惊恐障碍的非精神科误诊调查分析

目的调查惊恐障碍患者的误诊特点。方法自制统计表对55例确诊惊恐障碍的患者的性别、年龄、疾病病程、曾误诊的疾病种类、重复就诊于非精神科次数、误诊期间诊治费用以及正确治疗后达临床治愈的疗程进行调查统计。结果 52.73%的惊恐障碍患者非精神科误诊时间长于1年;58.18%的患者就诊非精神科次数少于5次,14.55%的患者大于10次;误诊期间浪费的诊治费用有47.27%的患者超过5000元;确诊后住院治疗期90.91%的患者在2个月内惊恐发作消失。结论惊恐障碍的非精神科误诊率高,误诊时间长,医疗资源浪费严重,但确诊后经精神科治疗近期疗效较好。     

1例初中生惊恐障碍的诊断与治疗

目的以1例惊恐障碍的初中生为例探讨条件性情绪干预法对惊恐障碍干预的有效性,为惊恐障碍的心理干预提供临床借鉴。方法在单个被试的情况下,采用多基线实验设计,运用条件性情绪干预法对来访者进行临床干预。同时用汉密顿焦虑量表（HAMA）、焦虑自评量表（SAS）、症状自评量表（SCL-90）对干预过程中各项指标的变化进行评估。结果干预后来访者的各项指标稳定,惊恐发作次数减少,焦虑水平降低,社会适应性增强。结论运用条件性情绪干预法可对惊恐障碍进行有效干预,降低惊恐焦虑水平,长期训练有彻底治愈的可能。     

惊恐障碍的分子遗传学研究进展

惊恐障碍病因可能与经典神经递质GABA、5－HT、DA、Ach及神经肽CCK等功能异常有关，本文对近年有关惊恐障碍患者的GABA、5－HT、DA、ACH及CCK受体基因的研究作一综述。     

丁螺环酮治疗惊恐障碍的临床观察

目的　丁螺环酮治疗惊恐障碍临床疗效观察。方法　符合 CCMD-3惊恐障碍诊断标准 ,采用汉密顿焦虑量表(HAMA)于治疗前及治疗后 3周、6周分别进行评分比较。结果　丁螺环酮治疗惊恐障碍显效率 5 8.8% ,总有效率 73 .5 %。结论　丁螺环酮治疗惊恐障碍有明显疗效     

惊恐障碍的分子遗传学研究进展

惊恐障碍病因可能与经典神经递质ＧＡＢＡ，５－ＨＴ，ＤＡ，Ａｃｈ及神经肽ＣＣＫ等功能异常有关，本对近年有关惊恐障碍患的ＧＡＢＡ，５－ＨＴ，ＤＡ，Ａｃｈ及ＣＣＫ受体基因的研究作一综述。     

文拉法辛缓释剂对首发惊恐障碍的疗效及安全性观察

目的观察文拉法辛缓释剂治疗首发惊恐障碍的治疗效果和安全性。方法对37例门诊首发惊恐障碍患者予以文拉法辛缓释剂治疗观察共6周,治疗前后采用汉密尔顿焦虑量表（HAMA,14项）评分观察疗效和国内统一4级疗效评定和比较,以及观察记录不良反应。结果①文拉法辛缓释剂治疗惊恐障碍的临床治愈率和总有效率分别为70.2%和91.9%。文拉法辛缓释剂治疗后的总分在第一周末就已经开始下降,并且差异有显著性（t=11.35,P〈0.05）;②37例患者治疗前后HAMA评分有明显改变,治疗过程中各时段两量表评分比较,差异均有显著性（P〈0.05）,并且文拉法辛缓释剂的疗效随治疗时间的延长而提高;③服药治疗6周后近90%患者的不良反应会自行缓解。结论文拉法辛缓释剂具有起效快,疗效好,安全性高,副作用轻微,依从性好的特点,不失为治疗首发惊恐障碍的首选药物。     

帕罗西汀合并认知行为疗法治疗惊恐障碍对照研究

目的观察帕罗西汀合并认知行为疗法对惊恐障碍的治疗效果。方法将符合ICD-10诊断标准的40例惊恐障碍患者分为治疗组和对照组,治疗组给予帕罗西汀30~40mg/d合并认知行为治疗,对照组只给予帕罗西汀30~40mg/d治疗,应用临床标准疗效及汉密尔顿焦虑量表（HAMA）、临床疗效总评量表（CGI-SI）及副反应量表（TESS）评定疗效和不良反应。观察12周。结果在治疗第4、8和12周末时,治疗组疗效均优于对照组,具有显著性统计学意义（P〈0.05）。两组不良反应轻微,无需处理。结论帕罗西汀合并认知行为疗法治疗惊恐障碍效果优于单纯用药物治疗。     

惊恐障碍伴癔症性人格特征一例报告

患者,女,28岁,未婚,初中文化,无业.发作性头晕、心慌、全身不适10年,加重3年.家族史阴性,既往体健.患者自幼聪明伶俐,爱唱歌、跳舞,性格外向,重感情,喜表现,好面子.10年前患者与第一任男友分手后突然出现心慌、憋气、头晕、舌头发麻、恐惧和濒死感,持续约20分钟缓解,之后1个月内有2次类似发作.     

惊恐障碍诊断延迟的相关因素分析

本文作者近期研究资料提示 ,惊恐障碍患者平均的诊断延迟时间为 2 5.36± 4 1.2 9月 ,其中男性的平均诊断延迟时间为 2 0 .80± 2 6 .2 0个月 ,女性为16 .90± 19.50个月[1] 。而Ｍｏｒｅａｕ等综合报道惊恐障碍患者的平均诊断延迟时间为 12 .7年[2 ] 。可见惊恐障碍患者常不能早期确诊 ,延误治疗且造成医疗卫生资源极大的浪费。本文的目的就是对与惊恐障碍诊断延迟有关的因素进行分析。1　资料和方法1990年 1月至 1997年 12月 ,在本院心理咨询门诊符合ＤＳＭ -Ⅲ -Ｒ惊恐障碍诊断标准的患者作为入组对象 ,共 10 0例。入组后用自编的调查表…     

认知行为疗法并帕罗西汀治疗惊恐障碍疗效分析

目的评价认知行为疗法并帕罗西汀治疗惊恐障碍的治疗效果。方法将符合中国精神障碍分类与诊断标准的69例惊恐障碍患者随机分为研究组（n=37）和对照组（n=32）。研究组给予认知行为并帕罗西汀治疗,对照组单用帕罗西汀治疗,疗程12周,在入组前和治疗2、4、8、12周末应用临床疗效标准和汉密尔顿焦虑量表（HAMA）评定疗效。完成该研究的60名参与者的数据纳入了结果分析。结果汉密顿焦虑量表总分研究组治疗2周末较治疗前有极显著性下降（t=5.56,P〈0.01）;对照组治疗4周末较治疗前有极显著性下降（t=4.27,P〈0.01）;治疗后2、4、8、12周末研究组疗效显著优于对照组。结论认知行为疗法并帕罗西汀治疗惊恐障碍效果优于单用帕罗西汀治疗。     

Assessment Tools for Adult Bipolar Disorder

This article reviews the current state of the literature on the assessment of bipolar disorder in adults. Research on reliable and valid measures for bipolar disorder has unfortunately lagged behind assessment research for other disorders, such as major depression. We review diagnostic tools, self-report measures to facilitate screening for bipolar diagnoses, and symptom severity measures. We briefly review other assessment domains, including measures designed to facilitate self-monitoring of symptoms. We highlight particular gaps in the field, including an absence of research on the reliable diagnosis of bipolar II and milder forms of disorder, a lack of empirical data on the best ways to integrate data from multiple domains, and a shortage of measures targeting a broader set of illness-related constructs relevant to bipolar disorder.     

惊恐障碍的几种主要心理治疗简介

惊恐障碍(PD)是一组反复出现的心悸、出汗、震颤等植物神经症状，伴强烈的濒死感或失控感为特征的急性焦虑障碍。数次发作后可以出现预期焦虑、场所恐怖及抑郁症状。在美国PD的终身患病率在3％左右，且女性较男性更易患PD。     

Panic Disorder and Smoking

An integrated theoretical conceptualization of the cooccurrence of panic disorder and smoking (PDSM) is presented. First, the nature and prevalence of this apparently costly, yet largely unrecognized, co-occurrence of health care problems is described. Second, a theoretical analysis regarding how smoking may negatively impact panic disorder is described. Third, the negative impact of panic disorder on smoking outcomes is discussed. Finally, primary implications of this conceptualization for the research and treatment of individuals with PDSM are elaborated, including the need to assess for smoking among persons with panic disorder and the potential need for specialized treatment approaches.     

Differential performance on tasks of affective processing and decision-making in patients with Panic Disorder and Panic Disorder with comorbid Major Depressive Disorder

BACKGROUND: Neuropsychological studies have provided evidence for deficits in psychiatric disorders, such as schizophrenia and mood disorders. However, neuropsychological function in Panic Disorder (PD) or PD with a comorbid diagnosis of Major Depressive Disorder (MDD) has not been comprehensively studied. The present study investigated neuropsychological functioning in patients with PD and PD + MDD by focusing on tasks that assess attention, psychomotor speed, executive function, decision-making, and affective processing. METHODS: Twenty-two unmedicated patients with PD, eleven of whom had a secondary diagnosis of MDD, were compared to twenty-two healthy controls, matched for gender, age, and intelligence on tasks of attention, memory, psychomotor speed, executive function, decision-making, and affective processing from the Cambridge Neuropsychological Test Automated Battery (CANTAB), Cambridge Gamble Task, and Affective Go/No-go Task. RESULTS: Relative to matched healthy controls, patients with PD + MDD displayed an attentional bias toward negatively-valenced verbal stimuli (Affective Go/No-go Task) and longer decision-making latencies (Cambridge Gamble Task). Furthermore, the PD + MDD group committed more errors on a task of memory and visual discrimination compared to their controls. In contrast, no group differences were found for PD patients relative to matched control subjects. LIMITATIONS: The sample size was limited, however, all patients were drug-free at the time of testing. CONCLUSIONS: The PD + MDD patients demonstrated deficits on a task involving visual discrimination and working memory, and an attentional bias towards negatively-valenced stimuli. In addition, patients with comorbid depression provided qualitatively different responses in the areas of affective and decision-making processes.     

Interpersonal Relationships in Panic Disorder With Agoraphobia: A Review of Empirical Evidence

Recently there has been considerable research exploring the interpersonal relationships of patients diagnosed with panic disorder with agoraphobia. In general, recent empirical investigations support the notion that agoraphobics' interpersonal relationships are problematic and can decrease treatment efficacy. In addition, it appears that involving the partner of the agoraphobic in treatment may be more effective than treating the client alone. However, these conclusions are limited by several methodological and conceptual shortcomings, including narrow and/or biased sample selection, lack of adequate measures, and insufficient use of suitable control groups.     

对一例惊恐障碍的系统式家庭干预

随着心理咨询与治疗在中国的蓬勃发展,读者对阅读个案有越来越迫切的需要。如何审阅个案,是困扰了本刊多年的一个难题。从本期开始,本刊尝试不定期刊登经过专家点评的个案。请您将对这种方式的看法和建议告诉我们,以便本刊不断加以改进。同时欢迎您将自己的个案寄给本刊编辑部,寄出前必需征求来访者的书面同意。另外,从2001年开始设置的“心理咨询与治疗讨论园地”现并入“心理咨询与治疗专栏”,继续对重点问题和疑难问题进行讨论。欢迎大家踊跃投稿,或者将您认为值得讨论的问题告诉我们。讨论稿请寄本刊编辑部,或钱铭怡教授(北京大学心理学系,邮编100871)。     

惊恐障碍病人随访研究

目的 :探讨惊恐障碍病人维持治疗中出现的有关问题及影响因素。方法 :对 38例住院的惊恐障碍的病人出院后跟踪随访 ,对维持治疗中出现的问题 (如依从性、复发等 )以及影响因素进行分析。结果 :38例中 ,复发 2 2例 ,其中不依从者 15例 ,显著多于未复发组 ( 3/ 16 ,χ2 =9 0 8,P <0 0 5 )。大部分复发发生在出院后的第一年 ( 18/ 2 2 ) ,尤其是最初半年 ( 13/ 2 2 )。不依从原因有较多 ,其中患者对维持治疗重要性认识不足最常见 ,减药或停药者复发较多。认知行为治疗对改善伴场所恐怖的惊恐障碍患者的回避行为很有帮助。结论 :惊恐障碍患者维持治疗至少应有一年 ,部分还应适当延长。并应加强认知治疗及病人对治疗依从性的教育。维持治疗中减药或停药时均应谨慎 ,尤其是SSRI类