新型冠状病毒肺炎3例患者遭受网络暴力的心理干预

本文中报道的3例新型冠状病毒肺炎患者均为30多岁年轻女性,入院后在遭受个人私生活方面的网络暴力伤害后,出现明显的情绪应激反应,如抑郁状态、急性应激障碍、分离性障碍。我们采用短程、个体化、综合性心理干预,包括支持、鼓励、倾听、安全确认、宣泄、心理暗示、激发内在潜能等对患者进行心理干预,其中例3患者在进行心理干预的同时辅以...     

新型冠状病毒肺炎疫情心理危机干预重点及工作方式的转变

本文初步分析了新型冠状病毒肺炎(COVID-19)疫情下民众存在的主要心理问题,并对当下心理危机干预工作的重点及工作方式的转变进行了较为系统的思考和梳理,以期为下一步顺利开展工作提供参考。     

新型冠状病毒肺炎疫情心理危机干预步骤——Response模式

本文目的是为服务于本次新型冠状病毒肺炎(COVID-19)的广大心理援助者提供专业的指导和建议。根据临床工作和既往危机干预经验,本文详细介绍了进行危机干预的Response模型。Response模式包括8个步骤:建立治疗关系、评估、制定解决方案、优先排序、实证方法、价值中立、主观判断和退出。该模式在强调建立良好治疗关系的前提下,也强调心理援助者需要具备和疫情相关的基础知识,并进行准确评估、运用循证的心理治疗方法对求助者的核心诉求进行干预。本文将逐一讨论Response模型的干预步骤,供专业同行参考。     

新型冠状病毒肺炎病人康复早期心理应激状态调查及影响因素分析

目的 探讨新型冠状病毒肺炎（COVID-19）病人康复早期心理应激状态及其影响因素。方法 以2020年3月1日至2020年3月14日由专科医院治愈出院并转入我院隔离观察病房的COVID-19康复者126例为研究对象,通过网络问卷调查采集心理学信息,问卷包含创伤后应激障碍自评量表（PTSD-SS）、抑郁自评量表和焦虑自评量表。采用多元线性回归分析检验影响因素。结果 126例PTSD-SS评分平均（45.5±18.9）分,39例（31.0%）存在应激障碍;创伤性再体验评分平均（15.4±6.8）分,52例（41.3%）有反复重现体验症状;回避症状评分平均（11.9±5.7）分,35例（27.8%）存在回避症状;警觉性增高评分平均（11.3±5.0）分,51例（40.5%）警觉性增高。28例（22.2%）有焦虑情绪,48例（38.1%）有抑郁情绪。多因素线性回归分析发现,退休、心理支持与PTSD-SS评分及其三个症状评分呈显著负相关（P<0.05）,女性、焦虑情绪与PTSD-SS评分及其三个症状评分呈显著正相关（P<0.05）,抑郁情绪与警觉性增高评分呈显著正相关（P<0.05）。结论 近1/3的COVID-19病人康复早期存在应激障碍,女性、未退休、缺乏心理支持、存在焦虑抑郁情绪这四大类人群应激障碍症状尤为严重,建议所有康复病人定期接受心理评估     

新型冠状病毒肺炎疫情心理危机干预中的"三安"原则

本文通过简要分析新型冠状病毒肺炎疫情给不同人群造成的身心影响,提出适用于疫情防控心理危机干预的"三安"原则,以期帮助受影响的群众顺利渡过疫情心理难关,促进身心康复。     

重症急性呼吸综合征患者应激相关障碍及其心理干预的初步分析

20 0 3年春 ,我国突发的重症急性呼吸综合征 (severeacuterespiratorysyndrome ,SARS)是一次灾难性事件。在这一事件中 ,患者承受着各种精神压力 ,包括自身躯体上的痛苦、生与死的精神压力 ,部分患者还同时承受着亲属感染甚至病故等多重痛苦和压力。在 4月中旬北京建立了SARS定点医院后 ,患者中相继出现了拒绝治疗甚至自杀等严重精神问题。为此 ,北京市卫生局迅速组织了由精神科医师为主的专业队伍 ,于 5月初进驻各SARS定点医院。现将SARS定点医院———北京胸科医院的资料进行初步分析。一、住院SARS患者中出现的精神症状自 2 0 0 …     

小剂量奥氮平治疗新型冠状病毒肺炎患者冲动攻击行为2例

本文目的是报道2例新型冠状病毒肺炎患者在被隔离治疗期间出现冲动攻击行为时,小剂量奥氮平疗效确切。该2例患者系来自同一个家庭的一对母女,均有疫区接触史。在被隔离治疗后对医护人员表现出各种不配合、言语攻击,予一般心理疏导收效甚微,但联合奥氮平1. 25~2. 50 mg/晚治疗后效果好,情绪稳定、配合治疗,冲动攻击行为消失,未见副作用。     

新型冠状病毒肺炎疫情和游戏障碍风险:防控常态化形势下的回顾和思考

我国目前已基本控制住新型冠状病毒肺炎疫情,并处于常态化防控形势下。此时对2020年疫情期间游戏障碍风险的相关问题进行回顾和思考,可为精神卫生工作者防控游戏障碍提供重要参考。本文在澄清疫情期间游戏厂商的不当宣传和媒体的不实报道,回顾人们游戏使用行为大幅上升和游戏市场快速扩张的趋势之后,指出了人们因过度的游戏行为模式而可能增加的健康风险;同时也指出并分析了疫情期间女性游戏使用人群扩大的新趋势,以及游戏与赌博进一步深度复合的动向;最后,本文为精神卫生工作者在疫情常态化防控中和“后疫情时代”应对上升的游戏障碍风险提出了建议。     

新型冠状病毒肺炎合并急性脑梗死一例

新型冠状病毒肺炎(COVID-19)为2019新型冠状病毒所致,其起病隐匿,潜伏期较长,具有高度传染性的特点。新型冠状病毒除了可累及呼吸系统,还可累及其他系统,如心脏、肾脏、消化道,并且可合并多个系统疾病,如急性脑血管病等,如果在接诊患者时不引起高度重视、做好防护,极易造成医护人员的感染。文中总结1例起病隐匿的COVID-19患者合并脑梗死症状,在行静脉溶栓治疗后造成1名医务人员感染的临床体会,探讨其临床特点、治疗经过并对其防控环节进行分析,以帮助疫情防控中首诊医生注意识别、减少漏诊、科学排查以减少职业感染。     

《新型冠状病毒感染的肺炎疫情紧急心理危机干预指导原则》专家解析

新型冠状病毒肺炎疫情是一次突发的公共卫生危机事件,不仅威胁人们的身体健康,也会给大众带来心理冲击,引起相应的心理行为问题。2020年1月26日,国家下发《新型冠状病毒感染的肺炎疫情紧急心理危机干预指导原则》,本文从由谁提供(心理危机干预服务)、给谁提供、提供什么、怎么提供、注意事项5个方面对上述指导原则总体内容进行概括整理,并提出几点思考,以帮助提供相关服务的精神心理工作人员更好地理解和实施指导原则。     

Obstructive sleep apnea (OSA) and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: a systematic review and meta-analysis

BackgroundObstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder which could impair someone's quality of life and is also associated with poor outcomes from many diseases. Currently, the evidence regarding the link between OSA and coronavirus disease 2019 (COVID-19) is still conflicting. This study aims to analyze the relationship between OSA and poor outcomes of COVID-19.Materials and methodsWe systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 10th, 2020. All articles published on COVID-19 and OSA were retrieved. The quality of the study was assessed using the Newcastle–Ottawa Scale (NOS) tool for observational studies. Statistical analysis was done using Review Manager 5.4 software.ResultsA total of 21 studies with 54,276 COVID-19 patients were included in this meta-analysis. This meta-analysis showed that OSA was associated with composite poor outcome [OR 1.72 (95% CI 1.55–1.91), p < 0.00001, I² = 36%, random-effect modeling] and its subgroup which comprised of severe COVID-19 [OR 1.70 (95% CI 1.18–2.45), p = 0.005], ICU admissions [OR 1.76 (95% CI 1.51–2.05), p < 0.00001], the need for mechanical ventilation [OR 1.67 (95% CI 1.48–1.88), p < 0.00001], and mortality [OR 1.74 (95% CI 1.39–2.19), p < 0.00001].ConclusionsExtra care and close monitoring should be provided to patients with OSA to minimize the risk of infections. Simple questionnaires such as STOP-Bang questionnaire can be used for screening patients who may be at risk for severe adverse outcomes.     

Parkinson's disease may worsen outcomes from coronavirus disease 2019 (COVID-19) pneumonia in hospitalized patients: A systematic review,meta-analysis,and meta-regression

BackgroundParkinson's Disease (PD) is among one of the common comorbidities in older patients. People with PD may be more vulnerable to severe pneumonia, due to the impairment of pulmonary function. Currently, the association between PD and COVID-19 is not yet established. This study aims to analyze the relationship between PD and in-hospital outcomes of COVID-19.Materials and methodsWe systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 25th, 2020. All articles published on COVID-19 and Parkinson's Disease were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies and Joanna Briggs Institute (JBI) Critical Appraisal Tools for cross-sectional studies. Statistical analysis was done using Review Manager 5.4 software.ResultsA total of 12 studies with 103,874 COVID-19 patients were included in this meta-analysis. This meta-analysis showed that Parkinson's Disease was associated with poor in-hospital outcomes [[OR 2.64 (95% CI 1.75–3.99), p < 0.00001, I² = 81%] and its subgroup which comprised of severe COVID-19 [OR 2.61 (95% CI 1.98–3.43), p < 0.00001, I² = 0%] and mortality from COVID-19 [RR 2.63 (95% CI 1.50–4.60), p = 0.0007, I² = 91%]. Meta-regression showed that the association was influenced by age (p = 0.05), but not by gender (p = 0.46) and dementia (p = 0.23).ConclusionsExtra care and close monitoring should be provided to Parkinson's Disease patients to minimize the risk of infections, preventing the development of severe and mortality outcomes.     

Residual olfactory dysfunction in coronavirus disease 2019 patients after long term recovery

IntroductionHyposmia is among the most common symptoms of COVID-19 patients. Previous research has mainly described this issue at the disease’s early stages. Because olfactory impairment can indicate neurological degeneration, we investigated the possibility of permanent olfactory damage by assessing hyposmia during the late recovery stage of COVID-19 patients.MethodsNinety-five patients were assessed with the Brief Smell Identification Test for Chinese (B-SITC) and Hyposmia Rating Scale (HRS) after 16 weeks from disease onset. Five weeks later, 41 patients were retested with B-SITC.ResultsAt the first visit, hyposmia was identified in 26/82 (31.7%) and 22/95 (23.2%) of participants by HRS (HRS score ≤22) and B-SITC (B-SITC score <8), respectively. The rates of hyposmia in patients who performed B-SITC after 14–15 weeks, 16–17 weeks, and ≥18 weeks from disease onset were 7/25 (28%), 8/35 (23%) and 7/35 (20%), respectively, which demonstrated a trend of olfaction improvement as recovery time prolonging. Hyposmia percentages decreased from the first visit (34.1%) to the second visit (24.4%) for the 41 patients who completed 2 visits. B-SITC scores of the first-visit hyposmia participants increased significantly at the second visit (5.29 ± 2.02 to 8.29 ± 2.40; n = 14, P = 0.001). Severe cases tended to recover less than common cases.ConclusionsHyposmia was present in up to one-third of COVID-19 patients after about 3 months from disease onset. Notable recovery of olfactory function was observed at a next 5-weeks follow-up. Clinical severity had little influence on olfactory impairment and recovery.     

Momentary stress moderates procoagulant reactivity to a trauma-specific interview in patients with posttraumatic stress disorder caused by myocardial infarction

Hypercoagulability of the blood might partially explain the increased cardiovascular disease risk in posttraumatic stress disorder (PTSD) and is also triggered by anticipatory stress. We hypothesized exaggerated procoagulant reactivity in patients with PTSD in response to a trauma-specific interview that would be moderated by momentary stress levels. We examined 23 patients with interviewer-diagnosed PTSD caused by myocardial infarction (MI) and 21 post-MI patients without PTSD. A second diagnostic (i.e., trauma-specific) interview to assess posttraumatic stress severity was performed after a median follow-up of 26 months (range 12-36). Before that interview patients rated levels of momentary stress (Likert scale 0-10) and had blood collected before and after the interview. The interaction between PTSD diagnostic status at study entry and level of momentary stress before the follow-up interview predicted reactivity of fibrinogen (P = 0.036) and d-dimer (P = 0.002) to the PTSD interview. Among patients with high momentary stress levels, PTSD patients had greater fibrinogen (P = 0.023) and d-dimer (P = 0.035) reactivity than non-PTSD patients. Among patients with low momentary stress levels, PTSD patients had less d-dimer reactivity than non-PTSD patients (P = 0.024); fibrinogen reactivity did not significantly differ between groups. Momentary stress levels, but not severity of posttraumatic stress, correlated with d-dimer reactivity in PTSD patients (r = 0.46, P = 0.029). We conclude that momentary stress levels moderated the relationship between PTSD and procoagulant reactivity to a trauma-specific interview. Procoagulant reactivity in post-MI patients with PTSD confronted with their traumatically experienced MI was observed if patients perceived high levels of momentary stress before the interview.     

新型冠状病毒性肺炎疫情下神经外科急诊诊疗行为的建议及策略

目的 探讨新型冠状病毒肺炎（COVID-19）疫情期间神经外科急诊诊疗行为的建议及策略。方法 回顾性分析2020年1月20日到2020年3月20日武汉大学人民医院神经外科一病区收治的67例急诊病人的临床资料。分析67例病人及与这些病人有接触的41位医护人员感染COVID-19的情况,总结防控经验。结果 67例病人中,4例确诊COVID-19,3例疑似COVID-19。所有医护人员中,2名医师确诊感染COVID-19,其中1人为无症状感染,1人为轻症感染;1名护士确诊COVID-19,为轻症感染;医师及护士均未见疑似感染者。医护人员确诊感染COVID-19均发生在标准化防控措施开始执行之前,且不能排除社区感染的可能性。结论 通过科学的防控措施可将COVID-19的院内感染发生率控制在低水平,在疫情期间为神经外科急诊病人持续提供优质,安全的医疗服务     

Collateral damage caused by COVID-19: Change in volume and spectrum of neurosurgery patients

BackgroundThere has been a dramatic change in the pattern of patients being seen in hospitals and surgeries performed during the ongoing COVID-19 pandemic. The objective of this study is to study the change in the volume and spectrum of surgeries performed during the ongoing COVID-19 pandemic compared to pre-COVID-19 era.MethodsDetails of all patients who were operated under department of neurosurgery at our institute since the onset of COVID-19 pandemic in India were collected and compared to the same time period last year. The demographic profile, diagnosis, surgery performed, type of surgery (routine/emergency, cranial/spinal and major/minor) in these two groups were compared. They were further categorized into various categories [neuro-oncology (brain and spine tumors), neuro-trauma (head injury and spinal trauma), congenital cases, degenerative spine, neuro-vascular, CSF diversion procedures, etc.] and compared between the two groups.ResultsOur study showed a drastic fall (52.2%) in the number of surgeries performed during the pandemic compared to pre-COVID era. 11.3% of patients operated during COVID-19 pandemic were non-emergent surgeries compared to 57.7% earlier (p = 0.000). There was increase in proportion of minor cases from 28.8% to 41.5% (p = 0.106). The proportion of spinal cases decreased from 27.9% to 11.3% during the COVID-19 pandemic (p = 0.043).ConclusionsThe drastic decrease in the number of surgeries performed will result in large backlog of patients waiting for ‘elective’ surgery. There is a risk of these patients presenting at a later stage with progressed disease and the best way forward would be to resume work with necessary precautions and universal effective COVID-19 testing.     

COVID-19 and traumatic stress: The role of perceived vulnerability,COVID-19-related worries,and social isolation

The purpose of the present study was to propose and test two models to understand the relationship between perceived vulnerability to COVID-19 (PVC) and COVID-19-related traumatic stress (TS), as well as the variables that may mediate and moderate this relationship among individuals who have not yet been infected with COVID-19. Using an online survey, data were collected between late March and early April 2020. Participants were recruited through Amazon Mechanical Turk and included 747 adults living in the United States. Supporting our hypotheses, results indicated that both COVID-19-related worries and social isolation were significant mediators of the relationship between PVC and TS (Model 1). In addition, the results of a moderated mediation analysis indicated that the indirect effect of PVC on TS through COVID-19-related worries was stronger for participants who reported greater social isolation (Model 2). Although future research is needed, these findings suggest that both social isolation and disease-related worries may be important variables that can be targeted in interventions to reduce pandemic-related TS.     

Neuroinflammation caused by mental stress: the effect of chronic restraint stress and acute repeated social defeat stress in mice

ABSTRACT

Objectives: Cerebrovascular disease (CVD) is the leading cause of permanent disability worldwide. Inflammation has been reported to play an important role in the progression of CVD. Neuropsychiatric disorders such as depression are associated with increased incidence of CVD epidemiologically, although the mechanisms underlying this association are not clear. In this study, we assessed the effect of the acute repeated social defeat stress (RSDS) and chronic restraint stress (CRS) on neuroinflammation in mice.

Methods: A total of 40 6-week-old male C57BL/6J mice were divided into RSDS, CRS, and corresponding control groups. In the RSDS group, male C57BL/6J mice were repeatedly subjected to bouts of social defeat by a larger CD-1 mouse for 10 min daily for 10 consecutive days. In the CRS group, the mice were exposed to restraint stress for 6 h per day for 28 consecutive days. Depressive behavior was evaluated by conducting sucrose preference test over 24 h. Peripheral blood serum and brain tissues were collected for measurement of corticosterone (CORT), epinephrine (EPI), and inflammatory factors (TNF-α and IL-6) using ELISA or real-time PCR 24 h after the sucrose preference test.

Results: Both RSDS and CRS decreased the sucrose preference ratio. The acute stress increased serum CORT and EPI, while the chronic stress did not significantly influence them. Both stress models induced an inflammatory response in peripheral serum and the brain.

Conclusions: RSDS and CRS are two effective models of depressive behavior, and both models cause neuroinflammation, which may be responsible for the increased risk of CVD seen in patients with depression.