支气管哮喘患者生活质量状况的心理社会影响因素调查

目的:调查哮喘患者的生活质量及其心理社会影响因素.方法:采用哮喘生活质量评估表(AQLQ)、艾森克人格问卷简式量表中国版(EPQ-RSC)、医用应对问卷(MCMQ)及社会支持评定量表(SSRS)对769名哮喘患者进行调查.结果:①神经质性人格(r=-0.338)和屈服的应对方式(r=-0.466)与生活质量总分呈显著负相关.②回归分析的结果显示,中重度病情、良好的经济状况、神经质的性格特征以及屈服的应对方式能够显著地预测哮喘患者的生活质量.③路径分析的结果显示,对社会支持的利用度及屈服的应对方式在人格与生活质量间起中介作用.结论:屈服应对和神经质性人格是影响哮喘患者生活质量的重要心理因素.     

灼口综合征患者心理健康状况及相关因素分析

目的:探讨灼口综合征患者心理健康状况及相关因素。方法:采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、艾森克人格问卷简式量表中国版(EPQ-RSC)以及医学应对方式问卷(MCMQ)对60例灼口综合征患者和对照组进行测评。结果:灼口综合征患者抑郁、焦虑情绪明显高于对照组,"回避"和"屈服"应对方式与抑郁情绪呈正相关;精神质、神经质和掩饰性人格与抑郁、焦虑情绪呈正相关。结论:灼口综合征患者并发较高程度的抑郁、焦虑症状,同时不同人格类型与应对方式对其焦虑、抑郁有较大影响。     

肠易激综合症的人格特征及心理健康影响因素

目的从心理学的角度出发,探讨肠易激综合症(IBS)患者心理健康的程度及其独特的人格特点。方法选取64例IBS患者和64例正常人作为研究对象,使用症状自评量表(SCL-90)和艾森克人格问卷,研究IBS患者心理健康的影响因素,及其与正常人人格之间的差异。结果 IBS患者的躯体化、敌对、精神病性、人际敏感、抑郁、焦虑和恐怖因子分显著高于正常人(t=2.76～7.26,P<0.05)。除恐怖因子外(F=3.18,P<0.05),不同年龄的IBS的SCL-90得分无明显差异。而女性的躯体化因子分明显高于男性(F=3.04,P<0.05)。而人格测验结果显示IBS患者精神质P、神经质N和掩饰性L得分均明显高于正常人(t=4.45～7.12,P<0.01),内外向E得分显著低于正常人(t=3.51,P<0.01)。结论 IBS患者的人格出现明显的异常,其精神质、神经质和掩饰性得分显著比正常人高,而且其心理健康水平总体偏低。     

述情障碍对冠心病合并2型糖尿病患者应对方式及生活质量的影响

目的:探讨述情障碍对冠心病合并2型糖尿病患者应对方式及生活质量的影响。方法:对符合世界卫生组织冠心病、2型糖尿病诊断标准的70例患者,依据多伦多述情障碍量表(TAS-20)评分分为2组,总分60分为述情障碍组,50分为非述情障碍组,50~60分不做研究。述情障碍组41例,无述情障碍组29例。尔后分别进行医学应对问卷(MCMQ)、生活质量综合评定问卷(GQLI)测评,并进行比较分析。结果:述情障碍组MCMQ面对因子评分显著低于非述情障碍组(t=-8.23,P0.01),而回避、屈从因子评分则显著高于非述情障碍组(t=5.21,4.27;P0.01)。非述情障碍组GQLI总分及躯体健康、心理健康、社会功能因子分均显著高于述情障碍组,差异有统计学意义(t=3.66,3.82,3.66,2.37;P0.01);物质生活维度评分差异无统计学意义(P0.05)。患者TAS-20评分与MCMQ的面对因子评分呈显著负相关(r=-0.34,P0.01),而与MCMQ回避、屈从因子评分呈显著正相关(r=0.32,0.34;P0.01);与GQLI总分、躯体健康、心理健康及社会功能因子分呈显著负相关(r=-0.31,-0.33,-0.30;P0.01),与物质生活维度评分无相关性。结论 :冠心病合并2型糖尿病述情障碍患者多采用回避和屈服的消极应对方式,而较少采用积极应对方式;其生活质量较非述情障碍患者差。     

心理因素对血液透析患者睡眠质量的影响

目的 探讨哈尔滨市终末期肾脏疾病血液透析患者睡眠质量与心理因素的相关性.方法 86例终末期肾脏疾病血液透析患者均使用肾脏疾病生存质量量表中的睡眠质量分量表、艾森克人格问卷(EPQ)、Zung's抑郁自评问卷和Zung's焦虑自评问卷、社会支持问卷、应对方式问卷进行调查.结果 睡眠质量得分与性别、神经质、焦虑、抑郁、年龄、透析年限呈负相关,并存在线性回归关系.与客观支持、对支持的利用度呈正相关.结论 终末期肾脏疾病血液透析患者的睡眠质量与焦虑、抑郁等心理因素相关.因此,必须把心理治疗和躯体治疗有效结合来提高整体治疗的效果.     

心理因素对糖尿病患者睡眠质量的影响…

目的:探讨糖尿病患者心理因素与睡眠质量的相关性。方法:248例糖尿病患者均使用国际匹兹堡睡眠质量量表(PSQI)、艾森克人格问卷(EPQ)、Zung’s抑郁自评问卷和Zung’s焦虑自评问卷、社会支持问卷、应对方式问卷进行调查。结果:睡眠质量得分与性别、神经质、焦虑、抑郁、主观支持、消极应对呈正相关(r=0.246,0.327,0.372,0.363,0.249,0.294),并存在线性回归关系。与客观支持、对支持的利用度呈负相关(r=-0.245,-0.276,P<0.05)。结论:糖尿病患者的睡眠质量与焦虑、抑郁等心理因素相关。因此,必须把心理治疗和躯体疾病治疗有效结合来提高整体治疗的效果。     

儿童期受虐与肠易激综合征关系的临床研究

目的:探讨儿童期受虐在肠易激综合征(IBS)发生及患者精神心理状态、生活质量中所起的作用。方法:72例IBS患者(患者组)评定儿童期虐待问卷(CTQ),评估儿童期受虐情况,并与92例正常健康人(对照组)进行对照。IBS患者同时还评定抑郁自评量表(SDS)、焦虑自评量表(SAS)、肠易激综合征患者生活质量表(IBSQOL)。结果:1患者组CTQ评分显著高于对照组,差异有统计学意义(t=3.590,P0.001);患者组儿童期受虐发生率为44.4%,高于对照组的27.2%,差异有统计学意义(χ~2=5.313,P0.05);2与无儿童期受虐的IBS患者(40例)比较,有儿童期受虐的IBS患者(32例)SAS评分显著较高,差异有统计学意义(t=2.099,P0.05);3有儿童期受虐的IBS患者QOL评分显著高于无儿童期受虐的IBS患者,差异有统计学意义(t=-2.223,P0.05)。结论:儿童期受虐可能是IBS发生的社会心理学因素之一,并可能对IBS患者的心理状况、生活质量产生不良的影响。     

肠易激综合征患者的胃排空

目的　探讨肠易激综合征 (irritablebowelsyn dromeIBS)患者的胃运动功能。方法　应用标准试餐加服固体小钡条的放射性胃排空试验 ,观察 30例健康者与 76例肠易激综合征 (其中便秘组 4 6例 )患者的胃排空异常率及与上消化道症状间的关系。结果　便秘组IBS患者胃排空延迟发生率明显高于对照组 (P <0 0 5 ) ,伴有上消化道症状者胃排空延迟更显著 结论　IBS患者存在胃动力障碍肠易激综合征患者的胃排空@崔振芹$山东大学齐鲁医院消化科!济南250012 @卢雪峰$山东大学齐鲁医院消化科!济南250012 @李延青$山东大学齐鲁医院消化科!济…     

正念减压改善肠易激综合征的效果

目的:探讨肠易激综合征(IBS)治疗方法。方法:对门诊就诊志愿者69例进行正念减压疗法6个月,应用症状自评量表和炎症性肠病问卷对干预前后效果评估情绪、情感状态及社会功能。结果:正念减压(MBSR)训练前后SCL-90结果比较躯体化有显著变化(t=3.753,P0.01),焦虑(t=2.219)、敌对(t=20.60)、抑郁(t=2.032)、人际关系敏感(t=3.141)及恐怖(t=2.772),变化有统计学意义(P0.05),强迫症状、偏执及精神病性变化不明显(P0.05);炎症性肠病问卷肠道症状(t=-2.085),全身症状(t=-2.542)、情感功能(t=-2.088)、社会功能(t=-3.259)及总分(t=-3.314)均有统计学意义(P0.05)。结论:MBSR训练能够改善IBS患者心身状态和社会功能,提升了幸福感。     

盐酸帕罗西汀治疗肠易激综合征伴焦虑抑郁的疗效观察

目的研究盐酸帕罗西汀对肠易激综合征（IBS）伴焦虑抑郁的临床疗效。方法Zung氏抑郁量袁（SDS）≥40分者；Hamilton焦虑量表（HAMA）〉14分者，服用帕罗西汀10～30mg tid（失眠烦躁明显者每晚临时服用苯二氮卓类药物1周）治疗，6周后用SDS及HAMA的减分率评定疗效。以减分率〉25％且躯体症状有改善为有效。结果86例患者中焦虑抑郁障碍改善达84％以上，躯体症状改善达540以上。结论帕罗西汀可有效改善肠易激综合征伴有的焦虑抑郁及躯体性不适症状。     

Polysomnographic and actigraphic evidence of sleep fragmentation in patients with irritable bowel syndrome

STUDY OBJECTIVE: To characterize the function and quality of sleep in patients with irritable bowel syndrome (IBS). DESIGN: A prospective study with a historic comparison group. SETTING: A regional hospital that also serves as a tertiary referral center. PATIENTS: Eighteen patients with IBS and a comparison group of 20 matched adults with mild benign snoring. INTERVENTIONS: A polysomnography study and a wrist actigraphy study. MEASUREMENTS: All subjects underwent sleep studies and completed self-report questionnaires (IBS severity, psychosocial variables, sleep function, and Epworth Sleepiness Scale). Fourteen IBS and 11 comparison patients underwent actigraphy. RESULTS: The IBS patients had more than 70% less slow-wave stage sleep (4.5 +/- 7.3% vs 19.3 +/- 12.9%; P = 0.006), compensated by increased stage 2 sleep (72.2 +/- 6.6% vs 60.1 +/- 16.8%; P = 0.01). The IBS group had significant sleep fragmentation with a significantly higher arousal and awakening index (P < 0.001), a longer wake period after sleep onset (P = 0.02), and more downward shifts to lighter sleep stages (P = 0.01). The 4-night actigraphy study supported the polysomnography findings. The sleep fragmentation index was significantly higher (P = 0.008) in the IBS group. The IBS patients reported greater daytime sleepiness (9.0 +/- 4.8 vs 6.4 +/- 4.8, Epworth Sleepiness Scale score, P < 0.01) and greater impairment in quality of life, which correlated significantly with the sleep fragmentation indexes. The difference between the groups was not due to differences in baseline anxiety/depression levels. CONCLUSIONS: Patients with IBS have impaired sleep quality, reduced slow-wave sleep activity, and significant sleep fragmentation. The cause-and-effect relationship of these findings with patients' daytime symptoms should be studied further.     

Symptom interpretation and quality of life in patients with irritable bowel syndrome

BACKGROUND: Patients with irritable bowel syndrome (IBS) are often believed to attribute unexplained symptoms to physical disorders. We tested this hypothesis by assessing symptom interpretation, symptom severity, and quality of life in patients attending hospital gastroenterology clinics. AIM: The main aims of this study were: to assess the symptom attributional styles of hospital gastroenterological outpatients with IBS and non-IBS disorders in comparison with unselected patients attending their GP; to establish the relationships between attributional style, quality of life, and IBS severity score in hospital gastroenterology outpatients; and to test the hypothesis that the IBS severity score correlates with a somatising style of symptom attribution. DESIGN OF STUDY: Systematic quantitative analysis. SETTING: General practice and gastroenterology outpatient clincs. METHOD: Patients attending hospital gastroenterology clinics were recruited prospectively and completed validated questionnaires. These were the Medical Outcome Survey (MOS SF-36), the IBS Severity Score, and the Symptom Interpretation Questionnaire (SIQ). The latter measures the tendency to interpret somatic symptoms in three ways: as a physical disorder (somatising attributional style), as an emotional response to stress (psychologising attributional style), or as a normal experience (normalising attributional style). The diagnosis of IBS was based on the Rome II criteria; the control groups comprised gastroenterology outpatients with non-IBS diagnoses and unselected patients attending general practice. RESULTS: Quality of life in IBS patients attending hospital outpatients (n = 32, male:female ratio 9:23) was not significantly different from that of non-IBS patients (n = 70, male:female ratio 32:38). In all patient groups, the normalising style of symptom interpretation predominated; psychologising styles correlated with impaired quality of life in the mental health domains. In IBS patients, the tendency to seek a psychological explanation for physical symptoms correlated significantly with the severity of the abdominal pain. CONCLUSIONS: Symptom interpretation does not differ between IBS and non-IBS patients referred to hospital gastroenterology clinics. The tendency to attribute somatic symptoms to a physical disorder does not explain why only a minority of IBS subjects seek medical attention. The idea that most IBS patients are committed to a somatic explanation of symptoms appears to be a myth.     

Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome

OBJECTIVE: The purpose of this study was to investigate the presence of emotional abuse and two psychosocial constructs (self-blame and self-silencing) in a sample of women diagnosed with irritable bowel syndrome (IBS) relative to a comparison sample of women diagnosed with inflammatory bowel disease (IBD). METHODS: Women diagnosed with IBS (N = 25) were compared with women diagnosed with IBD (N = 25) on measures of history of abuse, self-blame, and self-silencing. RESULTS: It was found that women in the IBS sample scored significantly higher on emotional abuse, self-blame, and self-silencing than did women in the IBD sample. These three variables were also found to be significantly intercorrelated in both the IBS and IBD samples. Finally, emotional abuse was significantly higher in IBS patients than in IBD patients beyond the differences accounted for by physical and/or sexual abuse history. CONCLUSIONS: These findings empirically demonstrate an association between IBS and emotional abuse, as well as a possible connection with psychosocial variables, that may mediate the connection between emotional abuse and functional bowel symptoms. We suggest that these variables be further evaluated in the context of clinically relevant research on IBS.     

Relationship Between Cognitive Factors and Anxiety in Individuals with Irritable Bowel Syndrome

Background

Individuals with irritable bowel syndrome (IBS) have high anxiety. There is insufficient information about the relationships between concrete cognitive contents and anxiety in IBS.

Purpose

The present study investigated the relationship between cognitive factors and anxiety in individuals with IBS.

Method

The participants were 1,087 college students (male, 506; female, 576; unidentified, 5; age, 19.72?±?1.76?years) who completed a set of questionnaires that included the Rome II Modular Questionnaire (based on diagnostic criteria for IBS), Anxiety Sensitivity Index (ASI), Cognitive Appraisal Rating Scale (CARS; subscales: commitment, appraisal of effect, appraisal of threat, and controllability) for measuring symptom-related cognition, an item about attention to abdominal symptoms, the Hospital Anxiety and Depression Scale-Anxiety Scale (HADS-A), and an item regarding the presence of avoidant behavior due to anxiety of IBS symptoms.

Results

The participants included 881 individuals without IBS and 206 individuals with IBS. Individuals with IBS had higher ASI and HADS-A scores than those of the individuals belonging to the control group (p?p?p?Conclusion Severe anxiety sensitivity in individuals with IBS related to their symptom-related cognition, and the altered cognition increases anxiety, leading to the possible development of a disabling condition.     

Abuse,dissociation, and somatization in irritable bowel syndrome: towards an explanatory model

This study tested a preliminary model of the role of dissociation and somatization in linking abuse to irritable bowel syndrome (IBS). Outpatients with IBS (N = 64) or bowel symptoms explained by physical disease (N = 61) completed questionnaires to assess recollections of abuse as children or adults and current dissociation, somatization, and emotional distress. By comparison with physically diseased patients, patients with IBS recalled more sexual abuse as children and adults, more physical abuse as children, and more psychological abuse as adults. They were more anxious and depressed, and somatized and dissociated more. Analyses indicated a causal chain linking, in turn, abuse, dissociation, somatization, and IBS. The results are consistent with a model in which childhood abuse is linked to IBS because it causes a tendency to dissociate, and because dissociation causes a general increase in physical symptoms. Future research should identify factors that explain why a generally increased level of physical symptoms should, in some patients, lead specifically to IBS.     

Efficacy of individualized homeopathic medicines in irritable bowel syndrome: A double-blind randomized,placebo-controlled trial

ContextGastrointestinal ailments are some of the common conditions treated in homeopathy; yet only a few trials have explored the effects of individualized homeopathic medicines (IHMs) for irritable bowel syndrome (IBS).ObjectiveTo explore the efficacy of IHMs in treatment of IBS.DesignDouble-blind, randomized, placebo-controlled trial.SettingOutpatient departments of Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, India.PatientsSixty patients suffering from IBS; randomized to receive either IHMs (n = 30) or identical-looking placebo (n = 30).InterventionsIHMs or placebo in the mutual context of concomitant care in terms of dietary advice, yoga, meditation and exercises.Main outcome measuresPrimary – IBS quality of life (IBS-QOL) questionnaire; secondary –IBS severity scoring system (IBS-SSS) and EQ-5D-5L scores; all measured at baseline and every month, up to 3 months.ResultsGroup differences and effect sizes (Cohen's d) were calculated on intention-to-treat (ITT) sample. Groups were comparable at baseline. Recruitment, retention and attrition rates were 64.5%, 91.7% and 8.3% respectively. Group differences in IBS-QOL total scores, IBS-SSS, EQ-5D-5L scores favored IHMs against placebo overall and at all the time points (all P < 0.001). Pulsatilla nigricans (n = 4, 6.7%) and Thuja occidentalis (n = 4, 6.7%) were the most frequently prescribed medicines. Barring some minor events unrelated to interventions, no harms or serious adverse events were recorded in either of the groups. Thus, IHMs acted significantly better than placebos in the treatment of IBS. Independent replications are warranted. [Trial registration: CTRI/2019/10/021632]     

Reasons for consultation in irritable bowel syndrome: symptoms and patient characteristics.

This study compared the characteristics of patients with symptoms of irritable bowel syndrome who had either consulted or not consulted a general practitioner in the preceding two years. The subjects were identified by questionnaire in a community survey of irritable bowel syndrome symptoms and samples of 24 consulting and 24 non-consulting patients were interviewed. The groups were well matched for demographic characteristics, although those who consulted for irritable bowel syndrome also consulted more frequently for other problems. The only significant differences in the pattern, frequency and severity of a range of symptoms, which included the Manning criteria, were that more of the consulting patients experienced visible abdominal distension and had a higher mean score for severity of pain than the non-consulters. Mean negative life event scores and anxiety and depression scores were higher in the group who consulted and more of these patients were concerned about the possible serious nature of their symptoms, including fear of cancer, emphasizing the importance of eliciting patients' beliefs and anxieties about the meaning of their symptoms.     

Patients with irritable bowel syndrome: health status and use of health care services.

BACKGROUND: The reason for consulting a physician is more related to illness behaviour than to the severity of complaints. Yet, little is known about the course of complaints, the health care seeking behaviour, and psychosocial factors influencing these items in patients with irritable bowel syndrome (IBS) attending the general practitioner (GP). AIM: To study health status, lifestyle, and use of health care services of patients with IBS in order to indicate problem areas accessible for intervention strategies. METHOD: Structured interviews of 53 patients with IBS aged 15 years and older compared with a general population of 12,975 in the same age range, all drawn from the Dutch National survey of Morbidity and Intervention in General Practice. RESULTS: Patients with IBS revealed a lower grade of education (P < 0.001), poorer health (P < 0.001), a higher mean complaint score (8.3 versus 4.0, P < 0.001), a higher score on the General Health Questionnaire (P < 0.001), a higher score on the biographic problem list (BIOPRO, 2.3 versus 1.4, P < 0.001), and more absence from work (32% versus 18% in two months, P < 0.01). Patients with IBS consulted the family physician (1.6 versus 0.8 in three months, P < 0.001), the physical therapist (30% versus 15% in one year, P < 0.001), and the alternative therapist (32% versus 15% in five years, P < 0.001) more often than those without. CONCLUSIONS: The study shows an excess of comorbidity, psychosocial problems, use of health care services, and absence owing to disease in patients with IBS. Special guidelines and training of GPs to apply a more integral approach may reduce the cost of health care and may lead to a more favourable course in patients with IBS.