抑郁治疗的心理学疗法述评

在浅析精神分析、行为主义、人本主义、认知学派对抑郁成因解释的同时简要介绍了目前抑郁临床治疗中所使用的各心理学疗法。并在进一步分析各疗法利弊的同时对存在主义学派的Frankl首创的意义疗法进行详细介绍,旨在通过对抑郁精神层面的意义分析,为抑郁治疗提供新的启示。     

针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍临床疗效观察

目的 观察针刺联合镜像疗法治疗脑卒中患者上肢运动功能障碍的临床疗效。方法 将90例脑卒中上肢运动功能障碍患者按随机数字表法分为对照1组（30例,给予针刺治疗）、对照2组（30例,给予镜像疗法治疗）和观察组（30例,给予针刺联合镜像疗法治疗）,疗程均为2周。比较3组患者治疗前后Fugl-Meyer评估量表上肢板块（Fugl-Meyer assessment upper extremity,FMA-UE）评分,Wolf运动功能测试（Wolf motor function test,WMFT）量表评分,改良Barthel指数（modified Barthel index,MBI）,国际功能、残疾和健康分类（international classification of functioning,disability and health,ICF）评分及伸腕主动运动范围（active range of motion,AROM）和基于FMA-UE评分判定临床疗效。结果 观察组临床疗效优于对照1组和对照2组（P＜0.05）;治疗后3组患者FMA-UE评分、WMFT评分、MBI均较治疗前显著增加（P＜0.05）,ICF评分显著减少（P＜0.05）,且观察组FMA-UE评分、WMFT评分、MBI增加程度,ICF评分减少程度显著大于对照1组和对照2组（P＜0.05）;治疗后观察组患者伸腕AROM显著大于对照1组和对照2组（P＜0.05）。结论 针刺联合镜像疗法能有效改善脑卒中患者上肢运动功能障碍。     

调肝益肾汤、帕罗西汀单用和联用治疗早泄临床观察

目的观察单用帕罗西汀、调肝益肾汤及帕罗西汀联合调肝益肾汤治疗早泄的临床疗效。方法将96例早泄患者随机分为帕罗西汀组、调肝益肾汤组、中西医结合组,每组32例。帕罗西汀组予以帕罗西汀,每次20mg,口服,每晚1次;调肝益肾汤组予以中药调肝益肾汤口服,每日1剂,早晚分服;中西医结合组联合服用帕罗西汀与中药调肝益肾汤。3组疗程均为8周,比较3组患者治疗前后及停药10周末阴道内射精潜伏时间(intravaginal ejaculatory latency time,IELT)、中国早泄患者性功能指数(Chinese index of sexual function for premature ejaculation,CIPE)及不良反应。结果治疗后及停药10周末,3组患者IELT均较治疗前明显延长(P<0.05),CIPE评分及各条目评分均较治疗前明显升高(P<0.05);与帕罗西汀组、调肝益肾汤组比较,治疗后及停药10周末中西医结合组患者IELT明显延长(P<0.05),CIPE评分及各条目评分明显升高(P<0.05)。停药10周末,调肝益肾汤IELT显著大于帕罗西汀组(P<0.05),而CIPE评分及各条目评分与帕罗西汀组比较,差异均无统计学意义(P>0.05)。3组不良反应发生率比较,差异无统计学差异(P>0.05)。结论调肝益肾汤联合帕罗西汀治疗早泄的短期疗效和长期疗效较好,不良反应少。单用调肝益肾汤因其较好的安全性及长期疗效,亦有一定的临床应用价值。     

Integration of the Family Therapy Specialist into Public School Pupil Personnel Services

SUMMARY

The integration of a full-time family counseling specialist into the Pupil Personnel Service (PPS) Team of the modern public school is described. The roles of the present specialists are delineated as well as the problems inherent within the present Pupil Personnel Services Team. Inclusion of a family counseling specialist on the PPS Team would help schools avoid the antagonist position they find themselves in when a family opposes their suggestions and interventions. In such cases, the PPS Team attempts to wrest control of the case from the parents which subjugates the family, limiting the family's inherent resilience and strength. The family comes to resent the PPS Team, seeing them as blameful and controlling. Conversely, the PPS Team comes to resent the family, claiming it is “dysfunctional” in some way and using diagnostic labels to satisfy themselves that their “expert” actions are justified. This antagonist position in the schools arises more out of fear of litigation than good case management. We propose a new integration of family system and school system. Creation of a family counseling specialist who is highly trained in systems, narrative and structural/strategic family therapy could ameliorate this antagonist problem. Numerous functions for such a new specialty are listed as well as suggestions for including this member into PPS Team work.     

早产儿视网膜病变及其与吸氧的因果关系

早产儿视网膜病变主要发生于眼球发育不完善的新生儿,常会导致盲目或眼球萎缩等严重后果。该病的发病原因众多,较多学者认为与血氧浓度过高或过低有一定关系。在因ROP引致的纠纷中,吸氧治疗与疾病的因果关系常成为需要认定的重要问题。在进行此类案件的鉴定时,应当考虑多方面因素,全面分析,综合判断。     

Early maladaptive schemas in convicted sexual offenders: Preliminary findings

Core cognitive schemas may play a role in the vulnerability for sexual offending. Identifying these schemas could help to conceptualize sexual crimes and rehabilitate convicted sexual offenders. The aim of this preliminary study was to explore the relationship between early maladaptive schemas (EMSs) and sexual offending, as well as how rapists and child sex molesters differ in terms of these schemas. Thirty-two men convicted for rape, 33 convicted for child sexual abuse, and 30 non-offenders were evaluated using the Young Schema Questionnaire (YSQ-S3) and the Brief Symptom Inventory (BSI). Results showed that participants convicted for child sexual abuse presented significantly more schemas from the disconnection/rejection, impaired autonomy/performance, other directness, and over vigilance/inhibition domains than non-offenders, whereas rapists presented more schemas from the impaired autonomy/performance domain than non-offenders. Differences between sex offenders showed that child molesters presented more schemas of pessimism than rapists. Preliminary findings suggested that EMSs may impact sex offender's perceptions about themselves and about the world. Schema-focused therapy (Young, 1990, 1999) may thus be an acceptable approach to sex offender's psychological assessment and intervention.     

‘Monsters don’t bother me anymore’ forensic mental health service users’ experiences of acceptance and commitment therapy for psychosis

Acceptance and Commitment Therapy for psychosis (ACTp) is an approach that aims to change the relationship an individual with psychosis has with difficult thoughts, emotions and experiences. It promotes the use of acceptance, defusion, mindfulness and focussing on valued outcomes as opposed to struggling with psychotic experiences. This service evaluation project explored service users’ experiences and meanings of ACTp within a medium secure mental health service. Thematic analysis was used to analyse interviews with 10 male service users. Four main themes emerged from the data: ‘Recovery’, ‘Insight’, ‘Developing Skills’ and ‘Accessibility’. Overall, service users viewed their experience of ACTp positively and identified encouraging therapeutic outcomes. These findings suggest that ACTp is an approach that should be considered a therapeutic option within forensic mental health contexts. These outcomes were compared with previous research findings. Limitations of the study, clinical implications and ideas for future research have been discussed.     

Managing children's and adolescents' medical complaints amid parent conflict: Strategies and tools for professionals

Children and adolescents who are having difficulty coping with stress often present with complaints of physical discomfort. Effective treatment approaches exist for many of these issues. Among high-conflict parents, however, children's medical issues can become another canvas for conflict, with parents focused more on blaming one another for the child's distress than on options for assisting the child. Professionals can be drawn into the conflict to such a degree that they overlook essential steps for addressing and managing these issues. The authors present a research-informed model for managing medical and psychophysiological issues amid parental conflict.     

Forensic occupational therapy to reduce risk of reoffending: a survey of practice in the United Kingdom

Forensic services are required to reduce an individual’s risk of reoffending. Despite being integral to forensic mental health services, the contribution of forensic occupational therapy to achieving this aim is unclear. This study describes current forensic occupational therapy practice to reduce reoffending risk in the United Kingdom. Responses to a cross-sectional survey consisting of multiple choice and free-text questions were analysed using frequency counts and percentages, and thematic analysis respectively. Of the 58 participants, 83% actively addressed reoffending risk. Participants informed practice with occupation-focused theories, models and assessment tools. Five themes described forensic occupational therapy to reduce reoffending risk: an occupational perspective of risk assessment and formulation; volitional realignment; increasing protective factors; community integration; and enhancing understanding of forensic occupational therapy. Forensic occupational therapists perceive their practice to contribute to reducing reoffending risk, but are yet to establish routine outcome measurement in this area. Implications for practice and future research are discussed.     

Lowering the age of consent: Legal,ethical, and clinical implications of adolescent-directed therapy

This article discusses a recently enacted Colorado law that aims to reduce the youth suicide rate by lowering the age of consent for psychotherapy from age 15 to age 12. The author discusses the challenges therapists face when young adolescents seek therapy without parental consent in cases involving interparental conflict. Suggestions for managing adolescent-directed therapy are offered.