原发性青光眼个性心理因素的研究进展

原发性青光眼是眼科常见的一种不可逆性致盲眼病.青光眼属典型的心身疾病范畴.随着医学模式向生理-心理-社会医学模式的转化,青光眼患者的心理变化越来越受到关注.临床上发现青光眼患者个性心理状态异于常人,情绪的改变与青光眼的发病、药物治疗、手术及生活质量密切相关.全面系统地了解个性心理因素在青光眼发生、发展中的作用,对今后建立合理规范的心理干预治疗具有重要的指导意义.     

原发性青光眼个性心理因素的研究进展

原发性青光眼是眼科常见的一种不可逆性致盲眼病.青光眼属典型的心身疾病范畴.随着医学模式向生理-心理-社会医学模式的转化,青光眼患者的心理变化越来越受到关注.临床上发现青光眼患者个性心理状态异于常人,情绪的改变与青光眼的发病、药物治疗、手术及生活质量密切相关.全面系统地了解个性心理因素在青光眼发生、发展中的作用,对今后建立合理规范的心理干预治疗具有重要的指导意义.     

青光眼患者术前术后的心理护理

目的　分析青光眼患者术前、术后的心理变化。方法　对 6例急性闭角性青光眼患者术前、术后的心理变化进行分析 ,采取相应的护理措施。结果　患者能保持情绪的稳定 ,以一种良好的心态接受治疗 ,取得较好的手术效果。结论　青光眼患者对病情有一定的了解 ,更能积极配合医生的治疗 ,由于心理护理的配合 ,可取得较好的治疗效果     

原发性闭角型青光眼心理和行为特征调查

目的:研究闭角型青光眼患者的心理、个性和行为特征,探讨青光眼患者心理因素与疾病的关系。方法:运用SCL-90、艾森克个性问卷和A型行为问卷对100例青光眼患者和45例正常对照组进行测试比较。结果:SCL-90评分中,青光眼组的躯体化、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性等症状因子评分和SCL-90总分均明显高于对照组(P<0.05),而强迫因子得分两组间差异无显著性。A型行为问卷测评结果,青光眼组TH量表得分高于正常组,有明显差异,TH+CH和CH得分两组间无明显差异。青光眼组的精神病性(P)、神经质或情绪(N)得分明显高于对照组(P<0.05),而内外向、掩饰两项得分青光眼与对照组无显著性差异(P<0.05)。结论:社会心理因素与原发性青光眼有明确的联系,青光眼患者主要表现为A型性格,患者的精神性和神经质倾向人格特征与闭角型青光眼发病密切相关。     

原发性闭角型青光眼患者心理及人格特征关系的临床观察

目的分析闭角型青光眼患者心理、个性特征与疾病的关系。方法选择在西安市第四医院门诊及住院的西安市青光眼患者100例,分别运用艾森克个性问卷、A型行为问卷以及焦虑和抑郁自评量表对其人格、行为特征和焦虑、抑郁状态进行测试,并与正常对照组进行比较。结果A型行为问卷,青光眼组TH量表得分高于对照组,差异有统计学意义（P〈0.05）,青光眼组TH＋CH和CH得分与对照组无明显差异（P〉0.05）。艾森克个性问卷中青光眼组的精神质（P）、神经质或情绪（N）得分明显高于对照组（P〈0.05）,而内外向、掩饰两项得分青光眼与对照组无显著性差异（P〈0.05）。焦虑和抑郁自评量表中,青光眼组的评分均明显高于对照组（P〈0.05）,并且急性闭角型青光眼患者的焦虑评分与慢性闭角型青光眼患者也有明显差异（P〈0.05）。在相关分析中,青光眼患者的焦虑和抑郁情绪与精神质（P）、神经质（N）、TH和CH＋TH成明显正相关。结论闭角型青光眼患者主要表现为A型性格,患者具有典型的精神性和神经质倾向人格特征;闭角型青光眼患者的情绪受人格和行为特征的影响。     

心理干预对闭角型青光眼患者心理和视野及眼压的影响

目的:评估心理治疗对闭角型青光眼患者心理、视野及眼压的影响。方法:运用SCL-90、焦虑和抑郁自评量表对100例闭角型青光眼患者进行问卷调查,并在术后3mo对患者的视野、眼压和HRTⅡ进行检查。结果:通过一定的心理干预后,干预组SCL-90量表中人际关系、抑郁、焦虑、恐怖和偏执等指标评分较非干预组有所改善。干预组与非干预组相比,焦虑和抑郁评分明显改善,差异具有统计学意义(P<0.05)。术后3mo,干预组患者的眼压较非干预组低,差异具有统计学意义(P<0.05),但干预组与非干预组的视野平均缺损和模式标准差无显著性差异。HRTⅡ中的指标,干预组中C/D和线性C/D与非干预组有显著性差异外,其余指标均无明显差异。结论:心理干预对闭角型青光眼患者的治疗作用只能是在药物和手术治疗的基础上起一定辅助作用,提高药物、手术治疗的疗效。     

心理干预对青光眼患者生存质量影响的临床研究

目的 探讨心理干预对青光眼患者生存质量的影响,为青光眼的护理干预提供科学依据和对策.方法 采用视功能损害眼病患者生存质量量表、健康促进生活方式量表和自行设计的焦虑相关因素调查问卷对患者分别在人院前、手术前后、出院前进行评估.结果 实验组和对照组比较,心理干预后实验组与对照组焦虑评分、生存质量总评分、精神与心理方面评分、症状与视功能方面评分以及医患顺应性有显著差异(P<0.01).身体机能、社会活动方面评分无显著差异(P>0.05).健康行为与婚姻家庭状况、文化教育程度、心理干预、经济状况、社会支持、青光眼症状发作显著相关(P<0.01).结论 心理干预可以明显缓解青光眼患者住院期间情绪波动所造成的发作性症状,改善焦虑情绪及心理状态,提高住院期间视功能及相关生存质量.     

心理干预在青光眼治疗中的作用

1资料与方法1.1临床资料自2002年2月~2004年3月我院入院的青光眼患者共258例(男120例,女138例),从中随机选取108例原发性青光眼患者(排除先天性和继发性青光眼),对之施行药物加心理干预治疗,其中男48例,女60例,年龄36~78岁。1.2方法在一般药物治疗的同时,通过心理干预使患者能理解并克服负性情绪和过度的应激反应,具体方法为:(1)评估:进行心理干预前对患者进行初步评估,确定其当前急需解决的问题,以给予相应的心理干预;(2)针对患者心理问题产生的原因进行干预:使患者正确认识思维方式是导致心理问题的原因之一,及时进行自我调整,并及时与家…     

原发性急性闭角型青光眼患者心理社会因素分析及其对预后影响的初步研究

目的 分析原发性急性闭角型青光眼(acute primary angle-closure glaucoma,APACG)患者的心理健康状况及心理人格特征,探讨心理干预对APACG 治疗和预后的影响.方法 APACG确诊患者40例为病例组(A组),健康体检者20例为对照组(B组).A组入院即行控制眼压治疗,同时填写症状自评量表(symptom checklist 90,SCL-90),艾森克个性问卷(Eysenck personality questionnaire,EPQ)和生活事件量表(life event scale,LES)3种问卷.B组同样填写问卷.A1组术前、术后均给予心理干预治疗,A2组无心理干预治疗.A组患者均由同一术者予常规小梁切除术.结果 A组SCL-90量表的各项指标分值均高于B组,差异有统计学意义(P<0.05).EPQ结果显示:A组精神病性、神经质或情绪人格稳定性得分高于B组,差异有统计学意义(P<0.05).LES结果显示:在心理应激相关因素中,A组家庭事件、社交及其他事件、生活事件总分明显高于B组,差异有统计学意义(P<0.05). A1组术后眼压波动较A2组小,差异有统计学意义(P<0.05).结论 APACG患者具有精神病性、神经质倾向、情绪及人格缺少相对稳定性等心理人格特征. 心理干预对改善患者内分泌,免疫系统紊乱,维持术后平稳的安全眼压起积极作用.     

心理干预对青光眼患者焦虑情绪和皮质醇的影响

目的 观察心理干预对盲光眼患者焦虑情绪、皮质醇及术后前房恢复的影响。方法 将入选住院患者随机分为2组，2组患者给予常规治疗，治疗组同时实施心理干预，观察治疗前后2组病人的焦虑情绪、血皮质醇变化及术后前房恢复情况。结果 治疗组患者焦虑情绪和血皮质醇较对照组明显降低，前房恢复较快。结论 心理干预可降低应激引起的青光眼患者情绪焦虑和血皮质醇的分泌增加，促进青光眼的好转。     

Psychological characteristics of patients with primary open-angle glaucoma

Psychological disorders of different severity are observed in 89.7% patients with primary open-angle glaucoma. They can be detected both clinically and by psychological tests. The psychological status and personality characteristics of patients with glaucoma were evaluated by SMOL method and Cattel's 16 Personality Factors. Signs of psychological disadaptation are more pronounced in patients with the initial and well-developed stages of the disease and in those not treated surgically. The duration of the disease does not affect the psychological characteristics of patients with primary open-angle glaucoma. Consideration for the psychological factor is obligatory in combined therapy of patients with glaucoma.     

青光眼视野损害的身心交互特征

进行性视野缩小是青光眼的主要视功能损害特征。偏执人格及焦虑/抑郁特征则贯穿了发病过程及病程进展。而焦虑/抑郁为主要特征的青光眼患者情绪/心理障碍，对残留视野的范围和视敏度均产生负性影响。身心交互作用的结果使青光眼视功能损害的速度和程度都发生特征性变化。“心因性误差”或称“功能性误差”，导致视功能病理损害的误判。关注青光眼患者情绪障碍与视野损害的交互作用，促进了对青光眼病程身心联合干预策略的发展。     

注重青光眼是一种心身疾病的诊治研究

青光眼是一种重要的眼科心身性疾病。了解青光眼患者的精神心理、个性、行为特征和社会环境因素等以及其与疾病发生发展的关系,对改进青光眼的防治工作具有重要意义。在关注青光眼临床诊治的同时,应关注对青光眼患者的人格特质与疾病之间关系的研究,以及开展从精神心理状态来帮助防控青光眼病情的研究。     

原发性青光眼患者心理因素分析

目的探讨原发性青光眼患者的心理特征。方法41例原发性青光眼患者(其中POAG者12例,PACG者29例)和41例正常对照者分别用汉米尔顿焦虑量表(附自评量表STAI),汉米尔顿抑郁量表HRSD(附抑郁自评量表SDS)、躁狂评定量表MRS进行测评,记分项目包括:汉米尔焦虑量表总分A,包括2个因子,精神性焦虑(A1)、躯体性焦虑(A2);STAI表总分用D表示;HRSD表总分用B表示,包括5个因子,焦虑/躯体化(B1)、体重(B2)、认识障碍(B3)、迟缓(B4)、睡眠障碍(B5);SDS表总分用E表示;MRS表总分用C表示,病情程度用病情指数(C0)表示。结果评分并统计进行测评,所有受试者的各量表总分均在抑郁或焦虑症、燥狂状态的诊断分数以下,各量表包含的影响因子得分分析:对照组与原发性青光眼组比较:HRSD表中的体重因子(以体重减少0.5kg加1分记分)得分结果无显著性差异,t=0.47,P=0.643>0.05,青光眼患者体重不受疾病影响而变化,除此因子外,其余12项均有显著性差异(P<0.05),自评量表结果与调查者评分结果一致,显示出青光眼患者心理因素较对照组有明显不同;POAG和PACG比较:MRS表(C)分数有显著性差异,其中焦躁易激惹因子分突出(C0),POAG组因子分明显高于PACG组(P<0.05),其余11项无显著性差异(P>0.05);Logistic回归分析结果:HRSD表中的焦虑/躯体化因子B1、迟缓因子B4、以及SDS表得分结果进入回归方程,得到OR值分别为13.772,11.776,0·577。结论和正常人比较,青光眼患者群在心理评定量表中的多项因子有显著差异,青光眼患者的心理特征和正常人不同。     

Psychological characteristics of patients with normal-tension glaucoma

· Background: A study was carried out to evaluate the extent of psychosomatic complaints in patients with normal-tension glaucoma. · Methods: Twenty-four patients (M:F=3:21; mean age 58±15.3 years) with normal-tension glaucoma were rated according to the von Zerssen Symptom List (psychosomatic discomfort), the Maudsley Personality Inventory (MPI-N, emotional status and MPI-E, extroverted–introverted), the Beck Depression Inventory (BDI), and the Sixteen Personality Factor Questionnaire (16PF). An age- and sex-matched control group (n=24; M:F=3:21; mean age 56±13 years) without any ocular or other general chronic disease was selected. · Results: In comparison with the control group the patients with normal-tension glaucoma showed significantly more complaints (von Zerssen Symptom List) and were more emotionally unstable (MPI-N). No group differences were found regarding extroversion–introversion (MPI-E) and depression (BDI). In the 16PF, patients with normal-tension glaucoma were remarkable, only for a significant negative correlation between the duration of illness and psychic endurance. · Conclusion: The results demonstrate that patients with normal-tension glaucoma show evident psychosomatic involvement. However, the sequence of the pathogenetic development remains unclear. Therefore, it is not known whether these psychological disturbances are factors contributing to the development of normal-tension glaucoma or whether they are a result of normal-tension glaucoma. Nevertheless, some patients with normal-tension glaucoma had these disturbances. Besides reduction of intraocular pressure and improvement of vascular condition, those who display psychological disturbances should receive psychological support, such as autogenic training. Received: 24 July 1998 Revised version received: 28 January 1999 Accepted: 1 February 1999     

青光眼心理特征和心理干预对青光眼患者影响的研究进展

青光眼是全世界范围内的主要致盲性眼病之一,虽然其病因至今尚未完全清楚,但社会心理因素在青光眼的临床诊疗过程中的作用逐渐引起人们的关注。我们就青光眼的心理特征的评价和心理干预对青光眼患者影响的研究概况做一综述。     

Depression in patients with glaucoma as measured by self-report surveys

PURPOSE: This study aimed to determine whether patients with glaucoma have more depressive symptoms than patients without glaucoma. DESIGN: Prospective case-control study. PARTICIPANTS: The study population was recruited from two university-based glaucoma clinical practices and a university-based general ophthalmology clinic and consisted of 121 patients with open-angle glaucoma, 42 with diagnoses of suspected glaucoma, and 135 with no chronic ocular conditions except cataract. INTERVENTION: The Center for Epidemiologic Studies Depression Scale (CES-D) and Composite International Diagnostic Interview, Short Form (CIDI-SF) questionnaires were administered to all subjects. Demographic information, medical history, and responses to the questionnaires were elicited by an interviewer. Medical record review was performed to obtain clinical examination data and to substantiate the medical and demographic data obtained by the interviewer. MAIN OUTCOME MEASURES: The questionnaire scores by diagnostic group, demographic characteristics, and medical history were examined. Secondary outcome measures were questionnaire scores in patients with glaucoma by visual impairment and glaucoma medication use. RESULTS: Depression scores for patients with glaucoma did not differ significantly from scores of control patients. Having past or present mental illness was the only consistent predictor for depression in both questionnaires. Among glaucoma patients, visual acuity level, visual field severity, and use of topical beta-blockers were not predictors for depression. CONCLUSIONS: Patients with glaucoma do not report being more depressed than patients without glaucoma as measured by the CES-D and the CIDI-SF questionnaires.     

Profil einer universitären Glaukomsprechstunde

BACKGROUND: In order to look for conceptual improvements in the practical management of patients sent to our glaucoma department, we analyzed the structures, behaviour, and knowledge about the disease in this patient group.METHODS: Glaucoma patients who were sent for the first time to our department were included prospectively. Before being examined 129 patients were asked to answer a questionnaire concerning their individual characteristics, their behaviour, and patterns of treatment.RESULTS: Of the patients 74% had open-angle glaucoma (including normal tension, exfoliative, and pigment glaucoma), 22% had secondary glaucoma (including neovascular, congenital, and chronic closed-angle glaucoma), and 4% had suspected glaucoma. Written documentation of previously performed intraocular pressure measurements was not available for 84% of the patients. Younger patients had significantly more knowledge about glaucoma and used more possibilities to get information about the disease than elder patients.CONCLUSION: Education about glaucoma disease should be optimized especially for elder glaucoma patients. Documentation of intraocular pressure measurements is insufficient in our patient group.