社会工作者参与精神卫生服务不同模式的比较研究

本文从社会工作者（社工）参与精神卫生服务角度比较专项社工人才培养、购买社工组织服务、精神卫生医疗机构社工岗位设置三种模式的异同及应用前景。选取了北京市、重庆市、上海市作为典型模式代表。前两种模式由政府行政部门主导,第三种模式由医疗机构主导;在社工队伍发展方面,专项社工人才培养能够短期内充实队伍,购买社工组织服务能够充分发挥现有社工队伍的作用,精神卫生医疗机构设置社工岗位使队伍更稳定;在服务侧重方面,政府购买服务更注重在社区持续开展服务,精神卫生医疗机构内的社工主要在院内开展服务,并承担对社区精神卫生社工服务的带动指导作用。三种模式并不是孤立互斥的,各地应根据经济水平、社会组织资源、医疗机构实力等实际情况进行综合探索,推动精神卫生工作中社会服务的发展。     

Preventive Psychiatry: The Psychiatric Team as Consultant to the Public Health Nurse

Various forms of collaboration between the disciplines of public health and psychiatry are briefly reviewed and the 25-year-old mental health program of the Vancouver Health Department is described. The public health nurse has prime responsibility in all children with emotional disorders. She is supported by a psychiatric team which provides active treatment and educational and consultative help for the nurse and the school. During the year 1963, six social workers had 2357 contacts with nurses and school personnel but only 1049 treatment interviews. Of 401 children referred to the psychiatric team, 138 received active clinic treatment, 141 remained under supervision by the public health nurse, and 122 were referred elsewhere. In addition, 1330 children were identified as “mental hygiene cases” in the caseload of the 170 public health nurses in the community. By close co-ordination, the public health nurse and the psychiatric team can enhance each other's contributions to community mental health.     

A Psychiatric Home Care Program: A Report on Three Years'' Experience (1962-1964)

The activities covering a three-year period of a psychiatric home care treatment program attached to a psychiatric unit of a general hospital are described. A detailed account of its operation and the roles played by each member of the team is given. This service frequently provides a substitute for hospitalization in the management of both acute and chronic psychiatric states and thereby constitutes an important preventive measure in the field of public health. Even if the initial attitude of the patient is negative it is possible to gain the co-operation of the family who become a useful ally in the treatment. The co-operation of the patient is not as essential as has been thought. The traditional role of the psychiatrist is reversed by virtue of his attending the patient at home. The active participation of social agencies is an integral part of the treatment.     

The mental health visitor and psychiatric after-care.

The results of a project, originating in South Australia, designed to assist the discharge of psychiatric patients are described. The project introduced a new category of mental health worker, the mental health visitor. These mature-age "subprofessionals" attached to social work departments after a brief, specific, in-service training, have worked closely with Mental Health Services psychiatrists, psychologists and social workers in various situations. They have established good relationships with social workers in other agencies and with general practitioners and their activities have included initial assessment, liaison and after-care. The demand for them appears to be increasing.     

Habilitation of Patients with Congenital Malformations Associated with Thalidomide: Pediatric Aspects

Since November 1961 it became apparent that the administration of thalidomide to pregnant women was associated with the occurrence of severe congenital anomalies. These deformities are frequently symmetrical, involving the limbs, particularly the proximal part, and associated with an absent external ear, mid-line facial hemangioma with saddle nose, atresia of the bowel and other congenital anomalies. Care of these children is a complicated problem requiring a team of specialists of many disciplines, particularly a pediatrician, an orthopedic surgeon, a prosthetic specialist and a social worker. Treatment by such a team ideally would commence immediately after delivery of the infant and continue until the child has been totally habilitated. Such care ideally should be provided within existing services in the country for the habilitation and rehabilitation of handicapped children.     

江西省精神科医师转岗培训现状分析与对策研究

为提高江西省重性精神疾病救治管理和医疗保障水平,不断提升基层精神卫生防治能力和水平,2012年开始,我省以实施严重精神障碍管理治疗项目和贫困家庭重性精神免费救治工作为抓手,整合精神卫生工作资源,率先在国内启动精神科医师转岗培训工作,积极探索构建符合江西省情的精神科医师培训模式.受江西省卫生健康委的委托,江西中医药大学自...     

医务工作者子女SARS心态对照研究

目的:了解医务工作者子女"非典"时期心理反应,以便对传染病爆发期儿童的心理干预提供理论依据.方法:对西安市所属的七个区各随机抽取一个学校,每个学校抽取四、五、六年级各两个班,对2000名儿童进行调查.选取母亲职业为医务工作者的小学生286名为研究组,母亲职业为非医务工作者的具有可比性的小学生615名为对照组,利用自制量表进行问卷调查.结果:研究组的神经衰弱(neurasthenia )、恐惧(fear)、抑郁(depression)因子得分高于对照组,而强迫-焦虑(force-anxiety )、消极(passiveness)因子得分低于对照组(P＜0.05、0.001).研究组四年级疑病(hypochondriasis )因子得分最高、消极(passiveness)因子得分最低(P＜0.001).强迫-焦虑、疑病、抑郁因子中度～重度的发生率明显高于对照组(P＜0.05、0.001).结论:医务工作者子女SARS 心理健康状况除消极因子外,其余因子从程度上、或从发生率上高于对照组,需引起社会工作者的重视.     

Mental health education in three primary care specialties

The authors used a questionnaire to examine the characteristics of the mental health components of residency training in traditional internal medicine, primary care internal medicine, and family practice. Traditional internal medicine programs relied almost exclusively on the consultation method and inpatient facilities, offered little formal instruction, used the psychiatrist as the primary teacher, and spent considerably less per resident for mental health training than the other programs. Psychologists and social workers as a group were the primary mental health teachers in family medicine residencies. Traditional internal medicine programs emphasized psychophysiological reactions and simple pharmacotherapy, while primary care internal medicine and family practice programs concentrated on life cycle issues, psychosocial awareness, and simple psychosocial management techniques. None of the three types of residencies focused on complex psychiatric disorders or management techniques. The three specialties differed significantly (F = 13, p = .0001) in the total amount of time on average the resident spent in formal mental health instruction. The need for evaluation of the outcome of training is also discussed.     

中美高校大学生心理健康教育的比较与启示

在急剧变化和迅速发展的现代社会情境下,大学生成长的环境日趋复杂,其心理素质状况越来越令人担忧.本文从比较中美两国高校大学生心理健康教育的教育理念、教育体制、教育领域、教育途径、队伍建设和评价体系的差异入手,借鉴美国高校大学生心理健康教育的最新发展,探析当代高校大学生心理健康教育的新模式,对于现阶段加强大学生心理健康教育具有重要的现实意义.     

Emotional Reactions to Disfigurement from Cancer Therapy

Disfigurement not only produces current anxieties but reactivates childhood conflicts. The emotional reaction depends upon the disturbance to the patient's major adaptations to life as well as the meaning of the organ to the patient. Fear of isolation and rejection by others may be more terrifying than fear of death. Emotional reactions include regression with marked dependency, anxiety, depression, hostility and, if severe, paranoid states, hypochondriasis, denial, counterphobic behaviour, obsessive-compulsive reactions and schizophrenic reactions. Management basically involves early establishment of a positive doctor-patient relationship. In such a relationship the physican should educate his patient, undercut guilt, accept transient regression and expression of anger, set limits on counterphobic behaviour, either support or gently question denial of reality, and support, without being overly sympathetic, a depressed patient. The nurse, social worker, psychiatrist and the patient's family may be valuable members of the therapy team. Disfigurements of various body areas pose individual problems of management.     

Validity and reliability of Tamil version of Strengths and Difficulties Questionnaire self-report

BACKGROUND: Child and adolescent mental health services are scarce in Sri Lanka. Moreover there are no validated instruments to measure the mental health problems of Tamil speaking adolescents in Sri Lanka. Hence, strengths and difficulties questionnaire (SDQ) self-report was translated into Tamil and validated in the District of Jaffna, Sri Lanka. SDQ self-report was translated from English to Tamil using standard translation and back translation method. The Tamil version of the SDQ self-report was validated against a gold standard (ie. diagnosis made by a consultant psychiatrist). Both clinic and community samples were included in the validation study. Thirty-five adolescents (11-16 years) attending a psychiatric clinic and 91 adolescents from the community were included. The consultant psychiatrist made the diagnosis independent of the SDQ responses. Receiver operating characteristics (ROC) curve was used to measure the validity of SDQ. Reliability was measured using internal consistency. RESULTS: The ROC curve indicated high validity for the identification of adolescents with mental health problems: area under the curve 0.87 (95% - CI = 0.79-0.93). International cut-off point of 15 gave a sensitivity of 69.4% and specificity of 92.2%. Cronbach's alpha values (0.67-0.78) were good in all subscales and total difficulties scale. CONCLUSION: The SDQ self-report Tamil version can be used effectively for screening of adolescents to identify mental health problems as well as for research purposes.     

Sinhala translation of child behaviour checklist: validity and reliability

OBJECTIVE: To translate the child behaviour checklist (CBCL) into Sinhala and validate it for assessment of mental health status of children aged 5-10 years. DESIGN AND SETTING: Translation/back-translation method was used to translate the English CBCL into Sinhala. Each item in the Sinhala CBCL (CBCL-S) was rated by mental health professionals to determine semantics, content, and conceptual validity types. To ascertain criterion validity, total scores obtained for CBCL-S by administering it to parents or parent surrogates of 49 girls and 80 boys aged 5-10 years attending the specialist psychiatry clinics and 69 boys and 69 girls in the same age group from the community were compared with clinical diagnoses by a child psychiatrist. Receiver operator characteristic curves were drawn to obtain the cut-off points in CBCL-S for boys and girls separately. RESULTS: Semantics, content, and conceptual and criterion validity of CBCL-S were satisfactory. At the cut-off level of 39, CBCL-S had a sensitivity of 90% and a specificity of 88% for boys and a sensitivity of 89% and a specificity of 92% for girls. Internal consistency, test-retest reliability, and inter-interviewer reliability of CBCL-S were satisfactory. INTERPRETATION: CBCL-S is a valid and reliable instrument to measure mental health status of Sinhalese children aged 5-10 years in Sri Lanka.     

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.     

家庭医生团队职业倦怠现状及影响因素研究

背景　家庭医生制度是强化基层医疗卫生服务的重要任务之一,家庭医生团队是家庭医生服务的第一责任人,其身心健康与服务质量是影响家庭医生签约服务发展的关键因素,但目前国内以服务供方角度探讨家庭医生制度的研究相对较少。目的　了解家庭医生团队的职业倦怠现状,并分析其影响因素,为科学干预职业倦怠提供理论依据。方法　于2017年5—10月,采用典型抽样法在徐州市选取已开展家庭医生服务的社区卫生服务中心28家,以其所有家庭医生团队成员为研究对象,共600例。采用马斯勒职业倦怠调查普适量表（MBI-GS）调查纳入成员的职业倦怠情况,采用多因素Logistic逐步回归分析其职业倦怠的影响因素。结果　共回收有效问卷568份（包括全科医生165例、护士272例、公共卫生医生131例）,问卷有效回收率为94.7%。家庭医生团队成员的职业倦怠阳性检出率为75.4%（428/568）,其中情感衰竭、去个性化、个人成就感降低维度的中重度倦怠占比分别为51.8%（294/568）、34.7%（197/568）、66.0%（375/568）,个人成就感降低维度高于情感衰竭维度、情感衰竭维度高于去个性化维度（P<0.05）。多因素Logistic逐步回归分析结果显示,月收入、用工形式、职业喜爱程度、自评工作意义、工作压力是家庭医生团队职业倦怠的影响因素（P<0.05）。结论　家庭医生团队的职业倦怠阳性检出率较高,尤其体现在情感衰竭和个人成就感降低两方面,建议通过健全家庭医生绩效考核制度、给予团队社会支持、引导家庭医生团队转变医疗观念等方式降低其职业倦怠检出率,以保障家庭医生队伍的稳定与发展。     

Ethical issues in long-term psychiatric management.

Two general ethical problems in psychiatry are thrown into sharp relief by long term care. This article discusses each in turn, in the context of two anonymised case studies from actual clinical practice. First, previous mental health legislation soothed doubts about patients'' refusal of consent by incorporating time limits on involuntary treatment. When these are absent, as in the provisions for long term care which have recently come into force, the justification for compulsory treatment and supervision becomes more obviously problematic. Second, Anglo-American law does not normally allow the preventive detention of someone who may be dangerous but has not actually committed any crime. The justification for detaining a possibly dangerous user of mental health services without his or her consent can only be based on risk assessment, but this raises issues of moral luck. Is the psychiatrist who decides not to take out a supervision order for a possibly dangerous patient with an initial psychotic diagnosis morally at fault if that person harms someone in the community, or himself? Or is the psychiatrist merely unlucky?     

Valve replacement in endocarditis: setting limits in noncompliant intravenous drug abusers

An intravenous (IV) drug abuser underwent repeated valve replacements because of recurrent infective endocarditis. Is it ethically permissible to withhold valve surgery in a recalcitrant, noncompliant IV drug abuser? We believe so, and in our analysis, discuss the principles of futility, rationing, personal responsibility, and justice. Because of her continued drug abuse, the patient is responsible and accountable for the medical consequences. The consequences are that physicians will not be able to provide her with beneficial treatments without disproportionate harm, and that society will no longer be able to provide resources for her treatment without unfairly jeopardizing the availability of resources for other members of society. Although valve surgery does not constitute futile treatment, maximizing and egalitarian principles of societal justice support the withholding of such an expensive intervention. The patient should be jointly evaluated by the physician, social worker, and psychiatrist. The medical team will emphasize patient compliance and willingness to undergo drug rehabilitation, and will offer the first valve replacement. The recidivist abuser with demonstrable non-compliance who sustains a second episode of endocarditis need not be offered another valve. To avoid bedside rationing, we recommend the formulation of such a policy by nations and professional bodies.     

综合性医院精神科会诊的回顾性研究

目的对综合性医院联络精神会诊进行分析研究。方法将本院2003年12月至2005年12月邀请精神科会诊的科室分布、病种、诊断及用药情况进行年度间对比分析。结果:邀请会诊的科室以内科最多(55.13%),其次是外科(43.35%);且2005年内科及外科两大科室会诊病例数比2004年有较大递增(P<0.05);躯体疾病伴发精神障碍要求协助诊治是会诊的主要原因(85.93%),2005年高于2004年(P<0.05);会诊主要针对控制燥闹(镇静)表现占74.14%,2005年高于2004年(P<0.05);会诊执行率(95.82%)、有效率(87.45%),两年度变化不明显(P>0.05)。结论:需要我们进一步加强精神、心理卫生宣传,增加综合医院临床医师对精神、心理卫生的认识,大力开展联络精神会诊,这有利于提高精神科与非精神科医生的业务水平,全方位提高医院诊治病人的能力。     

潮汕地区精神分裂症患者求医行为及影响因素

目的探讨潮汕地区精神分裂症患者患病后首诊行为及影响因素。方法对就诊于精神科专科的被确诊为精神分裂症的114例患者及监护人,采用自行设计的精神分裂症患者首诊行为及其影响因素调查问卷进行问卷调查。结果发病后求助于精神科的26例(22.8%),求助于迷信治疗的47例(41.2%),求助于非专科医疗机构的41例(36.0%)。精神分裂症患者是否首诊精神科主要受人们对精神科的接受程度(与地区文化、传统观念有关)及疾病的发病形式影响,求医行为与城乡、经济收入、监护人文化、求医习惯、监护人对疾病判别及对精神病知识了解程度等因素有关。结论受潮汕地区独特的文化影响,精神分裂症患者在求医精神科前普遍存在着不良的求医行为。加强精神卫生常识宣教,减少不良的地区文化影响,提高潮汕人对精神病的接受程度是纠正不良求医行为的有效办法。     

社会支持和应对方式对创伤性颅脑损伤患者家属的压力和心理健康的影响(英文)

目的：探讨社会支持和应对方式对创伤性脑损伤患者家属的压力与心理健康之间的影响。方法：采用 家属应激量表、症状自评量表、社会支持评定量表和简易应对方式量表对长沙300名创伤性脑损伤患者家属进行测 量。结果：创伤性脑损伤患者家属的心理问题与较高的应激水平、更多的消极应对、更少的积极应对和社会支持密 切相关。除家属的应激与心理问题直接相关外,应对方式和社会支持也起到了中介作用。这些因素的中介效应为 23.6%~43.0%,社会支持的中介效应要大于应对方式。结论：在对创伤性脑损伤患者家属进行心理护理时,应考虑社 会支持和应对方式的作用,以便预防和调节家属的心理问题,从而促进患者的治疗与康复。     

家庭支持对我国老年人身心健康影响的城乡差异研究

【摘要】 目的 了解我国城乡老年人身心健康及社会支持的现状,并探究不同家庭支持类型对老年人身心健康影响的城乡差异。方法 本研究数据来源于2013年中国健康与养老全国追踪调查（China Health and Retirement Longitudinal Study,CHARLS）数据。生理健康用日常生活自理能力（ADL）/工具支持型生活自理能力（IADL）量表测量,心理健康用流行病学调查用抑郁量表(CES-D)测量。家庭支持包括经济支持、日常照料和情感慰藉。利用二分类logistic模型进行影响因素的分析。结果 子女的经济支持对农村老年人的生理健康存在积极影响(P <0.05);子女的精神慰藉对农村老年人的心理健康存在积极影响(P <0.01);子女日常照料对城乡老年人的身心健康均存在积极影响(P <0.01)。结论 家庭支持对老年人身心健康的影响存在明显的城乡差异,农村老年人身心健康对家庭支持的依赖性高于城市老年人。应不断完善老年人正式社会支持体系,减小城乡差距。同时继续发挥家庭支持对老年人身心健康的作用。