儿童焦虑症治疗的第一步

约有6%～20%的儿童和青少年患有广泛性焦虑、分离性焦虑和社交恐惧症,但是临床医生对于儿童和青少年的精神障碍认识尚不充分.这一问题非常严重,因为如果发病年龄小、病情较重,那么患者成人之后的结局往往很差.此外,如果不能早期诊断,焦虑症、抑郁症和药物滥用的发生率就会增加.在最近的<新英格兰医学杂志>中,发表了由Walkup等人进行的有关儿童-青少年焦虑症的多模型研究(CAMS)的结果,该项研究对上述精神障碍早期治疗的必要性进行了论述.     

The active ingredient in EMDR: is it traditional exposure or dual focus of attention?

Very little is known about the mechanisms that underlie the therapeutic effectiveness of eye movement desensitization and reprocessing (EMDR). This study tested whether the content of participants' responses during EMDR is similar to that thought to be effective for traditional exposure treatments (reliving), or is more consistent with distancing, which would be expected given Shapiro's proposal of dual process of attention. The responses made by 44 participants with post‐traumatic stress disorder (PTSD) were examined during their first EMDR treatment session. An independent rater coded these responses according to whether they were consistent with reliving, distancing or focusing on material other than the primary trauma. The coding system was found to have satisfactory inter‐rater reliability. Greatest improvement on a measure of PTSD symptoms occurred when the participant processed the trauma in a more detached manner. Cross‐lagged panel correlations suggest that processing in a more detached manner was a consequence of the EMDR procedure rather than a measure that covaried with improvement. Copyright © 2006 John Wiley & Sons, Ltd.     

Physiological neutrophilia of pregnancy is not associated with a rise in plasma granulocyte colony-stimulating factor (G-CSF)

A patient with neutropenia and life-threatening infections secondary to T-γ lymphoproliferative disease, who did not respond to treatment with recombinant human G-CSF (filgrastim), was treated with filgrastim plus cyclosporine A (CyA). The patient achieved a good response in the absolute neutrophil count and subsequently required a dose reduction in the filgrastim. The patient was eventually discontinued from the CyA but continues on filgrastim alone. While on therapy, the large granular lymphocytes disappeared from the circulation and the beta-TCR rearrangement, which was present prior to beginning therapy, became undetectable. The patient had no significant toxicity to the CyA or the filgrastim and he has not experienced any serious infections or required hospitalization. Filgrastim has proven to be relatively nontoxic and of some benefit to patients with this disease and should probably be utilized first when treatment is necessary. However, if improvement is not observed, these findings suggest that a trial of the combination of CyA plus filgrastim may be beneficial.     

Indomethacin retinopathy: case report and review.

The case of a 33-year-old man with probable indomethacin retinopathy is presented. The relevant literature is reviewed and the differences between our case and those previously reported are noted. Our patient appears to have suffered severe and irreversible ocular damage due to the very high dose of indomethacin ingested over a prolonged period.     

A double-crossover trial comparing the effects of topical carteolol and placebo on intraocular pressure.

The effect of topical carteolol 2% on the intraocular pressures of 12 patients suspected of having glaucoma was measured in a double-crossover trial of six weeks' duration. Carteolol produced a significant reduction in intraocular pressure (p less than or equal to 0.001), when compared with placebo. This represented reductions of 11% and 14%, after one and two weeks of treatment.