運用正念認知療法於一位雙相情緒障礙症鬱症發作個案之護理經驗

Nursing Experience of Administering Mindfulness-Based Cognitive Therapy to a Patient Experiencing Depressive Episodes of Bipolar Disorder

李佳容(Jia-Rong Li) ； 許佳茵(Jia-Yin Syu) ； 翁紹綺(Shao-Chi Weng)

《精神衛生護理雜誌》 18卷1期 (2023/08) Pp. 44-50

https://doi.org/10.6847/TJPMHN.202308_18(1).06

摘要

本文為運用正念認知療法於一位雙相情緒障礙症鬱症發作個案之護理經驗，個案因婚姻問題及經濟壓力，反覆出現自殺意念及企圖而住院，照護期間為2019年8月15日至10月21日，以整體性評估確立個案有潛在危險性自殺及無效性因應能力等健康問題。首先筆者與其建立治療性人際關係，運用BSRS-5評估情緒困擾程度並針對高分處給予護理指導，教導運用正念認知的技巧，學習接納自己及情緒，應用蘇格拉底法駁斥非理性信念，協助找尋內外在資源，於個案出院後，藉由病房新創立之Line視訊關懷督藥，顯示能預防再次自殺及提升因應能力等。預防再次自殺及雙相情緒障礙症復元是條漫長之路，建議臨床上推廣正念認知療法之運用，出院後持續追蹤及關懷個案，並結合社會資源及支持團體，以預防自殺及提升生活品質。

關鍵字

正念認知療法 ； 雙相情緒障礙症 ； 鬱症發作

並列摘要

This article presents a nursing experience of administering mindfulness-based cognitive therapy to a patient experiencing depressive episodes of bipolar disorder from August 15 to October 21, 2019. The patient, who was under marital and economic stress, was frequently hospitalized because of suicidal attempts. The patient's problems were ineffective coping skills and a risk of self-directed violence. First, a therapeutic relationship was established with the patient. Then, the five-item Brief Symptom Rating Scale was used to evaluate the patient's emotional distress; nursing guidance was provided when the score was high. Additionally, the patient was trained to use mindfulness and cognitive skills to accept himself and his emotions and apply the Socratic method to refute his irrational beliefs; he also received assistance in finding internal and external resources. After the patient was discharged, the author provided care and supervision through the Line communication app. This facilitated treatment for preventing suicidal behavior and improving coping skills. It is a long journey for patients with bipolar disorder to achieve recovery and prevent suicide. Mindfulness-based cognitive therapy should be promoted in clinical practice. Our hospital not only provides continuous follow-up and care to discharged patients but also integrates social resources and support groups to prevent suicide and improve their quality of life.

並列關鍵字

mindfulness ； cognitive therapy ； bipolar disorder ； depressive episodes

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