CN114652313A - Rehabilitation method for treating mental depression - Google Patents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B5/16—Devices for psychotechnics; Testing reaction times ; Devices for evaluating the psychological state
- A61B5/165—Evaluating the state of mind, e.g. depression, anxiety
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- A—HUMAN NECESSITIES
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- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/024—Detecting, measuring or recording pulse rate or heart rate
- A61B5/02438—Detecting, measuring or recording pulse rate or heart rate with portable devices, e.g. worn by the patient
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- A61B5/6801—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be attached to or worn on the body surface
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- A61M21/00—Other devices or methods to cause a change in the state of consciousness; Devices for producing or ending sleep by mechanical, optical, or acoustical means, e.g. for hypnosis
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Abstract
The invention discloses a rehabilitation method for treating mental depression, relates to the field of depression treatment, and aims to solve the problems that treatment mode change is lacked and disease development cannot be monitored in the prior art, and the adopted technical scheme is that the rehabilitation method comprises the following steps: determining a degree of depression in the patient; selecting an appropriate treatment route according to the depression degree; the patient wears a heart rhythm detection device, and data are transmitted back for monitoring so as to judge the rehabilitation condition of the patient; the patient is periodically reviewed, and whether the treatment way needs to be changed or not is determined according to the review condition; after the depression degree of the patient is determined, a proper treatment way is selected according to the actual condition of the patient, the pertinence of treatment is stronger, the rehabilitation effect is better, the heart rhythm change of the patient can be monitored in real time by wearing the heart rhythm monitoring device, the illness state change of the patient can be known through monitoring of the heart rhythm change of the patient by an attending physician under the cooperation of esketamine, so that the pertinence adjustment is conveniently made, and the whole treatment rehabilitation process is more efficient.
Description
Technical Field
The invention relates to the field of depression treatment, in particular to a rehabilitation method for treating mental depression.
Background
Depression is a common mental disorder, mainly manifested by low mood, reduced interest, lack of pleasure, etc., and the severer may suicide negatively; the treatment of depression is mainly: pharmacotherapy, electroshock therapy (ECT), transcranial magnetic stimulation Therapy (TMS), vagal nerve stimulation therapy (VNS), sleep deprivation therapy, phototherapy, neurosurgical therapy, psychotherapy, and the like. The psychotherapy mainly comprises cognitive therapy, behavior therapy, dynamic psychotherapy and interpersonal relationship therapy, and also comprises group therapy of family therapy, operation therapy of supportive psychotherapy and integration of some therapies.
Depression is a common affective and psychiatric disorder with three clinical manifestations:
core symptoms: at least one symptom of depressed mood or mood, lack of interest or loss of enjoyment; psychological symptoms: anxiety, subjective guilt, presence of delusions or hallucinations, decreased attention and memory, suicidal ideation, thought retardation, and slow communication; ③ somatic symptoms: sleep disorder, anorexia, sexual hypofunction, energy loss, morning and night sickness, headache or general pain, general malaise, palpitation, short breath, gastrointestinal dysfunction, frequent micturition, etc.
The pathogenesis of depression is not completely understood. Research suggests that it may be the result of the interaction of many factors, including psychosocial factors and various biological changes. Major stressful life events are a major cause of depression, followed by genetic factors; in terms of biochemical mechanism, factors such as neuroendocrine and the like induce the decrease of the content of neurotransmitters such as central norepinephrine, 5-hydroxytryptamine (5-HT), Dopamine (DA), acetylcholine (Ach) and neuropeptide and the decrease of the function of the receptor thereof. Several theories proposed so far, such as monoamine transmitter changes (mainly 5-HT), endocrine changes (hypothalamic-pituitary-adrenal axis function, hypothalamic-pituitary-thyroid axis thyroid stimulating hormone function, and hypothalamic-pituitary-gonadal axis activity changes), immune changes, and cell signal transduction changes, are related to monoamine transmitter or hormone levels. Recent studies have also found that depression is associated with glutamate conduction dysfunction.
Although there are many treatments for depression, drug therapy is still the current primary method of treating depression. Antidepressants are used as a main means for treating depression or depression states, and play an important role in eliminating symptoms of patients, recovering normal life, learning and social functions, preventing relapse and the like.
Classification of antidepressants antidepressant drugs currently used in clinical practice are mostly classified into tricyclic, tetracyclic, neurotransmitter inhibitors, monoamine oxidase inhibitors, etc. according to their chemical structures and pharmacological actions or action mechanisms, and only some documents are uniformly classified according to their pharmacological actions or action mechanisms.
In the prior art, in the depression treatment process, after a treatment scheme is usually formulated for the first time, the scheme is used in the whole subsequent process, changes according to actual conditions are lacked, and the disease development of a patient cannot be visually monitored by an attending physician, so that inconvenience is brought to subsequent treatment.
Disclosure of Invention
In view of the problems in the prior art, the invention discloses a rehabilitation method for treating mental depression, which adopts the technical scheme that the rehabilitation method comprises the following steps:
step 1, determining the depression degree of a patient;
step 2, selecting a proper treatment route according to the depression degree determined in the step 1;
step 3, enabling the patient to wear a heart rhythm detection device, and transmitting data back for monitoring so as to judge the rehabilitation condition of the patient;
and 4, periodically rechecking the patient, and determining whether the treatment path needs to be changed according to the rechecking condition.
In a preferred embodiment of the present invention, in step 1, the patient is informed of the symptoms by communicating with the patient or a patient accompanying person to determine whether the patient is mild depression, moderate depression or major depression.
Mild depression: mild depression can have significant changes in mood and behavior, and sometimes physical sensation can be enhanced. Common symptoms include: irritability, negative thoughts, feeling abnormally tired, feeling desperate, feeling strong sadness, often being at the edge of lacrimation, self-aversion, difficulty concentrating, feeling unpowered, wanting to stand alone, unexplained, slight body pain, loss of companionship to others.
The following 5 points can be summarized:
do not want to actively interact;
dysthymia, dysphoria and easy irritation;
the work and the study can be adhered to, but the efficiency is very low;
taking unpleasant things into account, and thinking about the bad things;
laziness in consciousness, fatigue, sluggish brain, slow response and lack of confidence.
Moderate depression: when mild depression is not effectively controlled and further progresses, serious consequences can be caused;
has some characteristics of heavy weight, but does not have hallucination;
just seeing the negative side, what often thinks of seeing things is the worst prospect, always because of each kind of miniscule self-disclaimer;
body language: the shoulders droop, the movement is less, and the posture is possibly unchanged for a long time;
reduced activity, poor sleep: early awakening, early weight, mild behavior, anorexia, weight loss;
major depressive disorder: patients with severe depression, whose symptoms are apparent in the appearance of outsiders; the person in such a situation may be very infirm and difficult to perform normal activities;
suicidal ideation is particularly strong, with suicide attempts and behaviors;
the occurrence of hallucinogenic delusions, which are usually auditory hallucinations, guilt and delusions due to deficiency;
brain response is very sluggish, little or no language, slow in speech speed and low in voice;
the patient feels a sense of hopelessness and helplessness and does not feel to be rescued, and treatment is refused.
In a preferred embodiment of the present invention, in step 2, the selectable therapeutic route is psychological persuasion, drug therapy, ECT therapy or TMS therapy.
Psychological mediation refers to general psychological treatment, which is also called individual psychological treatment. Is currently the most common psychological treatment used most commonly. It has no, or no, specific theory, and relies on the common general knowledge of human beings and human comprehension of therapists. The general psychotherapeutic principles are embodied in any therapeutic paradigm. Regardless of the method used to treat a patient, a good therapeutic relationship is first established with the patient, so the most general principle and the most important principle of psychological treatment are the interaction between the doctor and the patient. This relationship is established before further treatment is possible, otherwise all treatments are useless. For the patient, the physician holds a "psychotherapeutic baseline attitude" in which patience, understanding, affirmation, and confidence are important. With the shift in medical models and the increasing health needs of people, patients with depression are more in need of special care, care and nursing. Educating patients about diseases, enhancing confidence, overcoming self-inferior feeling, and educating patients about disease adaptation and coping skills. Meanwhile, the propaganda and education of the mental health knowledge of family members of the patient are enhanced, the support of the family society for the patient is strived for, more care and help are expected to be provided, various bad stimuli are reduced, and a foundation is laid for the patient to return to the society. The common techniques of general psychotherapy are listening, explaining, guiding, relieving adverse situation contradiction or physical and psychological pain, encouraging and supporting, expressing and leading to catharsis, keeping good doctor-patient relationship, etc.
The drug therapy mainly uses antidepressant drugs, and the antidepressant drugs mainly act on neurotransmitters such as 5-hydroxytryptamine (5-HT) and Norepinephrine (NE). Mainly comprises monoamine oxidase inhibitor (MAOI), tricyclic antidepressant (TCA), tetracyclic antidepressant, selective 5-hydroxytryptamine reuptake inhibitor (SSRI), Norepinephrine Reuptake Inhibitor (NRI), 5-HT/NE reuptake inhibitor (SNRI), NE, specific 5-HT antidepressant (NaSSA) and the like.
There are several drug treatments:
selective 5-hydroxytryptamine reuptake inhibitor (ssRl): the selective 5-hydroxytryptamine reuptake inhibitor increases 5. hydroxytryptamine concentration in synaptic cleft by inhibiting reuptake of 5-hydroxytryptamine by presynaptic membrane, and the inhibition is selective and has little effect on other neurotransmitters, so adverse effects are relatively small and only appear as mild gastrointestinal reactions, and the adverse effects are far less than that of tricyclic antidepressant. The medicine is represented by fluoxetine hydrochloride, has good oral absorption, does not influence the medicine absorption after eating, has the bioavailability close to 100 percent, is suitable for treating various depression accompanied by anxiety, and is particularly suitable for senile depression. Also used clinically are fluvoxamine, paroxetine, sertraline, and the like.
The medicines of norepinephrine and specific 5-hydroxytryptamine reuptake inhibitor are mostly tetracyclic medicines, and currently, mirtazapine, mianserin and the like are clinically applied. The medicine represented by mirtazapine is a novel antidepressant developed in recent years, and can block central noradrenergic neurons and presynaptic membrane adrenergic alpha 2 autoregulatory receptors of nerve endings thereof and postsynaptic membrane alpha 2 allosteric receptors of 5-hydroxytryptamine nerve endings, thereby promoting the release of noradrenaline and 5-hydroxytryptamine. The compound has a selective blocking effect on 5-hydroxytryptamine (5-HT) receptors, namely 5-TH2A, 5-HT2c, 5-HT3 and the like are blocked to generate antidepressant and anxiolytic effects, but the affinity to 5-THlA, 5-HTlB and 5-HTlD receptors is low, so that adverse reactions such as insomnia, sexual dysfunction, nausea, dysphoria and the like can be obviously reduced.
ECT therapy, also called electroconvulsive therapy, is a method for treating unconsciousness and spasm attack by passing a certain amount of current through the brain, and intravenous anesthetics and muscle relaxants are added before electroconvulsive therapy, so that patient convulsion is obviously relieved and has no fear feeling. It has been used as a standard treatment because of its wide range of indications, high safety and few complications. The specific method comprises the following steps: the method is implemented with the participation of an anesthesiologist, 0.5mg of atropine is injected into muscle before treatment, 1.0-2.5 mg/kg of 1% thiopentone sodium is administered according to the age and the weight of a patient to induce the sleep of the patient, 0.5-1.5 mg/kg of 0.2% succinylcholine chloride (secoline) is administered when yawning and corneal reflex is slow to the patient, and the muscle relaxation degree is observed. When tendon reflex disappears or weakens, the face and the whole body generate muscle fiber tremor, the breathing becomes shallow, and the whole body muscle relaxes (generally about 2 minutes after administration), the power can be supplied for 2-3 seconds. Slight twitching of the corners of the mouth, the periphery of the eyes, the fingers and the toes is observed for 30-40 seconds, so that the traditional Chinese medicine is an effective treatment.
TMS (transcranial magnetic stimulation) is a painless and noninvasive green treatment method, magnetic signals can penetrate through the skull without attenuation to stimulate cranial nerves, and the magnetic signals are not limited to stimulation of the head and the peripheral nerve and muscles can also stimulate in practical application, so that the TMS is called magnetic stimulation at present; according to the difference of TMS stimulation pulse, the TMS can be divided into three stimulation modes: monopulse tms (stms), dipulse tms (ptms), and repetitive tms (rtms). sTMS is output by manually controlled arrhythmic pulses, and multiple stimuli can also be fired, but the stimulus intervals are longer (e.g., 10 seconds), often for routine electrophysiological examinations. pTMS continuously gives two stimulations with different intensities at the same stimulation site at extremely short intervals, or two stimulators (also called double-coil TMS, dTMS) are applied at two different sites, and are mostly used for researching the facilitation and inhibition of nerves. The rTMS is divided into high frequency and low frequency, and it is necessary for the device to give a slow rhythm low frequency or a fast rhythm high frequency rTMS at the same stimulation site.
As a preferred technical scheme of the invention, for patients with mild depression, a psychological persuasion mode can be adopted for treatment; for patients with moderate depression, the treatment with drugs can be used, and for patients with severe depression, the treatment with ECT or TMS can be used, and the drugs can be used for assistance.
As a preferred technical scheme of the invention, in the treatment process, cognitive behavior treatment and interpersonal relationship treatment are carried out simultaneously, and the cognitive behavior treatment and the interpersonal relationship treatment are both special psychotherapy methods.
The cognitive behavior therapy is suitable for patients after an acute period or patients with mild depression, and particularly for problems in a disease remission stage, the determination of negative cognition is performed one by one, and positive cognition is enhanced. Doctors need to help patients to identify their negative thinking and logic errors, so that patients can practice to check their own cognitive hypothesis, change behaviors to change cognition, replace irrational beliefs with rational beliefs, reconstruct healthy cognitive structures, and enable patients to objectively treat themselves. The cognitive behavior psychotherapy can improve the cognition of depression patients, delay the decline of cognition and improve the depression symptom, and the cognitive psychotherapy is adopted in the treatment process of depression, so that the purposes of relapse prevention and lasting curative effect can be achieved; pure drug therapy can only relieve depression symptoms, but the cognitive disorder of depression still exists to a considerable extent, so that the aim of treatment is achieved by adopting a method of combining drug therapy and cognitive behavior therapy in the clinical treatment of depression.
Patients with depression often have a loss and confusion of interpersonal communication. Adjusting and reconstructing interpersonal interaction of patients can reduce the attack of depression, promote the recovery of depression symptoms and reduce the incidence of depression. Interpersonal psychological treatment considers the impairment of interpersonal relationships and the decline in social functioning as a trigger or as a consequence of depression, and alleviates the symptoms of depression by improving the ability to resolve interpersonal problems (sadness, role changes, interpersonal conflicts, and lack of interpersonal relationships) in depressed patients. Interpersonal psychological therapy is mainly used for treating the acute stage of depression and aims to improve some social problems of depression patients; the characteristics of treatment include that (1) the emphasis is on the current difficult treatment, rather than solving the past problems; the aim of the treatment is to identify secondary symptoms accompanying the treatment of primary depression and depressive episodes; and the treatment technology comprises the steps of confirming target symptoms, clarifying roles and modifying communication modes. Interpersonal psychological therapy is a short-range, time-limited and operable therapy, which is mainly used for improving the mood and the living interest of patients and reducing the self-liability and suicide ideation.
As a preferred embodiment of the present invention, in the step 4, after confirming the degree of depression of the patient at the time of the review, an appropriate treatment method or combination may be selected from psychological counseling, drug therapy, ECT therapy, TMS therapy, and the effect of the combination therapy is often better than that of the single therapy.
As a preferred technical scheme, the heart rhythm detection device is a heart rhythm detection bracelet, the heart rhythm can be continuously detected by wearing the heart rhythm detection bracelet, the heart rate of depression patients is generally high, and the patient condition change can be effectively monitored by detecting the heart rate change in cooperation with the drug esketamine.
As a preferred technical scheme of the present invention, the heart rate detection bracelet includes a display screen, a housing, a wrist strap, an optical heart rate sensor, a communication module, a battery and a microprocessor, the optical heart rate sensor, the communication module, the battery and the microprocessor are all installed in the housing, the display screen and the wrist strap are all connected to the housing, the microprocessor is connected to the display screen, the housing, the wrist strap, the optical heart rate sensor, the communication module and the battery, the heart rate detection bracelet can continuously detect the heart rate of a patient through the optical heart rate sensor, the communication module transmits the heart rate detection information back to a main physician, and the main physician can preliminarily judge the rehabilitation effect according to the change of the heart rate of the patient.
The invention has the beneficial effects that: according to the invention, after the depression degree of the patient is determined, a proper treatment way is selected according to the actual condition of the patient, so that the pertinence of treatment is stronger, the rehabilitation effect is better, the heart rhythm change of the patient can be monitored in real time by wearing the heart rhythm monitoring device, and the illness state change of the patient can be known by monitoring the heart rhythm change of the patient by an attending physician under the cooperation of esketamine, so that the pertinence adjustment can be conveniently made, and the whole treatment and rehabilitation process is more efficient.
Furthermore, psychological persuasion is assisted in the treatment and rehabilitation process, the mental state of the patient can be fundamentally changed, the rehabilitation effect is better, and the change of the illness state of the patient can be deeply known in the psychological persuasion process, so that the next targeted adjustment is more effective.
Detailed Description
Example 1
The invention discloses a rehabilitation method for treating mental depression, which adopts the technical scheme that the rehabilitation method comprises the following steps:
step 1, determining the depression degree of a patient by communicating with the patient or a patient accompanying person;
step 2, selecting a proper treatment route according to the depression degree determined in the step 1, wherein the selectable treatment route comprises psychological counseling, drug treatment, ECT treatment or TMS treatment;
step 3, enabling the patient to wear a heart rhythm detection bracelet, and returning and monitoring data to judge the rehabilitation condition of the patient;
and 4, periodically rechecking the patient, and determining whether the treatment path needs to be changed according to the rechecking condition.
In a preferred embodiment of the present invention, in step 1, the degree of depression includes mild depression, moderate depression or major depression.
As a preferred technical scheme, for patients with mild depression, the traditional Chinese medicine can be used for treating the patients with the mild depression in a psychological dispersion mode, and the psychological dispersion can lead the thinking of the patients and help the patients to get rid of the depression from a cognitive aspect; for patients with moderate depression, the medicine can be used for treating, for patients with severe depression, the ECT treatment or the TMS treatment can be used, the medicine is used for assisting, the treatment can be carried out in a form of combining a plurality of modes in the treatment process, and the treatment effect is better.
As a preferable technical scheme of the invention, in the treatment process, the cognitive behavior treatment and the interpersonal relationship treatment are simultaneously carried out, and the cognitive behavior treatment and the interpersonal relationship treatment are carried out in the whole treatment process.
As a preferred embodiment of the present invention, in the step 4, after confirming the degree of depression of the patient in the review, an appropriate treatment method or combination may be selected from psychological counseling, drug therapy, ECT therapy, and TMS therapy according to circumstances, and the combination therapy may be performed according to circumstances, so that the rehabilitation effect may be effectively improved.
As a preferred technical solution of the present invention, the heart rate detecting bracelet includes a display screen, a housing, a wrist strap, an optical heart rate sensor, a communication module, a battery, and a microprocessor, the optical heart rate sensor, the communication module, the battery, and the microprocessor are all installed in the housing, the display screen and the wrist strap are all connected to the housing, the microprocessor is connected to the display screen, the housing, the wrist strap, the optical heart rate sensor, the communication module, and the battery, a patient can wear the heart rate detecting bracelet on the wrist through the wrist strap, the patient can check the heart rate at any time through the display screen, and the microprocessor processes the detection data of the optical heart rate sensor and then returns the detection data to the treating physician through the communication module.
Although the present invention has been described in detail with reference to the specific embodiments, the present invention is not limited to the above embodiments, and various changes and modifications without inventive changes may be made within the knowledge of those skilled in the art without departing from the spirit of the present invention.
Claims (8)
1. A rehabilitation method for treating mental depression, comprising the steps of:
step 1, determining the depression degree of a patient;
step 2, selecting a proper treatment route according to the depression degree determined in the step 1;
step 3, enabling the patient to wear a heart rhythm detection device, and transmitting data back for monitoring so as to judge the rehabilitation condition of the patient;
and 4, periodically rechecking the patient, and determining whether the treatment path needs to be changed according to the rechecking condition.
2. A rehabilitation method for the treatment of dysthymia according to claim 1, characterized in that: in said step 1, the symptoms of the patient are known by communicating with the patient or the patient's accompanying person to determine whether the patient is mild depression, moderate depression or major depression.
3. A rehabilitation method for the treatment of dysthymia according to claim 2, characterized in that: in step 2, the selectable treatment routes include psychological counseling, drug treatment, ECT treatment or TMS treatment.
4. A rehabilitation method for the treatment of dysthymia according to claim 3, characterized in that: for patients with mild depression, psychological counseling can be adopted for treatment; for patients with moderate depression, the treatment with drugs can be used, and for patients with severe depression, the treatment with ECT or TMS can be used, and the drugs can be used for assistance.
5. A rehabilitation method for the treatment of dysthymia according to claim 4, characterized in that: during the treatment process, the cognitive behavior treatment and the interpersonal relationship treatment are simultaneously carried out.
6. A rehabilitation method for the treatment of dysthymia according to claim 3, characterized in that: in step 4, after confirming the degree of depression of the patient at the time of review, an appropriate treatment method or combination may be selected from psychological counseling, drug therapy, ECT therapy, TMS therapy, depending on the situation.
7. A rehabilitation method for the treatment of dysthymia according to claim 1, characterized in that: the rhythm of the heart detection device is a rhythm of the heart detection bracelet.
8. A rehabilitation method for the treatment of dysthymia according to claim 7, characterized in that: the rhythm of heart detects bracelet includes display screen, casing, wrist strap, optics rhythm of the heart sensor, communication module, battery and microprocessor, optics rhythm of the heart sensor communication module the battery with microprocessor all installs in the casing, the display screen with the wrist strap all with the casing links to each other, microprocessor with the display screen the casing the wrist strap optics rhythm of the heart sensor communication module the battery links to each other.
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