Management of nonresponsive hepatitis C

More than 50% of hepatitis C virus (HCV)-infected patients do not respond to the classical pegylated interferon (PEG-IFN)/ribavirin combination therapy. However, failing to respond to one course of treatment is not synonymous of therapy failure and retreatment is often beneficial. Alternative retreatment strategies include repeating the classical standard of care with an optimized drug regimen and adherence, including ribavirin serum concentration adjustment, correcting, if at all possible, comorbidities, and the addition of new specific anti-HCV molecules to the backbone of pegylated interferon/ribavirin. Options of retreatment should include consensus and natural interferons. For patients with advanced disease exposed to a high risk of lethal complications, customized maintenance therapy could be an effective option since it may slow down complications in some patients. Since low-dose interferon monotherapy is not sufficient, such a maintenance therapy remains to be verified via clinical trials. New possibilities of noninvasive assessment of fibrosis and the use of genetic tests to predict fibrosis progression and responsiveness to interferon are major emerging opportunities that run parallel to the revolution of the pharmacologic armentarium.     

大肠癌术后连续化疗患者的焦虑状态评估

目的 评估大肠癌术后连续化疗患者的焦虑状态。方法 对结直肠癌6次化疗前的患者,采用汉密顿焦虑量表(Hamilton Anxiety Scale,HAMA)进行焦虑状态评分。结果 首个疗程6次化疗中,第4、6次化疗前的HAMA评分高于首疗程首次化疗前评分,第2次化疗前HAMA评分低于第1次,且差异有统计学意义(P<0.05)。结论 大肠癌术后连续多次化疗后,患者焦虑状态有随化疗次数改变而逐渐变化的趋势,护理人员应采取相应的干预措施。     

护士离职意愿与心理契约破坏研究进展

护士离职意愿与心理契约破坏之间有着密切关系,为进一步了解和掌握目前护士心理契约破坏与离职意愿的相关情况.提高护士的满意度,降低护士的离职意愿,稳定和发展护士队伍.通过比较多篇文献关于护士离职相关因素分析护士离职原因,从护士的角度出发,对护士心理契约进行研究,找出心理契约破坏与离职意愿的关系.研究护士离职意愿相关因素是保证护士良好工作的必要条件.影响护士离职意愿的因素较多,但员工在心理契约得到有效兑现的情况下会表现出更高的工作满意度留职意愿和组织信任感,组织破坏心理契约则会给员工的工作态度及行为产生重大的负面影响.研究护士心理契约破坏与离职意愿的状况与相关影响因素有助于探索护理人员流失的原因和提高工作效率的方法,降低护理人员的离职意愿,提高护土队伍稳定性.     

空调车间女工心理卫生状况分析

本文采用ＳＣＬ—９０症状自评量表对某电子管厂空调车间１２８名女工的心理卫生状况进行了分析。结果表明，在空调车间气温、气湿、风速、二氧化碳、细菌总数、粉尘浓度、噪声均符合国家卫生标准的情况下已出现了明显的心理卫生问题，表现为躯体化、强迫、人际关系、抑郁、焦虑、敌对性、精神病性和阳性项目数明显高于对照组。而且观察组强迫、焦虑和精神病性因子分大于常模的检出率也显著高于对照组大于常模的检出率。另外，各因子分达到或超过中等程度以上的检出率比较，观察组躯体化症状多于对照组。各工龄组比较，小于１０年组的人际关系、抑郁、精神病性因子分及阳性项目数与等于和大于１０年组比较改变更明显。并对产生的原因进行了探讨     

A critical review of dimension-specific measures of health-related quality of life in cross-cultural research

This article reviews six dimension-specific health-related quality of life (HRQL) measures which have been used cross-culturally. The instruments reviewed are: the Beck Depression Inventory (BDI); the McGill Pain Questionnaire (MPQ); the Center for Epidemiologic Studies—Depression (CES-D); the Zung Self-Rating Depression Scale (SDS); the General Health Questionnaire (GHQ); and the Psychological General Well-Being Index (PGWB). These instruments primarily represent the psychological or emotional dimension of HRQL, and are scales that were developed and validated in the USA, Canada or the UK. The review of specific studies for each of the six instruments was not meant to be exhaustive, but rather to give an indication of the ways in which the instruments have been assessed or used in various countries. The focus throughout this article is on the psychometric properties (reliability, validity and responsiveness) of these scales in different cultures, as well as the processes used to translate the instruments from English into another language. Implications of the results of this review for cross-cultural use of dimension-specific HRQL instruments are drawn.     

The effects of substituting zopiclone in withdrawal from chronic use of benzodiazepine hypnotics

Twenty-four volunteers (19 women and five men) with insomnia and a history of chronic use of benzodiazepine hypnotics participated in a randomized, double blind, controlled clinical trial. The study was designed to assess the effects of substituting zopiclone (ZOP) – as an hypnotic – among chronic users of flunitrazepam (FLU), and to compare the subsequent withdrawal of ZOP with placebo controlled withdrawal of FLU. During the 5 weeks of a withdrawal protocol, sleep and physiological parameters were assessed by polysomnographic measures for 11 nights and by nightly actigraphic recordings for weeks 1, 3, and 5. Subjective effects of the withdrawal process were evaluated with daily sleep diaries, and with various weekly self-report symptom checklists. Paired t-tests performed on differences in objective sleep parameters between baseline and the last weeks of the withdrawal program showed a significant decrease in sleep quality within the FLU group, but not in the ZOP group. Subjective sleep diaries consistently reflected the objectively measured changes in sleep throughout the withdrawal program, indicating significant changes in sleep parameters only in the FLU group. The results obtained from the self report inventories aimed at assessing withdrawal symptoms, however, revealed no differences between the baseline week and the termination week of the program in any of the groups. After completing the pharmacological withdrawal, all subjects received a short-term cognitive behavioral intervention focused on improving their coping strategies with symptoms of insomnia; they were evaluated immediately after concluding the intervention, and at 3 and 12 month follow-ups. Received: 19 December 1997/Final version: 11 May 1998     

Kraepelin and modern psychiatry

A summarised account is given of Emil Kraepelin's research in the field of mental disorder, underlining his emphasis on objectivity and natural science and the need for a multi-disciplinary approach. At the same time attention is drawn to the limitations of his general outlook and to his political views, which in their historical context carry disturbing overtones of proto-fascism. It does not detract from the value of his work as a clinical scientist to conclude that his philosophical amblyopia, allied to an ineradicable chauvinism that was shared by many Germans of his class and status, resulted in a failure to demarcate the boundaries of his professional expertise and distorted his judgement on the wider implications of his own achievements. The lessons for the theory and practice of psychological medicine are briefly discussed.     

116例住院精神分裂症患者心理状态调查

目的：了解住院精神分裂症患者的心理状态，为康复治疗提供依据。方法：采用自编问卷分四部分对116例住院精神分裂症患者进行调查。结果：男女患者在心理状态上有显著性差异。大多数患者有自卑感，有被社会和家庭遗弃感。同时发现患者对治疗的态度积极，对心理治疗的需求很高。结论：住院精神分裂症患者药物治疗同时更应关注心理需求，应创造良好住院环境和人文环境促进患者的康复。