PSD的人群防治及管理
医务人员培训:在各级卫生部门和政策的支持下,积极进行医务人员培训对于可持续开展PSD的防治极为重要。以各地精神卫生医疗机构为主要培训基地,对各级综合性医院、专科医院、乡镇社区卫生院和护理院中的精神科医师、非精神科医师、心理咨询师、心理治疗师、医疗护理人员等进行PSD诊治的系统培训,建立一支由各级医疗卫生部门组成的可用人力资源、能广泛和有效开展PSD防治的精神卫生基础服务队伍。
精神卫生的健康教育:通过报告会、专题讲座、家庭访谈、宣传单、壁报栏、科普文章、电台广播等口头、文字、形象宣传等方式,开发和动员各种媒体的广泛参与,扩大宣传效应,提高社会人群对PSD的知晓率、识别率和就治率。
建立评估监测系统:对患者心身状态、功能障碍和生活质量等方面进行综合性监测和安全评估,及时发现高危人群,进行心理社会干预。对住院患者进行心身联络会诊服务,为其他科室(如神经内科、康复科)的PSD患者提供诊断、治疗处理建议和咨询服务。
建立良好医患关系及三级预防:通过医患之间的沟通,建立巩固良好的医患关系、提高防治依从性是提高治疗效果和治愈率的有效途径。此外,由于精神疾病治疗模式的局限性,有效实施和进行三级预防是减少精神行为障碍所致的残疾、减轻家庭和社会负担的有效策略。其中一级预防即病因预防,通过最积极、最主动的预防措施减少PSD的发生;二级预防的重点是早期发现、早期诊断、早期治疗,争取良好预后;三级预防的要点是防止疾病复发,做好康复训练,最大限度地促进患者社会功能恢复,提高患者生活质量。
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[作者及发表刊物(本文已以英文发表):
Fuying Zhao,Yingying Yue,Lei Li,Senyang Lang,Mingwei Wang,Xiangdong Du,Yunlong Deng,Aiqin Wu,and Yonggui Yuan*.Clinical practice guidelines for post-stroke depression in China,Rev Bras Psiquiatr,2018,doi:10.1590/1516-4446-2017-2343.(Epub ahead of print)]