The scientific understanding of pain has stayed on a traditional classic “pain pathway” for many years. However, with the continuous progress of clinical diagnosis, this pathway obviously cannot explain all pain phenomena, and the understanding and interpretation of pain needs to be updated. Based on the influence of comprehensive medicine based on philosophy and the continuous summary and research of clinical cases of somatic symptoms, this paper takes the biological defense mechanism as the basic starting point, analyzes the position of pain in the biological defense mechanism, and reinterprets and defines pain from the new point of view of comprehensive medicine with the new perspective of biological defense mechanism. In addition, this paper also presents the new treatment principles of pain according to the occurrence mechanism through the perspective of biological defense and psychosomatic mechanism, and puts forward new principles of treatment and the view that “defense” is the fundamental purpose of all biology, aiming to provide a reference for the reinterpretation of more diseases and the research on the nature of biological behavior.
Objective To investigate the family burden of depression inpatients, analyze the influencing factors and explore the approach to reduce the family burden. Methods On-the-spot investigation was conducted for the family members of 200 depression inpatients in Mental Health Center of West China Hospital of Sichuan University from January to December, 2008. Following questionnaires used for investigation were all self-scale and filled out by the family members: “Basic Information Scale of Patients and Family Members”, “Family Burden Scale of Patients with Depression” revised from Pai’s scale of “Burden on the Family of Disease” (scoring 0-48 points and covering 24 items under 6 dimensions, namely, financial burden, disruption of routine family activities, disruption of family leisure, disruption of family interactions, effect on physical health of family members, and effect on mental health of family members; rating each item on a 3-class scale, namely, zero for no burden, one for moderate burden, and two for severe burden) , and Xiao Shuiyuan’s “Social Support Scale” (10 items in total, a higher score indicates a better social support). SPSS 13.0 software was adopted to perform statistical analyses. Results The total score of family burden was 26.3±12.6, the positive answer rate of family burden was 100.0%, and the positive answer rate of the every dimension was above 80%. The score of family burden for parents and spouse was higher than that of children (Plt;0.05). The total score of social support was 40.22±9.06, and the correlation coefficient between family burden and family social support was –0.485 (Plt;0.001). Conclusion It is common for family members of depression patients to get family burden at different levels. The more social support family members get, the less the family burden is.
Objective To evaluate the therapeutic effect and safety of Bupropion hydrochloride sustained-release tablets in the treatment of depression. Methods A total of 48 patients meeting the diagnostic criteria of depression of CCMD-3 were randomly treated with Bupropion hydrochloride sustained-release tablets or Fluoxetine tablets for 42 days. Hamilton depression rating scale, Hamilton anxiety rating scale, clinical global impression and treatment emergent symptom scale were used to evaluate the therapeutic effect. Blood routine test, urine routine test and electrocardiogram were examined before and after the treatment. Results The effective rate of Bupropion hydrochloride sustained-release tablets [83% (20/ 24) ] was higher than that of Fluoxetine tablets [63% (15/ 24)], with a P value of 0.104. The incidence of adverse reactions was 46% (11/24) in both groups. Conclusion The therapeutic effect of Bupropion hydrochloride sustained-release tablets on depression is similar to that of Fluoxetine tablets, with mild adverse reactions to both treatments.
Objective To investigate the characteristics of cognitive function and its correlation to neuroendocrine status in patients with refractory depression. Methods A total of 41 patients diagnosed by ICD-10 as depression onset who have been treated with more than two antidepressants drugs, fulfilled the criteria of refractory depression. Another 40 patients diagnosed by ICD-10 as depression onset but who have not been treated, or have been treated with only one antidepressant drug were selected as controls. Patients in both groups were evaluated by WAIS-RC, STROOP, VF, TRAILS A, B, TOH and M-WCST, and the concentrations of CORT, ACTH, T3, FT3, T4, FT4, TSH were also determined. Results A significant difference was found in VF between the refractory depression group and the control group. This showed that the damage to short-term memory, attention and interference rejection capability was much more serious in the refractory depression group. The ACTH concentration in the refractory depression group was significantly different from that of the control group, which indicated that the damage to the Hypothalamic-pituitary-adrenal axis was more serious in the refractory depression group. In particular in relation to memory and attention defect. Conclusion Changes in the levels of CORT, ACTH, TSH, FT3 and T4 may be correlated to cognitive function damage in patients with refractory depression.
【摘要】 目的 评估四川省精神科专科医师培训基地带教师资培训效果、培训方式及提出建议。 方法 对2009年10月和2010年11月的两次培训均参加的59名带教师资采用自制评估表进行评估，其中男37名，女22名；年龄（39±9）岁。采用SPSS 13.0统计软件进行统计分析。 结果 参与培训带教师资对培训的效果总体评价，好22名，占37.29%，很好18名，占30.51%；对培训方式的总体评价，好25名，占42.37%，很好20名，占33.91%；参训教师各个方面较培训前均有显著提高。 结论 开展短期方式多样的集中培训可能是提高带教师资水平的一种快速途径。应该建立师资准入制度考核标准和标准培训内容，从而建立起一支高素质的精神专科医师培训的带教师资，保障精神专科医师培训的质量和顺利进行。【Abstract】 Objective To assess the results and styles of training process for faculty doctors in psychiatric specialist training center of Sichuan Province, and put forward suggestions. Methods We evaluated 59 psychiatric specialist training faculty doctors, including 37 males and 22 females aged (39±9) years old by giving out a self-made questionnaire. Factor analysis was done by adopting SPSS 13.0. Results Evaluation of the training results showed good in 22 doctors (37.29%), and very good in 18 doctors (30.51%); Evaluation of the training style showed good in 25 doctors (42.37%) and very good in 20 doctors (33.91%). After training, the faculty doctors got more progress than before in every aspects. Conclusions Short-term training with various training styles may be a quick way for faculty doctors in psychiatric specialist training center to increase their teaching ability. The standard enrollment criteria, standard training contents and standard exam criteria should be established. Through this, a high-quality faculty doctors in psychiatric specialist training center will be set up, which is very important in ensuring the quality and success of training for psychiatric specialist doctors.
Objective To investigate the association between types of rapid eye movements during sleep and ICD-10 as a mothod for diagnosing depression. Methods Depression was diagnosed according to ICD-10 and changes of 9 variables of REM sleep in 120 psychiatric outpatients and inpatients by calculating the Kappa values. Results In 120 psychiatric patients, 52 depressive patients were diagnosed by using ICD-10, and 58 patients were diagnosed as depression according to decreased REM sleep latency and increased REM activity, REM intensity, REM density, and increasing amount of REM sleep. Kappa value was 0.73, Plt;0.05, which implied that these two diagnosing ways were significantly consistent. Conclusions Measuremen of REM sleep variable should be investigated further as a supplementary method for diagnosing depression.
Objective To examine the prevalence of post-traumatic stress disorder (PTSD), anxiety, and depression for medical staffs who took part in rescue in the disaster area after Wenchuan Earthquake. Methods According to purpose sampling method, from June 12th to June 18th, we investigated the medical staffs in eight areas, and the total number was 500. The eight areas included Mianzhu, Deyang, Shifang, Chengdu, Mianyang, Pengzhou, Zitong, and Anxian. The survey tools were PTSD Checklist-Civilian Version (PCL-C), Self-Rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS). After collecting all questionnaires, we divided 500 medical staffs into 2 groups, according to the fact whether the rescue was carried out in the disaster area or not. Results A total of 500 questionnaires were given to the subjects, of which 481 effective ones were collected, and the effective rate was about 96.2%. In addition, the prevalence of PTSD for overall was 23.3%, anxiety was 21.6%, depression was 49.9%, and the anxiety plus depression was 19.54%. At the same time, we found out the averages of PCL-C (48.29±29.90 vs. 34.76±18.03), PCL-C frequency (16.27±15.14 vs. 9.99±10.25), PCL-C severity (32.03±15.26 vs. 24.85±8.60), SAS primitive (37.39±10.35 vs. 32.22±7.61), SAS standard (46.73±12.94 vs. 40.27±9.51), SDS primitive (42.00±8.32 vs. 37.99±9.63), and SDS standard (52.50±10.39 vs. 47.48±11.92) were different. The medical staffs in the disaster area were under more severe conditions, and there were significant differences between the 2 groups. The prevalence of PTSD (28.52% vs. 16.59), anxiety (28.89% vs. 12.32%), depression (58.15% vs. 39.34%), and anxiety plus depression (26.67% vs. 10.43%) between the 2 groups was significantly different, and the disaster area was under severe conditions. Additionally, the prevalences at three levels within SAS and SDS were much higher in the disaster area. There were also significant differences. Conclusion The prevalences of PTSD, SAS, and SDS within medical staffs who took part in rescue in the disaster area after Wenchuan Earthquake are higher than in the non-disaster area. Therefore, we should work out mental intervention and rehabilitation project for medical staffs, especially those who took part in rescue in the disaster area. Finally, the medical staffs’ ability to copy with stress can be improved.
Objective To observe the serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), platelet 5-HT and blood platelet count, emotion and burn injury healing of patients with moderate and severe burn injury and anxiety-depression symptoms. Methods In-patients with moderate and severe burn injury were selected from 2003.4 to 2005.2 and then divided into anxiety-depression group and control group according to their anxiety-depression scores by Hamilton Rating Scale for Depression (HAMD ) and Hamilton Rating Scale for Anxiety (HAMA) 3 days after being burnt. Routine therapy was given to two groups, which lasted 1 month. Their scores of anxiety and depression and the degree of injury healing were observed, and the serum levels of TNF-α and IL-6, platelet 5-HT and blood platelet count were measured in the two groups. Results Fifty-one in-patients with moderate and severe burn injury were divided into the anxiety-depression group (24 cases) and the control group (27 cases). After 30-day treatment, the depression scores did not decrease in the anxiety-depression group (P=0.12), but the anxiety scores decreased (P=0.00). In the anxiety-depression group, the burn injury healing time was postponed (P=0.00), the serum levels of TNF-α increased (P=0.00), and the platelet 5-HT levels decreased (P=0.04) before and after treatment. Conclusion Depressive reaction occurs in patients with moderate and severe burn injury, which is a continuously negative emotion. It can lead to high levels of serum TNF-α, reduction in platelet 5-HT, and delayed burn injury healing time. Due to the limited sample size and different location of patients, there may be some bias in this conclusion. We are prepared to increase the sample size and select patients in the same region in further relevant studies.
Objective To investigate the effect of music therapy plus selective serotonin reuptake inhibitors （SSRIs） on emotion and bum wound healing in bum patients. Methods Moderate and severe bum inpatient.s, aged 12-60 years were selected. Emotional problems were then measured by the Hamilton Rating Scale for Depression and Hamilton Rating Scale for Anxiety within three days after bum injury. Bum patients with depression and anxiety were randomly allocated into the trial group （28 patients） and the control group （27 patients）. Music therapy and SSRIs plus conventional burn care Were applied to the trial group, and conventional bum care to the control group, both for 30 days. The scores of anxiety, depression and the degree of bum wound healing were assessed. Results The differences of depression score and anxiety score before and after treatment were 13. 7 ±6.43 and 6.43 ±2.72 respectively in the trial group, and 4. 74 ±6.75 and 4.44 ±3.36 respectively in the control group. This showed both scores significantly improved compared with the control group （P 〈0. 05）. The time for burn wound healing was shortened in the treatment group （P 〈0. 05）. The anxiety score was positively correlated with bum index, and so was the depression score （P 〈 0.05 ）. Conclusions The anxiety and depression scores are positively correlated with the burn index. Music therapy plus SSrIs can ameliorate the emotional problems （ depression and anxiety）, and shorten the time for burn wound heating.
Objective To provide evidence for the construction of municipal public health system in Chengdu based on the existing problems. Method Using the priniple and method of evidence-based medicine, epicemiology and health care management, and the data searching, extraction and envaluation to analyse the current situation and problems of Chengdu’s public health system. also referring such research results from home and abroad with the hope of resolving such problems and make suggestions as to how to deal with this. Results There is a few literatures on the municipal public health system. The insufficient financial support, hardware and software condition deteriorated the serious situation of public health in Chengdu. Conclusions It is suggested that we should establish a managing committee of the public health system of Chengdu, make comprehensive plan to set up 6 professional centers, fund the research on main diseases and key techniques, increase financial appropriations by improving financing mechanism and establish a center for education and staff training.