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非精神科常见精神心理问题识别与处置
$40.51
本书内容聚焦在临床医患沟通理论和技能、精神心理问题识别的基本临床思路和方法,以及常见于临床各科的精神心理问题的基本处置三个方面,在内容和形式上兼顾科学性和普及性,以临床各科真实的常见示例导入,使用简明的理论框架对示例进行解释,便于读者理解;书中基本处置和干预部分突出在真实临床示例中应用的实践性和可操作性。
《非精神科常见精神心理问题识别与处置》的编写采用案例结合知识点的方式,全书分为三章:第一章为临床实践中与患者沟通的基本心理技能,第二章为非精神科医生开展精神心理工作的基本原则,第三章为临床常见精神心理问题的识别和处置。每一部分通过丰富、生动的实际案例串联起来,对常见临床接诊的情况予以阐述和说明,对案例进行分析,对应对措施给予建议;从非精神科医护人员的心理诊疗技能和基层诊疗水平出发,帮助非精神科医护人员提高一般心理疾病的诊断干预技能,从一定程度上对临床身体诊疗的效果起到正向积极作用。
国家心理健康和精神卫生防治中心是经中央编办批准设立的国家卫生健康委直属事业单位,为国家级心理健康和精神卫生防治专业机构。
第一章临床实践中与患者沟通的基本心理技能/1第一节基本的临床沟通技能/2一、语言沟通/3二、非语言沟通/10三、信息传递和接收/13四、组织晤谈/15第二节以患者为中心的晤谈和以医生为中心的晤谈/17一、医患关系模式/18二、以患者为中心的晤谈/19三、以医生为中心的晤谈/22四、晤谈方式的灵活使用/24第三节采集患者心身信息的医患沟通/26一、采集患者心身信息时常见的医患沟通困难/27二、采集患者心身信息的医患沟通框架/28三、采集患者心身信息的医患沟通实例/33第四节解释病情和协商治疗方案的沟通模型/35一、解释病情和协商治疗方案时的常见沟通困难/35二、解释病情和协商治疗方案的医患沟通技能/36三、解释病情和协商治疗方案的医患沟通实例/44第五节告知病情和坏消息的沟通模型/46一、告知病情和坏消息时的常见沟通困难/46二、告知病情和坏消息的医患沟通技能/48三、告知病情和坏消息的医患沟通实例/53第六节应对冲突和患者情绪的沟通/55一、冲突和患者情绪的发展规律/55二、应对冲突和患者情绪的CALM模型实践/57三、应对冲突和患者情绪的医患沟通实例/63第七节帮助患者改变不良健康行为的动机访谈/64一、帮助患者改变不良健康行为时的常见沟通困难/64二、帮助患者改变不良健康行为的医患沟通技能/65三、帮助患者改变不良健康行为的医患沟通实例/72第二章非精神科医生开展精神心理工作的基本原则/77第一节基本临床思路/78一、基于症状学的状态诊断/78二、排除器质性疾病的意义/80三、对症处理及病情观察/81四、掌握转诊时机/81第二节精神心理症状的检查和记录/87一、精神心理症状的问诊和检查/87二、精神心理症状的描述和病历记录/89第三节精神卫生法律法规/90一、关于诊疗条件、资质、权限的规定/90二、心理健康指导与转诊的义务/91三、对精神障碍患者实施外科手术和试验性医疗的特殊规定/91四、对联络会诊的特殊要求/91五、对精神卫生宣教的要求/92第三章临床常见精神心理问题的识别和处置/93第一节抑郁状态/94一、什么是抑郁状态/94二、为什么识别抑郁状态很重要/95三、抑郁状态的识别/96四、评估工具的使用/101五、非精神科医生的鉴别思路/105六、抑郁状态的干预/106七、小结/111第二节焦虑状态/112一、什么是焦虑状态/113二、为什么识别焦虑状态很重要/113三、焦虑状态的识别/114四、评估工具的使用/116五、非精神科医生的鉴别思路/121六、焦虑状态的干预/123七、小结/128第三节兴奋状态/129一、什么是兴奋状态/129二、为什么识别兴奋状态很重要/129三、兴奋状态的识别/129四、评估工具的使用/130五、非精神科医生的鉴别思路/135六、兴奋状态的干预/138七、小结/140第四节激越状态/140一、什么是激越状态/140二、为什么识别激越状态很重要/141三、激越状态的识别/141四、评估工具的使用/142五、非精神科医生的鉴别思路/145六、激越状态的干预/146七、小结/149第五节功能性躯体症状/149一、什么是功能性躯体症状/150二、为什么识别功能性躯体症状很重要/150三、功能性躯体症状的识别/151四、评估工具的使用/153五、非精神科医生的鉴别思路/157六、功能性躯体症状的干预/158七、小结/160第六节失眠及相关问题/161一、什么是失眠/161二、为什么识别失眠很重要/162三、失眠的识别/162四、评估工具的使用/163五、非精神科医生的鉴别思路/173六、失眠的干预/174七、小结/180第七节谵妄状态/180一、什么是谵妄状态/180二、为什么识别谵妄状态很重要/181三、谵妄状态的识别/181四、评估工具的使用/182五、非精神科医生的鉴别思路/188六、谵妄状态的干预/190七、小结/191第八节认知损害和痴呆/192一、什么是认知损害/192二、为什么识别认知损害很重要/194三、认知损害和痴呆的识别/194四、评估工具的使用/195五、非精神科医生的鉴别思路/198六、认知损害和痴呆的临床处理/199七、小结/202第九节应激反应/203一、什么是应激障碍和适应障碍/203二、为什么识别应激反应很重要/203三、应激障碍和适应障碍的识别/204四、评估工具的使用/205五、非精神科医生的鉴别思路/211六、应激和适应反应的干预/212七、小结/216第十节患者心理危机和干预/216一、什么是心理危机/217二、为什么识别心理危机很重要/218三、心理危机的识别/218四、评估工具的使用/220五、心理危机干预/222六、需要精神科处置的特殊心理危机状况/227七、小结/227
党和国家一直高度重视心理健康和精神卫生事业的发展。习近平总书记在2016 年全国卫生与健康大会上提出“规范发展心理治疗、心理咨询等心理健康服务”,同年12 月国家卫生和计划生育委员会、中宣部等22 部门联合印发《关于加强心理健康服务的指导意见》,也提出明确目标:到2030 年,常见精神障碍防治和心理行为问题识别、干预水平显著提高。2022 年7 月29 日,国家卫生健康委员会发布了关于设置国家精神疾病医学中心的通知,是国家在资源整合和机构设置方面大力发展精神卫生事业的重要举措,同年10 月,党的二十大报告中明确提出“重视心理健康和精神卫生”。为响应健康中国战略并落实国家心理健康和精神卫生相关政策要求,加强心理健康和精神卫生人才队伍建设,国家心理健康和精神卫生防治中心联合中国医学科学院北京协和医院、四川大学华西医院、中南大学湘雅二医院相关专家编写本书,希望其可以作为常见精神心理问题识别和初步干预的标准化指导性实用材料,普及常见精神心理问题相关的医学知识,提高非精神科医师对常见精神心理疾病的识别能力和初步干预能力,切实提高精神卫生服务的可及性。本书面向包括基层医疗机构在内的各级各类医疗机构各科室医务人员,重点面向非精神科医生、护士。本书内容聚焦于临床医患沟通理论和技能、精神心理问题识别的基本临床思路和方法,以及常见于临床各科的精神心理问题的基本处置三个方面。本书尽量在内容和形式上兼顾科学性和普及性,以临床各科真实的常见示例导入,使用简明的理论框架对示例进行解释,便于读者理解;书中基本处置和干预部分突出在真实临床示例中应用的实践性和可操作性。本书第一章为“临床实践中与患者沟通的基本心理技能”,介绍各种在日常临床医患沟通情景下可以使用的沟通模型。本书第二章主要介绍精神心理相关临床工作的一些基本思路和原则,包括如何对患者进行精神检查,形成精神心理问题的鉴别思路并明确其治疗原则和风险评估等。第三章重点是指导非精神科医生识别在临床工作中常见的精神心理问题,包括抑郁状态、焦虑状态、兴奋状态、激越状态、功能性躯体症状、失眠及相关问题、谵妄状态、认知损害和痴呆、应激反应、患者心理危机和干预10 个方面,分别介绍这些精神心理问题是什么,对临床工作有什么影响,如何识别,如何使用评估工具,处置时需要考虑哪些鉴别诊断和干预原则。全书大量穿插与内容相关的临床示例和实际情景,帮助读者对精神心理方面的临床医患沟通和常见精神心理问题有更加直观的认识。本书在编写过程中,有幸得到来自不同级别医疗机构中不同临床专业和科室的专家、医务和教育相关管理者,以及相关传媒界人士的宝贵建议,让我们有机会反复打磨,提高编写质量。但即便如此,疏漏和谬误仍属难免,在此谨代表本书全体作者,衷心希望广大读者对书中的不妥之处给予批评和指正!编者2023 年6 月
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