精神动力学心理治疗的效果

精神动力学心理治疗作为临床上主要的心理治疗形式之一,其有效性一直以来受到关注,本文通过外文数据库检索相关文献并进行复习,并探讨精神动力学心理治疗的临床效力效用研究以及循证心理治疗概念,对今后疗效研究提供建议。     

精神科临床工作中的若干法律问题

精神卫生立法工作虽然在我国仍处于漫长的起步阶段,但现代精神医学、尤其是精神卫生事业法律化管理方面的发展对于我国精神医学界的影响还是显而易见的。在人们法律意识不断增强的今天,许多需要以精神卫生法来调整的问题正日益凸现出来,如何通过立法来保护精神障碍患者的权益、规范当前新形势下的精神卫生工作、促进精神卫生事业更健康地发展,已经成为了摆在广大精神卫生工作者、法律工作者和有关卫生行政管理部门面前的一项紧迫的任务。以下我们拟就精神科临床工作中一些特殊并广泛存在争议的问题,结合国内外有关法律法规和具体实践,提出一些参考意见和看法。     

操作性心理动力学诊断简介

当代的精神疾病分类系统,比如ICD-10或DSM-Ⅳ,都是“纯描述”疾病的症状学,这两个诊断系统都对诊断过程进行了简化,因而使交流和研究都更便利,但也因此削弱了精神疾病诊断的丰富性和临床适用性,在用于精神动力学治疗中有很多限制。另一方面,一些精神分析取向或心理动力学取向的临床医生反对所有的分类系统,因为他们认为每个个案的心理病理表现都是“唯一的”。在这个背景下,约30多位来自于德国大学的心身医学和心理治疗部门的心理治疗师和心身科医师,利用三年多的时间,在1992年建立了操作性心理动力学诊断(Operationalized Psychodynami…     

精神科临床护士工作冲突的调查分析

目的 确认精神科临床护士在工作中冲突的水平和类型，及时采取有效措施，提高护士工作效率和对工作的满意度。方法 随机抽取2000年7月至2002年i0月在聊城市第四人民医院精神科临床工作的护士112名，进行问卷调查研究。结果 精神科临床护士工作中的冲突处于高水平状态，最常遇到的冲突类型为角色冲突。结论 护理管理者应不断评估精神科护士工作冲突的水平及类型，并及时采取应对措施，预防冲突的升级。     

心理治疗在口腔正畸治疗中临床应用的研究

目的在正畸治疗过程中配合应用心理治疗，可以提高正畸治疗效果。方法对12例18-32岁错he畸形并伴有一定程度不良心理表现的患者，采用固定矫治器正畸配合心理治疗。结果12例患者的不良心理表现均有明显改善或消除。结论在正畸治疗过程中配合应用心理治疗是非常必要、可行的。     

精神卫生机构功能的转变将成为推动心理治疗发展的重要契机

读《将心理治疗根植于精神科临床工作中》一文颇有感触。诚如作者肖泽萍所言,尽管有“当今医学模式是‘生物-心理-社会’共同作用的模式的共识,在精神医学界仍存在漠视‘心理-社会’因素是如何影响疾病的发展转归的现象,针对这部分因素进行干预的研究,其深度和广度远不及我们对生理因素的关注”。在2009年10月第九届精神科年会开幕前夕举行的中华医学会精神科分会换届改选会议上,第四届委员会做了的工作报告,报告中总结的第四届委员会在方方面面所做的大量卓有成效的工作,     

心理分析中的新鲜血液——认识领悟疗法

认识领悟疗法是钟友彬先生根据心理动力学理论，结合中国的具体情况和多年实践经验于七十年代末提出的一种心理治疗方法，是一种具有中国特色的短程精神分析方法。临床表明，它对神经症、恐人症、性变态等的治疗，具有十分良好的疗效。本文试着从它的理论根据、治疗遏程、治疗效果等入手，对它进行一个简要的评述。     

遭受工作场所暴力的精神科护士心理状况调查

目的 了解精神科护士遭受工作场所暴力后的心理压力状况,分析原因,探索对策.方法 采用症状自评量表(SCL-90)对203例遭受工作场所暴力的精神科护士进行调查.结果 203例护士SCL-90除人际敏感因子分低于中国常模,其余的阳性项目数和躯体化、焦虑、敌对因子分明显高于中国常模,差异均有统计学意义(P＜0.01).按不同年龄段及不同职称比较SCL-90各因子分,其中护士各年龄段之间差异均无统计学意义(P＞0.05),护士组的人际敏感、恐怖、精神病性因子分高于主管护师及以上职称护士,差异有统计学意义(P＜0.05);护师组的量表总分、阳性项目数、强迫、人际敏感、抑郁、恐怖、精神病性因子分高于主管护师及以上职称护士,差异均有统计学意义(P＜0.05).结论 遭受工作场所暴力的精神科护士心理压力普遍存在,低职称的护士心理压力要高于中级及以上职称护士,建议医院管理层根据不同的护士群体采取不同的干预对策.     

如何在精神科临床工作中规避风险

分析精神科临床中的健康风险,医疗风险和法律责任风险。提出如何防止危险发生。     

综合医院精神科会诊患者谵妄的临床特点

目的:探讨综合性医院精神科会诊中的谵妄与精神病专科医院中的谵妄的临床特点。方法:对综合性医院中精神科会诊中的58例谵妄患者(会诊组)与同期在精神病院的54例患者(非会诊组)的临床资料进行对照分析,并使用谵妄评分量表中文修订版(CAM-CR)测评。结果:会诊组中的谵妄患者年龄偏大,病因复杂,内科疾病以呼吸系统感染、脑卒中、心血管疾患多见,外科疾病以脑外伤、手术后、骨折多见,其中多系统疾病引起谵妄的几率最高,CAM-CR精神运动性抑制因子分显著高于非会诊组;非会诊组相对年龄偏小,病因简单,以精神活性物质依赖戒断、老年痴呆、抗精神病药应用不当多见,CAM-CR总分及意识水平的改变、知觉障碍、精神运动性兴奋因子分均显著高于会诊组。结论:综合性医院中的谵妄患者年龄大,病因症状复杂,误诊率高,预后差。会诊联络亟待加强。     

Psychotherapy in a psychiatric hospital

This study was aimed to evaluate the role of psychotherapy in psychiatric in-patient care at the example of the Bezirksklinikum Regensburg (BKR) (Community Clinic in Regensburg, Germany). Based on a sample of 6,719 patients suffering from F2-F6 ICD-10 diagnoses, the data of the psychiatric basic documentation (BADO) from January 1995 until April 1999 was retrospectively analysed regarding type and frequency of psychotherapy, influencing factors on indication, and effects of psychotherapy on treatment success.In 33% of cases, specific psychotherapy was in use. A client-centered therapy was carried out in 20% of patients. Other techniques of psychotherapy such as behaviour therapy, cognitive therapy, IPT for schizophrenics, or psychodynamic psychotherapy were applied to 2-6% of patients. Inpatients with eating disorders, personality disorders, neurotic disorders, somatization disorders, and depression were more likely to receive a specific psychotherapy. A significantly positive effect on treatment success was only documented in affective disorders, whereas a significantly negative influence was found in personality disorders.     

Psychotherapy research--implications for psychiatric treatment

The impact of findings gained in psychoanalytic-psychotherapeutic research and outcome studies on the psychiatric routine-treatment is reported. The importance of the psychoanalytic theory of mentalization for the treatment of patients with personality disorders is shown in three naturalistic efficacy studies. Interpretation of the dominating effect and of the transference-relationship-dyad could be confirmed as essential for the treatment progress. The empirical studies point at the necessity of interpreting affect-regulatory parameters, such as the hostile-externalizing-dysphoric parameter, from the very beginning of the treatment on. Acknowledgement and recognition of externalizing and projective mechanisms should be trained in the psychiatric routine treatment in order to establish a stable working alliance with psychiatric patients.     

Intensive Short-term Dynamic Psychotherapy in a private psychiatric office: clinical and cost effectiveness

OBJECTIVE: To assess the cost and clinical effectiveness of psychiatrist-provided Intensive Short-term Dynamic Psychotherapy (ISTDP) of patients referred to a private office. METHODS: ISTDP was provided to 89 patients referred to a private psychiatric office in Vancouver, Canada. Pretherapy self-report scores, (BDI, BAI, BSI, IIP [see full names in text]) medication costs, disability costs and healthcare costs were compared with posttherapy values and normative values. RESULTS: Patients' mean self-report scores went from the abnormal to normal range after an average of 14.9 hours of therapy. Returns to work, reduced healthcare utilization, and medication stopping accounted for a cost reduction of over Cdn$400,000 at one year after therapy. CONCLUSIONS: ISTDP appears to be an effective and cost-effective form of intervention when provided by a psychiatrist in a private office. Randomized controlled studies are warranted to further examine the cost benefits and efficacy of ISTDP.     

Science and clinical practice. 1865 psychiatric convention in Hannover

Psychiatric conventions in Germany have taken place since the 1840s. Concerning content and influence, outstanding was one in 1865 for scientists and physicians in Hannover, Germany. Practical and scientific problems of current psychiatric interest were discussed, particularly the question of monomania in the context of Unitarian theory, and further new, extramural ways of psychiatric care which already had received notice abroad (family care, agricultural colonies). The Hannover congress reveals the progressive influence of German institutional psychiatry.     

Evaluation and management of premenstrual syndrome in clinical psychiatric practice

Premenstrual syndrome, a long-recognized entity, has been the subject of increased interest in recent years. Many women, perhaps a majority, experience some premenstrual symptoms; a minority have severe symptoms. The authors explore possible links to psychiatric disorders, outline general evaluation and management approaches, and discuss specific implications for the treatment of psychiatric patients who have a menstrually related component to their symptoms. It is hoped that a continuing understanding of this complex area may further our conceptualization and treatment of both premenstrual symptoms and psychiatric disorders.