前瞻性护理干预在急性心力衰竭患者中的应用

目的探讨前瞻性护理干预在急性心力衰竭患者中的应用效果。方法选取2018年4月—2020年5月河南省某医院收治的122例急性心力衰竭患者为研究对象,采用随机数字表法分为观察组与对照组,每组61例。对照组患者采用常规护理,观察组患者采用前瞻性护理,比较2组患者的干预效果、并发症发生情况,干预前后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分及护理满意度。结果观察组患者干预总有效率为95.08%,高于对照组的75.41%,差异有统计学意义(χ²=9.385,P=0.002)。观察组患者并发症发生率为3.28%,低于对照组的18.03%,差异有统计学意义(χ²=6.974,P=0.008)。2组患者干预后SAS及SDS评分均低于干预前,且观察组低于对照组,差异均有统计学意义(P<0.05)。观察组患者护理满意度为98.36%,高于对照组的86.89%,差异有统计学意义(χ²=4.319,P=0.038)。结论前瞻性护理干预用于急性心力衰竭患者,有助于改善患者负性情绪及减少并发症的发生。     

认知重构干预对急性心肌梗死介入手术患者不良情绪及疾病感知的影响

目的探讨认知重构干预对急性心肌梗死(AMI)介入手术患者不良情绪及疾病感知的影响。方法72例AMI介入手术患者随机分为两组各36例,对照组给予常规护理干预,研究组在对照组基础上给予认知重构干预,比较两组的不良情绪、疾病感知以及治疗依从性。结果干预后,研究组的HAMA、HAMD评分均低于对照组,疾病感知各项评分均高于对照组(P<0.05)。研究组的治疗依从性为94.44%,高于对照组的75.00%(P<0.05)。结论认知重构干预对急性心肌梗死介入手术患者的不良情绪及疾病感知均有积极的影响,可提升患者的治疗依从性。     

痛情绪相关神经递质及神经环路研究进展＊

痛情绪是指因疼痛引发的情绪和情感体验，是疾病过程中最常见的一种情绪。痛情绪相关神经机制非常复杂，但主要与单胺类神经递质、神经肽和某些神经环路有关，笔者将结合目前研究现状分别从以上两方面展开，就痛情绪相关单胺类神经递质和神经肽在受体分类、脑区通路、共疾病以及各神经递质之间的联系和痛情绪相关神经环路中各个蛋白的作用机制等方面进行探讨。     

Facial expression recognition in Alzheimer’s disease: A systematic review

Introduction: It is well established that behavioral variant frontotemporal dementia can impair social and emotional function. However, there is no consensus regarding how Alzheimer’s disease can affect facial expression recognition. We aim to systematically review all the literature addressing this issue over the last 10 years.

Method: We conducted a search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search for literature was undertaken on 19 September 2017, using Pubmed, SciELO, BIREME, and Thomson Reuters Web of Science electronic databases. The key terms for the search were: Alzheimer’s disease, dementia, and facial expression recognition.

Results: We screened 173 articles, and 22 of them were selected. The most common methodology involved showing participants photographs of people expressing the six basic emotions—fear, anger, sadness, disgust, surprise, and happiness. Results were ambiguous. Among people with mild Alzheimer’s disease, happiness was easier to recognize than the other five basic emotions, with sadness and anger the most difficult to recognize. In addition, the intensity level of the emotions presented seems to be important, and facial expression recognition is related to specific cognitive capacities, including executive function and visuoperceptual abilities. Impairment in facial expression recognition does not appear to be a consistent neuropsychological finding in Alzheimer’s disease.

Conclusions: The lack of standardized assessment instruments and the heterogeneity of the methods and samples used across studies hamper comparisons. Future researches should investigate facial expression recognition through more ecological and standardized methods.     

Interoception Primes Emotional Processing: Multimodal Evidence from Neurodegeneration

Recent frameworks in cognitive neuroscience and behavioral neurology underscore interoceptive priors as core modulators of negative emotions. However, the field lacks experimental designs manipulating the priming of emotions via interoception and exploring their multimodal signatures in neurodegenerative models. Here, we designed a novel task that involves interoceptive and control-exteroceptive priming conditions followed by post-interoception and post-exteroception facial emotion recognition (FER). We recruited 114 participants, including healthy controls (HCs) as well as patients with behavioral variant frontotemporal dementia (bvFTD), Parkinson''s disease (PD), and Alzheimer''s disease (AD). We measured online EEG modulations of the heart-evoked potential (HEP), and associations with both brain structural and resting-state functional connectivity patterns. Behaviorally, post-interoception negative FER was enhanced in HCs but selectively disrupted in bvFTD and PD, with AD presenting generalized disruptions across emotion types. Only bvFTD presented impaired interoceptive accuracy. Increased HEP modulations during post-interoception negative FER was observed in HCs and AD, but not in bvFTD or PD patients. Across all groups, post-interoception negative FER correlated with the volume of the insula and the ACC. Also, negative FER was associated with functional connectivity along the (a) salience network in the post-interoception condition, and along the (b) executive network in the post-exteroception condition. These patterns were selectively disrupted in bvFTD (a) and PD (b), respectively. Our approach underscores the multidimensional impact of interoception on emotion, while revealing a specific pathophysiological marker of bvFTD. These findings inform a promising theoretical and clinical agenda in the fields of nteroception, emotion, allostasis, and neurodegeneration.SIGNIFICANCE STATEMENT We examined whether and how emotions are primed by interoceptive states combining multimodal measures in healthy controls and neurodegenerative models. In controls, negative emotion recognition and ongoing HEP modulations were increased after interoception. These patterns were selectively disrupted in patients with atrophy across key interoceptive-emotional regions (e.g., the insula and the cingulate in frontotemporal dementia, frontostriatal networks in Parkinson''s disease), whereas persons with Alzheimer''s disease presented generalized emotional processing abnormalities with preserved interoceptive mechanisms. The integration of both domains was associated with the volume and connectivity (salience network) of canonical interoceptive-emotional hubs, critically involving the insula and the anterior cingulate. Our study reveals multimodal markers of interoceptive-emotional priming, laying the groundwork for new agendas in cognitive neuroscience and behavioral neurology.     

情景模拟健康教育在晚期肺癌患者癌痛管理中的应用

目的 探讨情景模拟健康教育在晚期肺癌患者癌痛管理中的应用效果，旨在提高晚期肺癌患者提高癌痛应对和管理能力。方法 采用便利抽样法，选取2019年5月-2020年5月在同济大学附属上海市肺科医院肿瘤科住院的晚期肺癌患者60例为研究对象，按其住院时间先后顺序分为对照组（n=30）和观察组（n=30）。对照组患者给予肺癌常规护理及健康教育，观察组在其基础上给予情景模拟健康教育干预，主要围绕正确认识癌痛、癌痛自我评估、癌痛应对、躯体功能应对和负性心理情绪调试等展开。分别于患者入院第1天及第7天评估患者疼痛管理效能及情绪状况。结果 入院第1天，两组患者慢性疼痛自我效能感量表和中文版简式-简明心境问卷得分组间比较，差异无统计学意义（P＞0.05），入院第7天，组间比较有统计学差异（P＜0.05）。结论 情景模拟健康教育可有效提高晚期肺癌患者疼痛管理自我效能，改善患者负性心理情绪，进而提高其生活质量，值得临床进一步应用和推广。     

Emotional Communication in Advanced Pediatric Cancer Conversations

ContextCancer is a life-changing diagnosis accompanied by significant emotional distress, especially for children with advanced disease. However, the content and processes of discussing emotion in advanced pediatric cancer remain unknown.ObjectivesTo describe the initiation, response, and content of emotional communication in advanced pediatric cancer.MethodsWe audiorecorded 35 outpatient consultations between oncologists and families of children whose cancer recently progressed. We coded conversations based on Verona Coding Definitions of Emotional Sequences.ResultsAbout 91% of conversations contained emotional cues, and 40% contained explicit emotional concerns. Parents and clinicians equally initiated cues (parents: 48%, 183 of 385; clinicians: 49%) and concerns (parents: 51%; clinicians: 49%). Children initiated 3% of cues and no explicit concerns. Emotional content was most commonly related to physical aspects of cancer and/or treatment (28% of cues and/or concerns, present in 80% of conversations) and prognosis (27% of cues and/or concerns, present in 60% of conversations). Clinicians mostly responded to emotional cues and concerns implicitly, without specifically naming the emotion (85%). Back channeling (using minimal prompts or words that encourage further disclosure, e.g., uh-huh) was the most common implicit response that provided space for emotional disclosure (32% of all responses). Information advice was the most common implicit response that reduced space for further emotional disclosure (28%).ConclusionEmotional communication in advanced pediatric cancer appears to be a subtle process where parents offer hints and clinicians respond with non-emotion-laden statements. Also, children were seldom engaged in emotional conversations. Clinicians should aim to create an environment that allows families to express emotional distress if and/or when ready.     

Assessment of a conceptually informed measure of emotion dysregulation: Evidence of construct validity vis a vis impulsivity and internalizing symptoms in adolescents with ADHD

ObjectivesDespite advances in understanding associations among attention‐deficit hyperactivity disorder (ADHD), emotion dysregulation (ED), and related outcomes, there is incongruity between ADHD‐relevant conceptualizations of ED and available measures of ED. To assess the psychometric properties of a parent‐report questionnaire of ED conceptualized as deficits in the ability to modulate the (a) speed/degree of emotion escalation; (b) expression intensity; and (c) speed/degree of de‐escalation.MethodsParticipants were 209 adolescents with ADHD (78% male; 13.5–17.8 years old [M = 15.2 SD = 0.91]). Questionnaire items were selected from parent‐report scales of ED and oppositional defiant disorder and subjected to exploratory factor analysis (EFA) and validity analyses.ResultsThe EFA revealed two factors, with speed/degree of escalation combined with intensity as factor one, and speed/degree of de‐escalation as factor two. Factor one scores were related to ADHD impulsivity symptoms but not to anxiety and depression symptoms and they remained predictors of impulsivity even in the presence of self‐report ED, evincing convergent, discriminant, and incremental validity. Factor two scores were related to anxiety and depression but not impulsivity, evincing convergent and discriminant validity.ConclusionThese results inform our understanding of ADHD‐relevant ED in adolescence and offer avenues for future research in measurement development, as well as for understanding ED and ADHD‐related impairment.