Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.
J Clin Psychiatry. 2012 May;73(5):640-4. doi: 10.4088/JCP.11r07381.
Providing psychiatric consultation to elite athletes presents unique and complex issues. These patients present with multifaceted medical, psychological, and performance concerns. We provide the first report of professional and ethical quandaries that arise in treating elite athletes and ways to address them.
We identified studies through a MEDLINE search. Search terms included the following, individually and in combination: psychiatry, athletes, elite athletes, professional athletes, sports, sport psychiatry, mental illness, major depressive disorder, depression, bipolar disorder, suicide, anxiety, generalized anxiety disorder, obsessive compulsive disorder, social phobia, social anxiety disorder, panic disorder, post traumatic stress disorder, specific phobia, psychosis, eating disorders, anorexia nervosa, bulimia nervosa, attention deficit hyperactivity disorder, substance abuse, substance dependence, addiction, alcohol, anabolic steroids, stimulants, antidepressants, mood stabilizers, anxiolytics, antipsychotics, sedative-hypnotics, psychotropics, medications, and psychiatric medications. We restricted results to the English language and used no date restrictions. We retrieved all articles discussing psychiatric diagnosis or psychiatric treatment of athletes. We reviewed each article's findings to see if they applied to elite athletes and reviewed the references of each article for additional articles that had been missed in the initial search and that might include findings relevant to the scope of our article. Our search found no controlled data to guide treatment in working with elite athletes. We describe the literature that does exist and present 4 case examples to illustrate diagnostic and treatment issues with elite athletes.
Patient and family characteristics are described as they bear on treatment context. The key pitfalls that interfere with treatment are listed, and clinical guidelines to improve outcomes are suggested. Specific key pitfalls that interfere with treatment include elite athletes' expecting "special treatment," issues of flexibility in treatment to accommodate travel schedules and the need for privacy, and inclusion of coaches and significant others in treatment. Recommendations for working with this population include being flexible within reason about timing of sessions, involving family members when relationship issues are involved, and not compromising on delivering the appropriate treatment, including medications and hospitalizations as necessary.
The challenges of treating the elite athlete are great, but successful treatment is possible.
为精英运动员提供精神科咨询带来了独特而复杂的问题。这些患者表现出多方面的医疗、心理和表现问题。我们首次报告了在治疗精英运动员时出现的专业和道德困境，并提出了解决这些问题的方法。
我们通过 MEDLINE 搜索确定了研究。搜索词包括以下单独和组合的词：精神病学、运动员、精英运动员、职业运动员、运动、运动精神病学、精神疾病、重度抑郁症、抑郁症、双相情感障碍、自杀、焦虑、广泛性焦虑障碍、强迫症、社交恐惧症、社交焦虑障碍、惊恐障碍、创伤后应激障碍、特定恐惧症、精神分裂症、饮食障碍、神经性厌食症、神经性贪食症、注意缺陷多动障碍、物质滥用、物质依赖、成瘾、酒精、合成代谢类固醇、兴奋剂、抗抑郁药、心境稳定剂、抗焦虑药、抗精神病药、镇静催眠药、精神药物、药物和精神药物。我们将结果限制为英语，并且没有使用日期限制。我们检索了所有讨论运动员精神科诊断或治疗的文章。我们审查了每篇文章的发现，以确定它们是否适用于精英运动员，并审查了每篇文章的参考文献，以查找在初始搜索中遗漏的可能包含与我们文章范围相关的发现的其他文章。我们的搜索没有找到指导与精英运动员合作的治疗的对照数据。我们描述了现有的文献，并提出了 4 个案例示例来说明与精英运动员相关的诊断和治疗问题。
描述了与治疗背景相关的患者和家庭特征。列出了干扰治疗的关键陷阱，并提出了改善治疗效果的临床指南。干扰治疗的关键陷阱包括精英运动员期望“特殊待遇”、治疗时间灵活以适应旅行计划和隐私需求以及包括教练和重要他人参与治疗的问题。与该人群合作的建议包括在合理范围内灵活安排会议时间、在涉及人际关系问题时让家庭成员参与、以及不妥协地提供适当的治疗，包括必要的药物治疗和住院治疗。
治疗精英运动员的挑战很大，但成功的治疗是可能的。
