理性情绪疗法对糖尿病患者心理行为的影响

目的探讨理性情绪疗法对糖尿病患者心理行为的影响。方法将60例糖尿病患者随机分为对照组（30例）和实验组（30例），用症状自评量表和糖尿病患者行为评估表对两组患者干预前后心理和行为状态进行评定。结果干预后两组比较，症状自评量表各因子得分差异均具有统计学意义（P〈0．01或P〈0．05）。干预后14d两组患者在坚持运动、纠止不良饮食习惯、血糖控制、戒烟、戒酒、复查时间的掌握方面差异具有统计学意义（P〈0．01或P〈0．05），按时服药或注射胰岛素方面差异无统计学意义（P〉0．05）；干预后30d两组患者在血糖控制、峰持运动、戒酒、按时服药或注射胰岛素、纠正不良饮食习惯、戒烟、复杏时间的掌握方面差异均具有统计学意义（P〈0．01或P〈0．05）。结论理性情绪疗法对提高糖尿病患者的心理健康水平，增加其健康行为具有积极作用。     

聚焦解决模式心理干预对社区2型糖尿病患者负性情绪和社会支持水平影响

目的 探讨聚焦解决模式对社区2型糖尿病患者负性情绪和社会支持水平影响.方法 将120例社区2型糖尿病患者随机分为研究组与对照组各60例.观察组按照聚焦解决模式5个步骤进行干预、健康教育,对照组按照常规内容和模式进行健康教育,分别于干预前、后对两组患者的糖尿病情绪(HAMA、HAMD)、社会支持水平及血压、糖化血红蛋白等进行比较.结果 干预前后比较,干预组HAMA评分较干预前、对照组有明显下降(P<0.05),HAMD评分虽然没有统计学意义,但也有一定程度降低.干预组的社会支持总分、主观支持、对支持利用度均有明显改善(P<0.05).两组患者干预前后各生物学指标差异没有统计学意义(P>0.05).结论 采用聚焦解决模式对社区2型糖尿病患者实施针对性心理干预,可改善患者焦虑情绪以及社会支持水平,但对血糖、糖化血红蛋白等生物学指标没有明显改变.     

功能障碍性信念矫正辅助治疗对改善抑郁症患者集体心理治疗和健康教育依从性的影响

目的 功能障碍性信念矫正辅助治疗抑郁症患者集体心理治疗和健康教育依从性的效果.方法 将122例服用别米替林治疗的抑郁症患者随机分为研究组和对照组.研究组患者进行功能障碍性信念矫正辅助治疗,共12周.根据功能障碍性信念矫正辅助治疗的内容设计集体心理治疗和健康教育依从性问卷,内容为药物治疗、集体心理治疗和健康教育依从性.分3个等级,分别为治疗依从性好、良好和差.问卷效度和信度有专家进行测评.采用SPSS - PC 10.0对数据进行分析处理.结果 研究组患者的治疗依从性明显优于对照组(P＜0.05),且集体心理治疗和健康教育的依从性显著提高.结论 功能障碍性信念矫正辅助治疗有助于提高抑郁症的集体心理治疗和健康教育依从性.     

患者中心疗法对2型糖尿病患者心理行为的影响

目的 探讨患者中心疗法对糖尿病患者心理状况及行为的影响.方法 将60例糖尿病患者随机分为对照组(30例)和干预组(30例),对干预组进行患者中心疗法干预,干预前后用症状自评量表(SCL-90)和糖尿病患者行为评估表对两组患者心理状况和行为状态进行评定.结果 干预前两组患者在SCL-90量表各因子上得分的差异无统计学意义(P>0.05),干预后两组比较,躯体化、强迫、人际关系敏感、敌对、恐怖、偏执、精神病性等因子均统计学意义(P<0.01);干预后两组患者在不良饮食习惯纠正、戒酒、复查时间的掌握及在血糖控制、坚持运动锻炼、戒烟方面的差异有统计学意义(P<0.01),按时服用降精药物或注射胰岛素无统计学意义(P>0.05).结论 患者中心疗法对提高糖尿病患者的心理健康水平,增加其健康行为有积极的作用.     

Factors related to recruitment and retention of patients into diabetes group visits in Federally Qualified Health Centers

Rationale, Aims and Objectives

To examine factors related to recruitment of eligible patients and retention of enrolled patients in diabetes group visits (GVs).

Method

As part of a cluster randomized trial, 272 eligible patients were contacted and 75 patients were eventually enrolled in GVs at six community health centers (CHC). Fisher's exact tests and χ² tests were used to compare enrolled and nonenrolled patients by patient recruitment method, gender and preferred language. Linear mixed models were used to evaluate characteristics associated with GV attendance such as diabetes self-empowerment and diabetes-associated distress. Content analysis was used to analyse patients' open-ended survey responses, and template analysis was used to analyse CHC staff interviews.

Results

In terms of recruitment and enrollment analysis, patients who received in-person contact only and both phone and in-person contact comprised a greater fraction of the enrolled than unenrolled group, while those who received phone only and both phone and mail comprised a smaller fraction of the enrolled than unenrolled group (p = 0.004). In terms of retention analysis, 70 of the 75 enrolled patients attended at least one GV (93%). The average number of GVs was 3.2 out of 6 visits. Higher GV attendance was associated with lower baseline diabetes empowerment (p = 0.03). Patients' most common self-reported motivating factors to attend GVs were to learn more about diabetes, gain improved blood glucose control and find support from peers.

Conclusion

In-person recruitment for GVs at CHCs was more effective than recruitment by telephone/mail. Patients who felt less empowered to manage their diabetes were most motivated to attend GVs. These findings could help clinicians implement targeted recruitment of patient populations who are more likely to attend diabetes GVs and tailor self-management education interventions to their patient populations, particularly for underserved patients who face disparate clinical outcomes.     

Phototherapy in the context of psychotherapy

Phototherapy, or treatment with bright artificial light, has been used to treat seasonal affective disorder and related conditions. Using the cases of two patients who were treated with both psychotherapy and phototherapy, the author explores the potentially powerful psychotherapeutic aspects of this new treatment. Within a therapeutic relationship, light has a rich symbolism, and it may serve as an inanimate symbol of the therapist. Perhaps because of the lack of well-established guidelines or traditions regarding its use within psychotherapy, however, light treatment can lead to the violation of the usual boundaries of treatment. If this danger is avoided, phototherapy may be a powerful adjunct to psychotherapy.     

心理护理对乳腺癌患者术后生活质量的影响

目的观察心理护理对乳腺癌患者术后生活质量的影响。方法180例乳腺癌术后患者随机分为:对照组(术后进行化疗)和观察组(化疗同时进行心理护理),治疗后2组采用生活质量问卷(QLQ-C30)和卡氏功能量表(KPS)测查。结果观察组QLQ-C30各指标和KPS得分均优于对照组。结论心理护理能减轻乳腺癌患者化疗的负反应及术后提高生活质量。     

Interpersonal psychotherapy group (IPT-G) for depression

A case study of a time-limited interpersonal psychotherapy group (IPT-G) is presented to illustrate the use of interpersonal therapy (IPT) to treat patients with major depression in a group psychotherapy format. The use of individual outcome measures as a helpful adjunct to clinical psychotherapeutic practice is demonstrated. Because IPT-G has only a few exclusion criteria (active suicidality and significant borderline personality features), it can be used in a broad range of clinical settings. This clinical example demonstrates IPT-G to be a useful modality for addressing a common and difficult patient population.     

短期集体心理治疗对神经症患者的影响

目的探讨短期集体心理治疗对神经症患者疗效的影响。方法采用心理剧回馈量表评估22例主角和21例配角在其治疗3mo后的获益程度,并比较主角和配角获益程度的差异。结果总获益量表中获益最明显的是情绪获益,主角的总获益量和情绪获益显著高于非主角参加者(P<0.05),主角的再参加意愿和担任主角的意愿明显高于非主角参加者(P<0.05)。结论短期集体心理治疗对神经症患者有明显的疗效。     

集体心理治疗对住院慢性精神分裂症患者的康复效果

目的：探索集体心理治疗对住院慢性精神分裂症患者的疗效。方法：84例慢性精神分裂症患者分为心理组40例和对照组44例，均对症给予精神分裂症药物治疗；心理组并接受集体形式的讲座、讨论、问题解答等心理治疗。治疗前后采用90项症状清单（SCL-90）、阳性和阴性症状量表（PANSS）测评。结果：经过10个月的观察，心理组患者SCL-90和PANSS各因子分与治疗前及对照组比较均有改善，尤以阴性症状较明显。结论：集体心理治疗对住院慢性精神分裂症患者的康复有一定效果。     

Treatment of major depressive disorder--method and selection of the treatment

There are many ways of treatment for depression. Among them the most popular and effective treatment is pharmacotherapy. In the acute phase, pharmacotherapy with antidepressants, certain forms of psychotherapy, the combination of pharmacotherapy plus psychotherapy, and electroconvulsive treatment have clearly proven to be efficacious in most types of unipolar depressive disorders. The common augmenting agents probably are lithium, thyroid hormone, dopaminergic agents, and mood stabilizers. Certain treatments may be more effective in specific subtypes; for example, light therapy is useful for seasonal affective disorder. During the 16-24 weeks following remission, patients with antidepressant medications in the acute phase should be maintained on these agents to prevent relapse. For patient pharmacotherapy or psychotherapy has not been effective, the use of ECT may be useful. Following the continuation phase, maintenance-phase treatment should be considered for patients who have many depressive episodes to prevent recurrences of major depressive disorder.     

The parallel process of resistance by clients and therapists to starting groups: A guide for nurses

Group psychotherapy is well recognized as a treatment modality with a powerful healing capacity. Yet, as experienced group therapists will attest, it is immensely difficult to begin a group. Assembling clients who have sufficiently dealt with their resistance to join a psychotherapy group is a painstaking process. Students in group psychotherapy training programs also find beginning a new group an arduous and frustrating task. The authors have had the benefit of a postgraduate group psychotherapy training program to build on the expertise and skills already familiar to the Clinical Nurse Specialist. Our understanding of the parallel process in the resistance to beginning a group grew out of our training experience. We will explore within the parallel process framework some of the factors that make the development of a group psychotherapy practice so complex. Parallels will be drawn between clinician resistance to beginning a new group and cllent resistance to joining a group.     

Motivation for in-patient psychotherapy among patients of a psychosomatic pain clinic

OBJECTIVE: For a number of pain patients inpatient psychotherapy is an adequate treatment. Many of these patients are lacking in motivation, though. The present study aimed at identifying factors associated with acceptance or rejection of inpatient psychotherapy. METHODS: 63 patients of a psychosomatic pain clinic underwent a multimodal assessment based on a psychosomatic interview as well as a set of psychodiagnostic questionnaires regarding sociodemographic factors, symptomatology (pain intensity, BSS, SCL-90-R, BDI), state of chronification, psychological defense mechanisms (DSQ) and biographic traumatisation (risk index). RESULTS: 71% of the patients were recommended in-patient psychotherapy. Among those, 63% accepted the recommendation, 27% rejected it. Among the patients who accepted in-patient psychotherapy, the extent of total psychological impairment as well as severity of depression and anxiety were more severe and the state of chronification tended to be less marked than in the rejecting group. Referring to sociodemographic variables, pain intensity,physical impairment and severity of biographic traumatisation,no significant difference between the groups could be shown. CONCLUSIONS: In our highly selected population the extent of psychiatric comorbidity and the state of chronification determined motivation for in-patient psychotherapy. Further studies should focus on unselected pain patients and on differences in motivation between various forms of psychotherapy.     

The effects of outpatient psychiatric utilization on the costs of providing third-party coverage

Although previous studies conducted in prepaid group practice settings have indicated that the cost of providing coverage for outpatient psychotherapy may be offset by lower utilization of medical/surgical services among those who receive the benefit, no such studies have been conducted in a fee-for-service setting, nor have actual before and after claims costs been compared. This study establishes a methodology for using routinely collected Blue Cross claims data to show how the acquisition and use of a given benefit affects total utilization patterns and the overall costs of providing third-party coverage. The use and cost of outpatient psychiatric coverage in one subscriber group is the particular application given to this methodology in this report. Blue Cross claims records of 136 subjects who utilized outpatient psychiatric benefits over a 48-month period were analyzed. Results indicate that overall medical/surgical utilization is reduced for that subgroup who used the outpatient psychotherapy benefit and that average costs dropped by $9.41, from $16.47 per patient per month before outpatient psychotherapy to $7.06 after contact, with costs being adjusted to reflect parity with the base year. Factors other than psychiatric intervention which may have brought about this cost reduction as well as policy implications of these results are discussed.     

老年抑郁症住院患者的支持性心理干预研究

目的探讨支持性心理干预对老年抑郁症住院患者的效果。方法采用临床对照研究,选择20例确诊的住院患者作为对照组,给予抗抑郁药物治疗和一般精神科护理。另外选择同期住院的与之相匹配的20例患者作为研究组,在对照组的基础上,给予支持性心理干预4周。用Montgomery＆Asberg（MADS）抑郁量表评定效果。结果2组干预前后MADS总分均显著下降（p〈0．01）,但从第3周开始研究组MADS分低于对照组（p〈0．05）,且2组MADS各因子分比较显示,研究组的内心紧张、睡眠减少等七项因子分均低于对照组,差别有统计学意义（P〈0．05）。研究组住院天数少于对照组（p〈0．05）。结论对于临床住院老年抑郁患者,支持性心理干预联合药物治疗有利于其更快更好的恢复,有利于其症状的改善。     

Short- and long-term effects of real-time continuous glucose monitoring in patients with type 2 diabetes

OBJECTIVE

To determine whether short-time, real-time continuous glucose monitoring (RT-CGM) has long-term salutary glycemic effects in patients with type 2 diabetes who are not on prandial insulin.

RESEARCH DESIGN AND METHODS

This was a randomized controlled trial of 100 adults with type 2 diabetes who were not on prandial insulin. This study compared the effects of 12 weeks of intermittent RT-CGM with self-monitoring of blood glucose (SMBG) on glycemic control over a 40-week follow-up period. Subjects received diabetes care from their regular provider without therapeutic intervention from the study team.

RESULTS

There was a significant difference in A1C at the end of the 3-month active intervention that was sustained during the follow-up period. The mean, unadjusted A1C decreased by 1.0, 1.2, 0.8, and 0.8% in the RT-CGM group vs. 0.5, 0.5, 0.5, and 0.2% in the SMBG group at 12, 24, 38, and 52 weeks, respectively (P = 0.04). There was a significantly greater decline in A1C over the course of the study for the RT-CGM group than for the SMBG group, after adjusting for covariates (P < 0.0001). The subjects who used RT-CGM per protocol (≥48 days) improved the most (P < 0.0001). The improvement in the RT-CGM group occurred without a greater intensification of medication compared with those in the SMBG group.

CONCLUSIONS

Subjects with type 2 diabetes not on prandial insulin who used RT-CGM intermittently for 12 weeks significantly improved glycemic control at 12 weeks and sustained the improvement without RT-CGM during the 40-week follow-up period, compared with those who used only SMBG.The prevalence of diabetes is projected to rise from the current 11% of the U.S. population aged ≥20 years (1) to as much as 33% by 2050 (2). Those with type 2 diabetes represent ~90% of all people with diabetes. Poor glycemic control remains a problem for many people. Forty-four percent of people with type 2 diabetes have a hemoglobin A1C higher than the generally accepted target for most patients of 7% (3). Despite the emergence of several new classes of pharmacologic agents, the introduction of medication-use guidelines and algorithms by major professional organizations (4–6), the improvement in the quality and user-friendliness of devices for self-monitoring of blood glucose (SMBG), and the development of numerous care- and self-management tools for providers and patients that provide some decision support and facilitate the sharing of information, a significant number of type 2 diabetic subjects remain suboptimally controlled. This state of affairs suggests the need for additional approaches to glycemic management for people with type 2 diabetes. Such an approach might be real-time continuous glucose monitoring (RT-CGM).RT-CGM provides patients with a glucose reading every 5 min, typically on a visual display that shows the glucose trend and whether it is above, below, or within preset ranges. RT-CGM has been shown to improve glycemic control and/or reduce the frequency of hypoglycemic episodes in pediatric and adult patients with type 1 diabetes and in adult patients with type 2 diabetes taking prandial insulin (7–14), although age and frequency of sensor use affect the magnitude of the A1C reduction (15). RT-CGM has not been used as a tool for diabetes management in patients with type 2 diabetes who are not taking prandial insulin, by far the largest subgroup of people with type 2 diabetes. Their glycemic monitoring relies on SMBG at a frequency and time of day commensurate with their treatment regimen.We sought to determine whether RT-CGM could play an adjunctive role in the management of patients with type 2 diabetes who are not on prandial insulin. The rationale for this investigation was that the volume of information from RT-CGM and the visual display of that information as a trend could provide important feedback to participants on their glucose status. We recently reported that RT-CGM over 12 weeks was associated with a clinically significant reduction in A1C (1.0%) over the same period of time compared with SMBG before meals and before bedtime (0.5%) (16). We now report the legacy effects of this 12-week intervention on glycemic control and other diabetes-related outcomes in the same cohort over a total of 52 weeks.     

看图对话教育模式对首诊糖尿病患者认知及焦虑的影响

目的探讨看图对话教育模式对首诊糖尿病患者认知及焦虑的影响。方法将2011年6月至2013年6月入住我院内分泌科的154例首诊为2型糖尿病的患者按入院先后顺序分为两组,对照组（n=78）采用传统健康教育模式进行健康教育,观察组（n=76）采用看图对话教育模式进行健康教育,比较两组患者对糖尿病知识的认识及焦虑变化情况。结果观察组对糖尿病知识的认知评分高于对照组,焦虑评分低于对照组,差异有统计学意义（P〈0．05）。结论看图对话教育模式在提高首诊糖尿病患者对糖尿病知识的认识,降低糖尿病患者的负性情绪方面较传统健康教育模式更有优势。     

支持性心理疗法联合IDEAS模式用于手足显微外科骨折患者术前访视中对患者心理状态、心理韧性及疾病不确定感的影响

目的 探讨支持性心理疗法联合IDEAS模式用于手足显微外科骨折患者术前访视中对患者心理状态、心理韧性及疾病不确定感的影响.方法 将100例手足显微外科骨折患者以数字表法将其随机分为对照组(50例,常规术前访视护理)和观察组(50例,在对照组基础上应用支持性心理疗法联合IDEAS模式),各50例.观察两组干预效果.结果 ...