Illness perceptions in patients with fibromyalgia

Objective

Former studies in chronic diseases showed the importance of patients’ beliefs and perceptions. The Revised Illness Perception Questionnaire was developed to assess these illness perceptions. Our goal was to investigate psychometric properties of the IPQ-R for Fibromyalgia Dutch language version (IPQ-R FM-Dlv) and to describe illness perceptions of participants with FM.

Methods

196 patients completed the IPQ-R FM-Dlv. Internal consistency, domain structure and inter domain correlations were calculated and compared to the IPQ-R English language version. Scores were compared with chronic fatigue syndrome (CFS), rheumatoid arthritis (RA), and coronary heart disease (CHD).

Results

Most psychometric properties were comparable to those of the original IPQ-R. Participants showed a lack of understanding of their illness, expected their FM to be chronic and to have a lot of negative consequences on functioning. In 17 out of 24 domains significant differences were found between FM and CFS, RA, and CHD patients.

Conclusion

The IPQ-R FM-Dlv showed acceptable psychometric properties, although some aspects need closer examination. Illness perceptions of FM patients on the Dutch questionnaire were non-comparable to CFS, RA, and CHD patients on the English questionnaire.

Practice implications

The IPQ-R FM-Dlv can be used to assess illness perceptions of Dutch FM patients.     

疾病感知问卷中文版对急性心肌梗死患者的适用性和信效度分析

目的:探讨修订的疾病感知问卷(IPQ-R)中文版在急性心肌梗死患者中的适用性,并分析其信效度。方法:按量表翻译程序将IPQ-R译成中文,方便选取118名急性ST段抬高的心肌梗死患者进行IPQ-R中文版的测量,同时运用综合性医院焦虑抑郁量表(HADS)初步评价情绪状态。选取32名患者于初评后1个月重复测量。结果:IPQ-R中文版内部一致性系数为0.66-0.92;1个月的重测信度略低,为0.35-0.61;与焦虑评分相关明显(r=0.049-0.384,P<0.05)。探索性因素分析提取了7个特征根大于1的因子,各条目负荷范围为0.42-0.88,累积贡献率为60.75%,能够合理解释问卷的结构。结论:IPQ-R中文版适用于急性心肌梗死患者,具有较好的信度和效度。     

The impact of beliefs about mental health problems and coping on outcome in schizophrenia

BACKGROUND: Using the theoretical framework of the Self Regulation Model (SRM), many studies have demonstrated that beliefs individuals hold about their physical health problems are important in predicting health outcomes. This study tested the SRM in the context of a mental health problem, schizophrenia. METHOD: One hundred and twenty-four people with a diagnosis of schizophrenia were assessed on measures of symptom severity, beliefs about their mental health problems, coping and appraisal of outcome at two time points, 6 months apart. RESULTS: Using multivariate analyses and controlling for severity of symptoms, beliefs about mental health were found to be significant predictors of outcome. Beliefs about greater negative consequences were the strongest and most consistent predictors of a poorer outcome in both cross-sectional and longitudinal analyses. CONCLUSIONS: These results suggest that the SRM is a promising model for mental health problems and may highlight important areas for development in clinical, and especially psychosocial interventions.     

心理干预对儿童精神分裂症患者亲属心理健康的影响

目的：探讨心理干预对儿童精神分裂症症患者亲属心理健康的影响。方法：对入组的30例精神分裂症患儿亲属定期进行心理干预，采用症状自评量表（SCL－90）在干预前后进行心理卫生状况调查。结果：心理干预前与国内常模比较SCL－90总分及焦虑，抑郁，强迫症状，恐怖，偏执，精神病性因子分有显著性差异（P＜0．05，P＜0．01），干预后SCL－90总分及各因子分较干预前显著性差异（P＜0．05，P＜0．01）。结论：儿童精神分裂症患者亲属存在较多的心理问题，心理干预能有效提高精神分裂症患者亲属的心理健康水平。     

广州市妇幼医疗机构医护人员对产后心理行为问题的识别情况

目的了解广州市妇幼医疗机构的医护人员对产妇产后心理行为问题的识别处理情况和相关因素。方法采用分层随机整群抽样方法,选取广州市8家妇幼医疗机构产科的245位医护人员(医师95位,护士150位)和精神专科机构(广州市精神病医院)的59位精神卫生专业人员(医师22位,护士37位),分别完成孕产妇常见心理行为问题病例分析中有关产后抑郁症患者和精神分裂症患者的识别和处理问卷。采用χ2检验和精确概率法统计妇幼机构医护人员和精神卫生专业人员的问卷答案正确率比较,采用独立样本的t检验比较妇幼机构医护人员和精神卫生专业人员的问卷得分;采用单元及多元线性回归(后退法)探寻问卷得分的影响因素。结果两组医生正确识别产后抑郁无显著性差异(94.74%vs.100%,P=0.582),妇幼机构护士低于精神卫生专业护士(86.67%vs 100%,χ2=4.216,P=0.040);正确识别精神分裂症妇幼机构医护人员低于精神卫生专业人员(医师为16.84%vs 72.73%,χ2=28.077,P<0.001;护士为6.67%vs 43.24%,χ2=33.170,P<0.001);对两个病做出转入精神专科住院的正确处理方面;妇幼机构医护人员差于精神卫生专业人员,且差异有显著性(抑郁症病例:医师为24.21%vs86.36%,χ2=29.988,P<0.001,护士为10%vs 62.16%,χ2=49.874,P<0.001;精神分裂症病例:医师为32.63%vs 90.91%,χ2=22.727,P<0.001,护士为17.33%vs 67.67%,χ2=37.759,P<0.001)。精神卫生专业人员对抑郁症病例和精神分裂症病例的问卷得分及总分均高于妇幼机构医护人员;精神专科机构、医师、培训是抑郁症问卷得分的影响因素(β=0.338、0.218、0.152,t=6.168、4.282、2.756,P均≤0.01),精神专科机构、综合医院、医师、培训是分裂症问卷得分的影响因素(β=0.460、0.119、0.241、0.133,t=8.109、2.263、4.974、2.520,P均≤0.05)。结论妇幼医疗机构医护人员对产妇产后心理行为问题识别处理能力不足,未达到国家精神卫生规划要求。     

Do people with schizophrenia display theory of mind deficits in clinical interactions?

BACKGROUND: Having a 'theory of mind' (ToM) means that one appreciates one's own and others' mental states, and that this appreciation guides interactions with others. It has been proposed that ToM is impaired in schizophrenia and experimental studies show that patients with schizophrenia have problems with ToM, particularly during acute episodes. The model predicts that communicative problems will result from ToM deficits. METHOD: We analysed 35 encounters (> 80 h of recordings) between mental health professionals and people with chronic schizophrenia (out-patient consultations and cognitive behaviour therapy sessions) using conversation analysis in order to identify how the participants used or failed to use ToM relevant skills in social interaction. RESULTS: Schizophrenics with ongoing positive and negative symptoms appropriately reported first and second order mental states of others and designed their contributions to conversations on the basis of what they thought their communicative partners knew and intended. Patients recognized that others do not share their delusions and attempted to reconcile others' beliefs with their own but problems arose when they try to warrant their delusional claims. They did not make the justification for their claim understandable for their interlocutor. Nevertheless, they did not fail to recognize that the justification for their claim is unconvincing. However, the ensuing disagreement did not lead them to modify their beliefs. CONCLUSIONS: Individuals with schizophrenia demonstrated intact ToM skills in conversational interactions. Psychotic beliefs persisted despite the realization they are not shared but not because patients cannot reflect on them and compare them with what others believe.     

慢性精神分裂症照料者生命质量的调查

目的:调查慢性精神分裂症患者照料者的生命质量状况。方法:纳入符合ICD-10慢性精神分裂症患者照料者60例和与之匹配的健康对照组60例,采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、生活质量综合评定问卷(GQOLI-74)和领悟社会支持量表(PSSS)分别对两组进行评估。结果:慢性精神分裂症患者照料者的HAMD、HAMA评分高于健康对照组(t=8.218,6.144;P0.001),PSSS总分(t=6.242,P=0.000)和GQOLI-74各维度分(t=2.622,4.983,2.983,4.184,6.137;P0.05)低于对照组,差异有统计学意义。生活质量的心理功能维度与心理健康状况(HAMD,HAMA)呈负相关(r=-0.288,-0.312;P0.01),与家庭支持呈正相关(r=0.457,P0.01),总体生活质量因子分与抑郁情绪呈负相关(r=-0.167,P0.05),GQOLI-74的4个维度与社会支持总分呈正相关(r=0.157,0.281,0.414,0.164;P0.05或0.01)。结论:慢性精神分裂症患者照料者的心理健康状态、社会支持度、生活质量较健康对照组差,应引起重视。     

Illness perception in bulimia nervosa

The study was designed to extend our understanding of illness perceptions in patients with bulimia nervosa (BN). Seventy-eight participants with BN or BN-type Eating Disorder Not Otherwise Specified (EDNOS-BN) completed the Revised Illness Perception Questionnaire (IPQ-R) (Moss-Morris et al., 2002). Clinical variables were also assessed. Participants experienced their ED as chronic, with serious consequences and high associated levels of anxiety and depression. The disorder was attributed primarily to psychological causes. The results indicate the perceived severity of BN, and high level of associated distress. These findings highlight the potential for targeting illness perceptions in treatment.     

A multivariate perspective on schizotypy and familial association with schizophrenia: a review

Although generally accepted that schizotypal personality disorder diagnosis is more prevalent among relatives of individuals with schizophrenia and may be associated with genetic liability to schizophrenia, it seems likely that this diagnosis is itself heterogeneous and thus perhaps not as useful in identifying genes that affect schizophrenia risk (i.e. endophenotypes) as it could be. In contrast, symptoms and dimensions of schizotypal personality disorder may be more etiologically homogeneous, and thus more useful in genetic studies. The current review evaluated and consolidated evidence to date regarding specific symptoms and dimensions of schizotypal personality disorder among non-psychotic relatives of schizophrenia patients. Comparisons were made with relatives of affective disorder patients and non-psychiatric controls. Findings indicate strong support for elevation of social-interpersonal schizotypal symptoms among relatives of schizophrenia patients versus other groups along with moderate specificity. Results suggest only a small elevation of cognitive-perceptual and disorganized symptoms in relatives of schizophrenia patients and results for disorganized symptoms were inconsistent across studies. Thus, evidence to date supports further investigation of genetic associations between symptoms of schizotypal personality disorder and schizophrenia, and suggests that social-interpersonal symptoms may be particularly promising in genetic analyses of schizophrenia.     

Physical and psychological health of first and second generation Turkish immigrants in Germany

Recent studies in Germany suggest that first generation Turkish immigrants have lower mortality rates compared to native Germans. Conversely, studies examining morbidity, though not national in scope, have demonstrated that first generation Turks may have poorer health than native Germans. Additionally, little is known about the health of the emerging second generation Turkish population in Germany. To evaluate the discrepancy between mortality and morbidity trends and contribute to a better understanding of second generation Turkish immigrant health, this paper uses a nationally‐representative dataset, including the 2005 German Gender and Generations Study (GGS) (n = 10,017) and the 2006 GGS Turkish supplement (n = 4,045), to assess three health outcomes: chronic illness, self‐assessed health, and feelings of emptiness. The paper investigates whether sex, age, socioeconomic status, emotional support, or duration of residence in Germany predict these dimensions of health. Results establish clear health status differences between Turks and native Germans. Surprisingly, both first and second generation Turks tend to have lower chronic illness rates and rate their health as better than Germans at younger ages, but the advantage diminishes among higher age strata for the first generation. Feelings of emptiness results generally indicate an increased susceptibility to psychological problems for both generations of Turks. Controlling for socioeconomic status and age reduces these health differences modestly, pointing to their likely role as mediators. The relatively higher risks for all three health outcomes among Turkish females of both generations compared to their German counterparts suggest that female Turkish immigrants and their female offspring may be particularly vulnerable. Am. J. Hum. Biol. 2010. © 2010 Wiley‐Liss, Inc.     

Coping and Negative Appraisal as Mediators Between Control Beliefs and Psychological Symptoms in Children of Divorce

Examined control beliefs of children of divorce as predictors of their coping, negative appraisals for stressful events, and mental health problems. We tested whether coping and negative appraisal for stressful events mediated the relations between multiple dimensions of control beliefs and mental health problems. Different dimensions of control beliefs were related to different aspects of coping and negative stress appraisal. Internal control beliefs for positive events were related to both active and avoidant coping. Unknown control beliefs for positive events were related to higher active coping and higher negative appraisal. Unknown control beliefs for negative events were related to higher avoidant coping. In addition, evidence for mediation was found such that the effect of unknown control beliefs for positive events on mental health problems was mediated by negative appraisal. Implications and directions for further research are discussed.     

Classifying health‐related behaviours: Exploring similarities and differences amongst behaviours

Objectives. The classification of health behaviours may provide a useful framework for understanding their characteristics and therefore the ways in which they are similar and different. However, to date, little research has attempted to identify these characteristics and explore the dimensions along which behaviours differ. This paper uses an inductive approach to explore this issue. Design and methods. In Study 1, 25 repertory grid interviews and 3 focus groups encompassing lay public and health professionals identified 25 ways of describing health behaviours. These were refined into 11 key characteristics. In Study 2, 180 members of the general public rated 20 health behaviours on each of these characteristics. Results. Principal components analysis indicated behaviours were perceived along three key dimensions: ‘easy immediate pay‐offs’ versus ‘effortful long‐term pay‐offs’; ‘private unproblematic’ versus ‘public and problematic’; and ‘important routines’ versus ‘unimportant one‐offs’. Risk behaviours were clearly differentiated being perceived as ‘easy immediate pay‐offs’ and ‘public–problematic’. In contrast with other approach behaviours such as diet or self‐examination, physical activity behaviours were perceived as ‘effortful long‐term pay‐offs’. Conclusions. This research provides an useful starting point in the development of a framework that allows us to better understand differences and similarities between health behaviours. These dimensions may be important to consider when researchers set out to predict or change behaviour.     

女性精神分裂症患者配偶心理状况的调查

目的：探讨女性精神分裂病患者配偶的心理健康状况。方法：对173例女性患者配偶采用症状自评量表(SCL-90)社会支持评定量表(SSRS)、焦虑自评量表(SAS)，抑郁自评量表(SDS)进行测评。并以60例与这相匹配的非女性精神病的配偶为对照。结果：女性患者配偶SCL-90总分及各因子分均高于对照组，心理健康水平与社会支持水平呈负相关。城市与农村患者配偶除抑郁、焦虑、敌对、人际敏感，因子分外，总分及其余各因子分比较差异无显著性。且两组SAS、SDS总分和标准分均有差异。结论：女性精神分裂症配偶存在不同程度的心理问题．与社会支持、文化经济状况等有显著关系，城市患者配偶存在更多的心理问题。     

Attention bias for paranoia-relevant visual stimuli in schizophrenia

Introduction. A number of studies indicate that patients with schizophrenia share a bias for paranoia-relevant material. The presence of an attentional bias for such stimuli would be of utter importance for our pathogenetic understanding of the disorder in view of ample evidence that patients with schizophrenia gather little information before arriving at strong conclusions: A both scarce and affectively biased data selection of available information may heavily distort its inner representation and thus prompt the formation of false beliefs. To date, the profile of this putative attentional bias in schizophrenia (e.g., automatic vs. controlled; hypervigilance towards vs. problems to disengage from such stimuli) is not fully uncovered.Methods.To shed light on this aspect of information processing in schizophrenia, we administered a novel task based on the inhibition of return paradigm (IOR). Twenty-four schizophrenia patients and thirty-four healthy controls were presented neutral (e.g., cup), anxiety-relevant (e.g., shark), and paranoia-relevant cue pictures (e.g., gun) at either of two possible locations. Subsequent to either a short or long interval, a target appeared at the same or opposite location. Participants were requested to press a spatially corresponding button.

Results. Both currently paranoid and nonparanoid schizophrenia patients responded faster to all kinds of targets following paranoia-relevant pictures, that is, such stimuli speeded reaction times irrespective of the cue–target interval and spatial correspondence.

Conclusions. This indicates that paranoia-relevant information generally alerts patients more than other stimuli and facilitates processing of subsequent information. Possible implications of this finding for our understanding of delusion formation and maintenance are outlined.     

癌症与精神病人亲属心身状况及改善对策的跨文化探讨

目的研究居澳华裔及国内癌症及精神病人亲属的健康状况。方法以深层面谈和电话会谈、问卷法调查居澳华裔、居国内的癌症和精神病患者及其亲属共288人。结果绝大部分亲属有不同程度的焦虑、抑郁,伴有失眠、疲劳、衰弱等症状。2.78％～11．11‰被诊断为焦虑症、抑郁症或各种心身疾病。癌症病人亲属的健康状况随病人病情的波动而变化;精神病人亲属的健康状况随病人病情的进展和时间的推移趋向稳定。国内组与澳洲组表现有一定的差别。他们希望有完善的机构与设施帮助照顾其患病的亲人。结论建立完善的机构为癌症及精神病患者提供照顾等服务,帮助其亲属进行有效的心理调节,保持心身健康,是21世纪的国际性课题之一。     

How patients with schizophrenia use the internet: qualitative study

Background

The Internet is an important source of health information for people with psychiatric conditions. Little is known about the way patients with schizophrenia use the Internet when it comes to issues related to their illness. Data on their specific needs, difficulties, and the consequences related to Internet use are lacking.

Objective

Our objective was to investigate the nature and subjective consequences of health-related Internet use among patients with schizophrenia.

Methods

In all, 26 individual semistructured interviews were conducted and analyzed qualitatively in groups of 4 until theoretical saturation was achieved.

Results

Study results suggest that the Internet is an influential source of illness-related information for patients with schizophrenia. Many aspects of their behavior around the Internet resemble those of individuals not afflicted by mental illness. Importantly, problems specific to patients with schizophrenia were stimulus overflow, an inability to deal with the abundance of information, difficulties with concentration, lack of energy, paranoid ideas, symptom provocation, and the need to distance themselves from illness-related topics as part of the recovery process. Internet information was subjectively perceived as having the potential to significantly change patients’ attitudes toward medication and their relationships with doctors.

Conclusions

These findings provide insight into how individuals with schizophrenia handle illness-related Internet information. The data could contribute to the continuous development of Internet-based interventions and offer novel approaches to optimizing traditional treatment options.     

GP views of their management and referral of psychological problems: A qualitative study

The ways that GPs manage and make referral decisions for psychological problems are crucial for the provision of mental health care, although the ways they undertake these tasks are not well understood. A long tradition of psychiatric research in the UK has identified significant shortcomings in detection rates, raising concerns that a large proportion of mental health problems go unrecognized and untreated. Other research has suggested that GPs have a different approach to psychological problems than their mental health colleagues, accounting for some of the particular conditions of primary care, although this approach may differ from the methods used by mental health specialists. The present study explored the views of 10 GPs in one geographic locality about managing and making referral decisions for psychological problems. Grounded theory analysis of interview data allowed for the development of a model made up of five components. This model described the ways that GPs explored psychological problems in the context of containing patients' health problems. Referral decisions were made when GPs felt they had reached the limits of their capabilities for treating a particular problem, taking account of the patient's suitability for psychological therapy and access to psychology services. These decisions were influenced by GPs' views of psychological problems and therapies as well as by their professional interactions with psychologists. The implications of the findings for understanding how GPs work with mental health problems and the ways that psychological services can help are discussed.     

Increasing Mexican American attendance of support groups for parents of the mentally ill: Organizational and psychological factors

Research was carried out to identify organizational and psychological factors associated with the attendance by Mexican Americans at family support groups. Qualitative and action-oriented pilot research identified parents' preferences for organizational arrangements, and two support groups were created that were Spanish speaking, facilitated by bilingual mental health professionals, and closely linked to ethnic mental health agencies. A prospective study was then carried out that involved 32 Mexican families with a son/daughter being treated for schizophrenia at one of the two agencies. The parent who was the primary caregiver in each family was interviewed and then referred to one of the two groups; parents' attendance was followed for 1 year. Parent attendance was related to the level of burden experienced and assumptions about the causes of their son/daughter's problems.     

Social status,social support,and stress: a comparative review of the health consequences of social control factors

Abstract

The purpose of this review is to present evidence that two fundamental relationship dimensions, social status and social support, play significant roles in protecting individuals from stressors, stress responding, and related health problems. While there is a substantial literature on the link between social support and health, the role of social status has been largely overlooked in health psychology research. Research with humans and animals, in a variety of disciplines, demonstrates the effects of both status and support on acute stress responding and long-term health outcomes. Taken together, this research suggests that status and support serve to increase the individual's control over the social and physical environment, thus reducing the experience and effects of stress. The proposed social control model has implications for future research, including development of new measures, identification of health-relevant relationships, and generation of research questions to further illuminate our understanding of how social interactions affect health.