Psychopathology

精神病理学
  • 文章类型: Journal Article
    与幸福与痛苦之间的关系有关的“心理健康”和“精神疾病”的生物医学模型为精神病理学提供了信息,并在许多西方受过教育的工业化富裕民主(WEIRD)人群中占主导地位。本文旨在对模型进行批判,质疑精神病理学作为一个概念框架的适当性,当工作作为一个西方受过训练的临床医生与人口,如在中国,Japan,亚洲,中东和非洲。本文还考虑了西方精神病理学概念在与机构间常设委员会(IASC)《紧急情况下心理健康和社会心理支持准则》进行跨文化工作时的文化适用性,以及《机构间常设委员会关于紧急情况下心理健康和社会心理支持的准则》的执行情况审查。
    The bio-medical model of \'mental health\' and \'mental illness\' that relates to the relationship between wellbeing and distress informs psychopathology and dominates conceptualisation in many Western Educated Industrialised Rich Democratic (WEIRD) populations. This paper aims to critique the model, questioning the appropriateness of psychopathology as a conceptual framework when working as a Western trained clinician with populations such as in China, Japan, Asia, the Middle-East and Africa. The paper also considers the cultural appropriateness of western notions of psychopathology when working inter-culturally in relation to the Inter-Agency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support in Emergency Settings, and the Review of the Implementation of the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings.
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  • 文章类型: Journal Article
    目的:这项工作的目的是2倍:(1)评估当前知识并确定研究缓慢认知节奏(SCT)的关键方向;(2)在术语上达成共识,以反映当前科学并可能被研究人员接受,临床医生,看护者,和病人。
    方法:召开了一个国际工作组会议,2021年初,编制了一份关于SCT的所有研究的在线档案,并总结了目前的知识状况,注意到方法问题,并强调了未来的方向,并在2021年几乎举行了10次会议,讨论这些主题和术语。
    结果:在过去十年中,我们在以下研究领域对SCT的理解取得了重大进展:结构测量和稳定性;遗传,环境,病理生理学,和神经心理学相关因素;合并症;功能障碍;以及心理社会和药物干预。总结了这些领域的发现,并提出了在下一代SCT相关研究中寻求的潜在途径。经过对术语的反复讨论,工作组选择“认知脱离综合征”(CDS)替换“SCT”作为此构造的名称。该术语被认为最好地满足了在选择疾病或综合症术语时应考虑的因素,因为它不与其他结构的既定术语重叠,不是冒犯,反映了科学的现状。
    结论:很明显,CDS(SCT)已达到识别为独特综合征的阈值。还有很多工作要进一步澄清它的性质(例如,诊断因素,单独的障碍,诊断说明符),病因,人口因素,与其他精神病理学的关系,以及与功能损害的特定领域的联系。需要具有基本兴趣和专业知识的调查人员,临床,和转化研究,以增进我们的理解,并改善患有这种独特综合症的个人的生活。
    The aim of this work was 2-fold: (1) to evaluate current knowledge and identify key directions in the study of sluggish cognitive tempo (SCT); and (2) to arrive at a consensus change in terminology for the construct that reflects the current science and may be more acceptable to researchers, clinicians, caregivers, and patients.
    An international Work Group was convened that, in early 2021, compiled an online archive of all research studies on SCT and summarized the current state of knowledge, noted methodological issues, and highlighted future directions, and met virtually on 10 occasions in 2021 to discuss these topics and terminology.
    Major progress has been made over the last decade in advancing our understanding of SCT across the following domains of inquiry: construct measurement and stability; genetic, environmental, pathophysiologic, and neuropsychological correlates; comorbid conditions; functional impairments; and psychosocial and medication interventions. Findings across these domains are summarized, and potential avenues to pursue in the next generation of SCT-related research are proposed. Following repeated discussions on terminology, the Work Group selected \"cognitive disengagement syndrome\" (CDS) to replace \"SCT\" as the name for this construct. This term was deemed to best satisfy considerations that should apply when selecting terms for a condition or syndrome, as it does not overlap with established terms for other constructs, is not offensive, and reflects the current state of the science.
    It is evident that CDS (SCT) has reached the threshold of recognition as a distinct syndrome. Much work remains to further clarify its nature (eg, transdiagnostic factor, separate disorder, diagnostic specifier), etiologies, demographic factors, relations to other psychopathologies, and linkages to specific domains of functional impairment. Investigators are needed with interests and expertise spanning basic, clinical, and translational research to advance our understanding and to improve the lives of individuals with this unique syndrome.
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  • 文章类型: Journal Article
    传统的诊断系统超越了关于心理健康结构的经验证据。因此,这些诊断没有准确地描述精神病理学,因此,它们在研究和临床实践中的有效性是有限的。精神病理学的分层分类(HiTOP)联盟提出了一个基于结构证据的模型。它解决了诊断异质性的问题,合并症,和不可靠性。我们回顾了HiTOP模型,支持证据,在这个层次的维度框架中对精神病理学进行概念化。系统还不全面,我们描述了改进和扩展它的过程。我们总结了HiTOP预测和解释病因(遗传,环境,和神经生物学),危险因素,结果,和治疗反应。我们描述了基于HiTOP的措施的开发以及该系统的临床实施方面的进展。最后,我们回顾了突出的挑战和研究议程。HiTOP已经具有实用性,它的持续发展将产生一张精神病理学的变革性地图。
    Traditional diagnostic systems went beyond empirical evidence on the structure of mental health. Consequently, these diagnoses do not depict psychopathology accurately, and their validity in research and utility in clinicalpractice are therefore limited. The Hierarchical Taxonomy of Psychopathology (HiTOP) consortium proposed a model based on structural evidence. It addresses problems of diagnostic heterogeneity, comorbidity, and unreliability. We review the HiTOP model, supporting evidence, and conceptualization of psychopathology in this hierarchical dimensional framework. The system is not yet comprehensive, and we describe the processes for improving and expanding it. We summarize data on the ability of HiTOP to predict and explain etiology (genetic, environmental, and neurobiological), risk factors, outcomes, and treatment response. We describe progress in the development of HiTOP-based measures and in clinical implementation of the system. Finally, we review outstanding challenges and the research agenda. HiTOP is of practical utility already, and its ongoing development will produce a transformative map of psychopathology.
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  • 文章类型: Journal Article
    Abnormal behavior in nonhuman primates is oftentimes prematurely blamed on certain conditions, in the case of captive non-human primates, readily so on their husbandry, largely ignoring the underlying pathophysiological processes in the brain. Each life history shapes an individual\'s predisposition to develop or resist the development of a psychopathological disorder, which manifests itself in abnormal behavior when triggered by certain situations or conditions. In order to sustainably address the symptoms of psychopathologies, therapeutic approaches must be based on a structured, comprehensive diagnostic procedure, including behavioral and functional analyses, research into life history, and personality assessment..
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  • 文章类型: Journal Article
    使用动态评估(AA;Trull&Ebner-Priemer,2013)在精神病理学研究中,其中包括经验抽样方法以及生态瞬时评估,在过去的几十年里急剧增加。以前,已提出方法和报告指南,以概述最佳实践,并就规划和进行AA研究时面临的方法问题和决策提供投入(例如,Bolger&Laurenceau,2013;Mehl&Conner,2012;Stone&Shiffman,2002).然而,尽管公布了这些重要的资源和指导方针,在AA精神病理学研究的设计和报告中,有多少一致性或一致性是显而易见的,这仍然是一个悬而未决的问题。为了解决这个问题,我们回顾了在主要精神病理学期刊上使用AA发表的研究的报道实践(异常心理学杂志,心理医学,临床心理科学)过去7年(2012-2018年)。我们的审查重点是(a)样本选择和大小;(b)抽样设计;(c)措施的选择和报告;(d)使用的设备和软件;(e)合规性;(f)参与者培训,监测和薪酬;(G)数据管理和分析。最后,我们提出了报告精神病理学中未来AA研究特征的建议。(PsycINFO数据库记录(c)2019年APA,保留所有权利)。
    The use of ambulatory assessment (AA; Trull & Ebner-Priemer, 2013) in psychopathology research, which includes experience-sampling methods as well as ecological momentary assessment, has increased dramatically over the last several decades. Previously, methodological and reporting guidelines have been presented to outline best practices and provide input on methodological issues and decisions that are faced when planning and conducting AA studies (e.g., Bolger & Laurenceau, 2013; Mehl & Conner, 2012; Stone & Shiffman, 2002). However, despite the publication of these important resources and guidelines, it remains an open question as to how much uniformity or consistency is evident in the design and reporting of AA studies of psychopathology. To address this, we reviewed the reported practices of published studies using AA in major psychopathology journals (Journal of Abnormal Psychology, Psychological Medicine, Clinical Psychological Science) over the last 7 years (2012-2018). Our review highlights (a) sample selection and size; (b) sampling design; (c) selection and reporting of measures; (d) devices used and software; (e) compliance; (f) participant training, monitoring and remuneration; and (g) data management and analysis. We conclude with recommendations for reporting the features of future AA studies in psychopathology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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  • 文章类型: Journal Article
    Advanced heart failure therapies, including heart transplantation and durable mechanical circulatory support, are available to a limited number of patients because of the scarcity of donors, expense, and large burden of care. The importance of psychological and social determinants of health, including cognitive status, health literacy, psychopathology, social support, medical adherence, and substance abuse, are emphasized in advanced heart failure and further amplified in the context of mechanical circulatory support and heart transplantation. The psychosocial assessment of advanced heart failure therapy candidates remains largely subjective, requiring a multidisciplinary evaluation, which may include psychiatrists, social workers, case managers, financial coordinators, pharmacists, and clinicians. Objective tools-including the Stanford Integrated Psychosocial Assessment for Transplantation, Psychosocial Assessment of Candidates for Transplantation, and Transplant Evaluation Rating Scale-were developed and validated in limited populations to help standardize the evaluation process. Small, retrospective studies have inconsistently shown that these tools may predict clinical outcomes in the transplant population, with higher-risk scores associated with readmissions, rejection episodes, and infections. However, it has been more difficult to show that these tools can predict mortality, and their applicability to the mechanical circulatory support population is less studied. The International Society for Heart and Lung Transplantation released a consensus statement in 2018 to promote consistency of psychosocial evaluation across advanced heart failure programs, but it lacks specific recommendations given the current state of evidence. This state-of-the-art review expands on the current consensus by critically reviewing current studies supporting available objective assessment tools, proposing a psychosocial evaluation framework that uses a multidisciplinary approach and offering future directions for research.
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  • 文章类型: Journal Article
    皮肤病对患者来说可能是毁灭性的,尽管皮肤科医生专注于纠正这些疾病的皮肤表现,很容易错过下面潜伏的心理痛苦。研究表明,皮肤病学中的精神病合并症非常普遍。未被发现的精神病理学可以极大地降低患者的生活质量,甚至对其皮肤病的临床严重程度做出重大贡献。由于这些原因,至关重要的是,从业者学会在心理困扰存在时发现它,同样重要的是,他们了解有效干预的治疗方案。没有精神诊断和精神药理学的培训,面对需要管理这些条件时,皮肤科医生很容易感到不知所措或超出他们的舒适区,但是总体上与精神病相关的负面污名,精神病患者经常拒绝转诊,皮肤科医生也因此承担了责任。在这种情况下,不确定性比比皆是,但这篇综述旨在缓解心理皮肤病的不适,并分享实用和有影响力的建议,以协助诊断和治疗。在繁忙的皮肤科诊所,关键是有效和高效的筛选,结合药理学和非药理学治疗方案,这些方案可以根据筛查的具体结果通过算法方法分散。通过将这些建议付诸实践,皮肤科医生可能开始获得安慰与心理皮肤病的管理,作为一个专业,可能会扩大以填补对患者真正重要的患者护理漏洞,他们的家人,我们的社区作为一个整体。
    Dermatological disease can be devastating for patients, and although dermatologists are focused on remedying the cutaneous manifestations of these conditions, it is easy to miss the psychological suffering lurking below. Studies reveal that psychiatric comorbidity in dermatology is highly prevalent. Undetected psychopathology can greatly decrease a patient\'s quality of life and even contribute significantly to the clinical severity of their skin disease. For these reasons, it is vital that practitioners learn to detect psychological distress when it is present, and it is equally essential that they understand the treatment options available for effective intervention. Without training in psychiatric diagnosis and psychopharmacology, dermatologists can easily feel overwhelmed or out of their comfort zone when faced with the need to manage such conditions, but with the negative stigma associated with psychiatric disease in general, a psychiatric referral is often refused by patients, and the dermatologist is thus left with the responsibility. Uncertainty abounds in such situations, but this review seeks to alleviate the discomfort with psychodermatological disease and share practical and impactful recommendations to assist in diagnosis and treatment. In a busy dermatology clinic, the key is effective and efficient screening, combined with a repertoire of pharmacological and non-pharmacological treatment options that can be dispersed through an algorithmic approach according to the specific findings of that screening. By implementing these recommendations into practice, dermatologists may begin to gain comfort with the management of psychocutaneous disease and, as a specialty, may expand to fill a hole in patient care that is truly significant for patients, their families, and our communities as a whole.
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  • 文章类型: Journal Article
    目的鼻成形术,在保留或增强鼻气道的同时改变鼻子形状或外观的外科手术,在美国最常见的整容手术中排名,2014年报告的程序>200,000例。虽然很难计算手术后有或没有并发症的隆鼻患者所承受的确切经济负担,平均隆鼻手术通常超过4000美元。因并发症而产生的费用,感染,或翻修手术可能包括长期抗生素的费用,住院治疗,或因误工数小时/天而损失的收入。隆鼻的心理影响也可以是显著的。此外,来自鼻畸形/美学缺陷的心理压力的医疗保健负担,外科感染,手术疼痛,抗生素的副作用,和鼻腔填塞材料也必须考虑这些患者。在此准则之前,关于术前和术后管理的标准护理考虑因素以及确保接受隆鼻手术的患者获得最佳结果的标准手术实践的文献有限.本指南的推动力是利用当前的循证医学实践和数据来建立关于围手术期和术后策略的一致性,以最大程度地提高患者安全性并优化患者的手术结果。目的本指南的主要目的是为进行鼻整形或参与鼻整形治疗的临床医生提供循证建议。以及优化患者护理,促进有效的诊断和治疗,并减少有害或不必要的护理变化。目标受众是任何临床医生或个人,在任何设置中,参与这些患者的管理。目标患者群体是所有年龄≥15岁的患者。该指南旨在关注知识差距,实践变化,以及与此手术程序相关的临床问题;它不旨在成为改善鼻整理术后鼻形态和功能的综合参考。本指南中关于患者教育和咨询的建议也旨在包括患者<18岁时的护理人员。行动声明指南开发小组提出了以下建议:(1)临床医生应询问所有寻求隆鼻手术的患者手术动机和对结果的期望,应该就这些期望是否是手术的现实目标提供反馈,并应将此讨论记录在病历中。(2)临床医生应评估可能修改或禁忌症手术的共病条件的鼻整理术候选人,包括阻塞性睡眠呼吸暂停,身体畸形,出血性疾病,或长期使用局部血管收缩鼻内药物。(3)外科医生,或外科医生的指定人员,术前评估时,应评估鼻整复治疗鼻气道阻塞的候选方案。(4)外科医生,或外科医生的指定人员,应该教育隆鼻术候选人关于手术后的期望,手术如何影响鼻子呼吸的能力,手术的潜在并发症,以及未来鼻部手术的可能需要。(5)临床医生,或临床医生的指定人员,应就手术对鼻气道阻塞的影响以及阻塞性睡眠呼吸暂停可能如何影响围手术期管理,向有记录的阻塞性睡眠呼吸暂停的鼻整形候选人提供建议.(6)外科医生,或外科医生的指定人员,应在手术前对隆鼻患者进行治疗,以应对手术后的不适。(7)临床医生应在鼻整治后至少12个月内记录患者对其鼻外观和鼻功能的满意度。指南发展小组针对某些行动提出了建议:(1)当外科医生,或外科医生的指定人员,选择使用围手术期抗生素进行隆鼻手术,他或她不应在手术后>24小时内常规开抗生素治疗.(2)手术结束时,外科医生不应常规地将填塞物放置在隆鼻患者(有或没有鼻中隔成形术)的鼻腔中。专家组做出以下声明是一种选择:(1)外科医生,或外科医生的指定人员,可对隆鼻患者给予围手术期全身性类固醇。
    Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age. Action Statements The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon\'s designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon\'s designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician\'s designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon\'s designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patients\' satisfaction with their nasal appearance and with their nasal function at a minimum of 12 months after rhinoplasty. The Guideline Development Group made recommendations against certain actions: (1) When a surgeon, or the surgeon\'s designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration >24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon\'s designee, may administer perioperative systemic steroids to the rhinoplasty patient.
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  • 文章类型: Journal Article
    精神病理学研究已经确定了与一系列诊断和统计手册(DSM)精神障碍相关的心理过程,这些努力已经开始产生可以在诊断上应用的治疗原则和方案。然而,对最近工作的回顾表明,在治疗发展文献中,术语“诊断”的概念存在很大差异。我们认为,对“诊断”一词达成共识是有价值的。本论文的目的是概述目前使用术语“诊断”的三种主要方式,为了描述这三个类别的治疗方法,并考虑每种方法的潜在优缺点。
    Research in psychopathology has identified psychological processes that are relevant across a range of Diagnostic and Statistical Manual (DSM) mental disorders, and these efforts have begun to produce treatment principles and protocols that can be applied transdiagnostically. However, review of recent work suggests that there has been great variability in conceptions of the term \"transdiagnostic\" in the treatment development literature. We believe that there is value in arriving at a common understanding of the term \"transdiagnostic.\" The purpose of the current paper is to outline three principal ways in which the term \"transdiagnostic\" is currently used, to delineate treatment approaches that fall into these three categories, and to consider potential advantages and disadvantages of each approach.
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  • 文章类型: Journal Article
    Cognitive deficits are a core feature of schizophrenia and we examined the cognitive profile of first-episode and chronic schizophrenia in a Chinese Han population using the MATRICS Consensus Cognitive Battery (MCCB). We recruited 79 first-episode drug-naïve (FEDN) schizophrenia, 132 chronic medicated schizophrenia inpatients and 124 healthy controls. We assessed patient psychopathology using the Positive and Negative Syndrome Scale (PANSS). MCCB total score (p<0.01) and index scores of category fluency, trail making A, digital sequence, Hopkins Verbal Learning Test (HVLT), mazes, and Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) were significantly higher in FEDN than in chronic patients (all p<0.05). FEDN exhibited relative weakness in continuous performance, whereas chronic patients exhibited relative weakness in mazes. Multiple regression analysis confirmed that in FEDN and chronic patients, total score and negative symptom of PANSS were independent contributors to MCCB total score, respectively. Our results not only demonstrate the applicability of the MCCB as a sensitive measure of cognitive impairment for schizophrenia patients in a Chinese Han population, but also suggest that the compromised cognition is present in the early stage of schizophrenia, some of which could be more severe in the chronic stage of illness.
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