慢性疼痛与情绪障碍及其干预治疗效应

目的:分析慢性疼痛与情绪障碍之间的关系,探讨心理及药物治疗对慢性疼痛的干预作用。资料来源:应用计算机检索Medline1989-01/2004-05和Embase1989-01/2004-05有关慢性疼痛与情绪障碍关系的文献,检索词“Chronicache,emotionaldisorder,treament”,并限定文章语言种类为English。观察对象为疼痛持续时间超过6个月以上的患者。资料选择:选取有关慢性疼痛与情绪障碍关系及其治疗干预的文献,进行初审,删除陈旧及重复的文献,然后查找余下的文献全文。质量评价主要考察资料的真实性,调查设计是否严密,实施过程是否严格,统计学处理是否合理。资料提炼:共检索到20篇关于慢性疼痛与情绪障碍关系及其治疗干预的文献,11篇文献符合纳入标准。排除的9篇试验中,7篇系重复的同一研究,2篇是Meta分析。资料综合:11篇文献均包括观察组和对照组,其中观察组应用镇痛药合并心理治疗及抗抑郁药,对照组应用镇痛药但未合并心理治疗及抗抑郁药,对两组患者的疗效进行比较分析。结论:慢性疼痛与情绪障碍同时存在,应用镇痛药合并心理治疗及抗抑郁药可以显著缓解患者的疼痛,干预效果优于单纯应用镇痛药者。     

青少年情绪障碍的心理干预与治疗

目的：研究青少年情绪障碍的心理干预与治疗效果。方法：随机选择2013年6月~2015年6月合作中学的学生2 000例为研究对象,对其进行国际通用的卫生量表进行测量筛选,将筛选出的150例情绪障碍的学生随机分为干预组和对照组。对其中75例情绪障碍的青少年进行心理干预措施,该组为干预组。对剩余的75例情绪障碍的青少年一般的支持治疗,该组为对照组。统计两组患者的心理状况评分。结果：干预组患者的SAS评分和SDS评分均明显比进行心理干预前低。对照组患者SAS和SDS评分较之干预前也有小幅度的降低。干预组患者SAS评分和SDS评分均明显低于对照组,差异具有统计学意义（P＜0.05）。两组患者干预前均属于轻度抑郁状态,进行干预后,可以发现两组患者抑郁均得到了改善,干预组患者属于无抑郁状态,对照组患者还处于轻度抑郁状态。干预组患者HRSD得分明显低于对照组,差异具有统计学意义（P＜0.05）。结论：对患有情绪障碍的青少年实施心理干预措施,可以有效改善青少年的心理状态。     

青少年情绪障碍的心理干预与治疗

目的:研究青少年情绪障碍的心理干预与治疗效果。方法:随机选择2013年6月~2015年6月合作中学的学生2 000例为研究对象,对其进行国际通用的卫生量表进行测量筛选,将筛选出的150例情绪障碍的学生随机分为干预组和对照组。对其中75例情绪障碍的青少年进行心理干预措施,该组为干预组。对剩余的75例情绪障碍的青少年一般的支持治疗,该组为对照组。统计两组患者的心理状况评分。结果:干预组患者的SAS评分和SDS评分均明显比进行心理干预前低。对照组患者SAS和SDS评分较之干预前也有小幅度的降低。干预组患者SAS评分和SDS评分均明显低于对照组,差异具有统计学意义(P0.05)。两组患者干预前均属于轻度抑郁状态,进行干预后,可以发现两组患者抑郁均得到了改善,干预组患者属于无抑郁状态,对照组患者还处于轻度抑郁状态。干预组患者HRSD得分明显低于对照组,差异具有统计学意义(P0.05)。结论:对患有情绪障碍的青少年实施心理干预措施,可以有效改善青少年的心理状态。     

舍曲林治疗儿童情绪障碍

【目的】应用舍曲林对儿童情绪障碍 31例进行研究 ,探讨该药物的有效性和安全性。【方法】符合ICD 10这个标准的 31例儿童情绪障碍患儿按年龄舍曲林剂量分别为 2 5～ 15 0mg/d ,平均 5 6 .6 7mg/d ,治疗8周 ;分别于治疗前、治疗后 1周、2周、1个月、2个月使用儿童大体评定量表 (CGAS)评定障碍的严重程度 ,并用副反应量表 (TESS)评定药物的副反应。【结果】31例患者之治疗前CGAS评分 4 9.19± 7.11,治疗后 2周有不同程度好转 ;治疗 2个月有 2 7例 (87% )CGAS评分≥ 70 (达正常范围 )。研究结束时临床疗效痊愈 9例 ,显进 14例 ,有效率为 74 % ,好转 7例 (2 3% )。副反应发生 11例 (35 % ) ,无因副反应而中断治疗者。【结论】舍曲林是一种治疗儿童情绪障碍的有效药物 ;副反应轻微 ,大多数儿童均能耐受 ,安全性较好。     

精神分裂症儿童父母的情绪障碍

目的 探讨父母在孩子患精神分裂症后的焦虑和抑郁情绪。方法 对河南省精神病医院住院的49位儿童精神分裂症患者的98位父母采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和自编的定式调查表进行测评，并和国内常模进行比较。结果 精神分裂症患者的父母的SAS、SDS评分明显高于国内常模，患者母亲的情绪障碍较父亲重。结论 儿童精神分裂症患者的父母存在明显的焦虑及抑郁情绪，对他们应该进行合适的心理治疗和心理干预。     

外化疗法治疗情绪障碍

运用外化疗法治疗4例情绪障碍的病人,结果显示,4例病人的躯体化、焦虑、敌对情绪有显著下降,而抑郁情绪改善不明显。本文认为,对情绪障碍的病人采用药物治疗的同时,辅以外化疗法有其积极意义。     

儿童情绪障碍1例心理治疗过程报告

目的：报道1例儿童抑郁症的诊断与治疗,揭示儿童情绪障碍的非药物治疗方法方法：1例抑郁症儿童,男,10岁,小学四年级学生,发病前成绩优秀,做事认真,爱好绘画.于半年前出现情绪低落症状,后沉迷于网络游戏,感觉有一种难以言状的苦闷,认为自己一无是处,感到自己非常倒霉,死了比活着好,拒绝与任何人来往,近日焦虑恐惧情绪加重,伤人毁物.躯体检查无异常发现,精神检查：仪态整洁,被动接触,情绪低落、易激惹.拒绝叙述内心体验,讨厌学习,讨厌父亲,最烦的是没有人理解自己,不愿意说话,有过死的想法和自伤及伤人行为,自知力缺乏.根据中国精神障碍分类与诊断标准第3版诊断标准,符合儿童抑郁症的诊断.治疗的策略采取综合性心理治疗,首先采用绘画意象等整合调节患儿抑郁情绪,然后利用行为疗法调节患儿人际过敏情绪;再次运用亲情拓展游戏即家庭治疗,重建家庭和谐,改善亲子关系;最后通过能力训练和自信心训练提高儿童的社交技巧加深儿童自我认知,重建自信.心理咨询12次,50～60min/次,主要观察患儿综合心理治疗后,抑郁情绪改善情况,并于半年后进行复查.结果：①绘画房-树-人心理测试结果说明患儿有严重的抑郁情绪.②经过意象对话技术、音乐疗法及行为疗法训练,患儿的抑郁情绪明显好转,人际过敏情绪得到了调节.在家庭治疗中,通过亲情拓展游戏,亲子关系开始逐渐融洽,在孩子进步的过程中,父母也得到了教育,并有了相应的认知改变.③通过能力训练及自信心训练,患儿开始觉得自己有能力,心情好多了,意识到所有问题并不像自己担心的那样严重.④半年后复查,患儿精神面貌焕然一新,恐惧父亲的感觉消失,恢复正常上学,成绩也逐步提升. 结论：根据患儿发病的有关因素和症状特征及儿童期的特点,在治疗方面与成人比较,儿童的药物治疗占较次要位置,心理社会环境的调整常起更关键的作用.所以对于情绪障碍儿童的治疗采取非药物的综合心理治疗方法效果更好.     

神经症病人家属情绪障碍调查与心理干预

[目的]了解神经症病人家属的情绪障碍和心理干预的效果。[方法]采用90项症状自评量表(SCL-90)对120例神经症病人家属进行心理状况调查,并对病人家属进行心理干预。[结果]神经症病人家属普遍存在心理问题,情绪障碍以焦虑、抑郁、躯体化、睡眠障碍为突出,通过心理干预后,SCL-90评分明显下降。[结论]心理干预能有效减轻家属的焦虑、抑郁情绪,改善家属的躯体化障碍、睡眠障碍。     

绘画疗法在1例骨折伴多发伤儿童情绪障碍中的心理干预体会

目的:总结1例骨折伴多发伤儿童运用绘画疗法缓解情绪障碍的心理干预体会,以期为相似案例提供心理护理新思路。方法:以“房-树-人”“随意画”等绘画技术为媒介对患儿出现的情绪及行为问题进行干预。结果:患儿焦虑、抑郁和恐惧等情绪减轻,焦虑自评量表(SAS)评分从58分降至50分,抑郁自评量表(SDS)评分从55分降至49分,均在正常范围,破坏性行为减少,积极配合康复治疗。结论:绘画疗法能有效促进儿童情绪表达,缓解情绪障碍,改变行为模式,促进成长。     

Chronic pain disorders and headache chronification

It is estimated that nearly half of the global adult population suffers from an active headache disorder, most of whom experience attacks on an episodic basis. The transition from episodic to chronic headache is a poorly understood process. Epidemiological findings demonstrating comorbidity and common risk factors suggest that headache progression or prognosis may be related to the presence of other chronic pain disorders. This review highlights findings from population-based studies on headache and other pain disorders and how they relate to each other, with a focus on understanding headache chronification. We also consider the limitations and methodological challenges in understanding how two different chronic pain disorders may be related.     

Chronic pain/dysfunction in whiplash-associated disorders

OBJECTIVE: The purposes of this article are (1) to review current knowledge of and recent concepts pertaining to the causes of chronic pain and/or dysfunction following whiplash-type injuries and (2) to acquaint those who treat these types of injuries with possible mechanisms of continued pain and or dysfunction following whiplash. DATA COLLECTION: A review of the literature on mechanisms of injury and neurologic considerations was undertaken. A hand search of relevant medical, neuroscience, chiropractic, and online Index Medicus sources and other sources involving mechanisms of nociception, neurotransmitters, and receptors that might evolve from whiplash-type soft tissue injuries was conducted. RESULTS: Pain is a complex phenomenon that has great variability. Chronic pain appears to involve a deficient descending inhibitory process and/or ongoing excitatory input. CONCLUSIONS: There is a wide variety of reactions by individuals to any given type of stimulus. Injury may lead to increases in neuronal activity and prolonged changes in the nervous system. Chronic pain may be seen as part of a central disturbance accompanied by disinhibition or sensitization of central pain modulation, mirrored in the immune and endocrine systems. Patients with chronic whiplash syndrome may have a generalized central hyperexcitability from a loss of tonic inhibitory input (disinhibition) and/or ongoing excitatory input contributing to dorsal horn hyperexcitability. Dysfunction of the motor system may also occur, with or without pain. The purpose of treatment should be not only to relieve pain but also to allow for proper proprioception.     

Chronic pain rehabilitation in chronic headache disorders

This article reviews the treatment goals and efficacy of comprehensive pain rehabilitation programs for the treatment of chronic headache. Substantial data demonstrate improved outcomes from rehabilitative treatment for chronic noncancer pain. We present a discussion of the most relevant recent publications on pain rehabilitation in chronic headache disorders. This article describes pain rehabilitation, reviews outcome data for chronic pain patients treated in this setting, and describes the unique applicability of this treatment approach for patients with chronic headache. Particular attention is directed to the rationale for and the results of the withdrawal, in a pain rehabilitation setting, of opioids and simple analgesics, ergots, and triptans that contribute to medication overuse headaches. Additionally, a case example is reviewed that illustrates the structure and function of a pain rehabilitation program in the treatment of a patient with intractable headache.     

Chronic pain patients are impaired on an emotional decision-making task

Chronic pain can result in anxiety, depression and reduced quality of life. However, its effects on cognitive abilities have remained unclear although many studies attempted to psychologically profile chronic pain. We hypothesized that performance on an emotional decision-making task may be impaired in chronic pain since human brain imaging studies show that brain regions critical for this ability are also involved in chronic pain. Chronic back pain (CBP) patients, chronic complex regional pain syndrome (CRPS) patients, and normal volunteers (matched for age, sex, and education) were studied on the Iowa Gambling Task, a card game developed to study emotional decision-making. Outcomes on the gambling task were contrasted to performance on other cognitive tasks. The net number of choices made from advantageous decks after subtracting choices made from disadvantageous decks on average was 22.6 in normal subjects (n = 26), 13.4 in CBP patients (n = 26), and -9.5 in CRPS patients (n = 12), indicating poor performance in the patient groups as compared to the normal controls (P < 0.004). Only pain intensity assessed during the gambling task was correlated with task outcome and only in CBP patients (r = -0.75, P < 0.003). Other cognitive abilities, such as attention, short-term memory, and general intelligence tested normal in the chronic pain patients. Our evidence indicates that chronic pain is associated with a specific cognitive deficit, which may impact everyday behavior especially in risky, emotionally laden, situations.     

Chronic pain treatment with antidepressants--metaanalysis

Both preclinical and clinical evidence support the usefulness of antidepressants in chronic pain treatment. Monoamine uptake inhibitors influence the neurotransmissions of noradrenaline (NA) and/or serotonin (5-HT); their effect on nociception is thought to take place predominantly within the spinal cord. Antidepressant drugs seem to differ in their properties as analgesics and as thymoleptics. The present work is aimed at correlating the special mechanism of action of antidepressants in diminishing nocicepetion with the pharmacological profile of these drugs in clinical pain treatment. From a preclinical, experimental point of view, it can be expected, that mixed type uptake blockers should be superior to selective NA or 5-HT uptake inhibitors. The analgesic profile of antidepressants was established by a metaanalysis of clinical trials on the effect of these drugs, given alone or in combination with other analgetics, in chronic pain syndromes. 57 Clinical trials were separated into 5 groups according to their scientific quality: [1] placebo-controlled double-blind studies with high power; [2] placebo-controlled double-blind studies with low power; [3-4] open controlled studies or studies with historical controls; [5] case reports. A study was positive if the tested antidepressant was more effective than placebo or the compared drug or seemed beneficial with respect to the interval of its previous absence. The most effective antidepressants in chronic pain treatment only included unselective monoamine reuptake inhibitors in the following rank order: amitriptyline > clomipramine > or = desipramine > or = imipramine > or = doxepin. A statement about the appropriate dosage of these drugs in chronic pain treatment, however, must wait for properly conducted dose finding studies which include the measurement of plasma concentrations.     

The complex pain patient: interventional treatment and nursing issues

This article discusses interventional treatment for the complex pain patient, including intraspinal opioid administration spinal cord stimulation, and commonly performed nerve blocks. The role of the nurse has grown to support these technological interventions, and nursing has provided a foundation to strengthen the success of these interventions through watchful monitoring and patient education.     

Chronic pain patients' beliefs about their pain and treatment outcomes

A novel assessment procedure measuring chronic pain patients' agreement with information presented on a clinic orientation videotape was evaluated as a predictor of short-term treatment outcome. One hundred randomly selected outpatients viewed a 15-minute videotape detailing conservative approaches to pain management and completed a questionnaire measuring factual recall of the videotape presentation and their acceptance or rejection (ie, agreement) of this information. Patient ratings of satisfaction with treatment were assessed one month after treatment. Multivariate analyses revealed that extent of agreement with the videotape content was significantly associated with lower pain ratings, increased ratings of physical ability, and higher treatment satisfaction. Prognostic use of this procedure for identifying patients at risk for nonadherence to treatment is discussed.     

大鼠脑缺血再灌注后细胞间黏附分子1表达与白细胞浸润的关系及吲哚美辛的干预效应

目的：观察脑缺血2h再灌注不同时间点脑组织细胞间黏附分子1的表达与白细胞浸润的关系，并观察吲哚美辛对细胞间黏附分子1表达及白细胞浸润的影响。 方法：实验于2004-09／2005-03在大连医科大学附属第二医院中心实验室完成。取35只雄性SD大鼠随机分为假手术组5只、对照组25只，吲哚美辛组5只，对照组又分为缺血2h再灌注2，12，24，48．72h 5个亚组，每个亚组5只。①造模：采用线栓法制作大鼠大脑中动脉阻断模型，阻断大鼠大脑中动脉血流2h之后进行再灌注。②给药：吲哚美辛组在再灌注24h时灌胃给予吲哚美辛（按10mg／kg，溶于2mL生理盐水中），对照组中的再灌注24h亚组给予等容生理盐水。③观察指标：经免疫组化和苏木精-伊红染色，测定细胞间黏附分子1表达阳性微血管数和白细胞计数。 结果：35只大鼠均进入结果分析。①在脑缺血再灌注早期坏死区周围微血管内皮细胞表达细胞间黏附分子1即开始增多[再灌注2h：（15．94&;#177;1．90）个／视野，再灌注12h：（30．73&;#177;3．01）个／视野]，并于24h达高峰[（37．86&;#177;2．21）个／视野]，各对照亚组与假手术组[（0．68&;#177;0.69）个／视野]比较差异有显著性意义（P〈0．01），且各亚组间比较差异有显著性意义（P〈0．01）。②在脑缺血再灌注早期坏死区周围白细胞浸润即开始增多[再灌注2h：（2．30&;#177;0．91）个／视野，再灌注12h：（9．99&;#177;1．40）个／视野]，并于24h达高峰[（22．11&;#177;1．71）个／视野]，各对照组亚组与假手术组比较有显著性差异（P〈0．01），且各亚组两两比较组间差异有显著性意义（P〈0．01）。③细胞间黏附分子1表达与白细胞浸润的相关性分析表明两者之间呈正相关（r=-0．731，P〈0．01）。④吲哚美辛组细胞同黏附分子1表达及白细胞浸润计数[（16．01&;#177;11．43）个／视野，（10．55&;#177;2．64）个／视野1均低于再灌注24h亚组（P〈0．01）。 结论：脑缺血再灌注后细胞问黏附分子1可介导白细胞与内皮细胞的黏附；吲哚美辛可降低脑缺血再灌注后细胞间黏附分子1的表达和白细胞的浸润，对脑缺血再灌注损伤具有保护作用。