护生心理健康状况与临床实习效果的相关研究

[目的]调查分析护生心理健康状况及其对临床实习效果的影响。[方法]采用症状自评量表（SCL-90）、自制临床实习效果问卷对60名护生进行测试，并分析SCL-90各因子与临床实习效果的相关性。[结果]护生心理问题检出率为28．33％，护生心理健康水平低于全国正常成人常模水平，其中恐怖、敌对、焦虑、偏执、躯体化是困扰护生的主要精神症状。相关分析结果显示，SCL-90各项因子与护生临床实习效果呈负相关，其中躯体化、敌对、偏执与护生临床实习效果呈中度负相关，其余因子与临床实习效果呈低度负相关。[结论]护生存在一定程度的心理问题，并影响临床实习效果，应分析原因，寻找对策，提高其心理健康水平。     

心理干预对流动人口肺结核患者强化期治疗负性情绪的影响

目的:探讨心理干预对流动人口肺结核患者强化期治疗负性情绪的影响。方法:将164例初治涂阳流动人口肺结核患者按就诊时间分为干预组和对照组各82例,对照组实施常规护理,干预组在常规护理基础上实施心理干预,心理干预时间为强化期治疗2个月,第2个月完成强化期初治涂阳疗程后,采取症状自评量表(SCL-90)对两组患者进行调查,并比较两组各因子评分。结果:实施心理干预的干预组在SCL-90量表中躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐惧、偏执、精神病性等因子评分低于对照组,有统计学意义(P<0.05),显示心理干预后患者心理健康水平明显提高。结论:心理干预可减轻流动人口肺结核患者强化期治疗的负性情绪,增强了患者的心理适应能力。     

传染性非典型肺炎恢复期患者103例症状自评量表因子特点分析

背景传染性非典型性肺炎(severe acute respiratory syndrome,SARS)作为一种应激源,给人们带来了较大的心理压力.在这场危机中,SARS患者更是处于高度的心理应激状态.心理学、病原学等与SARS的发病的相关关系仍处于研究探索阶段.心理因素在SARS病程中的作用如何呢?目的了解SARS恢复期患者的心理状态,为解决这些患者的心理问题提供依据.设计以患者为研究对象的抽样调查.单位中国中医研究院广安门医院气功康复科.对象2003-04/06北京老年病医院三病区以及其他病区的部分恢复期SARS患者(病情得到控制,趋向好转).干预采用症状自评量表(SCL-90)和特质应对问卷(TCSQ)对恢复期SARS患者进行心理评定.主要观察指标①SARS恢复期患者的心理状态.②不同性别、年龄、文化程度SARS恢复期患者SCL-90评定差异.结果①SARS恢复期患者的躯体化症状明显高于常模(P＜0.05),而强迫、人际关系敏感、敌对和偏执因子都要明显地低于常模(P＜0.05).②女性SARS患者躯体化和焦虑水平明显高于常模,而人际关系敏感和偏执水平较常模低.男性患者除躯体化和精神病性以外其他因子分都显著低于男性常模.男性SARS患者在SCL-90总分、躯体化症状、焦虑和恐怖得分低于女性,差异均有显著性意义.③从各年龄组的因子分来看,老年组(50～60岁)的各因子分都低于其他年龄组,而30～40岁年龄组的患者焦虑和躯体化症状因子明显高于其他年龄组,提示此年龄组的患者在这两方面的问题要多于其他年龄组患者.④文化程度组(大专文化程度及以上)除躯体化症状和焦虑因子外,其他所有因子得分均低于低文化程度组(高中文化程度及以下),差异均有显著性.⑤在日常生活中以消极应对方式为主的SARS患者在SCL-90所有因子上的得分都要明显的高于以积极应对方式为主的SARS患者.结论总体上SARS恢复期患者的心理状态无明显异常,但女性患者的焦虑水平明显升高,而且受教育水平低的患者以及日常以消极应对方式为主的患者心理状态与其他患者有明显差异.     

A coping with Stress Training (SBT) for persons with mental illness--pilot study on a group training programme in support of occupational rehabilitation

OBJECTIVE: This pilot study investigates the effects of a coping with stress training (SBT) programme which had been offered in the Workshop for Disabled People of the Stuttgart Occupational Rehabilitation Center Rudolf-Sophien-Stift to persons with mental illness. The group training is aimed at supporting the participants in coping effectively with stress, avoiding over- or under-stimulation and strengthening positive experiences. METHOD: In a control-group study design, data was collected from 19 participants of the training group and 11 participants of a (waiting) control group. Data collection was carried out before and after the training. RESULTS: In the pre-post comparison the training group shows a reduction of symptoms in general and especially in somatization, obsessive-compulsiveness, anxiety, and paranoid ideation. The participants showed improvements in quality of life in the areas of capability, ability to enjoy and relax, positive and negative mood. In respect of attitudes of competence and control they showed improvements in internal control attitudes. Also, as regards illness coping and prevalent coping styles, active and problem-oriented coping styles were found to have increased to some extent. In the problem solving training, 84.2% of the participants stated in their self-ratings that they had been able to achieve positive changes in a specific problem area. CONCLUSIONS: From a methodological angle it has to be pointed out that the study had examined a very small group. Although a number of open questions remain the results obtained are encouraging and in accordance with the objectives of the training. Further studies need to be carried out with larger samples from different facilities in the fields of medical, vocational and social rehabilitation.     

The clinical characteristics of new daily persistent headache

New daily persistent headache (NDPH) is a subtype of chronic daily headache. The literature on NDPH is scant and its true aetiology is unknown. A retrospective chart review was carried out from a computerized database at the Jefferson Headache Centre from August 1997 to May 2000 to identify patients with NDPH using the Silberstein et al. criteria. Forty women and 16 men were identified. Age of onset ranged from 12 to 78 years. The peak age of onset was the second and third decade in women and the fifth decade in men. Eighty-two per cent of patients were able to pinpoint the exact day their headache started. Onset occurred in relation to an infection or flu-like illness in 30%. A prior headache history was found in 38% of patients. A family history of headache was documented in 29%. The duration of daily headache ranged from 1.5 h to 24 h; 79% were continuous. Nausea occurred in 68% of patients, photophobia in 66%, phonophobia in 61%, and lightheadedness in 55%. Laboratory testing and neuroimaging in all patients was normal except for Epstein-Barr virus antibody titres, which were positive in 71% of seven patients tested, representing past infection. NDPH appears to be a female-predominant disorder, marked by a continuous daily headache with associated migrainous symptoms. Over 80% of patients could state the exact date their headache began. One-third of patients developed NDPH with a flu-like illness.     

Headache Associated With Aseptic Meningitis

A retrospective analysis of all patients admitted with the diagnostic codes of aseptic or viral meningitis was performed at two institutions over 3 years. Forty-one patients with cerebrospinal fluid confirmation of aseptic meningitis (increased protein; increased white count; negative gram stain; and negative fungal, tuberculosis, and bacterial cultures) were analyzed.
All the patients had headache, which was typically severe and bilateral in 39 of the 41 patients. The headache was of abrupt onset or the worst of the patient's life in 24 of the patients. The quality of the headache, when described, was usually throbbing (11 of 14). Nineteen patients had prodromal symptoms, including malaise, myalgia, gastrointestinal symptoms, and urinary tract infections. All had associated symptoms, including nausea (25), vomiting (23), photophobia (18), stiff neck (25), and back pain (11). Thirty patients were febrile. Lumbar puncture was performed for headache and fever unexplained by systemic illness in 30 patients, meningeal signs in 15, headache of abrupt onset or the worst headache ever in 24, neurologic signs or symptoms in 12, and for other reasons in 2. Computerized tomography, when performed, was negative in all cases. Focal neurologic findings were present in 5 patients, a decreased level of consciousness in 6, and papilledema in 1.
A severe headache that worsens, is abrupt in onset, or is the worst of the patient's life could be due to aseptic meningitis, bacterial meningitis, or a subarachnoid hemorrhage. Although not universally present, meningeal signs, fever, and neurologic signs or symptoms should alert one to a possible central nervous system infection.     

The occurrence of recall bias in pediatric headache: a comparison of questionnaire and diary data

OBJECTIVE: To investigate whether children and adolescents can recall prior headache complaints accurately and to study whether age, gender, headache severity, preferred coping strategies, depression, somatization, and trait anxiety are related to recall errors, causing recall bias. METHODS: A retrospective headache questionnaire and a prospective 4-week headache diary were filled out by 181 children aged 9 to 16 years who experienced headache at least weekly. In addition, several other questionnaires were administered, measuring coping strategies, depression, somatization, and trait anxiety. Headache frequency, intensity, and duration, as scored on the questionnaire and the diary, were compared using Wilcoxon tests. Regression analyses were performed to study whether age, gender, headache severity, preferred coping strategies, depression, somatization, and trait anxiety can predict the size of differences between the diary and the questionnaire. RESULTS: Compared with the diary, headache intensity and headache duration were overestimated on the questionnaire. At group level, median headache frequency as measured by the diary and the questionnaire was equal. Regarding headache frequency and headache intensity, age and headache severity were statistically related to errors in recall. For headache frequency, depression was also predictive of the size of recall error. CONCLUSIONS: Recall errors occur when children are asked to report their headaches on a retrospective questionnaire. As compared to a prospective diary, pain complaints are evaluated more negatively on a questionnaire. Other factors such as age, depression, and headache severity influence the way children and adolescents recall their headaches. To minimize bias, the use of a diary when studying recurrent headache complaints in children is recommended.     

Primary headaches in preschool age children: clinical study and follow-up in 163 patients

Although headache frequency is increasing in preschool age children, an extensive evaluation of the clinical features in affected patients has yet to be achieved. This retrospective study examined 243 patients who were separately analysed in two distinct groups according to the age of onset and the age of first clinical evaluation. Group 1 included preschool age children, while Group 2 consisted of pubertal age patients. In all the patients the importance of a positive family history for headache as a risk factor was confirmed. In addition, when compared with Group 2, Group 1 showed greater male gender prevalence and earlier onset of the attacks. Regarding clinical features, in Group 1, compared with Group 2, the attack duration was shorter with lower symptom association such as photo- or phonophobia, nausea and no pain increase during physical activity. In the same group, tension-type headache was the predominant diagnosis, in contrast to the high migraine prevalence of Group 2. This study also showed that the International Headache Society 1988 classification criteria are not fully adequate for juvenile headaches. In fact, the headaches of more than 10% of patients in Group 1 still remained unclassifiable, while those of all the subjects in Group 2 were properly classifiable.     

Memory functions in patients with chronic daily headache

Memory loss is a common complaint in headache sufferers. 71 patients, 50 women and 21 men, affected by chronic daily headache with different diagnoses at onset and at study entry underwent a test battery in order to evaluate both short- and long-term memory according to the different sensorial pathway of data acquirement. Statistical analysis of the results was performed using means of Spearman's correlation coefficients, analysis of variance, chi-square, Fisher's test and Mann-Whitney U test. A percentage of patients, ranging from 2% to 56%, according to the different tests, showed a worse performance than normal subjects. The percentage of the subjects with memory difficulty was higher in women and in patients with migraine-type headache at onset, but was not different between overusers and nonoverusers of analgesics, nor among the different forms of present headache. A complex neurotransmitter disorder might account for impairment of both short- and long-term memory in headache patients.     

临床护士心理健康状况与应对方式的相关性研究

目的　了解临床护士心理健康状况与应对方式的关系 ,为临床护理和人员管理提供依据。方法　采用SCL 90症状自评量表和应对方式问卷调查 ,对我院 89名临床护士进行检测 ,并分析差异与相关性。结果　样本的SCL 90症状自评的阳性项目数、躯体化、焦虑和恐怖具有统计学意义 (P <0 .0 5 ) ;消极应对与SCL 90症状自评因子的躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执和精神病性呈显著正相关 (r =0 .2 3～ 0 .38)。结论　临床护士的心理健康状况较一般人群差 ,心理健康状况与应对方式存在明显的相关性 ,在某种程度上影响着临床护士的心理健康状况