分离性身份识别障碍的诊断与治疗

分离性身份识别障碍(DID)是一种常见的分离性障碍。近年来的实证研究表明,DID患者与其它精神疾病患者在人格特征和症状表现上存在显著差异,这种差异为DID的诊断提供了支撑。DID的治疗目标往往并不是消除其他人格,而是达到各人格相互合作的稳定状态,为此治疗师普遍采用了阶段性的、多元的治疗方法和策略。未来的研究应该促进DID患者特征的实证研究在诊断程序中的应用,通过不同流派治疗方法与DID治疗的结合,形成多元化系统化的治疗模式。     

惊恐障碍非诊断性评估工具的现状

本文综述分析了国内外惊恐障碍临床用评估工具研究现状。从临床表现及病理心理机制2个角度总结了10种惊恐障碍评估工具的心理测量学特点及应用现状。     

强迫症患者防御方式与人格特征的相关分析

强迫症(obsessive-compulsive disorder,OCD)的起病与患者病前人格特征有一定关系;防御方式是个体面对某种心理压力或心理应激时,所采取的适应性应对措施,它可缓和内心冲突的痛苦.本研究从防御方式和人格特征两方面对强迫症进行研究,探讨强迫症的病理心理机制.     

肺心病急性发作患者血浆强啡肽A1～13免疫活性物质变化的临床研究

肺心病是临床上常见病之一,其病理发展过程与缺氧性肺血管收缩机制密切相关.近年来,尤其是进入90年代特别重视研究缺氧性肺血管收缩机制与各种神经肽类物质介导作用的关系.大量的研究表明,各种心理、生理或病理性刺激可以激活这一系统,使强啡肽A1-13(DynA1-13)的分泌增加[1].但对缺氧、二氧化碳潴留以及是否涉及参与形成肺心病急性发作期及并发症的机制,至今尚未见文献报道.本研究拟探讨这些问题.     

肺心病急性发作患者血浆强啡肽A1~13免疫活性物质变化的临 …

肺心病是临床上常见病之一,其病理发展过程与缺氧性肺血管收缩机制密切相关.近年来,尤其是进入90年代特别重视研究缺氧性肺血管收缩机制与各种神经肽类物质介导作用的关系.大量的研究表明,各种心理、生理或病理性刺激可以激活这一系统,使强啡肽A1-13(DynA1-13)的分泌增加[1].但对缺氧、二氧化碳潴留以及是否涉及参与形成肺心病急性发作期及并发症的机制,至今尚未见文献报道.本研究拟探讨这些问题.     

高等职业院校大学生心理危机预警与干预机制构建

机制指内部组织和运行变化的规律。高等职业院校大学生心理危机预警与干预机制,是指高等职业院校大学生心理危机预警干预工作中的组织及其规律,包括高等职业院校大学生心理危机的预防机制、预警机制、干预机制、预后机制。国内对大学生心理危机的研究是一个热点,但大多是对大学生心理危机预警与干预的体系、模式、对策、方法等的研究,而对高等职业院校大学生心理危机预警与干预机制的研究却很少,缺少从机制建设的角度探讨高等职业院校大学生心理危机的干预机制,缺乏从机制形成的高度研究高等职业院校大学生心理危机的构建。为此,本文从以下方面着力构建高等职业院校大学生心理危机预警与干预机制。     

杀人抑郁障碍案例的特点和病理心理机制探讨

目的：探讨杀人抑郁障碍案例的特点及其杀人行为的病理心理机制，方法：对我所１０年精神疾病司法鉴定案例中的３３例诊断为抑郁障碍的杀人案例进行对照研究，对照组为同期住院的抑郁障碍患者，性别相同，年龄、病程基本匹配。结果：发现两组在精神疾病家族史、既往躯体疾病史、起病诱因、基本症状和诊断分型上都有显著差异（Ｐ＜００１或００５）。结论：杀人抑郁障碍案例的基本特点可做为预测因素，对其杀人行为的病理心理机制进行了理论性探讨。     

应激性心肌病病理生理机制研究进展

应激性心肌病是一种好发于围绝经期后女性患者,与心理或躯体应激相关,具有短暂性左心室收缩功能障碍特征的获得性心肌病。该病病理生理机制尚未完全阐明,可能的机制主要包括:雌激素缺乏,冠状动脉结构及微血管功能障碍,遗传易患性,儿茶酚胺过负荷等,研究其病理生理学机制有助于应激性心肌病的诊断及治疗方案的选择。     

边缘性人格障碍发病机制研究进展

目的回顾最近几年有关边缘性人格障碍的研究,探讨边缘性人格障碍的发病机制。方法应用Medline和中国知网期刊文献检索2008年2月之前关于边缘性人格障碍的相关文献,检索词为边缘性人格障碍(borderline personality disorder)和发病机制(mechanisms)。结果选择以边缘性人格障碍发病机制相关的文献有46篇,分别涉及到边缘性人格障碍的神经传递素、亲附特点、神经成像、遗传学、认知以及分型。结论边缘性人格障碍是指一群异质的个体,他们在症状表现、病因、心理病理机制的反应等方面可能都存在着很大的差异,它是受生物、心理和社会多方面影响的。     

依恋及其与心理病理的关系

依恋及其与心理病理的关系周世杰湖南医科大学附二院医学心理研究中心热衷于心理病理的病因学研究的发展心理学家和临床心理学家们，尽管其理论背景可能各不相同，但基本上都同意这样一个假设，即早期亲子关系在儿童的人格和社会发展或日后心理障碍的发生中起着重要作用。...     

Dissociative identity disorder and memory dysfunction: the current state of experimental research and its future directions.

Memory dysfunction is a central feature of dissociative identity disorder (DID). Following the memorial anomalies outlined by Putnam [Putnam, F. W. (1994). Dissociation and disturbances of self. In: D. Cicchetti & S. L. Toth (Eds.), Disorders and dysfunctions of the self, vol. 5 (pp. 251-265). Rochester, NY: University of Rochester Press; Putnam, F. W. (1995). Development of dissociative disorders. In: D. Chicchetti & D. J. Cohen (Eds.), Developmental psychopathology, vol. 2 (pp. 581-608). New York: Wiley], the experimental research using DID case studies and samples is reviewed. As a whole, research suggests that amnesic barriers between alter personalities are typically impervious to explicit stimuli, as well as conceptually driven implicit stimuli. Autobiographical memory deficits are also experimentally evident in DID. Although no experimental studies have addressed the issue of source amnesia or pseudomemories, there is some evidence that pseudomemories are an infrequent but real phenomenon in DID patients. Finally, potential deficits in working memory are outlined, including those relating to cognitive inhibition. Research directions are discussed throughout to further elucidate the nature of memory dysfunction in DID.     

Alters in dissociative identity disorder. Metaphors or genuine entities?

How should the different identities (i.e., alters) that are thought to be typical for dissociative identity disorder (DID) be interpreted? Are they just metaphors for different emotional states or are they truly autonomous entities that are capable of willful action? This issue is important because it has implications for the way in which courts may handle cases that involve DID patients. Referring to studies demonstrating that alters of DID patients differ in their memory performance or physiological profile, some authors have concluded that alters are more than just metaphors. We argue that such line of reasoning is highly problematic. There is little consensus among authors about the degree to which various types of memory information (implicit, explicit, procedural) may leak from one to the other alter. Without such theoretical accord, any given outcome of memory studies on DID may be taken as support for the assumption that alters are in some sense "real." As physiological studies on alter activity often lack proper control conditions, most of them are inconclusive as to the status of alters. To date, neither memory studies nor psychobiological studies have delivered compelling evidence that alters of DID patients exist in a factual sense. As a matter of fact, results of these studies are open to multiple interpretations and in no way refute an interpretation of alters in terms of metaphors for different emotional states.     

Simulation of multiple personalities: A review of research comparing diagnosed and simulated dissociative identity disorder

Dissociative Identity Disorder (DID) has long been surrounded by controversy due to disagreement about its etiology and the validity of its associated phenomena. Researchers have conducted studies comparing people diagnosed with DID and people simulating DID in order to better understand the disorder. The current research presents a systematic review of this DID simulation research. The literature consists of 20 studies and contains several replicated findings. Replicated differences between the groups include symptom presentation, identity presentation, and cognitive processing deficits. Replicated similarities between the groups include interidentity transfer of information as shown by measures of recall, recognition, and priming. Despite some consistent findings, this research literature is hindered by methodological flaws that reduce experimental validity.     

What percolation theory can tell us about COPD

Damage to the lung elastic fiber network is largely responsible for the distention and rupture of alveolar walls in chronic obstructive pulmonary disease (COPD). It has therefore been suggested that blood or urine levels of the unique elastic fiber crosslinks, desmosine and isodesmosine (DID), may serve as a biomarker for the progression of the disease. The prognostic value of DID may be limited, however, by the large degree of variance associated with their measurement in patients with COPD. To overcome this problem, we propose that specific patterns of DID release from damaged elastic fibers, rather than their absolute quantity, may provide a better indication of morphological changes in the lungs of patients with COPD. Using percolation theory to model the elastic fiber network in the lung, it will be shown that the relative amounts of damaged and intact elastic fibers may be reflected at the molecular level by urinary levels of free and peptide-bound DID, respectively. The self-similar nature of percolation networks further suggests that detachment of crosslinks from elastic fibers may be analogous to the rupture of alveolar walls in COPD. Consequently, the ratio of free to bound DID may be a measure of emphysematous changes in this disease.     

高Z重金介质的肿瘤放疗增敏效应研究现状

目的：探讨高Z重金介质的放射剂量增强效应及其应用于肿瘤放疗增敏的研究历史、当前进展与未来发展方向。方法：全面检索高Z介质表面/界面的剂量效应及其用于肿瘤放疗增敏的早期研究和最新报道。针对近年来开展的重金介质放疗增敏相关研究,按照放疗射线类型和增敏效应研究手段分别进行总结述评,以把握该领域的发展历史和研究现状,并对现存的问题进行讨论和展望。结果：目前针对高Z重金介质的放疗增敏研究主要包括质粒DNA辐照、体外细胞辐照、动物肿瘤模型试验以及剂量学模拟等手段。针对传统X-γ射线放疗的增敏效应研究最为深入,针对同步辐射放疗、质子重离子放疗等先进放疗技术的重金增敏研究也有开展。研究结果已充分证明了重金介质的放射增敏效应及其用于肿瘤放疗增敏的可行性,为临床前试验的进一步开展提供了重要的理论和实验依据。结论：高Z重金介质的肿瘤放疗增敏效应研究近年来取得了较快的进展,部分研究已从增敏效应验证进入放疗试验的增敏参数优化和作用机理研究阶段,为实现其在临床肿瘤放疗中的应用,增敏效应的微观作用机理是必须深入研究的重要课题。     

Differential Diagnosis between Anomalous Experiences and Dissociation Disorder Using the Dissociative Disorders Interview Schedule (DDIS)

Background. It is important to understand the most diverse cultural aspects related to religiosity. Scientifically, it is important to understand religious manifestations and their relation to health, and to differentiate them from psychopathological manifestations. Objective. To evaluate the mental health of a group of mediums and compare it with that of a control group from the same religious context who do not manifest mediumship, using the Dissociative Disorders Interview Schedule (DDIS). Methods. This was a cross-sectional study, evaluating 47 mediums (Group 1) and comparing them with 22 non-medium volunteers from the same religious context (Group 2) using the DDIS questionnaire. All results were matched with historical data from patients with dissociative identity disorder (DID) who answered the DDIS. Results. Scores obtained from the DDIS were similar in both groups. The number of positive symptoms was comparable in a wide range of analyzed areas, involving but not being restricted to somatization disorder, major depressive episode, borderline personality disorder, extrasensory/paranormal experiences, physical/sexual abuse and five dissociative disorders. There were considerable differences when we compared these results with historical data from patients with DID. Conclusion. In agreement with the extant literature, these results showed that mediumship can be considered a non-pathological form of dissociative phenomena.     

物质成瘾的中枢机制研究进展

物质成瘾的中枢机制是解决临床和治疗药物成瘾的关键,至今仍不清楚,既往工作表明,学习记忆功能在物质成瘾的中枢机制中居于重要的中心环节,我们在总结既往物质成瘾研究工作基础上联系脑的高级功能,试图从系统整合层次分析相关领域研究工作的不足和今后工作的发展方向。     

Assessment of Genuine and Simulated Dissociative Identity Disorder on the Structured Interview of Reported Symptoms

ABSTRACT

Little is known about how to detect malingered dissociative identity disorder (DID). This study presents preliminary data from an ongoing study about the performance of DID patients on the Structured Interview of Reported Symptoms (SIRS, Rogers, Bagby, & Dickens, 1992), considered to be a “gold standard” structured interview in forensic psychology to detect feigning of psychological symptoms. Test responses from 20 dissociative identity disorder (DID) patients are compared to those of 43 well informed and motivated DID simulators. Both the simulators and DID patients endorsed such a high number of symptoms that their average overall scores would typically be interpreted as indicative of feigning. The simulators' mean scores were significantly higher than those of the DID patients on only four out of 13 scales. These results provide preliminary evidence that well informed and motivated simulators are able to fairly successfully simulate DID patients and avoid detection on the SIRS. Furthermore, many DID patients may be at risk for being inaccurately labeled as feigning on the SIRS.     

Does Phasic Trauma Treatment Make Patients With Dissociative Identity Disorder Treatment More Dissociative?

Proponents of the iatrogenic model of the etiology of dissociative identity disorder (DID) have expressed concern that treatment focused on direct engagement and interaction with dissociated self-states harms DID patients. However, empirical data have shown that this type of DID treatment is beneficial. Analyzing data from the prospective Treatment of Patients With Dissociative Disorders (TOP DD) Study, we test empirically whether DID treatment is associated with clinically adverse manifestations of dissociated self-states: acting so differently that one feels like different people, hearing voices, and dissociative amnesia. We show that, over the course of the study, there were significant decreases in feeling like different people and hearing voices. These results indicate that this form of DID treatment does not lead to symptomatic worsening in these dimensions, as predicted by the iatrogenic model. Indeed, treatment provided by TOP DD therapists reduced, rather than increased, the extent to which patients experienced manifestations of pathological dissociation. Because severe symptomatology and impairment are associated with DID, iatrogenic harm may come from depriving DID patients of treatment that targets DID symptomatology.     

EEG Coherence and Dissociative Identity Disorder

Abstract

This is the first study to apply EEG coherence analysis to the study of Dissociative Identity Disorder (DID). EEG coherence is argued to be an objective measure of cortical connectivity. Five DID patients were compared to five controls, who were professional actors. Fifteen dissociated DID alter states were studied, as were 15 “alters” simulated by the actor control participants. Comparisons of EEG coherence were made between DID participants and controls. Significant differences in EEG coherence were found in comparing DID host and alter personalities, with coherence found to be lower in the alter personalities. No significant differences were found in comparing DID host personalities and controls. The acted alters matched for age and gender, showed no significant differences in coherence compared to DID alter personalities. The results indicate that EEG coherence may be an objective measure of the neuronal cortical connectivity associated with DID.