认知控制任务下精神分裂症患者健康亲属大脑激活模式的元分析

目的:探究认知控制任务下,精神分裂症患者健康亲属的大脑激活模式。方法:首先对近年来利用认知控制任务探究精神分裂症患者激活模式的文献进行整理;而后对各项研究的激活坐标进行提取和空间转换;最后利用似然估计的方法对提取的坐标进行系统的定量分析。结果:研究发现,与正常对照组相比,精神分裂症患者的健康亲属的左侧脑岛(似然估计值ALE=0.012,峰值坐标:x=-40,y=18,z=0)和左侧扣带回(似然估计值ALE=0.011,峰值坐标:x=-2,y=10,z=38)激活水平显著降低,左侧额上回(似然估计值ALE=0.013,峰值坐标:x=0,y=8,z=50)和左侧中央前回(似然估计值ALE=0.001,峰值坐标:x=-38,y=2,z=36)激活水平显著地增高(P0.05)。结论:与认知控制有关的大脑激活模式可能可以作为精神分裂症研究的一个内观遗传表型。     

How to support cancer genetics counselees in informing at-risk relatives? Lessons from a randomized controlled trial

Objective

In hereditary and familial cancer, counselees are requested to inform their at-risk relatives. We developed an intervention to support counselees in this task.

截瘫患者家属的情绪障碍及阶梯心理认知护理程序的探讨

目的 :调查了解截瘫患者家属情绪障碍的程度 ,采用阶梯心理认知护理 ,减轻其情绪障碍的程度。方法 :将 6 6例截瘫患者家属 (A组 )和 6 6例重症急症患者家属 (B组 )在入院 1周后进行抑郁、焦虑症状自评 ,比较其均分、阳性例数 ,截瘫患者家属按系统抽样分为两组 ,实验组给予阶梯心理认知护理程序 ,对照组实施常规心理护理 ,2周后进行测评比较。结果 :A、B两组抑郁焦虑程度、阳性例数及阶梯心理认知护理程序与常规心理护理有效性均有明显不同 (P <0 0 5 )。结论 :情绪障碍程度截瘫患者家属重于重症急症患者家属 ,情绪障碍阳性例数高于重症急症患者家属 ;实施阶梯心理认知护理程序有效 ,能够减轻情绪障碍的程度     

社会支持模式对重性精神疾病患者家属心理状况的影响

目的调查深圳市福田区在社区康复的重性精神疾病患者家属的心理健康状况,探讨福田区社会支持模式对改善重性精神疾病患者家属心理状况的效果。方法采用症状自评量表(SCL-90)在模式开展前对深圳市福田区174例重性精神疾病患者的家属进行测评;建立给予重性精神疾病患者家属以心理干预和健康教育为主的社会支持模式,为期一年;项目实施一年后再次对深圳市福田区174例重性精神疾病患者的家属进行第二次症状自评量表(SCL-90)测评。结果通过对患者家属给予以心理干预和健康教育为主的社会支持后,患者家属的SCL-90躯体化、抑郁、焦虑因子的评分较干预前有显著性降低(P<0.05)。结论重性精神疾病患者家属心理状况不容乐观,对在社区进行康复的重性精神疾病患者进行社会支持的同时,要重视对家属的社会支持,对家属实施以心理干预和健康教育为主的社会支持非常有必要,可有效改善患者家属的心理状况。     

Satisfaction with communication in ICU patients and relatives: comparisons with medical staffs' expectations and the relationship with psychological distress

Objective

To study intensive care unit (ICU) patients’ and relatives’ satisfaction in regard to communication with medical staff (nurses and physicians), perceived support, environmental strain and their psychological distress. Further, to compare this with expectations of the medical staff.

Methods

Cross-sectional study, 4–6 weeks post-ICU discharge. Respondents to the questionnaire were: 255 (63%) patients, 354 (82%) relatives and 145 (74%) medical staff. Degree of satisfaction and distress were measured on a five-point Likert-scale (0 = low to 4 = high).

Results

The mean score for patient satisfaction with communication was 3.0 (95%CI 2.9–3.1) and for relatives 3.4 (3.3–3.5). This was significantly higher than expected by the staff for patients 2.5 (2.4–2.6) and relatives 2.8 (2.7–2.9), both p < 0.001. Relatives’ degree of psychological distress, 2.5 (2.4–2.6) was significantly higher than for patients’, 1.6 (1.5–1.7), but was significantly lower than expected by the staff, 2.9 (2.8–3.0) and 2.7 (2.6–2.8) respectively, both p < 0.001.

Conclusion

Patients and relatives were more satisfied with the communication than expected by the staff. The staff overestimated the patients’ and relatives’ psychological distress. Relatives report more psychological distress symptoms post-ICU discharge compared to the patients.

Practice implications

Medical staff is aware of psychological distress in ICU patients and relatives and effort to reduce this during ICU stay and afterwards should be implemented.     

98例精神分裂症患者亲属心理状况调查及护理干预

目的:探讨精神分裂症患者亲属在患者住院时的心理状态,采用相应的护理干预,提高亲属的心理应激水平。方法:采用心理卫生自评量表(SCL-90)、焦虑自评量表(SAS)、抑郁自评量表(SDS)和自制调查表,分别在患者入院和出院时,对98例精神分裂症患者亲属进行测评。结果:多数亲属在患者入院时存在明显的焦虑及抑郁情绪,经干预后他们的SAS和SDS评分随之下降。心理护理干预前、后亲属的SCL-90各因子分有显著性差异。结论:患者入院对其亲属产生明显的心理影响,对其亲属的心理问题进行有针对性的干预,可提高亲属的心理应激能力,促进患者早日康复。     

Position statement on visiting in adult critical care units in the UK

To provide nurses with an evidence-based Position Statement on the standards patients and visitors should expect when visiting an adult critical care unit in the 21st century in the UK. The British Association of Critical Care Nurses (BACCN) is a leading organization for critical care nursing in the UK and regularly receives enquiries about best practice regarding visiting policies. Therefore, in keeping with the BACCN's commitment to provide evidence-based guidance for nurses, a Position Statement on visiting practices in adult critical care units was commissioned. This brought together experts from the field of critical care nursing and representatives from patient and relatives' groups to review visiting practices and the literature and produce a Position Statement. An extensive search of the literature was undertaken using the following databases: Blackwell Synergy, CINAHL, Medline, Swetswise, Cochrane Data Base of Systematic Reviews, National Electronic Library for Health, Institute for Healthcare Improvement and Google Scholar. After obtaining selected articles, the references from these articles were then evaluated for their relevance to this Position Statement and were retrieved. The evidence suggests a disparity between what nurses believe is best practice and what patients and visitors actually want. Historically, visitors have been perceived as being responsible for increasing noise, taking up space, taking up nursing time, hindering nursing care and spreading infection. The evidence reviewed for this Position Statement suggests there are many benefits to patients and nurses from visitors. There was no evidence to suggest that visitors pose a direct infection risk to patients. Clear visiting policies based on evidence will negate arbitrary decisions by nurses regarding who can visit and will lessen confusion and dispel myths which can only bring benefits to patients, staff and organizations. To make nurses aware of the physical and psychological benefits of visiting to patients. Visitors bring a positive energy to patients and can act as advocates. They can supply nurses with vital information about patients which will enable the nurse to provide more individualized care. Being cognizant of the evidence will help nurses develop policies on visiting which are up to date for the 21st century.     

Stress abnormalities in individuals at risk for psychosis: A review of studies in subjects with familial risk or with "at risk" mental state

Increased sensitivity to stress is known to play an important role in the transition to first episode psychosis (FEP). Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis, and, in general, an increased sensitivity to stress, have been hypothesised to be components of the vulnerability to psychosis, but whether these abnormalities are already present before the onset of psychosis has not yet been systematically reviewed. Here we have reviewed all studies examining psychological and biological markers of the stress response in the relatives of psychotic patients and in individuals at Ultra High Risk (UHR) for psychosis. In relatives, there is evidence of increased sensitivity to stress, as shown by increased emotional reactivity to daily life stress, increased adrenocorticotropic hormone (ACTH) in response to stress, increased pituitary volume and reduced hippocampal volume. However, evidence of increased cortisol levels is less consistent. On the other hand, subjects who experience attenuated psychotic symptoms show increased cortisol levels as well as increased pituitary and reduced hippocampal volumes. Moreover, this HPA axis hyperactivity seems to be even greater among those individuals who subsequently develop frank psychosis. In summary, an enhanced HPA axis response to stress appears to be part of the biological vulnerability to psychosis which is present prior to the onset of psychosis. A further increase in cortisol levels during the transition to FEP suggests the presence of an additive factor, possibly environmental, at this stage of the illness. Possible causes and consequences of HPA axis impairment in risk for psychosis are discussed.     

不同关系的社区精神分裂症家属的生存质量研究

目的了解不同关系精神分裂症家属的生存质量状况及其影响因素。方法对162位社区精神分裂症家属进行了一般资料及世界卫生组织生存质量测定量表简表(WHOQOL-BREF)的调查,并按照"父母"、"夫妻"、"兄弟姐妹"、"子女"对其进行分组,比较各组间差异。结果在社区精神分裂症家属中以"父母"比例最高,"父母"的生存质量总分、心理领域方面明显低于"子女"照料者,在生理领域方面"父母"得分均显著低于其他组。结论社区精神分裂症家属中"父母"的生存质量较低,尤其在生理领域方面。     

精神分裂症患者亲属间一对一模式干预对减轻情绪障碍的效果观察

目的探讨精神分裂症患者亲属一对一模式对情绪障碍干预的效果。方法将120名精神分裂症患者亲属按居住地分为观察组56名、对照组64名,两组均接受医护人员的疾病相关知识宣教及支持性心理疏导,观察组同时进行一对一模式干预。采用简易应对方式量表、抑郁自评量表、焦虑自评量表,分别在入组时、干预后6月和干预后1年时对两组患者亲属进行测评;自行设计精神分裂症相关知识知晓评价表,对精神分裂症患者亲属在入组时、干预后1年测评。结果两组患者亲属在入组时简易应对方式量表、抑郁自评量表、焦虑自评量表评分比较差异无统计学意义;干预后6月和1年,两组简易应对方式量表、抑郁自评量表、焦虑自评量表评分比较差异有统计学意义,观察组的精神分裂症相关知识认知较对照组高。结论精神分裂症患者亲属间一对一模式干预有利于解除心理问题和促进患者的康复。