不同年龄原发性开角型青光眼患者手术前后心理特征和生存质量的变化

目的探讨不同年龄原发性开角型青光眼(POAG)患者手术前后心理特征及生存质量变化的差别。方法纳入POAG患者76例,其中青年患者38例、中老年患者38例。所有POAG患者术前采用家庭支持量表、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)及低视力者生活质量量表(LVQOL)进行测试;术后3 d采用HAMA、HAMD进行测试,术后1个月采用HAMA、HAMD、LVQOL进行测试。结果术后1个月,青年组HAMA总分A、HAMD总分B与术后3 d差异无统计学意义(PA=0.585,PB=0.313);而中老年组HAMA总分A、HAMD总分B较术后3 d下降(PA=0.012,PB=0.014)。术后1个月,LVQOL总分较术前升高,差异有统计学意义(P=0.007);青年患者LVQOL总分与术前差异无统计学意义(P=0.238)。多元逐步回归分析显示,术后1个月LVQOL总分的主要影响因素是较好眼视野MD(β=0.410,P=0.002)、健康教育(β=10.134,P<0.01)、术后1个月HAMD总分B(β=-0.795,P<0.01)。结论心理特征及生存质量在青年及中老年POAG患者手术治疗前后发生不同变化,尤其对于青年POAG患者应加强必要的心理支持。     

Psychiatric outcomes amongst adult survivors of childhood burns

Background

Research on the adult psychiatric outcomes of childhood burns is limited.

Aims

To examine the rates of DSM-IV psychiatric disorder amongst adult survivors of paediatric burns, and to explore factors likely to contribute to variation in outcomes. In line with Meyer and colleagues [1], it was expected that high levels of psychopathology would be found.

Method

Participants were 272 adults hospitalised for burns during childhood between the years 1980 and 1990. Structured interviews and self-report questionnaires were used to assess psychiatric symptoms.

Results

Lifetime prevalence of any DSM-IV disorder was 42%, 30% for depressive disorders, and 28% for anxiety disorders. Eleven percent had made a suicide attempt. Female gender, single relationship status, higher level of disfigurement, longer hospital stays and higher number of burn-related surgeries were associated with adverse psychiatric outcomes.

Conclusions

High rates of suicidality and depression were concerning in adults with a history of childhood burns. Factors found to predict psychiatric outcomes could be used to direct interventions and further research is needed to establish how this could best be done.     

白血病患儿与父母的心理状态及护理干预的进展

白血病是儿童死亡的主要原因之一,护理工作在儿童白血病治疗中具有重要作用。其中,白血病患儿心理方面的不良因素也直接影响治疗的效果。该文概述了白血病患儿与父母的心理状态、产生心理问题的相关因素,并从缓解焦虑、恐惧,改善应对方式,寻求社会支持系统等方面综述了护理现状,指出白血病患儿及父母的心理护理趋势。     

Effect of psychological stress on the structure of the temporomandibular joint and the expression of MMP-3 and TIMP-3 in the cartilage in rats

Our aim was to observe the effects of psychological stress on the structure of the temporomandibular joint (TMJ), and to evaluate the expression of matrix metallopeptidase-3 (MMP-3) and tissue inhibitor of metalloproteinase-3 (TIMP-3) in condylar chondrocytes in rats. The rats were divided into 3 groups of 12 according to the duration of psychological stress: 3 weeks or 6 weeks, and 6 weeks of recovery. A fourth group of 12 rats was used as controls. Each rat was evaluated by the open-field test and the weight measured. The results confirmed psychological stress in 24 of the 36 rats (67%). The tissues of the TMJ were stained with haematoxylin and eosin and pathological changes were studied under a light microscope. MMP-3 and TIMP-3 expression was investigated using the SP kit. The experimental groups showed thinning of articular cartilage, shedding of collagen fibres, cracks in the articular discs, and other structural changes that were aggravated with time, from three weeks to six weeks. The 6-week recovery group showed an improvement in these changes, which indicated the initiation of joint repair. The MMP-3 expression rate correlated with the degree of joint lesion, while the TIMP-3 rate showed an opposite trend and was highest in the 6-week recovery group. Our findings clearly indicate that psychological stress may play an important part in the development of TMJ diseases in rats; further studies should be made to extrapolate the results to other models before clinical use.     

青年护理人员面对患者死亡心理应激状况的调查研究

目的 了解青年护理人员面对患者死亡的心理应激状况.方法 应用焦虑自评量表(SAS)、抑郁自评量表(SDS)对8所综合性医院急诊、ICU、临终关怀病房等96名青年护理人员(研究组),94名其他病房的青年护理人员(对照组)进行了调查,并进行对比分析.结果 研究组SAS及SDS评分、抑郁和焦虑的发生率均高于对照组,差异有统计学意义(P＜0.05).结论 经常面对患者死亡的青年护理人员,应激障碍发生率高,心理健康水平较低,值得护理管理者密切关注.     

Psychological response in spinal manipulation (PRISM): a systematic review of psychological outcomes in randomised controlled trials

BACKGROUND: The most important risk factors for back and neck pain are psychosocial. Nevertheless, systematic reviews of spinal manipulation have concentrated on pain and spine related disability, and ignored psychological outcomes. OBJECTIVE: To assess whether spinal manipulation was effective in improving psychological outcome. DESIGN: Systematic review of randomised controlled trials (RCTs). METHODS: RCTs were identified by searching Medline, CINAHL, Embase, CENTRAL, AMED, PsycINFO until November 2005. Trials reporting psychological outcomes including the mental health components of generic outcomes were extracted, and combined where appropriate in meta-analyses. RESULTS: One hundred and twenty nine RCTs of spinal manipulation were identified; 12 had adequately reported psychological outcomes. Six trials with a verbal intervention comparator were combined in a meta-analysis, and found a mean benefit from spinal manipulation equivalent to 0.34 of the population standard deviation (S.D.) [95% confidence interval (CI) 0.23-0.45] at 1-5 months; 0.27 of the S.D. [95% CI 0.14-0.40] at 6-12 months. Eight trials with a physical treatment comparator were combined in a meta-analysis and found a mean benefit of 0.13 of the S.D. [95% CI 0.01-0.24] in favour of manipulation at 1-5 months; 0.11 of the S.D. [95% CI -0.02 to 0.25] at 6-12 months. CONCLUSIONS: There was some evidence that spinal manipulation improved psychological outcomes compared with verbal interventions.     

HPV阳性患者心理焦虑状况调查与分析

目的探讨人乳头瘤病毒(HPV)阳性患者不同心理焦虑状态的程度和特点,为心理评估、治疗及协调医患关系作基础。方法在宫颈病变普查中,通过Zung氏焦虑自评表(SAS)和病人一般资料问卷对其中90例HPV阳性患者进行心理焦虑状态测评。结果不同年龄、职业、文化程度及HPV持续阳性时间不同患者焦虑状况不同;30岁以上妇女、本科及以上学历、公务员患者焦虑状态较重,患病时间越长其焦虑值越大。结论Zung氏焦虑自评表和病人一般资料问卷能够发现不同的HPV阳性患者具有不同心理焦虑状态及其特征,为制定医疗方案和心理干预提供依据。     

老年患者的心理特征及治疗

目的　探讨老年患者的特殊心理状态及治疗措施。方法　观察 1990年 1月 1日至 2 0 0 0年 12月 31日 6 0岁以上住院患者 5 0 0例 ,对有明显心理异常者进行回顾总结。结果　 94%老年患者心理异常 ,心理治疗有效率达 80 % ,并与社会地位、文化水平、经济收入、家庭环境等密切相关。结论　心理因素对老年患者的健康影响较大 ,在药物治疗的同时必须做好切实可行的心理治疗。     

100例肺结核患者心理健康状况调查分析

目的对肺结核患者心理健康状况进行探讨,为完善肺结核综合治疗提供社会心理学依据。方法采用症状自评量表（SCL-90）对100例肺结核患者进行调查。结果肺结核患者SCL-90评定,除强迫和偏执2因子外,其余各因子分和阳性项目数,显著高于国内常模（P〈0.05或0.01）;其中,女性患者评分较男性为高,30-60岁组患者评分高于其他年龄组,评分与病程和文化程度正相关,乡村患者抑郁因子分高于城镇患者,人际敏感因子分却低于后者。结论肺结核患者心理健康水平低下,在进行躯体治疗时应实施针对性心理干预、心理支持和健康教育,以提高患者心理健康水平和生活质量。     

Doctors also suffer when giving bad news to cancer patients

Giving bad news to patients with cancer may generate stress in doctors, who use distancing tactics. The causes of this anxiety come from social conventions and its consequences affect both doctors and their patients. There is no gold standard by which stress may be overcome during the interview but we offer some suggestions that may help.