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关键词： Mental health   Public health   Epidemiology  

摘要： Racial discrimination has been associated with a number of adverse health outcomes. There is limited information regarding racially-motivated housing discrimination and health. This thesis included two studies. Study 1 was a scoping review that examined the impacts of housing discrimination on physical and mental health, and educational pursuits across various ethnic minorities. Study 2 examined the impacts of housing discrimination on PTSD symptomology and university stress among Canadian Indigenous students. Results indicate racially-motivated housing discrimination was associated with reduced physical health outcomes (Study 1); and reduced mental health including increased depression (Study 1) and PTSD symptomology (Study 2). Racially motivated housing discrimination was also associated qualitatively with reduced motivation at university (Study 1), and quantitatively with increased perceptions of stress while at university (Study 2). The results highlight the need for greater policies and program supports to address this problem.

关键词： Counseling psychology   Continuing education   Clinical psychology  

摘要： The purpose of this study was to analyze vicarious trauma (VT) and examine the intricate process of incorporating the perspectives of clinicians who are exposed to trauma during the therapeutic stage. Vicarious trauma can be viewed as the emotional residue that occurs when treating and hearing stories related to traumatic events in one's life. A qualitative design and constructivist self-development theory will be used to guide the investigation into clinicians treating trauma within the military population. The research question for this study was: What are the perceptions of clinicians based on their emotional experiences and susceptibility to vicarious trauma while working with active-duty military personnel diagnosed with PTSD? Data for this research was collected from ten professional licensed clinicians utilizing semi structured interviews. Themes that were revealed indicated (a) lack of motivation to treat trauma, (b) ongoing trainings are effective when treating military personnel diagnosed with PTSD, (c) there are missed opportunities to tap into self-care on a regular basis, (d) the possibility of emotional imbalance when treating trauma, primarily stress and burnout. The findings may be used to help clinicians and their perceptions when treating military personnel suffering from trauma situations. Research has demonstrated that being exposed to trauma can potentially lead to developing psychological issues, which may in turn develop into complications associated with post-traumatic stress disorder (PTSD). Clinicians who treat individuals that suffer from these emotional disorders can experience negative responses themselves, which are stimulated by their reflections associated with past traumatic situations. The challenge was ensuring that clinicians who treat individuals with these complications also have the applicable measures implemented to help treat trauma patients when complex developments arise from employing their professional services. There is

关键词： Nutrition   Health sciences   Mental health  

摘要： Posttraumatic stress disorder (PTSD) is a mental health condition faced by many veterans, and veterans with PTSD have higher rates of poor health and obesity than civilians. Evidence suggests mental health issues such as PTSD may be associated with disordered eating behaviors. In addition, veterans with PTSD may select a variety of coping behaviors to manage stress and emotions, some of which may negatively impact their health. This study explored the relationships between coping process, emotion- and stress-related eating, and eating disorder risk among a sample of veterans with PTSD (n = 239) who were recruited through veteran service organizations throughout the United States. Participants completed Carver’s 28-item Brief COPE, Ozier and colleagues’ 24-item Emotion- and Stress-Related Eating scale of the Eating and Appraisal Due to Emotions and Stress (EADES) Questionnaire, and Garner and colleagues’ 26-item Eating Attitudes Test (EAT-26). A principal components analysis (PCA) was conducted on the 14 coping processes of the Brief COPE, revealing a three-component, second-order factor structure of related coping items. Comparing responses from the Brief COPE components of the PCA and the Emotion- and Stress-Related Eating scale of the EADES Questionnaire did not reveal statistically significant relationships. However, a statistically significant relationship was observed between emotion-focused coping (PCA Component 2) and eating disorder risk measured by the EAT-26 (r = .257, p < .05). Further analysis of the individual Brief COPE coping processes revealed statistically significant relationships between behavioral disengagement, self-blame, and acceptance and emotion- and stress-related eating as measured by the Emotion- and Stress-Related Eating scale of the EADES Questionnaire (r’s = -.153, -.174, .207 respectively, p < .05). In addition, statistically significant relationships were found between denial, venting, planning, and self-blame and eating disorder ris

关键词： 难治性精神分裂症   药物组合   遗传病理学  

摘要： 目的研究难治性精神分裂症的病因和发病机制,临床治疗期间患者使用的药物和方法。方法利用单一与联合用药以及合并重复脑反射治疗、电针治疗等治疗方法。结果利用本文治疗方法明显可以对病患的阳性症状及病患自身病理症状有显著的缓解,从而使患者的生命质量得到改善。结论该种治疗方法提升了患者的治愈率,对难治性精神分裂症的治疗有很大帮助。

关键词： 钆塞酸二钠   肝脏病变   增强MRI与CT  

摘要： 目的:比较钆塞酸二钠增强MRI剂及螺旋增强CT对肝脏局灶性病变诊断效能,探讨钆塞酸二钠（Gd-EOB-DTPA）增强MRI在肝脏局灶性病变（focal liver lesions,FLLs）诊断及鉴别诊断价值。材料和方法:收集2017年10月至2018年11月厦门大学附属第一医院诊断肝脏局灶性病变明确,研究组包括42例同时经钆塞酸二钠增强MRI和螺旋CT增强扫描的患者,42例患者均经过病理或随访证实。由2名放射科医生对不同的肝脏病灶进行独立盲法分析,同时对阅片对病灶分类的诊断信息作以评估,比较钆塞酸二钠增强MRI和螺旋增强CT在肝脏局灶性病变上的检出率、准确率及典型图像之间的差异。结果:51例肝脏局灶性病变。经病理或临床随访6-9个月诊断肝细胞肝癌（HCC）8例、肝硬化结节5例,肝血管瘤16例,局灶性结节增生8例（FNH）,肝转移14例。钆塞酸二钠增强MRI发现肝细胞肝癌（HCC）8例、肝硬化结节5例、肝血管瘤16例、有8例局灶性结节性增生（FNH）和14例肝转移,病灶检出率100.0%,螺旋增强CT共发现肝细胞肝癌（HCC）5例、肝硬化结节4例、肝脏血管瘤9例,肝脏局灶性结节性增生（FNH）8例,肝转移瘤10例,病灶检出率70.6%。钆塞酸二钠增强MRI诊断肝细胞肝癌（HCC）6例、肝硬化结节5例、肝血管瘤16例、有8例局灶性结节性增生（FNH）和14例肝转移,诊断准确率96.1%,螺旋增强CT共诊断肝细胞肝癌（HCC）3例、肝硬化结节3例、肝血管瘤9例、局灶性结节性增生（FNH）3例,肝转移7例,诊断准确率49.0%。钆塞酸二钠增强MRI检出率及准确率均明显优于螺旋增强CT的结果,得到与临床相似的结果。结论:钆塞酸二钠（Gd-EOB-DTPA）增强MRI能够提高病变的诊断及鉴别诊断准确率。

关键词： 酒精所致精神障碍   心理护理   社会功能  

摘要： 目的探讨支持性心理护理对酒精所致精神障碍患者社会功能康复及焦虑抑郁情绪的影响。方法选择2018年3月～2019年2月在本院治疗的80例酒精所致精神障碍患者,随机分为对照组和观察组,每组各40例。两组患者均进行常规药物治疗,对照组患者给予常规护理;观察组患者在对照组基础上给予支持性心理护理,连续护理8周后,采用住院精神病人社会功能评定量表(SSPI)、汉密顿焦虑量表(HAMA)及汉密顿抑郁量表(HAMD)评分对护理前后患者社会功能康复及焦虑抑郁情况进行评价。结果护理干预8周后,观察组患者的SSPI评分明显高于对照组(P<0.05);观察组患者的HAMA、HAMD评分均明显低于对照组(P<0.05)。结论酒精所致精神障碍患者在药物治疗的基础上给予支持性心理护理,能够有效改善患者的焦虑抑郁情绪,促进其社会功能恢复,效果显著。

关键词： 酒精所致精神障碍患者   社会支持   应对方式   生活质量  

摘要： 本文对酒精所致精神障碍患者社会支持、应对方式与生活质量方面近十年期间的相关文献进行阅读、分析和汇总,分析得出此类患者获得的社会支持要大大低于健康人群,其对社会支持的利用度也要低于健康人群,存在明显的社会功能缺陷,并且其面对问题时常采用退避、幻想和自责等应对方式,生活质量较低。因此对此类患者治疗时应加强对其社会支持,进行积极心理干预,以有效提高患者社会支持程度,改善其应对方式,进而改善其生活质量。

关键词： 躁狂症   喹硫平   氯氮平   碳酸锂   不良反应  

摘要： 目的对比分析使用喹硫平与氯氮平联合碳酸锂治疗躁狂症的临床疗效及安全性。方法随机从本院2015年11月至2018年2月收治的躁狂症患者中抽选80例进行观察,随机分为对照组和观察组,对照组患者接受氯氮平联合碳酸锂治疗,观察组患者接受喹硫平联合碳酸锂治疗,比较两组临床疗效及安全性。结果在精神症状评分上比较,两组治疗后较治疗前均有明显改善(P<0.05),但组间比较无明显差异(P> 0.05);在治疗的总有效率上比较,组间数据显示不存在统计学意义(P> 0.05);两组在不良反应发生率上比较,观察组不良反应发生率显著低于对照组(P<0.05)。结论临床治疗躁狂症采用喹硫平与氯氮平联合碳酸锂均能取得显著效果,但喹硫平联合碳酸锂治疗的不良反应发生率更低,更为安全可靠,具有较高的临床应用价值,值得推广。

关键词： 创伤后应激障碍   电针治疗   突触可塑性   BDNF-TrkB信号通路   调控机制  

摘要： 目的：　　本研究以创伤后应激障碍（Post-TraumaticStressDisorder，PTSD）模型大鼠为载体，运用醒脑调肾电针法，以杏仁核、海马突触可塑性及BDNF-TrkB信号通路为治疗靶点，结合行为学、电镜、电生理、分子生物学检测等手段进行研究、分析，力图揭示电针消退PTSD模型大鼠恐惧记忆的分子生物学机制，为今后关于PTSD的深入研究提供研究基础，为针灸治疗PTSD的临床运用提供客观依据。　　方法：　　体重180-220g的SpragueDawley（SD）雄性大鼠100只，SPF级，随机分为五组，分别为空白对照组(Control)、连续单一应激造模组（Single-ProlongedStress，SPS）、SPS加足底电刺激造模组（SPSandfootshock，SPS&amp;S）、SPS+电针治疗组(SPSandElectriacpunture，SPS+EA)、SPS+EA组，每组20只，电针治疗组接受电针治疗，一周治疗五天（周一至周五），每次20min,连续治疗3周。治疗结束后,（1）以自发活动、高架十字迷宫、Morris水迷宫、条件化恐惧反应检测等为评价方法进行PTSD相关行为学分析，评价电针治疗PTSD模型大鼠的临床疗效;（2）电镜下观察大鼠杏仁核、海马突触区域形态变化，电生理检测各组大鼠杏仁核、海马长时程增强（Long-TermPotentiation，LTP），运用ELISA实验检测杏仁核、海马组织中BDNF蛋白表达，运用免疫组化、WesternBlot、RT-PCR等方法检测突触关键蛋白-突触后致密物95（PostSynapticDensity95，PSD95）、突触素（Synaptophysin，SYN）、生长蛋白43（Growth-Associatedprotein43，GAP43）的蛋白水平及mRNA表达，基于以上手段以评价电针治疗对学习记忆的基础-突触可塑性的调控和修复效应;（3）运用免疫组化、WesternBlot、RT-PCR等方法检测PTSD模型大鼠杏仁核、海马BDNF-TrkB信号通路中的关键蛋白-脑源性神经营养因子（BrainDerivedNeurotrophicFactor，BDNF）、受体酪氨酸激酶B（TyrosinekinaseB，TrkB）及其下游MEK/ERK和PI3K/AKT信号通路中的关键物质AKT、ERK、CREB等的蛋白表达及mRNA水平;运用CO-IP实验验证电针干预对BDNF与TrkB结合的影响;运用CHIP实验验证电针干预对CREB与突触关键蛋白及BDNF启动子区结合能力的影响，基于以上方法评价电针干预对杏仁核、海马BDNF-TrkB信号通路的转录调控。　　结果：　　1.电针改善PTSD模型大鼠行为学表现的评价　　（1）Morris水迷宫：SPS+EA组和SPS&S+EA组大鼠定位航行实验中到达平台的潜伏期和探测距离均显著性低于对应模型组（p＜0.01,p＜0.01）,在空间探索实验中在目标象限停留次数显著高于对应模型组（p＜0.01，p＜0.01），到达平台的探测距离百分比显著低于对应模型组（p＜0.01，p＜0.01））;（2）条件化恐惧反应检测：在各阶段消退训练中及重建检测阶段，SPS+EA组和SPS&S+EA组大鼠接受条件恐惧刺激后的僵直时间百分比显著低于对应模型组（p＜0.01，p＜0.01）;（3）自发活动检测：SPS+EA组和SPS&S+EA组大鼠水平活动距离明显长于相应对照组（p＜0.01，p＜0.01）;（4）高架十字迷宫检测：SPS+EA组和SPS&S+EA组大鼠在开放臂滞留时间和进入开放臂的次数的百分比显著性高于对应模型组组（p＜0.01，p＜0.01）。　　2.电针修复杏仁核、海马脑区突触可塑性结果评价　　（1）突触形态：与对照组比较，SPS+EA组和SPS&S+EA组能够显著上调杏仁核、海马突触后致密物（PSD）厚度（杏仁核：p＜0.05,p＜0.05;海马：p＜0.05,p＜0.01），改善突触界面曲率（杏仁核：p＜0.05,p＜0.05;海马：p＜0.01,p＜0.01），SPS&S+EA组同时能显著下调海马突触间隙宽度（p＜0.01）;（2）LTP：与对照组比较，SPS+EA组和SPS&S+EA组大鼠在海马脑区的各时间点场兴奋性突触后电位（fieldExcitatorypostsynapticpotential，fEPSP）幅度均显著提高，LTP明显被激活;（3）突触标志蛋白及BDNF表达：与对照组比较，SPS+EA组和SPS&S+EA组杏仁核、海马脑区BDNF蛋白水平明显上调（p＜0.01,p＜0.01），SYN（p＜0.01,p＜0.01）、GAP

关键词： 创伤后应激障碍   乳腺癌   认知行为干预  

摘要： 目的:(1)探讨认知行为干预对降低乳腺癌患者抑郁、焦虑水平的作用;(2)探讨认知行为干预对改善乳腺癌患者生命质量的作用;(3)探讨认知行为干预对降低乳腺癌患者创伤后应激障碍水平的作用,为临床护理工作提供理论和实践参考依据。方法:选取长春市某三级甲等医院乳腺外科80例女性乳腺癌患者为试验对象,干预组和对照组各40例。对照组按照乳腺癌诊疗规范给予常规护理;干预组患者除给予常规护理外给予认知行为干预,分别于乳腺癌术后(干预前)、第二次化疗开始前(干预后)发放:广泛性焦虑障碍量表(GAD-7)、病人健康问卷抑郁量表(PHQ-9)、乳腺癌患者生命质量测定量表(FACT-B)进而对患者焦虑、抑郁水平及患者生命质量等资料进行采集,干预结束后对两组患者创伤后应激障碍(PTSD-SS)情况进行收集,采用SPSS21.0对各方面资料进行统计分析。结果:(1)焦虑情况的比较:干预前两组患者GAD-7得分情况比较,差异无统计学意义(P>0.05)。干预后两组患者在GAD-7得分比较干预组低于对照组,差异有统计学意义(P<0.001)。干预前后干预组患者在GAD-7得分比较,差异有统计学意义(P<0.001);干预前后对照组患者在GAD-7得分比较,差异无统计学意义(P>0.05)。(2)抑郁情况的比较:干预前两组患者PHQ-9得分情况比较,差异无统计学意义(P>0.05)。干预后两组患者在PHQ-9得分比较干预组低于对照组,差异有统计学意义(P<0.001)。干预前后干预组患者在PHQ-9得分比较,差异有统计学意义(P<0.001);干预前后对照组患者在PHQ-9得分比较,差异无统计学意义(P>0.05)。(3)生命质量情况的比较:干预前干预组与对照组的生理状况、社会家庭状况、情感状况、功能情况、附加关注各维度及FACT-B总分差异不具有统计学意义(P>0.05);干预后干预组与对照组患者在FACT-B得分差异具有统计学意义(P<0.05),干预组干预前后的乳腺癌患者在FACT-B得分差异具有统计学意义(P<0.05),干预组乳腺癌患者FACT-B总分得分情况显著增加。对照组干预前后的生命质量差异均无统计学意义(P>0.05)。(4)创伤后应激障碍情况的比较:干预后比较干预组和对照组创伤后应激障碍自评量表的得分情况,结果显示干预组和对照组在创伤性事件、回避症状、高警觉症状、社会功能受损及PTSD-SS得分及总分差异有统计学意义(P<0.05),经干预后干预组创伤性事件、回避症状、高警觉症状、社会功能受损及PTSD-SS得分总分均低于对照组(P<0.05)。结论:(1)认知行为干预可以有效降低乳腺癌患者的焦虑、抑郁的水平;(2)认知行为干预能够改善乳腺癌患者生命质量;(3)认知行为干预降低乳腺癌创伤后应激障碍的水平;