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关键词： 自拟涤痰泻火汤   躁狂症   临床效果  

摘要： 目的对躁狂症患者实施自拟涤痰泻火汤,分析临床效果。方法在遵循随机数字表法分组实施对比的前提下完成本次研究,选择64例本院2017年3月至2018年3月因躁狂症就诊的患者,分组得出对照组与分析组各有患者32例,分别落实常规西药治疗、自拟涤痰泻火汤治疗,组间对比躁狂症状评分、症状评分、不良反应率。结果分析组治疗后BRMS评分(11.33±1.05)分、CGI-SI评分(23.54±1.19)分、不良反应总发生率3.13%均体现更低,且P<0.05。结论躁狂症患者治疗中,应用自拟涤痰泻火汤治疗,可有效改善患者临床症状,保证治疗安全性。

关键词： Accounting   Mental health   Educational psychology  

摘要： Increasing numbers of military veterans and service members utilize the GI bill to enroll in college courses. Increased numbers of these students suffer from posttraumatic stress disorder (PTSD). Prior research has shown that individuals suffering from PTSD may encounter more psychological stressors adjusting to the college environment than students not suffering from PTSD. The problem examined in this study was how PTSD affects military veterans who are college accounting students. The purpose of this quantitative causal-comparative study design was to examine the effect of PTSD on students that are veterans versus students who do not suffer from PTSD and if the learning environment moderated those effects. The researcher used achievement goal theory (AGT) to describe and explain the achievement behavior of the students because AGT focuses on factors that drive students to succeed and act as barriers to student success. The sample size included 8 veterans suffering from PTSD and 32 students not meeting this criterion, which ensured a power value of .8733 and an alpha value of .05. The researcher collected data using Malgwi’s Accounting Anxiety Rating Scale (AARS) and analyzed the data using ANOVAs to determine if a student’s status as a veteran or service member with a self-reported diagnosis of PTSD had a significant effect on comfort levels and success rates in accounting courses. This research demonstrated that while veteran status and self-reported PTSD diagnosis did affect the respondents comfort levels, the effect was not statistically significant. The researcher did not examine student success rates and the effect of course environment, as final grades were not available, and the number of military respondents was low. While the results of this study were inconclusive, sponsored research may result in conclusive findings.

关键词： 车祸伤   创伤后应激障碍   发生   影响因素  

摘要： 【目的】探索车祸患者在不同时期创伤后应激障碍的发生情况及其影响因素,为今后对其进行心理干预与治疗提供理论依据。【方法】在2017年11月2018年6月本研究选择海南医学院第一附属医院、海南医学院第二附属医院、海南医学院附属海南医院、海口市人民医院急诊创伤外科、创伤医学中心、骨科、普通外科、神经外科以及口腔颌面外科收治的313例车祸患者开展半年时间的追踪调查,全程参与的患者有306例。采用一般情况调查表、创伤后应激障碍检查量表（PCL-C）、汉密顿焦虑量表（HAMA）、汉密顿抑郁量表（HAMD）、简易应对方式问卷（SCSQ）、社会支持评定量表（SSRS）在车祸事故后一个月时、三个月时、六个月时对其进行调查与评估。【结果】⑴本研究最终纳入车祸伤患者306例,平均年龄43.62±16.23岁,其中男性占56.9%、女性占43.1%,汉族占73.9%、已婚患者占61.1%,高达77.4%的患者均是高中及以下学历的。⑵车祸伤患者在道路交通事故后一个月时、三个月时、六个月时创伤后应激障碍（Post traumatic Stress Disorder,PTSD）的发生率分别为33%、37.6%、40.5%。经过两次随访发现,车祸伤所致PTSD患者每次都在前一轮调查的基础上增加患病的例数。⑶车祸伤患者发生创伤后应激障碍的主要影响因素:性别（OR=14.75,95%CI=4.802～45.33）、性格（OR=1.527,95%CI=0.196～3.542）、居住地为外省候鸟人群（OR=4.283,95%CI=3.695～7.234）、居住地为外省务工人群（OR=3.170,95%CI=2.364～4.981）、居住地为外省旅游人群（OR=1.629,95%CI=1.058～2.510）、医疗费用来源（OR=3.025,95%CI=1.382～6.943）、与家人关系差（OR=13.99,95%CI=4.841～40.41）、交通事故中有亲人受伤（OR=1.798,95%CI=2.035～6.138）、消极应对（OR=1.121,95%CI=0.891～1.625）、主观支持（OR=0.473,95%CI=0.273～0.818）、客观支持（OR=0.444,95%CI=0.245～0.806）、认识障碍（OR=2.037,95%CI=1.117～3.718）、阻滞症状（OR=2.701,95%CI=1.343～5.434）、抑郁总分（OR=1.251,95%CI=1.126～1.390）、躯体性焦虑（OR=2.104,95%CI=1.442～3.068）、精神性焦虑（OR=2.015,95%CI=1.330～3.052）、焦虑总分（OR=1.735,95%CI=1.371～2.196）、创伤严重程度（OR=1.967,95%CI=1.467～2.639）。【结论】⑴车祸伤患者发生PTSD的概率较高,且随着时间推移PTSD发生率逐渐升高。⑵创伤后应激障碍具有延迟性、持续性和长期性的特点。⑶性别、性格、居住地、医疗费用来源、与家人关系、交通事故中有无亲人受伤、应对方式、社会支持、抑郁、焦虑和创伤严重程度是PTSD患病的影响因素。其中主观支持和客观支持是创伤后应激障碍的保护因素,交通事故中有亲人受伤、与家人关系差、消极应对、焦虑、抑郁是创伤后应激障碍的危险因素。提示医护人员应尽早筛查PTSD的危险因素和发生情况,给予车祸患者针对性的心理疏导和广泛的社会支持,引导其正确应对车祸伤,以促进其身心健康。

关键词： 创伤后应激障碍   下丘脑-垂体-肾上腺轴   促肾上腺皮质激素   糖皮质激素受体   龟鹿二仙胶  

摘要： 目的:通过建立创伤后应激障碍(PTSD)的大鼠模型,研究补肾填精治法方药龟鹿二仙胶对PTSD大鼠的下丘脑-垂体-肾上腺(HPA)轴功能和行为学变化的影响,并阐明其发挥作用的可能机制。方法:(1)采用单一延长应激(SPS)的方法建立PTSD的大鼠模型(2)采用旷场实验和高架十字迷宫实验动态检测大鼠的行为学表现。(3)在地塞米松抑制实验中,动态检测血浆促肾上腺皮质激素(ACTH)水平.(4)采用ELISA法动态观察大鼠血浆中皮质酮(CORT)与促肾上腺皮质激素释放激素(CRH)的含量变化。(5)采用RT-PCR法和免疫组化法检测海马及杏仁核脑区中糖皮质激素受体(GR)、盐皮质激素受体(MR)、促肾上腺皮质激素释放激素1受体(CRF1R)和促肾上腺皮质激素释放激素2受体(CRF2R)的表达。结果:(1)PTSD模型大鼠在造模后d 9开始出现行为学改变,并且这种改变在造模后d29、d30时仍然存在。表现为与正常组相比,模型组在d9高架十字迷宫实验中开放臂进入次数百分比明显下降(P<0.05),在d23高架十字迷宫实验中,开放臂停留时间百分比、开放臂路程百分比和开放臂进入次数百分比均明显下降(P<0.05),在d 29旷场实验中总路程明显下降(P<0.05),在d 30高架十字迷宫中开放臂停留时间百分比、开放臂路程百分比和开放臂进入次数百分比均明显下降(P<0.05)。龟鹿二仙胶给药21 d后能明显提高大鼠在旷场实验中的总路程(P<0.05)和在高架十字迷宫实验中的开放臂进入次数的百分比(P<0.05)。(2)与正常组相比,PTSD模型大鼠血浆ACTH水平在d 8、d 22和d 29时均明显下降(P<0.05)。龟鹿二仙胶给药14、21 d均能提高大鼠血浆ACTH水平(P<0.05)。(3)PTSD模型大鼠的血浆CORT水平呈现出从d8到d29逐渐升高的趋势,其中在d 29时与正常组相比明显升高(P<0.05)。与模型组相比,龟鹿二仙胶给药21 d后能明显降低大鼠的血浆CORT含量(P<0.05);各组大鼠在3个时间点检测的血浆CRH含量均无明显变化(P>0.05)。(4)与正常组相比,PTSD模型大鼠海马GR mRNA、MR mRNA、CRF1R mRNA表达均明显升高(P<0.05),CRF2R mRNA表达明显下降(P<0.05);杏仁核MR mRNA、CRF2R mRNA表达明显下降(P<0.05),GR mRNA、CRF1R mRNA下降无统计学差异(P>0.05)。与模型组相比,龟鹿二仙胶给药21 d后海马GR mRNA、MR mRNA、CRF1R mRNA的表达明显降低,CRF2R mRNA表达升高;杏仁核CRF2R mRNA表达明显升高,MR mRNA、GR mRNA、CRF1R mRNA变化无统计学差异(P>0.05)。(5)与正常组相比,PTSD模型大鼠海马GR、MR表达明显升高(P<0.05),CRF1R、CRF2R变化无统计学差异(P>0.05);杏仁核GR、MR、CRF1R表达均明显降低(P<0.05),CRF2R变化无统计学差异(P>0.05)。龟鹿二仙胶给药21d后能明显降低海马GR、MR的表达(P<0.05),升高杏仁核GR、MR、CRF1R的表达(P<0.05),海马CRF1R、CRF2R和杏仁核CRF2R变化无统计学差异(P>0.05)。结论:(1)SPS造模后d 9模型组大鼠开始出现行为学改变,表现为持续的焦虑样行为,并在d 29时出现自主活动下降。龟鹿二仙胶给药21 d后能降低大鼠焦虑样表现,提高自主活动能力。(2)PTSD模型大鼠在造模后d9时出现HPA负反馈增强,并在d29仍然存在,基础CORT含量呈现动态变化,在d 29时明显升高。龟鹿二仙胶给药14 d后能抑制HPA轴的负反馈增强,给药21 d后能抑制HPA轴负反馈增强的同时降低CORT含量。(3)龟鹿二仙胶能明显改善PTSD大鼠的行为紊乱,调节HPA轴负反馈增强,其作用机制可能跟龟鹿二仙胶调节海马和杏仁核中GR、MR和CRF1R的表达有关。

关键词： Social psychology   Social work   Psychology  

摘要： The Veterans Affairs (VA) has documented 250,000 (30%) of veterans who suffer from posttraumatic stress disorder (PTSD) with those numbers increasing. Less than 10% of veterans who suffer from PTSD being treated by the VA attend or complete therapy the VA endorses. The VA estimates that over 22 veterans a day commit suicide citing difficulties in handling symptoms of PTSD as the primary cause. Veterans are seeking complementary and alternative medicines (CAMs) to manage their symptoms of PTSD with psychiatric service dogs (PSDs) emerging as a new treatment modality. The problem is standards for PSD-CAM therapy have not been developed which may compromise the safety and health of veterans, PSDs, family, and public. The purpose of this qualitative Classical Delphi research study was to build consensus among a panel of 30 experts, composed of mental health professionals and service dog trainers throughout the US, on the future standards, deemed desirable and feasible, (1) to qualify a veteran for a participation in PSD-CAM therapy, (2) to qualify a dog for participation in PSD-CAM therapy, and (3) compliance for a veteran to maintain the status as a participant in PSD-CAM therapy. Results from this study indicated that PSD-CAM therapy is multi-faceted with 23 items identified by an expert panel required to maximize the benefits of PSD-CAM therapy and ensure the safety and health of veterans, PSDs, family, and public. These standards act as the basics any organization can use in dealing with a veteran who suffers from PTSD and wants to incorporate PSD-CAM therapy.

关键词： art therapy   PTSD   exposure   reintegration to the community   sense of purpose   combat veterans  

摘要： The mental health concerns among veterans in The United States is a critical issue since there has been repeatedly reported that combat veterans suffer from Post-Traumatic Stress Disorder (PTSD) and Traumatic Brain Injuries (TBI). Some factors in a combat situation can add more stress to an already stressful situation. This may contribute to PTSD and other mental health problems. Despite the significant issues, many returning veterans do not have a proper evaluation, screening, or treatments of PTSD during and after their time in service. Research has reported that fifty percent of veterans with PTSD do not seek treatment; 19% of veterans may have traumatic brain injury (TBI); and PTSD distribution between services for Operation New Dawn (OND), Operations Iraqi Freedom (OIF), and Operation Enduring Freedom (OEF) are 67% of Army, 9%, of Air Force, 11% of Navy, and 13% of Marines (Congressional Research Service, Sept. 2010). As previous research explored the symptoms of PTSD among veterans and treatment, PTSD manifests through physical and psychological symptoms that result from a traumatic experience. Anxiety symptoms of avoidance and reoccurrence significantly impact social function. The research paper discusses combat stress-induced symptoms and describes various modalities of treatments for combat veterans with PTSD symptoms. The benefits of their engagement with art making are emphasized. Through historical research, two artists from the United States Veterans Artist Alliance (USVAA) have been chosen. These artists have had traumatic experiences, one of limb loss and the other of having been active duty. Several paintings of these two artists are analyzed to explore their experiences as veterans to see if there are any possible symptoms or signs of PTSD that manifested in their artwork, as well as any therapeutic benefits of art making." The findings of the study are that there are some PTSD related symptoms such as anxiety, sense of unsettlement, sense of loneli

关键词： 肺炎型肺癌   CT   诊断  

摘要： 目的:探究肺炎型肺癌患者接受CT诊断与鉴别诊断价值.方法 :于2017年11月 ～2018年11月期间,抽取我院70例患有肺炎型肺癌的病人作为观察对象,对其采取CT以及临床鉴别诊断,对其相关表现给予分析研究.结果 :70例病人当中,肿瘤细胞沿肺间质 、细支气管壁及肺泡壁呈伏壁状生长蔓延15例,远端支气管壁不规则增厚 、僵硬10例,管腔狭窄甚至闭塞16例,CT诊断肺炎型肺癌的检出率高达95.71％,常规检查仅为80.00％(P<0.05).结论 :对肺炎型肺癌采取CT和常规诊断,患者的基本病理特点为肿瘤细胞沿肺间质 、细支气管壁及肺泡壁呈伏壁状生长蔓延,远端支气管壁不规则增厚 、僵硬,管腔狭窄甚至闭塞,CT诊出率明显更高,临床应用效果好,值得推广.

关键词： 肺部孤立性结节   计算机X线断层扫描   敏感度   特异度  

摘要： 目的探析计算机X线断层扫描(Computed Tomography,CT)在肺部孤立性结节诊断与鉴别诊断中的应用价值。方法选取我院2018年1月至2018年11月收入的150例肺部孤立性结节患者为研究对象,均对其实施CT检查并以病理结果为参照,分析其诊断与鉴别诊断价值。结果病理结果证实,150例肺内孤立性结节患者中良性94例、恶性56例,CT诊断敏感度、特异度与之相比,差异无统计学意义(P> 0.05);良恶性结节净增强值、增强峰值差异有统计学意义(P<0.05),平扫值差异无统计学意义(P> 0.05)。结论 CT诊断肺部孤立性结节可靠性高且能够鉴别诊断其良恶性质,值得加以推广使用。

关键词： 血常规   珠蛋白生成障碍性贫血   缺铁性贫血   鉴别诊断  

摘要： 目的:分析血常规在珠蛋白生成障碍性贫血与缺铁性贫血鉴别诊断中的应用价值.方法:选取2018年2月-2019年4月30例珠蛋白生成障碍性贫血患者作为观察组,再选取同时段30例缺铁性贫血患者作为对照组,两组均行血常规检查,并比较两组患者的检查结果的差异.结果:观察组在各观察指标与对照组相比均有统计学差异(P<0.05).结论:血常规检查在不同类型贫血鉴别诊断中具有较好的应用效果,能够为临床诊断提供相关依据.

关键词： 心理护理   创伤后应激障碍   焦虑  

摘要： 目的探讨心理护理干预对于创伤后应激障碍的作用,为后续临床护理干预提高方法参考。方法 40例2016年1月～2018年6月期间收治的创伤后应激障碍的患者,按照入院时间分为观察组及对照组,对照组患者采取常规护理干预,观察组患者加入心理护理干预,SAS自评量表评价患者的焦虑程度;创伤后应激障碍量表(PCL-C)评价患者的治疗效果。结果经过不同护理干预后,观察组患者的SAS以及PCL-L量表得分均显著优于对照组(P<0.05)。结论对于创伤后应激障碍患者在常规护理基础上加入心理疏导可明显缓解患者不良情绪压力,改善生活质量。