Psychological therapies for bipolar disorder: the role of model-driven approaches to therapy integration

OBJECTIVES: The psychological and social aspects of bipolar disorder are receiving increasing recognition. Recently, there have been promising developments in psychological interventions, but there is scope for further improvement of therapeutic outcomes. This paper argues for the use of more detailed psychological models of bipolar disorder to inform the further development of therapeutic approaches. METHOD: Evidence for psychological, family and social factors in bipolar disorder is reviewed. The efficacy of current individual and family interventions are discussed. A model, which has potential to synthesize group and individual approaches, is outlined. RESULTS: Psychological, social and family factors have important influences on the onset, course and outcome of bipolar disorder. Interventions based on vulnerability stress models have proved effective. However, to enhance efficacy future developments need to be based on models that integrate current understandings of the multiple levels at which mood fluctuations occur. A particular recent model is discussed which leads to specific proposals for future intervention research. CONCLUSIONS: Psychological and family approaches to BD have much potential. They clearly have a role in conjunction with appropriate pharmacological treatment. If this potential is to be fully realized future developments need to be based on psychological models that can accommodate the complexity of this illness.     

急性心肌梗死患者与正常人社会心理因素、个性特征和生活方式的对照研究

目的 探寻社会心理因素、个性特征、生活方式与急性心肌梗死(Acute Myocardial Infarc-tion AMI)的病因学联系。方法 对51例AMI病人和50例正常人应用生活事件量表(LES)、社会支持评定量表(SSRS)、艾森克个性问卷(EPQ)、生活方式定式调查表及一般情况调查表进行对照调查。结果 AMI病人发作前有明显心理刺激因素占80.39％,AMI组负性生活事件发生率更高(P<0.01),社会支持度更低(P<0.01),有更多的外倾行为和情绪不稳定性格,E.N分更高(P<0.01),在生活方式方面AMI组有更多的饮食偏咸,不饮牛奶,喜食肥肉、猪油、高脂食品,业余生活单调,缺乏锻炼,嗜烟酒,睡眠差或睡眠无规律等(P<0.01)。结论 负性事件多发,缺乏亲人和社会支持,不良个性和不良生活方式等均是AMI的发病危险因素。     

更年期综合征相关因素研究

目的：探讨更年期综合征发生的相关因素。方法：用Kupperman改良量表、艾森克人格问卷（EPQ）、生活事件量表（LES）、世界卫生组织生命质量测定量表简表（WHOQOL-BRIEF）、抑郁自评量表（SDS）、焦虑自评量表（SAS）,对84例年龄在45-55岁的妇女进行调查,并测定其生殖激素。结果：Kupperman改良量表评分总分与各因子分相关系数（r）如下：LES总分（0．709）、LES负性值（0．700）、WHOQOL-BRIEF中的生理分量表（-0．683）、SDS（0．642）、SAS（0．630）、WHOQOL-BRIEF中的心理分量表（-0．548）、EPQ-N（0．546）、WHOQOL-BRIEF中的社会关系分量表（-0．449）、WHOQOL-BRIEF中的环境分量表（-0．358）、泌乳素（0．298）、LES正性值（0．223）。结论：更年期综合征的发生不仅仅与激素的改变有关,而是生物、社会、心理等多方面的综合因素共同作用的结果。     

Qualitative Exploration and Correction Strategies of the Criminal Psychological Mechanism of the Burglars

In order to explore the criminal psychological mechanism of burglars, this study adopts the qualitative research method of grounded theory to conduct in-depth interviews with 41 burglars in two prisons in Jiangxi Province, China. Nvivo 11.0 was used to code-construct and qualitatively analyze the interview content in order to refine the influencing factors and psychological evolution process of burglary behavior. The findings revealed that (1) burglary risk factors include burglary cognition, burglary motivation, burglary decision-making, delinquent peers, burglary opportunity, and incomplete reformation. (2) There are three stages in the psychological evolution process of burglars: cognitive formation, motivational dominance, and behavioral decision. (3) The interpretation of the criminal psychological mechanism of burglars is a comprehensive and dynamic outcome of the interaction of internal and external factors that shape the individual. Participants’ inspection and non-participants’ inspection were adapted to verify the research results’ validity, which showed that the results were reliable.     

白血病患儿家长积极心理资本现状及其影响因素

背景 心理资本会对个体创伤后成长和幸福感产生明显影响,而目前关于白血病患儿家长心理资本及其相关因素的研究较为有限。目的 探讨白血病患儿家长心理资本现状,并分析其影响因素,以期为制定提升白血病患儿家长心理资本的干预策略提供参考。方法 选取2021年3月-2022年4月在新疆医科大学第一附属医院儿内科就诊的143例白血病患儿的家长为研究对象。采用一般资料调查表、积极心理资本问卷（PPQ）、简体中文版创伤后成长量表（C-PTGI）和Campbell幸福感指数量表（IWB）对白血病患儿家长进行调查,运用多元线性回归分析积极心理资本的影响因素。结果 白血病患儿家长PPQ总评分为（113.48±15.80）分,PPQ总评分与C-PTGI总评分和IWB总评分均呈正相关（r=0.727、0.598,P均<0.01）。患儿病程（β=0.136,P=0.017）、受教育程度（β=0.139,P=0.012）、创伤后成长（β=0.622,P<0.01）是白血病患儿家长积极心理资本的影响因素,可解释总变异的57.6%。结论 白血病患儿家长积极心理资本水平有待提高,患儿病程、受教育程度以及创伤后成长是其积极心理资本的影响因素。     

Psychological distress and its correlates in older care-dependent persons living at home

Objectives: This study examined psychological distress in older people receiving home nursing care. The influence of risk factors and personal resources on their perceived psychological distress was also examined. Method: A linear regression analysis was applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological distress was measured using the General Health Questionnaire (GHQ). The independent variables were sex, education, age, living arrangement, household composition, reported illnesses, Barthel ADL Index, self-rated health, Subjective Health Complaints, Clinical Dementia Rating Scale, Sense of Coherence and Revised Social Provision Scale.

Results: Of the 214 participants, 23 (10.7%) reported experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score. Sense of coherence, education and subjective health complaints were the only factors that were significantly related to psychological distress in the multivariate analysis.

Conclusion: The general level of psychological distress was low. Low psychological distress was related to an inner strength conceptualized as sense of coherence. Commonly reported risk factors such as sex, household composition and perceived social support, and objective measures of somatic and mental health and bodily dysfunctions were not related to psychological distress. Suggested reasons for this are greater acceptance of bodily and functional shortcomings and of changes related to goal achievement in old age, according to the model of selective optimization with compensation.     

Hallucinatory experiences and onset of psychotic disorder: evidence that the risk is mediated by delusion formation

OBJECTIVE: To examine the hypothesis that the risk for onset of psychotic disorder in individuals with self-reported hallucinatory experiences (HE) would be higher in those who developed delusional ideation (DE) than in those who did not. METHOD: A population sample of 4673 individuals were interviewed with the Composite International Diagnostic Interview at baseline and 1 and 3 years later. At year 3, clinical re-interview took place to identify onset of psychotic disorder. RESULTS: Given the presence of HEs at baseline, the increase in risk of having the psychosis outcome at year 3 was much higher in those with DE at year 1 than in those without DE (risk difference between individuals with and without DE: 18.72%, 95% CI: 2.22-35.23, chi(2) = 4.94, df = 1, P = 0.026). CONCLUSION: The results are in line with current psychological theories stating that clinical outcome of psychosis-like experiences is related to the development of secondary beliefs and appraisals.     

Psychological approach of non-epileptic to epileptic patients: the dynamics of attitude changes during hospitalization

Measures of interpersonal relations of non-epileptic patients to epileptic were studied in search of answers to two questions: what is the initial attitude of non-epileptic patients to epileptic patients; and, do any changes in attitude occur during time spent together in hospital? In order to study these personal relations, a formal analysis of preferences was carried out. Twenty-two non-epileptic patients admitted to the Neurology and Epileptology Department, Medical Centre for Postgraduate Education, Warsaw were studied. Subjects were asked to rank-order (from 1 to 9 points) suggested ways of distributing the profits of a hypothetical joint (e.g., with a room-mate) money-earning venture. The experimental procedure for each patient was repeated for all three room-mates. Preferences were assessed three times — the day after admission to hospital, after 11 days and after 21 days in hospital. Following this procedure, it was possible to trace the dynamics of the patients' interpersonal relations. The data were correlated (Spearman's r_s) and submitted to analysis of variance (MANOVA) with repeated measures. Analysis of the attitudes of patients with non-epileptic neurological disorders towards epileptic patients revealed a dynamic tendency — from negative (measures one and partly two) to positive attitudes after three weeks spent together in hospital (measure three).     

Increased co-morbidity of depression and post-traumatic stress disorder symptoms and common risk factors in intensive care unit survivors: A two-year follow-up study

Objective. To investigate the long-term psychological impact of intensive care unit (ICU) hospitalization, as well as to establish risk factors which successfully discriminate patients at higher risk. Methods. The Medical Outcomes Study Short Form Survey (SF-36), the Center for Epidemiologic Studies for Depression (CES-D), and the Davidson Trauma Scale (DTS) questionnaires were obtained from 48 ICU survivors who were also interviewed and self-reported on several acknowledged risk factors. Results. A high co-morbidity between depression and post-traumatic stress disorder (PTSD) cases was observed. Both CES-D and DTS scores correlated negatively with the SF-36 mental health subscale scores; although a causative relation cannot be attributed to this finding, it indicates a potential negative impact of depression and PTSD symptoms on the patients’ quality of life even at 18- to 24-month post-ICU. The most important risk factor associated with a long-term impact on quality of life, depression and PTSD was lifetime history of any psychiatric disorder. Conclusions. During ICU admissions efforts should be made towards identifying and psychologically supporting those patients with a previous history of a psychiatric disease, as they are at considerably higher risk of suffering from the long-term psychological sequelae of ICU admission.     

Associations of ikigai as a positive psychological factor with all-cause mortality and cause-specific mortality among middle-aged and elderly Japanese people: Findings from the Japan Collaborative Cohort Study

Objective

To determine whether presence of ikigai as a positive psychological factor is associated with decreased risks for all-cause and cause-specific mortality among middle-aged and elderly Japanese men and women.

Methods

From 1988 to 1990, a total of 30,155 men and 43,117 women aged 40 to 79 years completed a lifestyle questionnaire including a question about ikigai. Mortality follow-up was available for a mean of 12.5 years and was classified as having occurred in the first 5 years or the subsequent follow-up period. Associations between ikigai and all-cause and cause-specific mortality were assessed using a Cox's regression model. Multivariate hazard ratios (HRs) were adjusted for age, body mass index, drinking and smoking status, physical activity, sleep duration, education, occupation, marital status, perceived mental stress, and medical history.

Results

During the follow-up period, 10,021 deaths were recorded. Men and women with ikigai had decreased risks of mortality from all causes in the long-term follow-up period; multivariate HRs (95% confidence intervals, CIs) were 0.85 (0.80-0.90) for men and 0.93 (0.86-1.00) for women. The risk of cardiovascular mortality was reduced in men with ikigai; the multivariate HR (95% CI) was 0.86 (0.76-0.97). Furthermore, men and women with ikigai had a decreased risk for mortality from external causes; multivariate HRs (95% CIs) were 0.74 (0.59-0.93) for men and 0.67 (0.51-0.88) for women.

Conclusion

The findings suggest that a positive psychological factor such as ikigai is associated with longevity among Japanese people.     

Analysis on the Driving Factors and Realization Path of the Value of Tutor-Student Relationship of Postgraduates-with Medical and Pharmaceutical Universities as an Example

A harmonious relationship between teachers and postgraduates presents the comprehensive value of psychological education, which guarantees training quality and acts as an effective carrier of mental health education of the postgraduates. Based on Bandura’s theory of reciprocal determinism and Austin’s input-output theory, this paper constructs a model concerning the value of psychological education in the tutor-student relationship. The path of realization is also explored in a structural equation model through a questionnaire survey of 1112 graduate supervisors and administrators in medical colleges. The experimental result indicates that (1) The interaction between teachers and postgraduates promotes the value of psychological education in the highest measure, among which the quality and frequency of tutor-student communication, mutual trust, and respect act as the key influencing indicators. (2) Tutor’s professional quality is considered as the fundamental driving force in the realization of psychological education value in the tutor-student relationship, the maximum mediating effect is observed in the developing path of “tutor’s professional quality-interaction behavior between teachers and postgraduates-psychological growth of teachers and postgraduates. (3) The objective results obtained by teachers and postgraduates, such as the improvement of quality and quantity, positively promote the overall quality of life satisfaction of both sides, which improves the major psychological growth indicators. (4) In the path that affects the psychological growth of teachers and postgraduates, female groups mainly focusing on natural sciences pay more attention to the tutor-student emotional experience, while male and lower-grade groups pay more attention to behavioral interaction; In the path that affects the interaction between teachers and postgraduates, the tutor does not value the difference in the quality of graduate students, lower-grade and natural science professional groups pay more attention to institutional environment.     

社会心理因素对终末期肾病行腹膜透析患者康复结局的影响*

目的：分析社会心理因素对终末期肾病行腹膜透析患者康复结局的影响。 方法：选择2005-08/2007-03北京大学第一医院肾内科腹膜透析中心确诊的终末期肾病接受腹膜透析治疗患者171例,男66例,女 105例,年龄(60±13)岁,平均透析时间22.8个月。采用问卷调查与访谈相结合方法对患者的康复结局进行评定：主要利用Karnofsky活力指数评估活动状况;采用社会功能缺陷筛选表评估社会参与状况。评估患者的心理社会因素主要采用Hamilton抑郁、焦虑等级量表、医学应对方式问卷和社会支持评定量表。 结果：共发放问卷200份,回收有效问卷171份,占85.5%。本组患者活动正常者134例,占78.4%;存在参与受限者129例,占75.4%;焦虑症状的发生率为24.5%(42例),抑郁症状的发生率为8.2%(15例)。本组患者对疾病在采取“屈服”应对方式方面的得分显著高于其他慢性病患者,而“面对”和“回避”两种应对方式的采用与其他患者无统计学差异。将反映康复结局的活动、参与指标作为因变量,社会心理因素中的抑郁焦虑水平、应对方式、社会支持等作为自变量,用多元逐步标准回归篩除法,找出影响康复结局的相关因素,最后进入回归模型的因素为患者的抑郁程度、对疾病采取面对或屈服应对方式、对社会支持的利用程度。 结论：社会因素中患者对社会支持的利用程度、心理因素中患者的抑郁状况及对疾病所采取的应对方式等因素对终末期肾病患者的康复结局有重要影响。     

Effectiveness of integrative and instrumental reminiscence therapies on depression symptoms reduction in institutionalized older adults: An empirical study

Objective: Reminiscence therapy is a psychological intervention which is specifically designed to address issues of particular relevance to older adults, such as depression. The latest approach to the research on therapeutic utility of reminiscence is gaining popularity among researchers and practitioners, and has yielded promising results. Specifying different types of reminiscence is a crucial component of the approach. The aim of this study was to examine the therapeutic effectiveness of integrative and instrumental types of reminiscence for the treatment of depression in institutionalized older adults dwelling in a nursing home.

Method: The study employed a three-group pre–post-test design with random allocation to instrumental or integrative reminiscence or an active social discussion control condition. Twenty-nine institutionalized older adults (12 men and 17 women) with depressive symptoms varying from mild to severe constituted the sample. The interventions were implemented in a short-form group format.

Findings: Analysis of changes from pre-test to post-test revealed that integrative reminiscence therapy led to statistically significant reduction in symptoms of depression in contrast with the control group. Although instrumental reminiscence therapy also reduced depressive symptoms, this improvement was not statistically significant compared to the control group.

Conclusion: This study provides additional support for the effectiveness of integrative reminiscence therapy as an intervention for depressed older adults living in residential care settings. This study also provides support for the hypothesis that certain types of reminiscence produce their own specific effects.     

Identification of Suicide Risk Factors in Medellín,Colombia: A Case-Control Study of Psychological Autopsy in a Developing Country

The incidence, methods and risk factors for suicide may vary among the different cultures, which makes necessary to study the risk factors for suicide in specific settings in order to design adequate intervention strategies. This study aims to determine the risk factors for suicide in Medellín (Colombia). It is a case-control study conducted among 108 individuals who committed suicide and 108 deceased in accidents, matched for age and gender. Both cases and controls were examined by means of psychological autopsy. Conditional logistic regression analysis identified the following factors: Adverse life events in the last six months (OR = 11.81, 95% CI: 4.29–32.52), family history of suicide (OR = 10.82, 95% CI: 2.23–52.47), major depressive episode (OR = 4.58, 95% CI: 1.53–13.67) and expression of a wish to die (OR = 3.54, 95% CI: 1.25–10.06). These findings may suggest that risk factors for suicide are similar across cultures.     

Psychological Influence Factors Analysis of the New Generation Employees’ Moral Choices from the Perspective of Cognitive Neurology

At present, the academic researches on moral choices focus mainly on the individuals’ external behaviors, without fully considering the influences of the individuals’ internal psychological factors. Based on the model of complete information static games in the Non-cooperative Game theory, the present research has designed a “Red and Blue Experiment” to explore the psychological influencing factors of the new generation employees’ moral choices. The research has conducted psychoanalysis on the new generation employees through experiments and interviews with 118 data sources, and concluded the characteristics in relation to the different stages of psychological processes and moral choices of the experimental population. Through comparative analysis, it is found that: the psychological factors, such as trust, doubt, and guilt will influence the new generation employees’ moral choices, guiding them to make choices, such as risk aversion and mutual benefit and win-win, in the process. Additionally, the research has also provided effective scientific evidence for the new generation employees’ mental health development and career planning.     

体检中心护士心理压力源危险因素及防护措施

目的 了解体检中心护士心理压力源、危险因素及防护措施。方法 采用整群问卷调查我院体检中心35名护士的常见心理压力源、危险因素,以及随机抽样调查2009-01-12共8 640人次危险因素防护前后的满意度,并统计危险因素防护前70 204人次,防护后72 852人次的护理不良事件、护理投诉发生率。结果 体检中心护士压力依次为检查考核、知识缺乏（2.757±0.823）分,客户投诉、差错事故（2.514±0.893）分,工作紧张、客户需求（2.385±0.944）分,社会地位、家庭观念（1.829±1.025）分,工作环境、人际关系（1.700±1.0165）分,（F=11.869,P=0.001）。对危险因素实施防护后护理满意度由防护前的90.72%上升至98.10%（P＜0.05）。护理投诉率由防护前的0.57%降至防护后的0.13%,护理不良事件的发生率由防护前的0.36%降至防护后的0.04%（P＜0.05）。结论 体检中心护士的压力源主要来自检查考核、客户投诉、工作紧张等,护士的危险因素有管理机制不健全、服务意识不强、法律意识淡薄等,管理者以人为本,提供安全、宽松的环境,努力营造团结合作的轻松氛围,护士应加强自身综合素质培养,改善自己的知识结构,增强法律观念,提高护理质量,以减轻压力,防止危险因素。     

Culture, risk factors and suicide in rural China: a psychological autopsy case control study

OBJECTIVE: Previous research on sociocultural factors for Chinese suicide have been basically limited to single case studies or qualitative research with ethnographic methodology. The current study examines the major risk factors and some cultural uniqueness related to Chinese rural suicide using a quantitative design. METHOD: This is a case control study with 66 completed suicides and 66 living controls obtained from psychological autopsy interviews in rural China. RESULTS: Both bivariate analyses and the multiple regression model have found that the Chinese rural suicide patterns are basically similar to those in most other cultures in the world: strong predictors of rural Chinese suicide are the psychopathological, psychological, and physical health variables, followed by social support and negative and stressful life events. Other significant correlates include lower education, poverty, religion, and family disputes. CONCLUSION: Culture has an important impact on suicide patterns in a society.