The paradoxical role of insight in mental illness: The experience of stigma and shame in schizophrenia,mood disorders,and anxiety disorders

This study examined the factor structure of the Hungarian version of the Birchwood Insight Scale (BIS) and analyzed its association with socio-demographics, diagnosis, internalized stigma, and shame using confirmatory factor analysis (CFA) with covariates. Mentally ill patients (N = 200) completed self-report questionnaires. CFA supported a two-factor structure. While previous hospitalizations and diagnosis were associated with insight, insight predicted higher internalized stigma and shame. Efforts to increase insight should be matter of importance in the wider spectrum of mental diagnoses. However, such efforts should be conducted with special care as further research is needed to understand the impact of insight on wellbeing.     

Anosognosia in individuals with schizophrenia: toward recovery of insight

This paper addresses the growing evidence that lack of insight, or unawareness of illness in people with schizophrenia, may actually be a medically based condition known as anosognosia. Major explanatory models and related research findings are discussed. A case scenario is presented, as well as current perspectives regarding assessment of insight and alternative treatment approaches. Implications for further research, nursing education, and practice also are included. With better understanding of the characteristics and treatment of diminished insight in individuals with schizophrenia, nurses can better assist clients to recover helpful insight that enables them to take an active role in managing their symptoms and problems.     

精神疾病病人病耻感体验的质性研究

目的:探讨精神疾病病人病耻感体验及应对方式。方法:对12例病人进行深度访谈以获取资料,用现象学分析法分析资料。结果:精神疾病病人在患病后都会产生羞耻心理;遭遇歧视时被他人躲避而感到无奈,工作、升职受到不公平待遇而痛心;在遭遇歧视后病人多采取回避社交、刻意的隐瞒病情等错误的应对方式;由于精神疾病,有些病人放弃了原本的工作以及对未来生活产生不确定感。结论:对精神疾病病人要加强疾病的健康宣教,改变病人不正确的认知;做好心理护理,提供情感支持;加强对公众精神卫生知识的宣教和普及。     

慢性精神分裂症患者自知力与精神症状的相关性

目的：探讨慢性精神分裂症患者自知力与精神症状的关系。方法：选择2001—01／2002—06北京市安康医院慢性精神分裂症患者120例。均为长期使用抗精神病药物，住院时间2个月-35年，年龄28-63岁，男90例，女30例。使用修订后的Markova自知力自评量表由患者自行评定，同时由医生对患者进行简明精神病量表、阴性症状量表、阳性症状量表评定。修订后自知力自评量表共28项问题，7个因子。每项问题分3个选择性答案（即从无到有，从轻到重）。评分标准：0分：无（重）（错），1分=时有时无（中等）（较正确），2分：一直有（轻）（正确）。结果：120例均进入结果分析，无脱落。①自知力自评量表评分与简明精神病量表评分相关分析：慢性精神分裂症患者自知力总分与简明精神病量表总分呈明显负相关，但在各因子中，表现为对自我变化的认识与活动过多和敌意猜疑无相关性，余呈负相关。②自知力自评量表评分与阴性症状量表评分相关分析：慢性精神分裂症患者自知力总分与阴性症状量表总分呈明显负相关，自知力中因子对环境变化的认识与阴性症状量表总分、思维贫乏、注意损害呈负相关，而与阴性症状量表其他3因子无特异性相关。自知力因子对自我变化的认识与阴性症状量表总分无相关，仅与思维贫乏、注意损害呈负相关。自知力因子中对自我处境的认识与阴性症状总分及其他因子均呈负相关。③自知力自评董表评分与阳性症状量表评分相关分析：慢性精神分裂症自知力总分与阳性症状量表总分呈负相关，在各因子中，自知力总分与怪异行为、阳性思维形式障碍呈负相关，与幻觉、妄想、情感不协调无相关性。自知力各因子中对住院治疗的态度与期望、意识到自身的变化、对存在疾病的认识与阳性症状量表总分呈负相关。而幻觉、妄想仅与自知力中对存在疾病的认识相关；情感不协调不影响自知力以及其各因子。结论：阴性症状更多地影响慢性精神分裂症患者的自知力，而阳性症状中的某些项目与自知力中的个别因子相关：     

慢性精神分裂症患者自知力与精神症状的相关性

目的:探讨慢性精神分裂症患者自知力与精神症状的关系。方法:选择2001-01/2002-06北京市安康医院慢性精神分裂症患者120例。均为长期使用抗精神病药物,住院时间2个月～35年,年龄28～63岁,男90例,女30例。使用修订后的Markova自知力自评量表由患者自行评定,同时由医生对患者进行简明精神病量表、阴性症状量表、阳性症状量表评定。修订后自知力自评量表共28项问题,7个因子。每项问题分3个选择性答案(即从无到有,从轻到重)。评分标准:0分=无(重)(错),1分=时有时无(中等)(较正确),2分=一直有(轻)(正确)。结果:120例均进入结果分析,无脱落。①自知力自评量表评分与简明精神病量表评分相关分析:慢性精神分裂症患者自知力总分与简明精神病量表总分呈明显负相关,但在各因子中,表现为对自我变化的认识与活动过多和敌意猜疑无相关性,余呈负相关。②自知力自评量表评分与阴性症状量表评分相关分析:慢性精神分裂症患者自知力总分与阴性症状量表总分呈明显负相关,自知力中因子对环境变化的认识与阴性症状量表总分、思维贫乏、注意损害呈负相关,而与阴性症状量表其他3因子无特异性相关。自知力因子对自我变化的认识与阴性症状量表总分无相关,仅与思维贫乏、注意损害呈负相关。自知力因子中对自我处境的认识与阴性症状总分及其他因子均呈负相关。③自知力自评量表评分与阳性症状量表评分相关分析:慢性精神分裂症自知力总分与阳性症状量表总分呈负相关,在各因子中,自知力总分与怪异行为、阳性思维形式障碍呈负相关,与幻觉、妄想、情感不协调无相关性。自知力各因子中对住院治疗的态度与期望、意识到自身的变化、对存在疾病的认识与阳性症状量表总分呈负相关。而幻觉、妄想仅与自知力中对存在疾病的认识相关;情感不协调不影响自知力以及其各因子。结论:阴性症状更多地影响慢性精神分裂症患者的自知力,而阳性症状中的某些项目与自知力中的个别因子相关。     

A simple examination of the relationships between pain, organic lesions and psychiatric illness

It is often assumed that pain can be caused by psychological illness and also that severely painful organic lesions may cause emotional change. If these assumptions are correct, pain in the absence of lesions should be associated with a very high rate of psychiatric diagnosis; pain with lesions should occur with psychological illness more often than by chance but less often than in the group without lesions. To test these hypotheses two groups have been compared, one with pain and no evidence of organic lesions, the other with pain proportionate to organic lesions. Ninety-seven per cent of the first group and 39% of the second group were found to have psychiatric conditions (P less than 0.001).     

Prevalence of and risk factors for high-altitude hyperuricaemia in Bai individuals: a cross-sectional study

ObjectiveHyperuricaemia is common in Bai individuals; however, its prevalence remains unclear. This work aimed to investigate high-altitude hyperuricaemia prevalence and risk factors in Bai individuals.MethodsAll eligible participants of Bai ethnicity (aged ≥18 years and undergoing routine medical examination at the People’s Hospital of Jianchuan County between January and December 2019) were consecutively enrolled. Demographic and laboratory data were collected to investigate hyperuricaemia prevalence and associated risk factors.ResultsA total of 1393 participants were assessed, comprising 345 (24.8%) with hyperuricaemia showing a male predominance (287/865 [33.2%] males versus 58/528 [11.0%] females). Hyperuricaemia prevalence was significantly higher in participants aged ≥50 years (100/332 [30.1%]) versus those aged 30–40 years (59/308 [19.2%]), and in overweight/obese individuals compared with those showing an underweight or normal body mass index (BMI; 267/885 [30.2%] versus 78/508 [15.4%]). Finally, haemoglobin concentrations and serum uric acid levels were positively correlated.ConclusionBesides traditional risk factors, including age, sex and BMI, polycythaemia due to prolonged exposure to high altitude may also cause hyperuricaemia in Bai individuals residing in Yunnan Province.     

Anxiety,mental illness,learning disabilities,and learning accommodation use: A cross-sectional study

BackgroundNurse educators require a robust understanding of nursing students' attributes to meet their learning needs and support their success.PurposeThis research seeks to understand the proportion of nursing students with self-reported medically diagnosed anxiety, mental illnesses (MI), learning disabilities (LD), and utilized learning accommodations (LA), and determine how these students compared to a normative sample regarding studying and test-taking anxiety.MethodA secondary analysis of quantitative cross-sectional data that included the Academic Success Inventory for College Students (ASICS) tool. First-year students were surveyed (4–6 weeks after program start, and students in years 1 through 4 were surveyed at the end of both academic terms.ResultsAt program start, 21% were diagnosed with anxiety, 16% with MI, 2% with a LD, and 6% accessed LA. By fourth-year these proportions were 23%, 22%, 8% and 13% respectively. Alarming proportions of respondents exhibited anxiety related to test-taking compared to the ASICS normative sample with large effect sizes (Anxiety h = 0.884; MI h = 0.601; LD: h = 2.094; LA h = 0.725).ConclusionTo support students, we highlight a need for early identification and tailored support, enriched faculty knowledge, faculty introspection and willingness to adapt, and time for relational and individual pedagogy.     

Gender differences in the relationships between sleep disturbances and academic performance among nursing students: A cross-sectional study

BackgroundSleep disturbances, such as insomnia, excessive daytime sleepiness, and poor-quality sleep, are common among nursing students and are closely linked with academic performance.ObjectivesTo examine the prevalence of sleep disturbances and academic performances in male and female nursing students and to determine gender-specific effects on the relationship between sleep disturbances and academic performance.DesignA cross-sectional study design was adopted.SettingsThis study was conducted in a school of nursing in Indonesia.ParticipantsA total of 492 undergraduate students (103 males and 389 females) were included.MethodsData pertaining to the biosociodemographic characteristics, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Epworth Sleepiness Scale, Morningness-Eveningness Questionnaire, and Beck Depression Inventory were collected from July 1, 2018 to September 30, 2018. Academic performance was measured using grade point average of the academic year 2017–2018. A multivariate logistic regression model was used for data analyses.ResultsThe prevalence of poor sleep quality, insomnia, and daytime sleepiness was 66.0%, 45.6%, and 24.3%, respectively, in male nursing students and 71.5%, 52.4%, and 28.8%, respectively, in female nursing students. For circadian rhythm preferences, 66% male and 51.7% female nursing students were categorized as intermediate- and morning-type people, respectively. Insomnia was the only variable among sleep disturbances that significantly correlated with the risk of poor academic performance in female nursing students even after adjustment of covariates.ConclusionsSleep disturbances were highly prevalent among female and male nursing students, and insomnia was substantially associated with poor academic performance in female nursing students. Identifying sleep disturbances among nursing students and designing effective interventions to specifically target them are required to improve academic performance of female nursing students.     

The relationship between insight and clinical factors for persons with schizophrenia

This correlational study examined the relationship of insight with positive and negative symptoms and level of functioning among persons with schizophrenia or schizoaffective disorder. Poor insight as a symptom of schizophrenia is the conceptual framework. Thirty-seven people receiving assertive community treatment, inpatient hospitalization, or outpatient treatment were assessed using 2 self-rating insight scales, the Scale for Assessment of Positive Symptoms (SAPS), the Scale for Assessment of Negative Symptoms (SANS), and the Global Assessment of Functioning (GAF). A significant negative correlation was found between insight and positive formal thought disorder. No significant relationships were found between insight and negative symptoms or level of functioning. Reactions to the self-rating insight tools suggest necessary revisions of the insight tool.     

Maternal severity of illness across levels of care: A prospective, cross-sectional study

Background

The severity of illness of women experiencing severe maternal morbidity has not been quantified outside of the intensive care setting yet is likely to have a bearing on clinical needs.

Aim

To examine severity of illness in women with severe maternal morbidity.

Methods

A prospective observational study of critically ill pregnant and postpartum women was undertaken in intensive care units (ICU), high dependency units (HDU) and delivery suites (DS) of seven tertiary-level hospitals in Melbourne, during 2002–2004. Severity of illness was scored using the Acute Physiology and Chronic Health Evaluation version II (APACHE II) and Therapeutic Intervention Scoring System 28 items (TISS 28).

Results

137 women participated in the study: ICU (n = 33), HDU (n = 46) and DS (n = 58). The mean APACHE II score was 8.6 (95% CI 7.7–9.5) and mean TISS 28 score was 22.5 (95% CI 21.2–23.9). Women in ICU were sicker according to both APACHE II (mean 12.6, 95% CI 8.3–16.9) and TISS 28 (mean 31.5, 95% CI 28.2–35.5) compared to women not admitted to ICU (p < .005). There was no difference in the mean APACHE II scores of women in HDU (7.7, 95% CI 5.5–9.9) and DS (7.0, 95% CI 5.2–8.8; p = .20). Women born outside of Australia were more likely to be admitted to ICU (OR 3.27, 95% CI 1.19–8.97). Known risk factors like multiple pregnancy, age ≥35 years and nulliparity were not associated with ICU admission.

Conclusions

There was no difference in the severity of illness in women cared for in HDU and DS. It was not possible to predict which women would require ICU admission. Measurement of severity of illness adds a valuable dimension to the study of severe maternal morbidity.     

自知力教育对首发及复发精神分裂症病人自知力影响的研究

[目的]探讨自知力教育对首发及复发精神分裂症病人自知力的影响。[方法]对首发（研究组）和复发（对照组）精神分裂症病人进行系统的抗精神病药物治疗和自知力教育，并分别于入院时及入院第4周、第8周、第12周进行自知力及治疗态度问卷（ITAQ）及服药依从性的评定。[结果]入院时ITAQ总分、服药依从性两组间比较，差异无统计学意义（P〉0．05）；入院第4周，对照组ITAQ总分高于研究组（P〈0.05），但第12周研究组ITAQ总分、服药依从性均明显高于对照组（P〈0．05）。[结论]自知力教育可改善首发精神分裂症病人住院中后期自知力，服药依从性提高。     

自知力教育对首发及复发精神分裂症病人自知力影响的研究

[目的]探讨自知力教育对首发及复发精神分裂症病人自知力的影响。[方法]对首发(研究组)和复发(对照组)精神分裂症病人进行系统的抗精神病药物治疗和自知力教育,并分别于入院时及入院第4周、第8周、第12周进行自知力及治疗态度问卷(ITAQ)及服药依从性的评定。[结果]入院时ITAQ总分、服药依从性两组间比较,差异无统计学意义(P>0.05);入院第4周,对照组ITAQ总分高于研究组(P<0.05),但第12周研究组ITAQ总分、服药依从性均明显高于对照组(P<0.05)。[结论]自知力教育可改善首发精神分裂症病人住院中后期自知力,服药依从性提高。     

Gait parameters,functional mobility and fall risk in individuals with early to moderate primary open angle glaucoma: a cross-sectional study

Objective

This study investigated the influence of early to moderate primary open angle glaucoma on gait, functional mobility and fall risk.

精神分裂症患者疾病不确定感与应对方式的相关性研究

目的探讨精神分裂症患者疾病不确定感和应对方式的关系。方法采用Mishel疾病不确定感与压力情景应对方式问卷对114位精神分裂症康复期患者进行问卷调查。结果92.1%的患者有中等水平或以上的疾病不确定感。精神分裂症患者较少采用任务应对方式,较多采用的是回避与情绪应对策略。精神分裂症患者的任务应对(r=-0.243,P<0.05)和回避应对(r=-0.263,P<0.05)与疾病不确定感呈负相关,情绪应对方式与疾病不确定感呈正相关(r=0.321,P<0.01)。结论精神分裂症患者的应对方式与其疾病不确定感具有一定的相关性,采用任务应对与回避应对方式可降低疾病不确定感水平。     

以学校为基础的自杀高危青少年针对性预防研究

目的 对有自杀风险的高危青少年进行针对性干预,评估干预方案的效果.方法 选取上海市浦东新区2所初中的初一和初二年级、2所高中的高一和高二年级,以班级为单位随机分为干预班级和对照班级.通过问卷筛查出有自杀风险的高危青少年210人,研究组101人,对照组109人.研究设计为add-on.研究组高危青少年除接受学校常规心理课程以外,另外接受20节团体认知行为课程,其父母接受青少年自杀预防宣教;对照组只接受学校常规心理课程,其父母不干预.在干预前和干预结束后6个月进行问卷调查,评估自杀行为和相关因素的变化.结果 干预前除研究组的敢于自表因子分高于对照组外(P=0.012),两组其他评估指标无统计学差异(P>0.05).干预后,研究组的自杀行为(P值分别为0.000、0.000、0.006)、最近1周和最严重时的BSI-CV(Beck自杀意念量表中文版)得分(P值分别为0.000、0.003)、BDI(Beck抑郁量表)得分(P=0.000)、BHS(Beck绝望量表)总分及对未来感觉和动力丧失因子分(P值分别为0.015、0.040、0.020)均显著低于干预前,SSRS(社会支持评定量表)总分及主观和客观支持因子分(P值均为0.000)、ESAP(情绪智力技能问卷)的敢于自表(P=0.017)和压力管理因子分(P=0.042)均显著高于干预前;干预后对照组的自杀行为(P值分别为0.000、0.002、0.008)、BDI得分(P=0.000)均显著低于干预前,SSRS总分(P=0.042)及主观支持因子分(P=0.001)、SCSQ(简易应对方式问卷)的积极应对因子分(P=0.009)均显著高于干预前;除研究组的客观支持因子分(P=0.013)和敢于自表得分显著高于对照组(P=0.004),最近1周的自杀意念显著低于对照组(P=0.048)外,上述其他指标在两组间无统计学差异.结论 干预方案能够改善自杀高危青少年的部分自杀行为和相关因素.目前干预结果提示我们应延长随访时间以便能够观察到最大化的干预效果.