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[基于近期病因学概念及当代精神病学理论变化对精神分裂症后遗症建立治疗性伙伴关系的理解]

[Development of a therapeutic partnership understanding of schizophrenia as a sequela of recent concepts of etiology and changes in psychiatric contemporary theory].

作者信息

Böker W

机构信息

Psychiatrische Universìtätsklinik Bern, Ostermundigen.

出版信息

Psychiatr Prax. 1991 Nov;18(6):189-95.

PMID:1771199
Abstract

Ideas and concepts of the essence and nature of mental diseases have always been rooted in the current zeitgeist that usually regarded the psychotic patient as a helpless victim of demoniacal influences, degenerative processes, organic (endogenous) diseases or the dynamics of familial determinants, all of which seemingly destroyed or paralysed the autonomy of the person who became a schizophrenic. In consequence of these concepts the doctor-patient relationship (active expert-passive object of treatment) has largely been asymetrical, whereas at the same time the doctors' attitude towards the relatives was either indifferent or in the manner of a defence reaction, or of a corrective nature. Recent theories such as the concept of vulnerability and stress-coping stimulated new and fruitful forms of cooperation between doctor, patient and relatives. The schizophrenic patient is now being credited with a greater measure of possibilities to influence the prodromata, the course and the consequences of his psychosis. His relatives can help him in doing so, and in fact they should. Clearly formulated and easily appreciated information on this concept, as well as common attention to and assistance of self-protective and compensatory efforts to cope with psychological basic deficiencies, managing of stressors, early symptoms and handicaps. could promote a "treatment partnership" that is also effective as a preventive measure. The idea of a partnership therapy, too, is linked to current trends in research theory and practice that are characterised by the systemic paradigm while aiming at partially restoring the mental patients' capacity and right to act.

摘要

关于精神疾病本质和特性的观念与概念一直植根于当前的时代精神之中,这种时代精神通常将精神病患者视为恶魔影响、退行性病变、器质性(内源性)疾病或家族决定因素动态变化的无助受害者,所有这些因素似乎都破坏或麻痹了成为精神分裂症患者的人的自主性。基于这些观念,医患关系(积极的专家 - 被动的治疗对象)在很大程度上是不对称的,而与此同时,医生对患者亲属的态度要么冷漠,要么表现出防御反应或具有纠正性质。诸如易感性和应激应对概念等近期理论激发了医生、患者和亲属之间新的且富有成效的合作形式。现在人们认为精神分裂症患者在更大程度上有可能影响其精神病的前驱症状、病程和后果。他的亲属可以在这方面帮助他,而且事实上他们应该这样做。关于这一概念的清晰表述且易于理解的信息,以及对应对心理基本缺陷、管理压力源、早期症状和残疾的自我保护及补偿努力的共同关注与协助,能够促进一种“治疗伙伴关系”,这种关系作为一种预防措施也是有效的。伙伴关系治疗的理念也与当前研究理论和实践的趋势相关联,这些趋势以系统范式为特征,同时旨在部分恢复精神患者的行动能力和权利。

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