分析。结果：用药指征合理率为99.8%;用药过程中有73.9%的药物方案选择合理,用法用量合理率为78.0%,治疗疗程合理率为98.3%;用药结果合理率为12.8%。结论：依照所建立的Hp根除方案的药物利用评价标准,并对本院Hp根除治疗方案进行评估,可发现治疗过程中的缺陷,为规范幽门螺旋杆菌的药物治疗提供参考。     

Mortality in male alcoholics after ten to fourteen years

OBJECTIVE: Alcoholics frequently die prematurely. The purpose of this study was to determine: (1) whether subjects in a sample of 360 male alcoholics, followed over a period of 10-14 years, died prematurely: (2) if so, from what causes; and (3) whether such deaths are predictable from characteristics present at initial assessment. METHOD: Subjects were male veterans (N = 360) with a diagnosis of alcoholism admitted to an inpatient substance abuse treatment program at the Kansas City Veterans Affairs (VA) Medical Center during 1980-1984 who consented to participate in intake evaluations and subsequent follow-ups at 1 year and 10-14 years later. Of the 357 (99.2%) men located at the 10-14 year follow-up, 96 (26.6%) were confirmed as deceased, 255 survivors agreed to be reassessed and 6 subjects refused reassessment. Information regarding cause of death was obtained from death certificates, VA records and other sources. RESULTS: At intake, the subsequently deceased men were older, had less education, lower psychosocial functioning, more medical problems and greater psychiatric severity. Their overall death rate was 2.5 times greater than that of a reference group of men. Men in the 35-44 year age group were 5.5 times as likely to die. A statistical model utilizing measures of alcohol dependence to predict mortality from intake to 10-14 year follow-up indicated that alcoholics who limited drinking were half as likely to die whereas those who engaged in morning drinking were 2.5 times more likely to die. CONCLUSIONS: Alcoholic men, especially those in the group aged 35 to 44 years, have a significantly higher risk of premature death than a reference group of men. Men who engaged in morning drinking and could not limit drinking appeared to be at higher risk of mortality 10 years later.     

Utility of the MMPI-168 with men inpatient alcoholics

The ability of the MMPI-168 to estimate full-scale high-point code types was evaluated in 772 men inpatient alcoholics. Although concordance of code types was found to be 35% across the entire sample, concordance rates of specific codes varied from 78% for the 2-4/4-2 type to only 15% for the 7-8/8-7 type. The MMPI-168 also underestimated the frequency of many full-scale code types. Overall, the data indicated that the MMPI-168 should be used very cautiously with alcoholics when the goal is to estimate full-scale code types.     

Integration of pharmacotherapies in the existing programs for the treatment of alcoholics: An international perspective

Summary

This review examines current therapies of alcoholism and addresses the difficulties encountered in evaluating the result of integrating pharmaco‐ and psychosocial treatment of alcoholics. A variety of treatment modalities and goals, and factors influencing admission of alcoholics, exist in different countries creating problems of comparability.

Recognition of alcoholism as a separate entity from associated psychiatric co‐morbidity coupled with the introduction of specific pharmacotherapies represent a major advance in the treatment of alcoholism.

Combining psychosocial and pharmacological treatments appears to be the most effective approach in the treatment of alcoholics. In the future, rational therapy with appropriate choice of treatment strategies will decrease the necessity for hospital treatment of alcoholic patients.     

Alcohol dependence among cocaine-dependent outpatients: demographics, drug use, treatment outcome and other characteristics

OBJECTIVE: Concurrent dependence on alcohol is common among those seeking treatment for cocaine dependence. More information is needed about differences between those with and without concurrent alcohol dependence, including possible special treatment needs or outcome differences. METHOD: Data were obtained from 302 adults (70% men) enrolled in outpatient treatment for cocaine dependence. Individuals who did and those who did not meet criteria for alcohol dependence were compared on demographics, drug use, treatment outcome and other variables. RESULTS: With regard to cocaine use, alcoholics were more likely than nonalcoholics to report an intranasal route of administration, use of cocaine in social settings, more simultaneous use of cocaine and alcohol, and more adverse consequences of their cocaine use. With regard to alcohol use, alcoholics reported consuming alcohol more frequently and in larger amounts, had longer drinking histories and were more likely than nonalcoholics to report increases in alcohol consumption when using cocaine. Alcoholics were heavier cigarette smokers than nonalcoholics and reported more severe employment, legal, family and psychiatric problems. There were overall improvements in both groups from intake through 12 months after treatment. With regard to treatment retention and cocaine abstinence, alcoholics had better outcomes than nonalcoholics when treated with intensive behavioral counseling plus incentives, but the reverse was true when treated with control treatments. CONCLUSIONS: Compared with nonalcoholic cocaine-dependent subjects, codependent patients exhibit a wider array of problems, many of which merit professional attention. Both alcoholics and nonalcoholics exhibit substantial improvements during treatment, with alcoholics perhaps requiring extra treatment efforts for successful outcomes.