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1.
目的:探讨双心医学模式下社区老年常见心脏疾病与抑郁症状共患情况。方法采用横断面调查法,共调查771名社区老年患者,采用流调研究用抑郁量表(CES-D)调查抑郁症状,追踪老年患者的门诊或住院病历记录调查其心血管疾病:包括心绞痛、冠心病和高血压。结果心血管疾病(不包括高血压)总患病率为22.7%,其中冠心病为20.5%,心绞痛为10.9%;高血压患病率为49.3%。抑郁症状在所有心血管疾病患者中的发生率是20.9%。伴心血管疾病老年人的抑郁症状发生率(33.1%)高于无心血管疾病者(18.3%),差异有统计学意义(χ^2=17.59,P〈0.001);有冠心病者的抑郁症状发生率(34.8%)高于无冠心病者(18.3%),差异有统计学意义(χ^2=20.25,P〈0.001);有心绞痛疾病患者的抑郁症状发生率(34.5%)高于无心绞痛疾病者(20.1%),差异有统计学意义(χ^2=9.19,P=0.002);有高血压患者的抑郁症状发生率(25.0%)高于无高血压者(18.4%),差异有统计学意义(χ^2=4.93,P=0.026)。结论社区老年人心血管疾病的罹患率高,在心血管疾病患者中抑郁症状的检出率比无心血管疾病患者高。需加强双心医学模式下对伴心血管疾患老年人的心理干预。  相似文献   

2.
目的:调查流浪精神病患者合并躯体疾病的情况。方法:回顾性分析1 043例住院流浪精神病患者的临床资料。结果:入组的患者中69%流浪精神病患者伴有躯体疾病,以皮肤软组织损伤(38%)、传染病(25%)和营养不良(15%)为最多。男性患者皮肤软组织损伤、骨折、感染性疾病伴有率明显多于女性(χ2=51.92,P0.001;χ2=5.82,P=0.016;χ2=8.15,P=0.004);女性患者梅毒感染率明显高于男性(χ2=13.42,P0.001)。结论:流浪精神病患者普遍伴有躯体疾病,女性患者性病伴发率高,男性患者躯体损伤、感染性疾病伴发率高。  相似文献   

3.
目的探讨早年创伤经历与双相障碍的相关性及其对患者应对方式的影响。方法采用病例对照设计,共纳入221例双相障碍患者和154名正常对照。用早年创伤问卷简表评估早年创伤情况,特质应对方式问卷评估应对方式,运用非参数检验、Spearman相关分析和Logistic回归分析早年创伤与双相障碍及其应对方式的相关性。结果双相障碍患者的普通创伤(χ^2=7.161,P=0.007)、情感虐待(χ^222.079,P〈0.001)和性创伤(χ^24.603,P=0.032)3个早年创伤分量表分和总分(χ^24.067,P=0.044)均高于对照组;躯体创伤和性创伤存在性别差异(χ^23.946,P=0.047;χ^216.092,P〈0.001);双相障碍患者的消极应对方式分值显著高于对照组(Z=-6.890,P〈0.001);情感虐待与双相障碍的发生及患者采用的应对方式相关(β=1.490,P〈0.001;β=0.739,P=0.035)。结论双相障碍患者有较多的早年创伤,多采用消极的应对方式,情感虐待可影响双相障碍的发生以及患者采用的应对方式。  相似文献   

4.
目的 比较河北省保定市不同工作年限社区医务人员心理健康和精神疾病预防知识的 知晓率及对精神疾病的态度。方法 以2016 年3 月10 日至4 月10 日保定市25 个县区进行集中培训的 社区医务人员2 541 人为调查样本,实际完成问卷调查2 433 份。采用卫生部办公厅精神卫生工作指标 调查评估方案制定的《普通人群心理健康知识和精神疾病预防知识知晓率调查问卷》《病例测验》及 《精神疾病有关态度问卷》调查,以工作年限20 年为界,分为< 20 年组1 246 人及≥ 20 年组1 187 人, 并进行对比分析。结果 < 20 年组与≥ 20 年组对精神卫生与心理保健知识知晓率的比较(98.1% 比 94.8%)差异有统计学意义(χ2=19.38,P < 0.001)。病例测验中阳性症状为主精神分裂症知晓率在< 20 年组与≥ 20 年组比较(52.9% 比43.1%)差异有统计学意义(χ2=23.17,P < 0.001)。< 20 年组及≥ 20 年组对精神疾病有关态度问卷总分比较[(34.90±6.42)分比(35.59±6.64)分]差异有统计学意义 (t=2.60,P=0.009)。结论 保定市不同工作年限社区医务人员对精神卫生知识知晓率不同,应加强对高 工作年限医务人员精神卫生培训力度,提高对低工作年限医务人员精神疾病态度的教育。  相似文献   

5.
阿立哌唑与氯氮平治疗精神分裂症Meta分析   总被引:1,自引:0,他引:1  
目的:了解阿立哌唑与氯氮平治疗精神分裂症的疗效和不良反应差异。方法:应用Meta分析对17项研究阿立哌唑与氯氮平治疗精神分裂症对照研究的文章进行再分析,重新评价其疗效和不良反应。结果:阿立哌唑组治疗前后的自身对照,合并效应量d=3.62,95%CI(0.607,6.63),综合显著性检验χ^2=8.52,P〈0.01,提示阿立哌唑治疗精神分裂症前后症状学变化差异有显著性,效应极强;阿立哌唑组与氯氮平组之间组间比较,d=0.043,95%CI(0.013,0.153),综合显著性检验χ2=4.65,P〈0.05,提示这两种药物的疗效差异有统计学意义,差异效应很弱;阿立哌唑组的失眠,头痛不良反应显著较比氯氮平组多,(χ^2=27.95,P〈0.001;χ^2=15.54,P〈0.001),氯氮平组的流涎、白细胞减少、嗜睡、体质量增加、便秘、心动过速、头晕等不良反应均显著较比阿立哌唑组为多(χ^2=39.11~360.60,P均〈0.001)。结论:阿立哌唑在平均8周左右的疗效显著优于氯氮平,不良反应却有显著不同。  相似文献   

6.
脑卒中后吞咽障碍与医院获得性肺炎的相关性   总被引:2,自引:0,他引:2  
目的探讨脑卒中后吞咽障碍与院内获得性肺炎(nosocomi alacquired pneumonia)的相关性。方法采用回顾性调查的方法,对380例脑卒中住院患者进行床边误吸试验,由此分为吞咽障碍组(A组)与无吞咽障碍组(B组),观察2组医院获得性肺炎发生与死亡情况。结果A组医院获得性肺炎发生率达26.53%,B组医院获得性肺炎发生率10.33%,2组差异有统计学意义(χ^2=16.405,P〈0.005),A组病死率11.73%,B组病死率2.72%,差异有统计学意义(χ^2=11.311,P〈0.005)。结论脑卒中后吞咽障碍与医院获得性肺炎的发生呈正相关,显著影响预后,应予以高度重视,尽量做到早诊断,早预防、早治疗。  相似文献   

7.
目的研究奥氮平与氯氮平对脑电地形图(BEAM)的影响。方法对服用奥氮平与氯氮平的各30例精神分裂症患者,分别于治疗前及治疗后2、4、8周进行脑电地形图检查,采用简明精神病评定量表(BPRS)评定疗效。结果奥氮平组BEAM的表现为轻,中度异常,异常率为36.7%(11/30);氯氮平组BEAM的表现为轻、中、重度异常,异常率83.3%(25/30),2组患者的BEAM异常率有统计学差异(χ^2=13.611,P〈0.001)。BPRS减分率》50%的患者中,奥氮平组有6例出现BEAM异常,氯氮平组为16例,有统计学差异(χ^2=8.925,P〈0.01)。结论奥氮平与氯氮平治疗8周,均引起患者脑电地形图异常,奥氮平治疗组脑电地形图的异常率低于氯氮平治疗组。  相似文献   

8.
目的研究伴白质病变(white matter lesions,WML)的抑郁患者的临床特征。方法对69例在上海交通大学医学院附属仁济医院神经内科门诊就诊的抑郁患者,根据白质病变情况分为无WML组、轻度WML组及中~重度WML3组比较其基本特征和汉密尔顿抑郁量表评分。结果与无WML者相比,伴随有中~重度WML的抑郁症患者年龄较高(t=-4.1,P=0.021)、婚姻状况差(χ^2=10.55,P=0.005)、受教育程度低(χ^2=15.23,P=0.002)、经济水平差(χ^2=10.74,P=0.013)。与无WML组、轻度WML组患者相比,中~重度WML组抑郁患者在焦虑/躯体化(躯体性焦虑、精神性焦虑、疑病)、认识障碍(有罪感)、阻滞(抑郁情绪、阻滞)方面的评分有统计学差异(均P〈0.05)。结论伴中~重度WML的抑郁患者的临床特征不同于无或轻度WML的患者。  相似文献   

9.
上海市199例网络成瘾中学生心理问题研究   总被引:2,自引:0,他引:2  
目的了解上海初中、高中和职校的网络成瘾学生的心理健康问题特征。方法首先采用问卷筛选和老师、家长推荐相结合的方法,得到网络成瘾者可疑样本,然后采取临床访谈形式,以Beard改编的Young诊断标准结合功能受损程度,诊断出网络成瘾中学生199例,最后使用精神发育和健康状况评定量表(DAWBA),得到网络成瘾学生心理问题情况。结果 199例网络成瘾中学生中65例(33.7%)存在心理问题,其中男生32.5%存在心理问题,女生为33.3%,差异无统计学意义(χ^2=0.01,P=0.92);网络成瘾初中生共存心理健康问题者多于高中和职校生(χ^2=17.22,P〈0.01);网络成瘾中学生中注意缺陷多动障碍(ADHD)检出率为20.6%,其中,男生ADHD检出率高于女生(分别为23.8%,7.7%;χ^2=4.94,P=0.03);而特殊恐惧、强迫、广泛性焦虑的检出率女生高于男生。结论网络成瘾中学生存在明显的共存心理健康问题现象,其中,男性网络成瘾者最常见的是ADHD,而女性网络成瘾中学生常见的是焦虑性障碍。  相似文献   

10.
目的主要探讨的是神经肌电图在Ⅱ型糖尿病患者周围神经病变的早期诊断中的价值。方法分析2011年7月至2014年1月在我院治疗的Ⅱ型糖尿病患者的临床资料。入组的Ⅱ型糖尿病患者根据患者的病程进行分组,包括A组(病程〉10年)、B组(病程1-10年)和C组(病程〈1年)。比较三组患者的临床资料,正中、尺神经、腓总神经的MCV(运动传导速度),SCV(感觉传导速度)以及胫神经H反射和尺神经f波的情况。结果本研究共纳入研究对象180例,其中A组57例,B组65例,C组58例。三组患者的正中神经(χ2=9.104,P=0.011)、尺神经(χ2=9.335,P=0.009)、腓总神经(χ2=9.898,P=0.007)的MCV异常比例均存在着显著的差异,且病程越长,异常率越高;三组患者的正中神经(χ2=13.44,P=0.001)、尺神经(χ2=13.56,P=0.001)、腓总神经(χ2=24.09,P=0.000)的SCV异常比例均存在着显著的差异,病程越长,异常率越高;三组患者胫神经H反射异常比例存在显著的差异(χ2=19.12,P=0.000),且病程越长,异常率越高。而尺神经F波异常比例并无统计学差异(χ2=3.152,P=0.207)。结论Ⅱ型糖尿病患者的病程越长,相应的尺神经、正中神经、腓总神经的MCV、SCV中的异常比例,以及胫神经的H反射异常检出率越高。结合尺神经F波可早期客观检测到糖尿病周围神经病神经近端损害,提高早期诊断。  相似文献   

11.
A transverse survey conducted in 142 young homeless (age: 18-30) shows that they mainly come from broken families where alcoholism, violence and mental illness hold an important place. Regarding work, the majority of the surveyed homeless have not worked more than 24 months in all their life and have nearly continuously been on welfare; those who had jobs lost them much more because of their alcohol or drug use and their problems of interpersonal relationships than because of unemployment. On a personal level, these young adults are particularly battling against two major problems: alcoholism and drug addiction, and mental illness. Although 23% of the surveyed subjects have already been hospitalized in psychiatry, the majority of these young homeless have never received any psychiatric care. Nevertheless, they show mental health problems which are often mistakenly dismissed as the effects of alcoholism or chronic drug abuse. The authors believe that means of detection and adequate treatment must be developed for this growing population instead of thinking of social measures which would only give the young homeless a meal and protection from the elements.  相似文献   

12.
Characteristics of persons who are homeless for the first time   总被引:4,自引:0,他引:4  
The Pathways Into Homelessness project in Toronto interviewed 300 unaccompanied adult users of homeless shelters to identify characteristics of individuals who are homeless for the first time. The sample reflected the total population of homeless shelter users in terms of age, sex, level of use, and type of shelter. Two fifths of the sample were homeless for the first time. There were more similarities than differences between those who were homeless for the first time and those who had been homeless previously. The prevalence of psychiatric and substance use disorders and the rate of previous hospitalization did not differ between first-time homeless persons and those who had been homeless before. The two groups were distinguished by some childhood experiences related to housing. Both groups had multiple indicators of serious problems, suggesting that the need for intervention is as pressing for persons who are homeless for the first time as it is for the larger population of homeless persons.  相似文献   

13.
This paper presents a case study from an emergency psychiatric outreach team that serves homeless and mentally ill persons in New York City. Mr. V was homeless and believed that he was possessed by evil spirits who were causing his physical and mental problems. He was hospitalized involuntarily twice for medical reasons, but he refused to cooperate in his treatment and returned to the streets after his first hospitalization. After one visit by a spiritual healer during his second hospitalization, Mr. V began to participate in his treatment. He was discharged to a nursing home, and after three years he had not returned to the streets.  相似文献   

14.
This study addresses the relationship of homeless veterans' discharge status from a domiciliary care program to biopsychosocial characteristics presented at admission into the program. Hypotheses were that younger age, less education, and substance abuse or psychiatric disorder would predict an irregular discharge. Research participants were 367 homeless male veterans who had been admitted to a domiciliary care program at the West Los Angeles Veterans Affairs Medical Center for treatment of medical, psychiatric, or substance disorders. Status of veterans' program discharge (regular or irregular) served as the outcome measure. Logistic regression analysis revealed that irregular discharge from the program was more likely among veterans who were black, who had poor employment histories, or who had problems with alcohol. Results are discussed in light of the need to maintain homeless veterans in treatment programs so that they can achieve maximum benefit from available programs.  相似文献   

15.
Many organizations that provide services to individuals with behavioral health disorders are required to include people with psychiatric disabilities on their boards and action groups, yet this requirement rarely results in successful, ongoing representation. We report on a pilot project that trained people who were homeless and formerly homeless, most of whom were diagnosed with behavioral health disorders, for internships on boards and action groups that provide services to people who are homeless. We relate the project's goals to the theme of empowerment, present our findings, discuss key implementation issues, and offer recommendation for future program efforts and research.  相似文献   

16.
OBJECTIVE: This study examined the effectiveness of the Pathways to Housing supported housing program over a five-year period. Unlike most housing programs that offer services in a linear, step-by-step continuum, the Pathways program in New York City provides immediate access to independent scatter-site apartments for individuals with psychiatric disabilities who are homeless and living on the street. Support services are provided by a team that uses a modified assertive community treatment model. METHODS: Housing tenure for the Pathways sample of 242 individuals housed between January 1993 and September 1997 was compared with tenure for a citywide sample of 1, 600 persons who were housed through a linear residential treatment approach during the same period. Survival analyses examined housing tenure and controlled for differences in client characteristics before program entry. RESULTS: After five years, 88 percent of the program's tenants remained housed, whereas only 47 percent of the residents in the city's residential treatment system remained housed. When the analysis controlled for the effects of client characteristics, it showed that the supported housing program achieved better housing tenure than did the comparison group. CONCLUSIONS: The Pathways supported housing program provides a model for effectively housing individuals who are homeless and living on the streets. The program's housing retention rate over a five-year period challenges many widely held clinical assumptions about the relationship between the symptoms and the functional ability of an individual. Clients with severe psychiatric disabilities and addictions are capable of obtaining and maintaining independent housing when provided with the opportunity and necessary supports.  相似文献   

17.
OBJECTIVE: Homeless persons with serious mental illness are especially likely to lack access to comprehensive medical and psychiatric care. This study examined the relative importance of predisposing factors, illness factors, and enabling factors as determinants of the use of Veterans Affairs (VA) health care services by mentally ill homeless veterans seeking services from a non-VA program. Predisposing factors included demographic characteristics and wartime service; illness factors were related to the type of medical problem and the need to seek medical care; and enabling factors included entitlement to VA medical services and location of VA facilities. METHODS: Logistic regression analysis was used to analyze data for 698 homeless veterans with mental illness who were enrolled in the Access to Community Care and Effective Services and Supports (ACCESS) program. RESULTS: About 56 percent of the mentally ill homeless veterans had used VA services at some time in their lives. Homeless veterans were almost twice as likely as other poor veterans to use VA services; those with a dual diagnosis were also more likely to use VA services. Enabling factors were more important than either predisposing or illness factors in predicting VA service use. Veterans most likely to use VA services were those who received VA benefits that gave them priority access to VA services and those who lived near a VA medical center. CONCLUSIONS: Specific characteristics of the service system and of veterans' entitlement were more important than clinical needs or predisposing factors in predicting service use.  相似文献   

18.
OBJECTIVES: Epidemiological research suggests that homelessness is a risk factor for elevated levels of psychiatric comorbidity and other health risks. This study examined the prevalence of disordered gambling and its association with treatment of psychiatric and substance use disorders among a cohort of homeless people seeking treatment at a community services program. METHODS: Between 1998 and 2000, intake workers evaluated the level of gambling disorder among 171 consecutive homeless persons with substance use disorders who sought treatment at the Moving Ahead Program in Boston. Program staff administered the DSM-IV subscale of the Massachusetts Gambling Screen at intake. RESULTS: The prevalence rates of level 2 and level 3 gambling disorders were 12.8 percent and 5.5 percent, respectively. These rates are higher than that of the general adult population but comparable to those of other patients with substance use disorders and psychiatric diagnoses. Program participants with level 3 gambling disorders had been homeless more often and at a younger age and had had less substance abuse treatment and more psychiatric treatment than participants with level 1 or level 2 gambling disorders. Participants with level 2 gambling disorders had been homeless more often and for a longer duration than participants without gambling disorders. CONCLUSIONS: These findings should encourage clinicians working with homeless people to screen for gambling-related problems and disorders.  相似文献   

19.
Demographic and clinical data are presented on 4,138 veterans assessed in the 20-site Department of Veterans Affairs (VA) Domiciliary Care for Homeless Veterans program during its first year of operation. More than two-thirds of the veterans who were screened had been hospitalized in VA medical centers during the year before assessment, and 34 percent were hospitalized at the time of assessment. Compared with veterans who were not admitted for residential treatment, veterans who were admitted were more likely to be previously involved in mental health treatment, literally homeless rather than at risk for homelessness, and without public financial support. Specialized service programs for the homeless such as the VA domiciliary care program may also be called on to play a broader role in the discharge and rehabilitative efforts of public mental health service systems.  相似文献   

20.
This was a study of crime among 188 homeless persons who were in a Veterans' Affairs Medical Center program for substance abusers. The purpose of the study was to find out: (a) what proportion committed crimes, and (b) what other problems, relational factors, and personal attributes predict crime. Data indicate 27% of these homeless veterans committed nuisance offenses, and 41% have committed crimes in the past year. Logistic regression procedures indicated that alcohol and other drug abuse, less education, lack of employment, psychiatric problems, and living with a substance abuser increased the odds of committing crimes. This study also finds that physical and sexual abuse before 18 years of age increases the odds of committing crimes, whereas self-efficacy, ego integrity, and resilience decrease these odds. These latter factors have received scant attention in the literature on homeless substance abusers, and yet they are among the strongest predictors of crime. Implications for psychiatric rehabilitation are discussed.  相似文献   

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