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.

贾英杰从脾论治肿瘤相关性抑郁

贾英杰教授认为,肿瘤相关性抑郁多是“因病致郁”,按其病因可分为浊实致郁、本虚致郁,中焦气机郁结,脾虚运化失司是肿瘤相关性抑郁的核心病机。贾教授认为,肝、脾二脏为该病的重要病变脏腑,在郁证肝脾同病的状态下,更要注重治脾,提出肿瘤相关性抑郁当从脾论治的观点。其认为该病的治疗可从“黜浊培本”理论出发,以脾为抓手,临证时应首辨虚实,调气祛浊运脾、化痰开郁醒脾、健脾安中解郁为主要治则,灵活运用多种中医外治疗法,多维立体,畅郁宁神,形神共调,积极干预提高治疗肿瘤疗效的同时,重视情志因素对疾病及患者生存质量的影响。

叶天士从少阳论治耳鼻喉科疾病探微

基于《临证指南医案》所载耳鼻喉科疾病相关医案,分析叶天士从少阳论治耳鼻喉科疾病之理论基础及方药立意。叶天士在耳鼻喉科疾病的辨证施治中针对温热类病邪闭阻官窍的病因病机以及病位深浅,治以轻宣少阳郁遏之热、清降少阳结聚之火与疏解少阳情志之郁三法,撷取苦丁茶、荷叶、桑叶、牡丹皮等质地轻薄、气味清香之品纳入耳鼻喉科少阳辨治体系。叶天士传承和发扬了源于《黄帝内经》的少阳理论,将少阳经络辨证和少阳枢机理论相结合,形成了轻可去实、辛凉渐苦的治疗特色。

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。

熊鸣峰教授辨治胰十二指肠术后胃瘫经验浅析

胰十二指肠术后胃瘫是消化道肿瘤术后常见的一种并发症。对于该病的治疗,熊鸣峰教授根据30余年临床观察与经验总结,提出独特的中医十层脉辨治方法。中医十层脉法主要将脉诊细分为十层进行分析,具体包括肺脉、大肠脉、心脉、小肠脉、脾脉、胃脉、肝脉、胆脉、肾脉、膀胱脉。熊教授基于中医十层脉诊治方法,深入分析胰十二指肠术后胃瘫的病机,认为本病与肝疏泄功能密切相关,主要病机在于肝气疏泄失常导致脾胃功能受损。基于这一认识,熊教授制定了以从肝论治为主的治疗方案,强调通过调理肝气恢复脾胃的正常运化功能,以达到治疗目的。在治疗过程中,熊教授注重脉象变化,根据脉象的不同,灵活选取不同的治疗方法。他擅长整体调整、内外同治,将中医内治法与外治法相结合,通过中药内服、针灸、推拿等多种手段对患者进行整体调整,旨在恢复机体动态平衡,以期达到最佳治疗效果。临床实践证明,熊教授的治疗方法在胰十二指肠术后胃瘫的治疗中取得了显著的疗效,不仅有效缓解了患者的症状,提高了其生活质量,还缩短了病程,为患者进一步接受放化疗治疗创造了有利条件。熊教授的辨治经验值得临床医师传承和学习,以便为胰十二指肠术后胃瘫提供更多有效的治疗思路和方法。

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。

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。

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。

Clinical study on depression differentiated as yang deficiency treated with the combined therapy of ginger-isolated moxibustion and western medicine

Objective To compare the differences in the clinical efficacy on depression differentiated as yang deficiency between the combined therapy of ginger isolated moxibustion and escitalopram and the simple application escitalopram.Methods Eighty patients of depression differentiated as yang deficiency were randomized into an observa-

“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。

加味四逆散对慢性心理应激抑郁症大鼠海马损伤的保护作用

目的观察加味四逆散对慢性心理应激抑郁症大鼠海马损伤的保护作用。方法采用多种应激源制作慢性心理应激抑郁症大鼠模型。30只Wistar大鼠分为正常组、模型组、中药组。观察各组大鼠海马神经元凋亡率,测定海马脑源性神经营养因子(BDNF)及其受体TrkB蛋白含量及神经元内Ca2+浓度。结果模型组大鼠海马神经元凋亡率较正常组增加,海马BDNF及其受体TrkB蛋白表达降低,神经元内Ca2+浓度升高(P<0.05或P<0.01)。中药组可降低海马神经元凋亡率,增加BDNF与TrkB蛋白表达,降低神经元内Ca2+浓度。结论加味四逆散可能通过上调海马BDNF的表达,降低胞内Ca2+,实现抗抑郁的作用。

浅论郁证从肺论治

传统中医治疗郁证多从心肝脾论治,鲜有从肺论治者。文章主要从病因病机、现代研究、临床验案3个角度探讨郁证从肺论治的可行性。研究发现郁证患者中肺郁的比例较高,情志病与呼吸系统关系密切,两者具有相关性,且在临床上古今部分医家尝试从肺治疗郁证取得满意疗效,因此认为郁证可从肺论治。