麦肯基疗法配合心理疗法治疗椎动脉型颈椎病的疗效观察

目的:观察麦肯基疗法配合心理疗法治疗椎动脉型颈椎病(CSA)的临床疗效。方法:将70例CSA患者随机分为观察组和对照组,每组35例。观察组用麦肯基疗法配合心理疗法治疗,对照组采用局部物理因子治疗。观察2组患者治疗前后总体有效率、抑郁自评量表(SDS)、焦虑自评量表(SAS)及经颅多普勒(TCD)检查结果的变化。结果:治疗4周后,2组SAS及SDS评分均较治疗前明显降低(P0.05),且观察组更低于对照组(P0.01)。治疗后,2组患者椎-基底循环各动脉Vm均较治疗前明显增加(P0.05),观察组更高于对照组(P0.01)。2组患者临床疗效比较,观察组总有效率明显高于对照组(P0.05)。结论:麦肯基疗法配合心理疗法治疗椎动脉型颈椎病是一种安全有效的方式,麦肯基疗法能够改善患者临床症状,帮助患者建立正确的姿势及运动模式,联合心理疗法,能够更好的发挥患者的主观能动性,从而实现患者身心健康。     

女性生殖器插入障碍诊疗效果观察

目的探索女性生殖器插入障碍的治疗方法,提高婚姻生活质量。方法对因女性生殖器插入障碍前来长沙市妇幼保健院就诊的患者进行治疗,尝试对阴道插入障碍患者进行分级评估,观察治疗效果,总结治疗经验。结果接受治疗的38例患者中,有21例治疗成功,12例有效,3例失访,2例放弃治疗。结论女性生殖器插入障碍的流行病学调查和诊治规范亟待关注,治疗需要性教育、性治疗和心理治疗的有机结合。开展全面性教育,需要全社会共同努力。     

Specificity of psychological treatments for bulimia nervosa and binge eating disorder? A meta-analysis of direct comparisons

Treatment guidelines state that cognitive–behavioral therapy (CBT) and interpersonal therapy are the best-supported psychotherapies for bulimia nervosa (BN) and that CBT is the preferred psychological treatment for binge eating disorder (BED). However, no meta-analysis which both examined direct comparisons between psychological treatments for BN and BED and considered the role of moderating variables, such as the degree to which psychotherapy was bona fide, has previously been conducted Thus, such an analysis was undertaken. We included 77 comparisons reported in 53 studies. The results indicated that: (a) bona fide therapies outperformed non-bona fide treatments, (b) bona fide CBT outperformed bona fide non-CBT interventions by a statistically significant margin (only approaching statistical significance for BN and BED when examined individually), but many of these trials had confounds which limited their internal validity, (c) full CBT treatments offered no benefit over their components, and (d) the distribution of effect size differences between bona fide CBT treatments was homogeneously distributed around zero. These findings provide little support for treatment specificity in psychotherapy for BN and BED.     

Mechanisms of change in interpersonal therapy (IPT)

Although interpersonal therapy (IPT) has demonstrated efficacy for mood and other disorders, little is known about how IPT works. We present interpersonal change mechanisms that we hypothesize account for symptom change in IPT. Integrating relational theory and insights based on research findings regarding stress, social support, and illness, IPT highlights contextual factors thought to precipitate and maintain psychiatric disorders. It frames therapy around a central interpersonal problem in the patient's life, a current crisis or relational predicament that is disrupting social support and increasing interpersonal stress. By mobilizing and working collaboratively with the patient to resolve this problem, IPT seeks to activate several interpersonal change mechanisms. These include: 1) enhancing social support, 2) decreasing interpersonal stress, 3) facilitating emotional processing, and 4) improving interpersonal skills. We hope that articulating these mechanisms will help therapists to formulate cases and better maintain focus within an IPT framework. Here we propose interpersonal mechanisms that might explain how IPT's interpersonal focus leads to symptom change. Future work needs to specify and test candidate mediators in clinical trials. We anticipate that pursuing this more systematic strategy will lead to important refinements and improvements in IPT and enhance its application in a range of clinical populations.     

Early preventive attachment-oriented psychotherapeutic intervention program with parents of a very low birthweight premature infant: Results of attachment and neurological development

The birth of a very small preterm infant ( 1500 grams) can be a traumatizing experience for many parents. A developmental risk model is presented that is the background to an early attachment-oriented preventive psychotherapeutic intervention. This comprehensive parent-centered intervention program is composed of supportive group psychotherapy, attachment-oriented focal individual psychotherapy, a home visit and video-based sensitivity training. The intervention aims at improving parental coping, the process of attachment and parent-infant interaction. In a prospective longitudinal design mothers were randomly assigned to a control (N = 44) and an intervention group (N = 43) after preterm delivery. Results show that the percentage of secure (control vs. intervention group: 77.8% vs. 59.4%) and insecure (control vs. intervention group: 8.3% vs. 31.3% avoidant, 13.9% vs. 9.4% ambivalent) attachment quality in high-risk preterm infants is comparable to results from studies with term infants. There was no significant statistical difference in terms of quality of attachment of the preterm infants between the control group and the intervention group. However, only in the control group, impaired neurological development corresponded significantly with an insecure quality of attachment, but not in the intervention group, although there were significantly more neurologically impaired infants in the intervention group. This result is discussed as an effect of the intervention program.     

The rationale behind a Dance Movement Psychotherapy intervention used in a small research pilot in a further education context to develop awareness about young people's body image

This study includes some of the comments from a small piece of quantitative research conducted in a British Further Education College. It was designed to investigate young people's experience of a Dance and Movement Psychotherapy intervention in relation to their body awareness and their body image.     

Cliniques urbaines africaines

The team of therapists who gathered around Henry Collomb at the Fann Hospital of Dakar in the sixties has noticed the particularities of the African psychiatry with a noticeable predominance of delirious puffs on the other pathologies. In the eighties, Maurice Dorès drew attention to the evolution of this situation marked by a notable reduction of the delirious puffs in favor of hysterical psychosis and other symptomatologies. This text accounts for the psychotherapeutics of patients who come to consult a psychologist in urban area and currently the most frequent motivations of this approach.     

De l’incarcération du corps au vécu d’enfermement. Le destin des pulsions contre les murs de la prison

ObjectiveThis article questions the impact of imprisonment on the subjective investment of the body of the drives. The author postulates the hypothesis of a reification of the object following the process of incarceration, which would have a direct impact on the subject's investment of his own body, as well as on the trajectories followed by his drives.MethodThe author exposes the case of psychotherapy with a patient in a medical care unit in a prison environment.ResultsThe analysis of this case illustrates how confinement artificially accentuates the outlines of areas left blank in the libidinal distribution of the erogenous body, and how, on the contrary, the source areas constrain the realization of the expression of the drives; an overinvestment of the intensity of the constrained thrust becomes itself the goal.DiscussionThe possibility of overcoming perceptual confinement in a clinical encounter is only present when there is a reversal on both sides of perceptual and affective elements, at a distance from successful representations. However, it would seem illusory to deny the very impact of representation in the associative process, if only through the narrative work that begins here, work that carries in itself the conditions for going beyond the perceptual in the transference.ConclusionThe drive, turned “upside down” by the ordeal of confinement, tends to come undone, in a way that recalls the undoing performed perverse processes. This can lead to a series of decompensations, themselves pretexts for the demand for care.