综合医院内科门诊患者焦虑障碍的患病状况调查

目的 调查综合性医院内科门诊患者焦虑障碍的患病状况以及了解内科医生对焦虑障碍的诊断和治疗情况.方法 按10∶1随机抽取2007年11月至2008年1月间于上海瑞金医院4个内科门诊的就诊者,使用综合性医院焦虑/抑郁情绪测定表(HAD)作为筛查工具,对焦虑分值≥8分的患者进行M.I.N.I.检查并作出诊断,再根据患者的门诊卡了解内科医生关于焦虑障碍的诊断和治疗.结果 所有焦虑障碍的患病率为2.51%,广泛性焦虑最多为1.47%;女性、丧偶者焦虑障碍的患病比例较高(P＜0.01);23%的焦虑障碍患者得到相应的治疗,但内科医生的诊断率只有3.2%.结论 上海综合性医院内科门诊中焦虑障碍的患病率较高,女性及丧偶者易患,而内科医生对其的识别率较低.     

Prescribing patterns in agoraphobia with panic attacks

Although medication is used commonly in the treatment of agoraphobia with panic attacks, the actual drug-prescribing patterns of the medical profession have not been well studied in this condition. The present study compares the prescribing patterns of general practitioners and psychiatrists in their treatment of agoraphobia with panic attacks. The medical records of 111 agoraphobic patients with panic attacks were analysed and divided into those who were referred by general practitioners and those who were referred by psychiatrists. Over all, in the treatment of agoraphobia with panic attacks, general practitioners prescribed drugs less often than did psychiatrists. They used fewer combinations of drugs and tended to prescribe tricyclic antidepressant agents in doses which generally are considered to be below the therapeutic range. This finding would suggest that general practitioners are less effective than are psychiatrists in prescribing for this condition as judged by current practice, although they are less likely to prescribe combinations of drugs--a practice which might well be to their credit.     

Follow-up status of patients with angiographically normal coronary arteries and panic disorder

Cardiology patients with normal coronary angiography demonstrate continuing and substantial social, health, and work disability. We hypothesized that the diagnosis of panic disorder would mark those for whom continuing disability is most likely. We interviewed 72 such patients at the time of their normal angiogram, and then again an average of 38 months later. Those with panic disorder (n = 36) demonstrated significantly more disability at follow-up than did the other study patients. We conclude that those patients with normal angiograms who have panic disorder are more disabled than those who do not have panic disorder. Panic disorder in psychiatric samples has been shown to be highly treatable. Therefore, early identification and treatment of panic disorder in this group is likely to minimize the suffering associated with this condition.     

社交焦虑障碍和惊恐障碍对患者生活质量的不同影响

目的比较社交焦虑障碍和惊恐障碍对患者生活质量影响的差异性。方法采用健康状况问卷(SF-36)对无明显其他精神障碍的35例社交焦虑障碍患者和35例惊恐障碍患者的生活质量进行评定。结果与正常常模SF-36比较,社交焦虑障碍组在社会功能和精神健康方面受影响明显(P<0.05);惊恐障碍在生理机能、生理职能和精神健康3个方面受影响明显(P<0.05)。结论未合并其他精神障碍的社交焦虑障碍主要影响社会功能和精神健康方面的生活质量;惊恐障碍在躯体和精神两方面都受到影响。     

Detection of depressive disorder for patients receiving prepaid or fee-for-service care. Results from the Medical Outcomes Study

We estimated clinicians' awareness of depression for patients with current depressive disorder (N = 650) who received care in either a single-specialty solo or small group practice, a large multispecialty group practice, or a health maintenance organization in three US sites. Depressive disorder was determined by independent diagnostic assessment shortly after an office visit. Detection and treatment of depression were determined from visit-report forms completed by the treating clinician. Depending on the setting, from 78.2% to 86.9% of depressed patients who visited mental health specialists had their depression detected at the time of the visit, compared with 45.9% to 51.2% of depressed patients who visited medical clinicians, after adjusting for case-mix differences. Among patients of mental health specialists, there were no significant differences by type of payment in the likelihood of depressive disorder being detected or treated. Among patients of medical clinicians, however, those receiving care financed by prepayment were significantly less likely to have their depression detected or treated during the visit than were similar patients receiving fee-for-service care.     

惊恐障碍患者患病行为研究

目的探讨惊恐障碍患者的患病行为方式。方法用患病行为问卷对47例惊恐障碍患者及38例正常对照者进行自评。结果惊恐障碍患者的心理取向(P/S)分与对照组相比差异无显著性,而一般疑病(GH)、疾病信念(DC)、情感压抑(AI)、情绪紊乱(AD)、否认心因(D)、易激惹性(I)均显著高于正常对照组。不伴广场恐惧的患者在GH(5.71±1.37)、DC(4.16±1.29)因子上显著低于伴广场恐惧的患者(6.57±1.09,4.93±0.73),余差异无显著性(P>0.05)。长病程的惊恐障碍患者在AD、AS因子上显著高于短病程患者(P<0.05),余差异无显著性。高教育年限组情感压抑(AI)因子分显著高于低教育年限组。以性别、婚姻、家族史等因素对惊恐障碍患者进行分组,组间均差异无显著性。结论我们应根据惊恐障碍患者患病行为特点,采取针对性的治疗措施。     

Recommendations for ensuring early thrombolytic therapy for acute myocardial infarction. The Heart and Stroke Foundation of Canada, the Canadian Cardiovascular Society and the Canadian Association of Emergency Physicians for the Emergency Cardiac Care Coalition.

OBJECTIVE: To recommend practical steps to ensure early thrombolytic therapy and thereby reduce mortality and morbidity associated with acute myocardial infarction (AMI). OPTIONS: Various factors were considered that influence time to thrombolysis related to patients, independent practitioners and health care systems. OUTCOMES: Reduction in morbidity and mortality associated with AMI. EVIDENCE: Early initiation of thrombolytic therapy reduces morbidity and mortality associated with AMI. The ECC Coalition analysed the factors that might impede early implementation of thrombolytic therapy. VALUES: Published data were reviewed, and recommendations were based on consensus opinion of the Emergency Cardiac Care (ECC) Coalition. The ECC Coalition comprises 20 professional, nongovernment and government organizations and has a mandate to improve emergency cardiac care services through collaboration. BENEFITS, HARMS AND COSTS: Early thrombolytic therapy reduces morbidity and mortality associated with AMI. Implementation of the recommendations will result in reduced time to thrombolytic therapy, streamlining of current practices and enhanced cooperation among health care professionals to expedite care. Depending on existing practices, implementation may require protocol development, and public and professional education. Although costs are associated with educating the public and health care professionals, they are outweighed by the financial and social benefits of reduced morbidity and mortality. RECOMMENDATIONS: Early recognition of AMI symptoms by the public and health care professionals, early access to the emergency medical services system and early action by emergency care providers in administering thrombolytic therapy (within 30 minutes after the patient's arrival at the emergency department). VALIDATION: No similar consensus statements or practice guidelines for thrombolytic therapy in Canada are available for comparison.     

Chronic illness and functional limitation in Ontario children: findings of the Ontario Child Health Study.

The Ontario Child Health Study (OCHS) was based on interviews of 1869 Ontario families who were selected by means of a stratified, multistaged sampling method from the 1981 census of Canada. Its primary purpose was to determine the prevalence and distribution of mental health problems in Ontario children aged 4 to 16 years and their families, but it also allowed an estimate of other significant medical conditions and provided an overview of these children's use of health care, education and social services. Our results are based on questionnaire responses concerning 3294 children. Limitation of function without a chronic illness or medical condition was reported in 1.9%, the converse in 14.0%, and a chronic illness or medical condition with limitation of function in 3.7%. When the three groups are considered together, 19.6% of Ontario children had a chronic health problem. Children of lower socioeconomic status were much more likely to have chronic health problems. Overall, children with chronic health problems were more likely to use physician, special education, social and mental health services. These findings have implications for those who provide services for children, plan community programs or train professionals in caring for children.     

上海市育龄妇女人工流产与生殖健康管理服务调查

  目的  了解分析上海市育龄妇女人工流产与生殖健康管理服务状况,探讨改善育龄妇女生殖健康管理服务的方法和途径,为进一步开展有效的育龄妇女性与生殖健康教育和提高生殖健康管理服务水平提供依据。  方法  2018年7月期间,选取在上海市3个行政区20家具有终止妊娠技术服务资质的定点医疗机构实施人工流产手术的3 013名育龄妇女作为研究对象,采用自行设计的调查问卷进行现场调查,采用SPSS 22.0统计学软件对数据进行统计分析。  结果  20~30岁女性是人工流产重点人群,已婚(81.1%)、已育(65.9%)女性占较大比例,教育水平分布均匀(22%~25%); 近一半(50.3%)女性是重复或多次流产,39.7%的女性“未采取任何避孕措施而导致本次怀孕”,43.1%的女性“没有怀孕的心理准备”; 网络(51.4%)是主要获得避孕知识的渠道,仍有17.6%的女性认为“人工流产对人体没有太多影响”,90.0%的女性本次人工流产手术后获得了生殖健康指导服务,86.7%的女性获得了生殖健康随访服务。  结论  大部分调查对象对生殖健康知识掌握不足,已婚已育女性生殖健康管理有待加强; 通过医教结合,构建社会-公共卫生服务机构-医疗机构的生殖健康管理模式,逐渐改变育龄女性对健康妊娠、安全性行为的认知; 顺应时代潮流不断创新育龄女性人工流产健康管理的内容和形式,构建专业权威的信息发布渠道,降低人工流产发生率。      

焦虑和抑郁障碍共病患者的生活事件、社会支持和家庭功能对照研究

目的 从社会学角度,探讨焦虑和抑郁障碍共病与焦虑障碍或／和抑郁 障碍的区别。方法 按DSM－IV诊断标准收集25例焦虑和抑郁障碍共病患者（共病组）、30例主要抑郁症患者（抑郁组）、14例广泛性焦虑障碍和6例惊恐障碍患者（焦虑组）。对所有病例使用LES、SSRS、FES－CV进行调查评定。结果 （1）共病组的负性生活事件评分与抑郁组、焦虑组无显著差异;（2）共病组的社会支持分显著高于抑郁组,而与焦虑组无显著差别;（3）共病组存在家庭功能缺陷,但显著较抑郁组和焦虑组为轻。结论 焦虑和抑郁障碍共病在社会支持和家庭功能方面具有不同于抑郁障碍和焦虑障碍的特征。     

Panic attacks in the community. Social morbidity and health care utilization

This article focuses on social morbidity and health care utilization in persons with panic attacks not meeting full diagnostic criteria for panic disorder. The findings are based on data from a random sample of over 18,000 adults drawn from five US communities. Panic attacks not meeting full criteria for panic disorder have a relatively high lifetime prevalence (3.6% of the adult population). Persons with panic attacks had impairment in perceived physical and emotional health, and in occupational and financial functioning, increased use of health care facilities, emergency departments, and psychoactive drugs. Persons with panic attacks were intermediate in severity between those with panic disorder and those with other psychiatric disorders. The findings could not be explained by comorbidity with other psychiatric disorders. We conclude that panic attacks have clinical significance and are associated with substantial morbidity.     

森田疗法治疗社交恐怖症的对照研究

目的　研究森田疗法对社交恐怖症的治疗康复作用。方法　将门诊符合 CCMD- 2 - R诊断标准的社交恐怖症患者随机分为 2组 ,森田疗法组 2 6例和药物治疗组 12例 ,疗程 10～ 12周。均于疗前疗后及治疗结束后半年做社交回避及苦恼量表 (SAD)和疗效评定。结果　治疗后森田疗法组 SAD总分比药物组下降显著。半年后随访时 ,森田疗法组 SAD总分继续呈显著下降 ,而药物组下降不明显。疗效评定见森田疗法组痊显率显著高于药物组、复发率显著低于药物组。结论　森田疗法治疗社交恐怖症优于药物治疗。     

急性心肌梗死患者与负性情绪的相关因素探讨

目的:为探寻负性情绪与急性心肌梗死(Acute Myocardial Infarction,简AMI)的病因相关因素。方法:对91例AMI患者和90例正常人应用SCL-90,LES,SSRS,HAMD,HAMA及一般情况调查表进行对照调查。结果:与正常人对照:AMI组发作前有明显心理刺激因素的有73例(80.22%)。心理健康状态方面:AMI组SCL-90的总分、阳性项目分、躯体化、强迫、抑郁、焦虑、敌对、恐怖、人际、偏执等因子分均显著高于对照组(P<0.01),提示AMI患者存在更多的心理障碍,心理健康状态较差。AMI组负性生活事件分更高(P<0.01),社会支持度更低(P<0.01)。负性情绪方面:AMI组在焦虑/躯体化、认知障碍、阻滞、绝望、睡眠障碍和焦虑抑郁总分均明显高于对照组(P<0.01)。结论:负性生活事件多发,缺乏亲人和社会支持,较差的心理健康状态和更多的负性情绪可能是急性心肌梗死发生发展的危险因素。     

简短精神动力性心理治疗在惊恐障碍患者中的应用

目的:探讨简短精神动力性心理治疗对惊恐障碍症状的影响。方法:采用简短精神动力性心理治疗,每周2次,共12周,对17例惊恐障碍进行治疗。治疗效果的评定采用焦虑敏感性调查表(ASI),害怕问卷(FQ),惊恐障碍严重度评定量表(PDSS),汉密尔顿焦虑量表(HAMA);汉密尔顿抑郁量表(HAMD)。结果:治疗12周后,患者惊恐发作的严重度及对惊恐发作的预期性焦虑明显下降。恐怖性回避及严重度明显下降;焦虑和抑郁情绪明显改善。治疗的有效率100%。结论:简短精神动力心理治疗对惊恐发作有效。     

Compulsory detention in hospital under the Mental Health Act 1983

Presented here are sections of England's and Wales' Mental Health Act 1983 that relate to the compulsory admission to a hospital of patients suffering from a mental disorder, together with a diagrammatic representation of how they should be used in decision making. These excerpts address the definition of mental disorder; the purpose and duration of detention; the grounds for admission; who may make the application; and which health professionals are required to make the medical recommendation. The Mental Health Act provides no authority for third party consent to treatment of patients without mental disorder who refuse treatment or for treatment of medical conditions unless the condition is causing mental disorder.     

上海流动老人卫生服务利用情况

目的 了解上海流动老人卫生服务利用情况,探索其影响因素,为提高流动老人卫生服务利用水平,保障其健康提供科学依据。 方法 利用2015年国家卫计委流动人口卫生计生动态监测调查中上海流动老人相关数据进行χ2检验等统计分析。 结果 调查涉及的752名流动老人,参保率为85.7%,主要参保地为户籍地;平常生小病就医率为56.8%(427人),自行买药占39.5%(297人);174名经医生确诊的高血压／糖尿病流动老人患者中接受过社区随访的仅占29.9%(52人)。流动老人住院率为4.0%(30人),经医生诊断需住院的有40人,实际住院人数为30人,应住院未住院患者中主要原因为本人／家人觉得没有必要占60.0%(6人),无人回答因经济困难未住院。卫生服务利用率在流动原因为养老者中最高,因为照顾子女者中最低;参加过社区健康体检者卫生服务利用率比未参加过者高;是否参加社会医疗保险对其卫生服务利用率没有影响,但是参加居民医保者其利用率显著高于参加其他类型医保者。 结论 流动老人卫生服务利用率明显较低,是基本公共卫生服务例如慢性病社区管理的覆盖盲区,社会医疗保险没有起到应有的保障作用,应该制定出适宜流动老人的基本公共卫生服务等相关政策与措施,同时提高流动老人的健康素养等,从而提高其对卫生服务的利用率。      

门诊式森田疗法治疗44例社交恐怖症

目的 :探讨门诊式森田疗法对社交恐怖症的治疗效果 ,为治疗社交恐怖症开辟新途径。方法 :采用门诊式森田疗法治疗社交恐怖症 44例。治疗前后分别用焦虑自评量表(SAS)、抑郁自评量表 (SDS)测量 ,并进行比较。按照《森田心理疗法实践》中提出的评定方法进行疗效评定。结果 :经过 3次～ 1 4次 ( 2 1d～ 1 50d)的治疗 ,44例患者治愈 2 6例( 59 1 % ) ,好转 1 5例 ( 34 1 % ) ,总有效率为 93 2 %。治疗后SAS、SDS得分显著降低 (P<0 0 1 )。结论 :门诊式森田疗法治疗社交恐怖症有效。与住院式森田疗法相比更经济、更灵活 ,适用于症状较轻、领悟力、忍耐力较强的患者。     

新型冠状病毒肺炎患者隔离点建设与运行：武汉市基层实践

在武汉市社会恐慌、医疗资源被严重挤兑、透支,而方舱医院、定点医院建设未完成的情况下,各种类别的隔离点发挥了重要作用,有效落实了分级分类防控的策略。通过隔离点的基本医疗卫生服务特别是中医药服务,使患者肺炎（也包括基础疾病）得到初步的诊疗,大大缓解了患者得不到救治的恐慌,同时也有效地阻断了病毒对家人的传播,缓解社区的恐慌。武汉市隔离点管理经验显示,在条件有限情况下,隔离点设置过程中要采取措施相对区分出清洁区、缓冲区和污染区等区域;针对少数患有结核病、艾滋病等其他传染性疾病的隔离对象,要分类管理。     

惊恐障碍临床分析

目的了解惊恐发作患者临床特点及就医行为。方法采用自编调查表,通过面谈逐一填写。结果初次惊恐发作的年龄集中在20～39岁之间。初次惊恐发作的场所在家发作者40例,占66.7%,男女之间有显著性差异。初次治惊恐发作到本院就医期间平均(10.52±12.31)月。来院就医时合并抑郁障碍者20例,占33.3%。临床表现在二个症状上男女之间有显著性差异。结论初次惊恐发作场所在家发作者最多,男女之间有显著性差异。临床表现在恶心或腹部难受,发热或寒战症状上男女之间有显著性差异。     

双相障碍与社交恐惧症共病的神经心理学研究

目的 从神经心理学角度探讨双相障碍和双相障碍共病社交恐惧症之间认知功能障碍的异同.方法 对符合精神疾病诊断与统计手册(第四版)(DSM-IV的40例单纯双相障碍组、38例双相障碍共病社交恐惧症组和37例正常对照组使用WAIS智力全套测验、WMS逻辑记忆与视觉再生测验、词汇流畅性、连线测验A及B、威斯康辛卡片分类测验改良...