心理干预对轻生者应对方式的影响

目的探讨心理干预对轻生者应对方式的影响。方法将60例有轻生企图的患者分为干预组和对照组各30例。入院后2组行常规的治疗和护理,干预组另给予心理干预。采用应对方式问卷(CSQ)进行问卷调查,比较2组应对因子评分。结果干预后,干预组在解决问题、求助因子评分明显提高,自责、退避因子评分明显降低,差异均有统计学意义(P<0.05)。干预后干预组解决问题、求助因子评分高于对照组,自责、退避因子评分低于对照组,差异均有统计学意义(P<0.05)。结论心理干预对轻生患者应对方式有积极的影响,值得临床推广应用。     

自尊水平及应对方式对大学新生的影响

初步探讨自尊水平及应对方式对大学新生的影响.采用应对方式问卷、自尊量表对药学院2008级318名药学类大学新生进行问卷调查,并开展个别访谈以及群体座谈.大学新生的自尊水平总体较高;大学新生在应对方式上都以解决问题为主,其次采取幻想和退避的方式,最少采用自责的应对方式;不同自尊组别的大学新生在各应对因子上存在着显著差异;自尊与解决问题、求助、合理化呈显著正相关,与自责、幻想、退避呈显著负相关.     

肿瘤科护士工作压力应对方式与心理健康状况调查

目的 探讨肿瘤科护士的工作压力、应对方式、心理健康状况及其相互之间的关系.方法 采用便利抽样法,对某三甲医院肿瘤科156名护士应用一般人口学问卷、护士工作压力源表、应对方式问卷和症状自评量表进行调查.结果 ①肿瘤科护士工作压力量表总均分为(2.53±0.41)分,处于中等水平;肿瘤内科护士压力高于肿瘤外科护士,差异有统计学意义.肿瘤科护士采用最多的应对方式是解决问题,其次为求助、退避、自责、合理化、幻想;肿瘤科护士SCL-90总分及各因子分高于国内常模,差异有统计学意义;②肿瘤科护士心理健康状况与感受到的压力呈正相关;采用解决问题应对方式与SCL-90各因子(除外恐怖症状)呈负相关;采用自责、退避、幻想、合理化应对方式与SCL-90各因子呈正相关;③自责、退避、工作压力量表总均分为影响SCL-90总分的3个主要因素.结论 肿瘤科护士心理健康水平较普通人群低,工作压力的大小以及采用自责、退避应对方式对心理健康影响较大,且对心理健康状况有一定的预测作用.     

60例失眠症患者的发病因素分析

目的探讨失眠症患者的发病因素及治疗方法。方法采用应付方式问卷（CSQ）、症状自评量表（SCL-90）和社会支持量表（SSS）对失眠症患者和正常对照者各60例进行测评。结果失眠症组自责、求助、退避分量表的得分显著高于对照组（P〈0.05）失眠症组SCL-90总分及躯体化、抑郁、焦虑、睡眠障碍各因子分与对照组比较差异有统计学意义（P〈0.05）。失眠症组的社会支持总分、客观支持和对社会支持的利用度评分显著低于正常对照组（P〈0.05）。结论失眠症患者多采用不成熟的应对方式,且有较多的心身症状,并且缺乏社会支持。     

中学生应对方式心理控制源自我效能感研究

目的 研究中学生应对方式和心理控制源、一般自我效能感的关系.方法 使用应付方式问卷、内在-外在心理控制源量表和一般自我效能感量表,对某市初一至高二五个年级共计631名中学生进行问卷调查.结果 ①中学生采用的应对方式依次是求助、解决问题、退避、幻想、合理化、自责:女生比男生更多使用求助的方式,男比女更多使用合理化方式,应对方式在年级变量上无差异.②中学生的应对方式与心理控制源、一般自我效能感有相关性.结论 中学生的应对方式在不同程度上受心理控制源、一般自我效能感的影响.     

门诊心理疏导对改善老年抑郁症的临床观察

目的探讨积极有效的改善老年抑郁症患者不良状态的应对措施,降低和防范老年人抑郁症的发生。方法回顾性分析我院门诊自2008年6月至2011年6月期间收治的152例老年患者,按照统计学原则随机分为干预组(76例)和对照组(76例),给予对照组研究对象常规门诊治疗,给予干预组研究对象躯体治疗同时给予心理疏导干预。分别在6个月和12个月时参考相关文献结合我院及患者实际情况制定调查问卷对所有研究对象进行抑郁情绪调查,同时对两组研究进行心理健康测评,然后对比两组研究对象干预后的效果。结果①两组测评结果比较。对照组与干预组接受治疗前的评分较高,但两组得分比较差异无显著统计学意义(P>0.05)。干预后6个月和12个月两个时间点两组评分均有明显下降,干预组下降分数较对照组明显,组间差异具有显著统计学意义(P<0.05)。②两组应对方式问卷测量结果显示,两组入院时主要表现为退避,幻想,自责等负面情绪居多,两组分数比较差异无显著统计学意义(P>0.05)。经过干预12个月时干预组可通过解决问题,求助等积极应对方式的人次增多,而退避,幻想,自责等负面情绪次数减少,同对照组比较,差异具有统计学意义(P<0.05)。结论对老年抑郁症患者实施心理护理,能够有效改善其生活状态,增强其生活自信心,提高其生活质量。     

某部特种兵心理健康与个性、应对、状态-特质焦虑的相关性分析

目的探讨特种兵心理健康与状态-特质焦虑、个性、应对的相关性,为特种兵心理健康教育和心理素质训练提供科学依据。方法随机整群抽取460名某部特种兵,应用一般情况问卷、状态-特质焦虑问卷(STAI)、应对方式问卷、艾森克个性问卷(EPQ)、症状自评量表(SCL-90)实施团体测试。结果特种兵SCL-90总分与中国军人常模无显著性差异,躯体化、强迫、焦虑、敌对、恐怖因子分显著高于中国军人常模(P<0.01或P<0.05);EPQ中EPQ-P、EPQ-N因子分显著低于国内军人常模,EPQ-L因子分显著高于常模(P<0.01);应对方式中解决问题、求助因子分显著高于军人常模(P<0.01),自责、幻想、退避、合理化因子分显著低于军人常模(P<0.01);状态焦虑、特质焦虑分均显著高于国内常模。相关分析显示,SCL-90总均分与EPQ因子分中EPQ-P、EPQ-N及应对方式中不成熟应对方式(自责、幻想、退避)和混合型应对方式(合理化)呈显著正相关(P<0.01);与EPQ因子分中EPQ-E、EPQ-L呈显著负相关(P<0.01)。回归分析显示,对特种兵SCL-90总分有显著性影响的因素由大到小依次为状态焦虑、EPQ-N、合理化、特质焦虑。4个变量的决定系数R2=0.746,对方程检验,F=51.52,P=0.00。结论特种兵总体心理健康状况与国内一般军人相当,心理健康受到个性、应对方式、状态-特质焦虑等中介变量的综合影响,其中保持适度可控的焦虑情绪是维持心理健康的重要因素。     

乳腺癌患者术后应对方式与生存质量的相关研究

目的探讨乳腺癌患者术后应对方式对其生活质量的影响。方法采用世界卫生组织生存质量测定量表简表、应对方式问卷对186例乳腺癌患者进行问卷调查。结果反映患者生存质量的生理和心理、社会因子得分低于常模,生存质量总分与CSQ的解决问题、求助类型分呈正相关,CSQ的自责分呈负相关,生存质量总分CSQ的解决问题、求助类型分呈正相关(r值分别为0.42、0.49、0.38,P<0.05),生存质量与CSQ的自责分呈负相关。结论为乳腺癌患者制定护理计划和健康咨询时,要充分评估患者采用的方式对其情绪和生存质量的影响,通过有效的护理干预进行正性引导,促进患者疾病的康复和提高患者的生存质量。     

地震灾害对应急救援军队医护人员心理健康状况影响的调查研究

目的 探讨地震灾害对应急救援军队医护人员心理健康状况的影响.方法 随机选取解放军255医院参加汶川地震抗震救灾应急救援医护人员为研究对象,共发放问卷120份,回收有效问卷60份,采用症状自评量表(SCL-90)测试心理健康水平,用应对方式量表测评应对行为类型,并对其心理健康状况与应对方式的相关性进行分析.结果 应急救援军队医护人员SCL-90各因子中躯体化、焦虑评分显著高于中国常模,强迫、敌对、偏执、抑郁和精神病性评分均显著低于中国常模,差异均有统计学意义(P＜0.05,P＜0.01);应对方式的使用程度依次是解决问题、求助、躲避、幻想、合理化和自责;SCL-90各因子与解决问题方式呈显著负相关,除躯体化、恐怖外,SCL-90各因子与求助呈显著负相关,与幻想、自责呈显著正相关(P＜0.05,P＜0.01).结论 应急救援医护人员在应急救援过程中受到了不同程度的心理伤害,采取成熟的应对方式可有效缓解压力,维护心理健康.     

偏头痛患者个性特征、应对方式及其与头痛发作相关性的研究

目的:探讨偏头痛患者个性特征、应对方式及其与头痛发作的相关性.方法:选择113例偏头痛作为观察组,另设76例健康人作为对照组,采用艾森克个性同卷、应对方式同卷、偏头痛诊断疗效评定标准进行测评.结果:观察组神经质、自责、退避等因子分显著高于对照组,内倾向和求助因子分显著低于对照组(P<0.01);自责、退避等与神经质呈显著正相关,解决问题、求助与精神质呈显著负相关(P<0.01);内向不稳定患者头痛程度、发作频率显著高于外向稳定患者(P<0.01).结论:多数偏头痛患者个性特征和应对方式存在一定的缺陷,头痛发作与个性缺陷和不成熟的应对方式密切相关.     

右旋与消旋佐匹克隆治疗睡眠障碍的随机双盲双模拟临床试验

目的以消旋佐匹克隆为阳性对照药评价右旋佐匹克隆治疗睡眠障碍的疗效及安全性。方法用双盲双模拟随机对照临床试验方法，每晚睡前，分别口服（试验与对照药）右旋和消旋佐匹克隆口服3，7．5mg，疗程为14天。结果右旋佐匹克隆（试验组）为68例，痊愈率为20．59％；消旋佐匹克隆（对照组）为57例，痊愈率为14．04％。药物不良反应发生率分别为36．76％，49．12％。2组临床疗效及药物不良反应发生率比较具有统计学差异。结论右旋佐匹克隆治疗睡眠障碍，安全、有效。     

扎来普隆与唑吡坦治疗失眠症的多中心随机双盲对照比较

目的 :评价国产Ⅱ类新药扎来普隆治疗失眠症的有效性和安全性。方法 :采用多中心随机双盲双模拟、阳性药平行对照研究。唑吡坦组 12 0例 ,扎来普隆组 118例分别口服扎来普隆片 10mg·d- 1或唑吡坦片 10mg·d- 1。 14d为一个疗程。结果 :意向性 (ITT)分析样本病人有 2 38例。疗效评价的睡眠障碍量表 (SDRS)评分在治疗结束时较基线显著减少 (F检验 ,P <0 .0 1)。唑吡坦组的有效率77.5 % ,扎来普隆组的有效率 73.7% ,差异无显著意义 (P >0 .0 5 )。不良反应分析显示 2组较常见的不良反应为思睡、口干、便秘、头晕和头痛。结论 :国产扎来普隆与唑吡坦具有类似的疗效 ,不良反应相当。为治疗睡眠障碍的安全而有效的新药。     

小剂量喹硫平对比唑吡坦治疗老年失眠症的临床观察

目的:比较小剂量喹硫平和唑吡坦治疗老年失眠症的疗效和安全性。方法:将68例老年失眠症患者随机均分为试验组与对照组。试验组患者每晚口服喹硫平片25 mg,并根据疗效和耐受性调整剂量,最大剂量不超过100 mg;对照组患者每晚睡前口服唑吡坦片10 mg。两组患者均治疗4周。采用匹兹堡睡眠质量指数量表(PSQI)评分评价患者的睡眠状况,并据此评价疗效,采用多导睡眠图(PSG)观察试验组患者的睡眠参数;比较两组患者的总有效率和不良反应发生情况。结果:治疗后,两组患者的PSQI量表评分的总分、睡眠质量、睡眠时间、睡眠效率评分与同组治疗前比较,差异均有统计学意义(P<0.05),而两组间各项PSQI评分比较,差异无统计学意义(P>0.05);试验组与对照组患者的总有效率分别为73.5%和85.3%,两组比较差异无统计学意义(P>0.05);接受PSG监测的27例试验组患者的总睡眠时间、觉醒时间、觉醒次数、睡眠效率与治疗前比较,差异有统计学意义(P<0.05或P<0.01)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:小剂量喹硫平治疗老年失眠症的疗效与安全性与相关指南推荐的唑吡坦相当。     

Efficacy and safety of eszopiclone across 6-weeks of treatment for primary insomnia

OBJECTIVE: Eszopiclone is a new, single-isomer, non-benzodiazepine, cyclopyrrolone agent under investigation for the treatment of insomnia. The present study was a randomized, double-blind, multicenter, placebo-controlled trial conducted to assess the efficacy and safety of eszopiclone in adults with chronic primary insomnia. RESEARCH DESIGN AND METHODS: Patients (n = 308) were randomized to receive placebo or eszopiclone (2 mg or 3 mg) for 44 consecutive nights, followed by 2 nights of single-blind placebo. Efficacy was evaluated with polysomnography (Nights 1, 15 and 29) and patient-reports (Nights 1, 15, 29 and 43/44). Next-day residual effects were evaluated using the Digit-Symbol Substitution Test (DSST). RESULTS: Eszopiclone 3 mg had significantly less time to sleep onset (p < or = 0.0001), more total sleep time and sleep efficiency (p < or = 0.0001), better sleep maintenance (p < or = 0.01), and enhanced quality and depth of sleep (p < 0.05) across the double-blind period compared with placebo. Eszopiclone 2 mg had significantly less time to sleep onset (p < or = 0.001), more total sleep time (p < or = 0.01) and sleep efficiency (p < or = 0.001), and enhanced quality and depth of sleep (p < 0.05) compared with placebo, but did not significantly improve sleep maintenance. There was no evidence of tolerance or rebound insomnia after therapy discontinuation. Median DSST scores showed no decrement in psychomotor performance relative to baseline and did not differ from placebo in either eszopiclone group. Treatment was well tolerated; the most common adverse event related to eszopiclone was unpleasant taste. CONCLUSIONS: Patients treated with nightly eszopiclone 3 mg had better polysomnographic (through Night 29) and patient-reported measures (through Night 44) of sleep over the 6-week trial. There was no evidence of tolerance or rebound insomnia and no detrimental effects on next-day psychomotor performance using the DSST.     

Rebound insomnia after abrupt discontinuation of hypnotic treatment: double-blind randomized comparison of zolpidem versus triazolam

Rebound insomnia is a transient intense worsening of sleep usually appearing within 3 days from the abrupt discontinuation of benzodiazepines (mainly short-acting), following long term use and abuse of these hypnotics. Zolpidem is an imidazopyridine, that binds selectively at ω₁-receptor subtypes within the GABA_A receptor supramolecular complex. It has a rapid onset of action and short-elimination half-life; it reduces the latency of sleep and prolongs the duration of sleep in patients with insomnia, without any major effects on sleep stages and rebound effects upon discontinuation. The present multicentre trial (three Italian centres) was aimed at assessing the symptoms/signs of rebound insomnia after discontinuation of either zolpidem or triazolam. A double-blind, randomized, parallel group trial of 20-day duration was carried out in 22 patients suffering from either transient insomnia, or short-term (situational stress) insomnia, or patients who were poor sleepers. The trial consisted of three periods: a 3-day run-in period with placebo, a 14-day active treatment period (zolpidem 10 mg od or triazolam 0.25 mg od), a 3-day withdrawal period with placebo. There were statistically significant [p = 0.0064 for Total Sleep Time (TST) and p = 0.0051 for Sleep Efficiency (SE%)] differences between triazolam- and zolpidem-treated patients during the first withdrawal night versus baseline: TST decreased to 34.5 min after triazolam but increased to 43.8 min after zolpidem, and a similar evolution was shown on SE% (a decrease of 6.3 per cent after triazolam and an increase of 9.9 per cent after zolpidem). Also the Wake-time After Sleep Onset (WASO) showed a statistically significantly (p = 0.0083) different pattern, during the first withdrawal night, remaining decreased after zolpidem (37.5 min) but suddenly increasing after triazolam (17.3 min). Also the subjective time to fall asleep changed with a statistically significant difference (p = 0.042), being increased after triazolam (8.6 min) and decreased after zolpidem (20.8 min). The results of the study demonstrate the presence of clear rebound insomnia after triazolam discontinuation, whereas such a drawback is absent with zolpidem. This allows the abrupt discontinuation of zolpidem without any need for a tapering procedure and without any risk of pharmacological dependence.     

安定类药物对失眠症患者日间功能和睡眠质量的影响

目的探讨长期使用安定类药物对失眠症患者日间功能和睡眠质量的影响。方法对35例长期使用安定类药物的老年失眠症患者（研究组）进行整夜多导睡眠图描记和日间功能问卷调查,并与30例未使用安定类药物的老年失眠症患者（对照组）对照分析。结果研究组和对照组日间功能异常者分别为91.4%和30.0%,两组差异有统计学意义（P〈0.05）;多导睡眠图显示研究组睡眠潜伏期缩短、睡眠时间延长、浅睡眠增多、深睡眠和快速眼动期（REM）睡眠减少,与对照组比较差异有统计学意义（P〈0.01）。结论长期使用安定类药物可导致睡眠质量和日间功能下降。     

国产与进口马来酸咪达唑仑片治疗失眠的疗效比较

目的：研究国产和进口马来酸味达唑仑片治疗原发性失眠患者的临床疗效，为相关药物的使用与选择提供临床依据。方法：采用随机、双盲、平行、对照的方法。44例原发性失眠患者随机分为两组，每组各22例。试验组服用国产马来酸味达唑仑片，对照组用进口马来酸味达唑仑片，观察临床疗效。以睡眠等级评估量表（sleep rating scale）进行评分。结果：在试验组与对照组间，睡眠等级评估量表服药日的各因子分值差异无显著性统计学意义（P〉0．05），且两组的显效率均为100％，差异无显著性（P〉0．05）。结论：国产和进口马来酸味达唑仑片对原发性失眠患者的临床疗效无明显差异。     

右佐匹克隆对焦虑症引起的失眠早期治疗疗效观察

目的：观察右佐匹克隆对焦虑症引起的失眠早期治疗的临床疗效。方法：将135例焦虑症引起的失眠早期患者随机分为3组：右佐匹克隆组、奥沙西泮组、乌灵胶囊组。在服药前、服药后2周末、4周末、8周末、12周末采用汉密尔顿焦虑量表（HAMA）、匹兹堡睡眠质量指数量表（PSQI）进行评定。结果：3组对焦虑引起的失眠均有治疗作用,右佐匹克隆通过快速改善入睡困难缓解患者的焦虑状态。结论：右佐匹克隆对治疗焦虑引起的失眠疗效好,不良反应少,对焦虑有明显的缓解作用。     

Sleep disturbances in patients with post-traumatic stress disorder: epidemiology, impact and approaches to management

Subjective reports of sleep disturbance indicate that 70-91% of patients with post-traumatic stress disorder (PTSD) have difficulty falling or staying asleep. Nightmares are reported by 19-71% of patients, depending on the severity of their PTSD and their exposure to physical aggression. Objective measures of sleep disturbance are inconsistent, with some studies that used these measures indicating poor sleep and others finding no differences compared with non-PTSD controls. Future research in this area may benefit from examining measures of instability in the microstructure of sleep. Additionally, recent findings suggest that sleep disordered breathing (SDB) and sleep movement disorders are more common in patients with PTSD than in the general population and that these disorders may contribute to the brief awakenings, insomnia and daytime fatigue in patients with PTSD. Overall, sleep problems have an impact on the development and symptom severity of PTSD and on the quality of life and functioning of patients. In terms of treatments, SSRIs are commonly used to treat PTSD, and evidence suggests that they have a small but significant positive effect on sleep disruption. Studies of serotonin-potentiating non-SSRIs suggest that nefazodone and trazodone lead to significant reductions in insomnia and nightmares, whereas cyproheptadine may exacerbate sleep problems in patients with PTSD. Prazosin, a centrally acting alpha1-adrenoceptor antagonist, has led to large reductions in nightmares and insomnia in small studies of patients with PTSD. Augmentation of SSRIs with olanzapine, an atypical antipsychotic, may be effective for treatment-resistant nightmares and insomnia, although adverse effects can be significant. Additional medications, including zolpidem, buspirone, gabapentin and mirtazapine, have been found to improve sleep in patients with PTSD. Large randomised, placebo-controlled trials are needed to confirm the above findings. In contrast, evidence suggests that benzodiazepines, TCAs and MAOIs are not useful for the treatment of PTSD-related sleep disorders, and their adverse effect profiles make further studies unlikely. Cognitive behavioural interventions for sleep disruption in patients with PTSD include strategies targeting insomnia and imagery rehearsal therapy (IRT) for nightmares. One large randomised controlled trial of group IRT demonstrated significant reductions in nightmares and insomnia. Similarly, uncontrolled studies combining IRT and insomnia strategies have demonstrated good outcomes. Uncontrolled studies of continuous positive airway pressure for SDB in patients with PTSD show that this treatment led to significant decreases in nightmares, insomnia and PTSD symptoms. Controlled studies are needed to confirm these promising findings.     

A comparison of efficacy and tolerance of the short acting sedatives midazolam and zopiclone.

AIMS: To compare the efficacy and tolerance of midazolam, 15 mg and zopiclone 7.5 mg once daily for seven days in a prospective, double blind trial of 88 patients, aged 18 or over, with sleep disorders in general practice. METHODS: Efficacy was evaluated using the Leeds sleep evaluation questionnaire (LSEQ). Adverse reactions were recorded as volunteered. RESULTS: fifty-one patients completed all aspects of the trial without violation of the protocol. Patients taking zopiclone improved in all aspects of the Leeds questionnaire (p < 0.01). Patients taking midazolam improved in six out of 10 items (p < 0.01). Rebound insomnia was evident in the zopiclone group in five out of 10 items of the LSEQ. Rebound was not evident in the midazolam group. There were no significant differences between midazolam 15 mg, and zopiclone 7.5 mg, in comparison between groups. Thirty-eight patients suffered 49 adverse drug reactions and there were no differences between the groups. CONCLUSIONS: Zopiclone 7.5 mg daily improved more items on the LSEQ than midazolam 15 mg daily but was associated with significant rebound insomnia. Adverse reactions were frequent with both drugs.