Psychological aspects of diabetes care: Effecting behavioral change in patients

Patients with diabetes mellitus(DM) need psychological support throughout their life span from the time of diagnosis. The psychological make-up of the patients with DM play a central role in self-management behaviors. Without patient's adherence to the effective therapies, there would be persistent sub-optimal contro of diseases, increase diabetes-related complications,causing deterioration in quality of life, resulting in increased healthcare utilization and burden on healthcare systems. However, provision of psychosocial support is generally inadequate due to its challenging nature of needs and demands on the healthcare systems. This review article examines patient's psychological aspects in general, elaborates in particular about emotion effects on health, and emotion in relation to other psychological domains such as cognition, self-regulation,self-efficacy and behavior. Some descriptions are also provided on willpower, resilience, illness perception and proactive coping in relating execution of new behaviors,coping with future-oriented thinking and influences of illness perception on health-related behaviors. These psychological aspects are further discussed in relationto DM and interventions for patients with DM. Equipped with the understanding of the pertinent nature of psychology in patients with DM; and knowing the links between the psychological disorders, inflammation and cardiovascular outcomes would hopefully encourages healthcare professionals in giving due attention to the psychological needs of patients with DM.

Psychiatric Aspects of Egyptian Women with Unexplained Infertility

Background: The diagnosis of unexplained infertility may be very frustrating for infertile couples and they show higher depression levels when compared to fertile couples. Aim: To assess the psychiatric aspects of Egyptian women with unexplained infertility. Methods: 220 infertile women were included in this study (110 with unexplained infertility and 110 with explained infertility). The psychiatric aspect of these women was evaluated using the translated and validated Hamilton Anxiety Rating Scale and the Beck Depression Inventory-II. Findings: The number of women with mild depression was significantly higher in the unexplained infertility group (47/110 (42.7%)) versus (22/110 (20%)) in the explained infertility group (P = 0.007). The number of women with moderate anxiety was significantly higher in the unexplained infertility group (26/110 (23.6%)) versus (8/110 (7.3%)) in the explained infertility group (P = 0.003). Conclusion: The current study concluded that mild depression and moderate anxiety were significantly higher in the unexplained infertility group. It is crucial to identify infertility women who are in need of psychological support and counseling during infertility treatment, because the psychological disturbance of the infertile women may affect the outcome of infertility treatment.

Difficult-to-Treat-Depression—Perceptions of GPs and GP Trainees

Introduction: GPs are often the first contact point for mental health concerns. Training to qualify as a GP involves completing a three-to-four year program. Among other things, the training program may include a six-hour mental health training workshop. The study’s purpose was to compare GPs’ and Trainees’ perceptions of difficult-to-treat-depression (DTTD). Methods: Using a semi-structured interview schedule comprising six questions, 10 GPs and six Trainees participated in focus groups or telephone interview. To understand participants’ perspectives, data were analyzed using the Framework Method. Findings: Trainees were less clear than GPs about the meaning of DTTD and other diagnostic terms. GPs’ diagnosis included querying diagnosis and treatment options. Trainees’ experience was limited but they raised barriers including non-response to various treatment trials. Both groups identified management difficulties including: doctor shopping, suicide risk, patients not being well informed;with management difficulties exacerbated by limited access/referring to health professionals, cost and/or unavailability of bulk billing. While some GPs and Trainees had heard of an illness management model or chronic illness model, few used a model. Most reported limited referring to psychiatrists, mainly because of cost and/or limited availability. GPs were more likely to refer to other health professionals and use pharmacological and complementary therapies. Both groups discussed the impact of external factors including cultural factors, patient compliance, treatment failure, and the importance of the relationship between the patient and the professional. Trainees were more likely to stress the importance local clinical guidelines. Discussion and Conclusion: Despite the small size and limited nature, this research provides insight into some of the similarities and differences of GPs’ and Trainees’ experiences and understanding of DTTD. This may have implications for training providers, clinical supervisors and Trainees, and suggests that enhancement in the role of mental health training may be relevant.

Difficult-to-Treat-Depression and GPs’ Role: Perceptions of Psychologists

Introduction: Since the Australian Government introduced the “Better Access to Mental Health Services” program in 2006, psychiatrists, psychologists and general practitioners (GPs) have become increasingly involved in service provision for people seeking help with mental health problems. The aim of this research was to a) explore psychologists’ perceptions of difficult to treat depression (DTTD) and b) explore what they thought about the GPs’ role in managing these patient given that most patients are referred to psychologist by GPs. Methods: A previously developed semi-structured interview schedule comprising six questions was used. Seven psychologists participated in a focus group held in Melbourne. Data were analysed using the framework method. Findings, including Discussion: While psychologists understood the term DTTD it was suggested that using different terms may limit understanding between health professionals. Rather than diagnosing, psychologists were more likely to conduct further assessment contextually to confirm GPs’ diagnosis. Communication with GPs was important, particularly when managing “long-term” and suicidal patients. Management included cognitive and behavioural interventions and referring to other mental health services, psychiatrists and/or other allied health professionals. Referral to psychiatrists could be difficult because of limited availability and for some patients, prohibitive costs. Although psychologists discussed non-pharmacological and/or complementary treatment options with patients, they were more likely to rely on GPs to discuss/prescribe these options. Conclusion: While generalisability may be limited, this study is the first to document some understanding of psychologists perceptions of DTTD and the importance of GPs and other health professionals’ role in managing this patient cohort.

基于“肝脾同调”阐析慢性肝病的中医治疗

慢性肝病是临床常见疾病,“郁、虚、湿、毒、瘀”是其核心病机,在疾病的不同阶段各有侧重,其中,以“郁、虚”为核心的肝脾失调是慢性肝病发生发展的关键。“肝脾同调”是治疗慢性肝病的基本治法,在慢性肝病不同阶段,其“肝脾同调”内涵同中有异。根据肝、脾生理病理特性,治脾明辨虚实,厘清轻重,活用运脾、健脾、温脾、醒脾、补脾等法;调肝体用并重,精准辨证,活用疏肝、缓肝、散肝、柔肝等法。临床上,治脾与调肝相辅相成,治调并举,常获良效。

基于“形神一体观”理论探讨心律失常合并焦虑抑郁辨治

心律失常是临床常见的心血管疾病,其发病率高,因生活模式改变及其不良预后导致患者合并焦虑抑郁问题愈加明显,西医治疗主要是抗心律失常与抗焦虑抑郁类药物的联合应用,但部分患者对精神类药品的依从性较差。中医学对于“心”的生理认识包括“心主血脉”和“心主神明”,注重“形与神俱”的整体观念,“心主血脉”即是有形,“心主神明”则是有神,与现代医学研究的“双心”理念不谋而合。该文基于“形神一体观”理论,从双心医学角度出发,认为心律失常合并焦虑抑郁当属形神共病,其中“形”坏是其发病的基础,“神”伤是其发病的关键,二者相辅相成,互为因果,可谓是一荣俱荣,一损俱损。治疗上当注重形神兼治,采用健脾益气、化痰祛瘀、清肝宁心、理气解郁、重镇潜阳等多种治法,改善患者的躯体症状与精神障碍,以达到机体气血阴阳的平衡。以期为心律失常合并焦虑抑郁的临床诊疗提供新思路与新方法。

调神治癌方联合心理干预治疗卵巢癌术后合并抑郁临床研究

目的:观察调神治癌方联合心理干预的“调神治癌”疗法治疗卵巢癌术后合并抑郁状态患者的临床疗效。方法:采用前瞻性研究设计方法,根据纳排标准筛选入组90例卵巢癌术后合并抑郁状态的患者,按随机数字表法分为调神治癌方联合心理干预的干预组和常规调神治癌方为主的对照组,两组各45例,干预4周为1个周期,共干预3个周期。两组患者分别于0、12周评估抑郁症筛查量表(PHQ-9)、广泛性焦虑量表(GAD-7)、多维疲劳量表(MFI-20)、匹兹堡睡眠指数(PSQI)量表及Karmofsky功能状态(KPS)评分,并于干预前后检测血常规、肝肾功能、肿瘤标志物糖类抗原125(CA125)。结果:治疗后干预组患者CA125水平显著低于对照组(P<0.05)。治疗后两组患者MFI-20疲劳评分均较前有所降低:其中疲劳总分、体力疲劳评分、脑力疲劳评分、动力下降评分、活动减少评分等均较治疗前明显下降(P<0.01);治疗后,干预组患者疲劳总分、体力疲劳评分、脑力疲劳评分以及活动减少评分,均显著低于对照组(P<0.05)。治疗后两组患者PSQI睡眠评分比较,对照组患者在睡眠障碍及日间功能障碍评分两方面均较治疗前显著减少(P<0.05),干预组患者在睡眠质量、催眠药物、睡眠障碍、睡眠效率以及PSQI总分5个方面均较治疗前下降(P<0.05);与对照组相比,治疗后干预组睡眠质量、睡眠时间、催眠药物使用、睡眠障碍、睡眠效率、日间功能障碍以及PSQI总分均显著优于对照组(P<0.05)。治疗后干预组患者抑郁和焦虑以及KPS生活质量评分改善也显著优于对照组(P<0.05)。结论:调神治癌方联合心理干预的“调神治癌”疗法能够改善患者抑郁、焦虑等负性心理状态,改善失眠、疲乏等多项临床症状,提高综合疗效。

从“十一脏取决于胆”论治冠心病合并焦虑抑郁

“十一脏取决于胆”首见于《素问》,强调胆在人体生命活动及临床治疗中的重要作用。冠心病具有病程长,易反复,需长期服药等特点,加之社会心理因素的影响,常易伴发焦虑抑郁。笔者在临床跟师过程中,发现导师从胆论治冠心病合并焦虑抑郁疗效显著,“十一脏取决于胆”的理论在临床中得到验证。导师认为,一者,肝胆相合,共主疏泄,与气机疏泄密切相关;二者,胆寄情志,疏调气机,精神活动,决断于胆;三者,胆蕴相火,通行气血,君相安位,则气血和调;因此,本病的病机主要在于气机失调,相火妄动,导致脏腑经络失和,神机失用。基于此病机,本文结合案例介绍从胆论治冠心病合并焦虑抑郁之经验,以期为临床提供治疗思路。

痴呆患者家庭照顾者照顾积极感受现状及影响因素分析

目的调查痴呆患者家庭照顾者照顾积极感受现状并分析其影响因素,为实施促进家庭照顾者积极感受干预提供参考。方法采用方便抽样法,选取济南市3所三级甲等医院神经内科门诊、记忆门诊及3个社区的201对痴呆患者及家庭照顾者作为调查对象,采用一般资料调查表、照顾积极感受量表、中国家庭照顾者自我效能问卷、Zarit照顾者负担量表、抑郁自评量表、社会支持量表进行调查。采用单因素分析及多元线性回归分析痴呆患者家庭照顾者照顾积极感受的影响因素。结果痴呆患者家庭照顾者照顾积极感受量表总分为(31.20±2.75)分。多元线性回归结果显示,照顾者性别、文化程度、个人月收入、对痴呆的了解程度、自我效能、照顾负担、社会支持水平是痴呆患者家庭照顾者照顾积极感受的影响因素(均P<0.05)。结论痴呆患者家庭照顾者照顾积极感受处于中等水平。护理人员应重视照顾者的照顾积极感受,通过提高其痴呆知识和技能水平,提升自我效能,减轻照顾负担,加强社会支持,以促进家庭照顾者照顾积极感受水平,从而提高痴呆患者及其家庭照顾者的生活质量。

基于“阴病治阳”治则浅析“重阳思想”在抑郁症诊疗中的应用

从阴阳观来看,抑郁症主症、发病机制、患病人群性别差异、患病季节及时空差异具有阴之属性,在宏观疾病观上抑郁症属阴病范畴,因此将抑郁症的病机归为阳虚阴盛;基于《黄帝内经》“阴病治阳”的治则,浅析以扶阳为主的“重阳思想”在抑郁症诊疗过程中的应用。

论帕金森病伴抑郁和原发性抑郁的异质性

抑郁是帕金森病常见的非运动症状,其虽与原发性抑郁具有相似的临床症状,但二者发病机制及治疗不尽相同。原发性抑郁可归属于中医学“郁证”范畴,帕金森病伴抑郁则属于“颤证”及“郁证”合病。从临床症状、发病机制、西药治疗、中医病因病机、中药治疗等方面论述帕金森病伴抑郁和原发性抑郁的异质性,以期为帕金森病伴抑郁的临床诊疗提供参考。

基于“治未病”理论防治卒中后抑郁

卒中后抑郁(post-stroke depression,PSD)是继发于脑卒中的最常见且最严重的后遗症之一,其发病率正在逐年上升,严重影响了卒中病人的康复。目前众多的治疗方法应用于PSD的效果均不理想,因此PSD的预防和治疗格外重要。基于“治未病”理论,将PSD的病因病机贯穿于防病和治病的过程中,在PSD的发生、发展以及预后的各个阶段提前干预,有助于卒中后康复。具体而言,通过普及PSD,防微杜渐,调畅情志,顺应自然做到未病先防;已病之时,运用中药、针灸等综合治疗既病防变;病情趋于平稳之时,食疗、足浴、饮食调护等防止病情复发。

冯五金老中医从寒湿论治抑郁症经验介绍

介绍冯五金老中医从寒湿论治抑郁症的临床经验。冯五金老中医认为,抑郁症侧重于精神障碍的表现,同时伴有畏寒、苔白腻等症状表现,有明显的脾肾阳虚、寒湿阻滞特点,提出从寒湿立论,治疗上以温阳散寒、除湿解郁为法。

“通督治郁”针法治疗脑卒中后抑郁对临床症状及血清5-HT、NE、DA的影响

目的观察“通督治郁”针法治疗脑卒中后抑郁(PSD)对临床症状及血清5-羟色胺(5-HT)、去甲肾上腺素(NE)、多巴胺(DA)的影响。方法选取2022年1月—2023年1月医院收治的60例PSD患者作为研究对象,按随机数字法分为对照组和观察组各30例,两组均给予脑卒中常规治疗,对照组采用常规针刺联合度洛西汀胶囊抗抑郁治疗,观察组采用常规针刺联合通督治郁针法治疗,比较两组临床疗效、中医证候积分、汉密顿抑郁量表(HAMD)评分、美国国立卫生院神经功能缺损评分(NIHSS)、Barthel指数、神经细胞因子[脑源性神经营养因子(BDNF)、神经生长因子(NGF)]、单胺类神经递质(5-HT、NE、DA)及不良反应发生率。结果两组治疗有效率比较差异无统计学意义(93.33%vs 80.00%)(P>0.05)。治疗后,两组中医证候积分、HAMD评分、NHISS评分均降低,Barthel指数和血清BDNF、NGF、5-HT、NE、DA水平均升高(P<0.05);且观察组NHISS评分均显著低于对照组,Barthel指数和血清BDNF、NGF水平均显著高于对照组(P<0.05),两组中医证候积分、HAMD评分及血清5-HT、NE、DA水平比较差异无统计学意义(P>0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论“通督治郁”针法和口服度洛西汀胶囊治疗PSD疗效相当,均可有效缓解抑郁症状,提高单胺类神经递质的合成释放,但前者在促进神经功能康复等方面优于后者,值得临床推广应用。

基于“从心治脑”探讨宁心解郁针法治疗中风后抑郁

抑郁是中风病常见并发症,与其不良预后密切相关,及时正确的诊治对患者康复十分重要。中医认为,“心主神明”,人的精神、思维、情绪虽分属五脏,但总归心主神明的功能。情志疾病首先伤及心神。中风后抑郁病位虽在脑,但核心在心。为此,本文提出心神失调是中风后抑郁发生的重要原因,并从心脑在主宰神明的主次作用,探讨针刺心经和心包经穴在治疗中风后抑郁中的运用,为临床相关治疗提供参考。

浅析从目病多郁论治黄斑水肿

目病患者,多因肝病,肝气郁结,气血不畅,阻闭目窍,遂发为病。目病引起的抑郁、焦虑对患者影响很大,部分患者由于黄斑水肿担心失明常伴有抑郁、紧张、焦虑,从而加重病情,造成恶性循环。临床上患者由于视力下降,引起情志不舒,气机郁滞,一系列脏腑功能失调等病证,属中医郁证。针对患者的不同情况,采取中医脏腑辨证论治,发挥中医特色异病同治优势,治疗黄斑水肿同时缓解抑郁症,有效地缓解了因视力下降而发生抑郁的双向恶性循环,起到较好疗效。

江一平胃滞肝郁理论及其应用

江一平认为肝胃痞病常是互为影响的,其治疗亦应多方考虑,临床常见证型有肝气犯胃证。其在长期的临床实践中总结出有胃滞肝郁之证型,该证多为情志抑郁、暴饮暴食、膏粱厚味、嗜饮醇酒等因素阻滞气机导致胃气郁滞、气机升降失常,影响肝气生发,日久致脂液痰湿蓄积于肌肤、血管和脏腑中。肝与脾胃关系密切,脾胃功能正常,气机升降协调,则有助于肝主疏泄,反之,胃气郁滞亦会引起肝脏疏泄功能失常,治疗应当从胃立论,运用理气和胃、清胃降火、通降胃气、益气健胃、消食和胃、滋养胃阴的方法治疗。

宗越鞠丸之意探究原发性高血压合并焦虑抑郁状态的防治思路

原发性高血压合并焦虑抑郁状态已成为现代社会较为常见的一种“双心疾病”,其患病趋势随社会压力加剧等相关因素迅猛发展,严重威胁人类身心健康。如果缺乏有效的干预措施,不仅会影响患者个人的生存质量,也必将为社会经济带来沉重负担。越鞠丸为中医药“解郁”的代表方剂,文章以越鞠丸为“切入点”,通过中医理论探究及西医机制探析,为临床治疗原发性高血压合并焦虑抑郁状态提供新的“突破口”。同时阐述中医药从“双心”角度,通过多途径,多靶点治疗原发性高血压合并焦虑抑郁状态的优势特色。

基于“宣可去壅”探讨辛味药在抑郁症治疗中的应用

以“辛味宣壅”之法为理论基础,谨守病机探究辛味药在抑郁症治疗中的应用。中医学认为“壅”是抑郁症发生的关键病机,即郁、痰、瘀、火、虚,虚实夹杂;“辛”味属阳而性最动,宣通之力较强,能散壅滞;“宣可去壅”即采用宣散之法疗壅滞之病,是契合抑郁症病机的治本之法。

基于网络药理学及分子对接技术探讨越鞠丸加味治疗高脂血症、2型糖尿病、抑郁症“异病同治”的分子机制

目的:基于网络药理学和分子对接技术探讨越鞠丸加味对高脂血症(HL)、2型糖尿病(T2DM)、抑郁症(MDD)“异病同治”的物质基础和作用机制。方法:通过中药系统药理学分析平台(TCMSP)数据库检索并筛选出越鞠丸加味(香附、川芎、苍术、栀子、大黄、黄芪、柴胡)的中药活性成分及作用靶点。利用GeneCards、DisGeNET、OMIM数据库筛选HL、T2DM、MDD疾病靶点,将药物和疾病靶点取交集后获得的共有靶点导入STRING数据库获得蛋白质-蛋白质相互作用(PPI)关系,并应用Cytoscape 3.8.2构建PPI网络。采用R语言Cluster Profiler程序包对关键靶点进行基因本体(GO)及京都基因和基因组百科全书(KEGG)通路富集分析,并利用Cytoscape 3.8.2构建关键靶点-功能-通路图及关键靶点中药药理调控网络。采用AutoDock Tools进行分子对接研究。结果:越鞠丸加味筛选得到活性成分87个,作用靶点236个,HL、T2DM、MDD及越鞠丸加味共有靶点有蛋白激酶B1(AKT1)、白细胞介素(IL)-6、肿瘤坏死因子(TNF)等127个。KEGG分析得到脂质和动脉粥样硬化、晚期糖基化终产物(AGEs)及其受体(RAGE)、IL-17信号通路等,涉及对脂多糖反应、膜筏、核受体活性等生物学过程。分子对接显示关键靶点与槲皮素结合活性较好。结论:越鞠丸加味主要通过抑制炎症及调节免疫对HL、T2DM、MDD“异病同治”。本研究初步揭示了越鞠丸加味对3种疾病异病同治的现代生物学机制,为探究中医异病同治治疗原则的内涵提供了一定科学依据。