精神疾病患者未成年一级亲属病耻感与情绪行为问题的关系

目的 探讨精神疾病患者未成年一级亲属病耻感与情绪行为问题的关系,以及自我效能和心理弹性在病耻感与情绪行为问题关系中的中介效应.方法 选取山东省某精神卫生中心前来门诊就诊及住院的精神疾病患者未成年子女104人作为研究对象,采用Link贬低-歧视感知量表、一般自我效能量表（GSES）、心理弹性量表（RS）、长处和困难问卷（SDQ）进行调查.结果 精神疾病患者未成年一级亲属的情绪行为问题分别在性别、居住地、就读学校和是否独生子女上存在显著差异性（P＜0.05,P＜0.01）;精神疾病患者未成年一级亲属SDQ总分与病耻感呈显著正相关（P＜0.01）,与自我效能和心理弹性均呈显著负相关（均P＜0.01）;病耻感分别与心理弹性和自我效能均呈显著负相关（均P＜0.01）;心理弹性与自我效能呈显著正相关（P＜0.01）;自我效能和心理弹性在病耻感与情绪行为问题之间起到完全中介作用（P＜0.05,P＜0.01）.结论 感知到病耻感的精神疾病患者未成年一级亲属存在情绪行为问题,而自我效能和心理弹性在病耻感与精神疾病患者未成年一级亲属情绪行为问题关系中起完全中介作用.     

患者病耻感的干预研究进展

病耻感是一个涉及医学、社会学、心理学等众多学科的复杂问题。通过阐述病耻感的概念及其公众病耻感和自我病耻感两个层面之间的关系,并归纳总结国内外应对病耻感的干预方法,旨在为护理专业人员应对患者病耻感提供参考。     

年轻乳腺癌术后患者病耻感的调查研究

采用一般资料调查表、社会影响量表对符合纳入和排除标准的123例接受乳腺癌手术的年轻患者进行现状调查。社会影响量表总分中社会排斥维度得分最高,经济歧视得分最低。提示年轻乳腺癌术后患者存在一定程度的病耻感,家庭和朋友应给予患者更多的关心和帮助;护理人员应该进行有效心理辅导,以减轻患者的病耻感。     

病耻感心理护理干预促进网络成瘾患者康复

目的观察病耻感心理护理干预对网络成瘾患者康复的效果。方法将60例存在病耻感的网络成瘾患者随机分为观察组和对照组各30例,对照组参加军训、学习、娱乐、劳动卫生等治疗活动;观察组在此基础上同时给予12周的病耻感心理护理干预,具体内容包括寻因治疗、心理分析、认知领悟疗法、能力训练行为矫正、亲情培养、社会适应能力的培养和成立家长同盟管理委员会等方法,以减轻患者的病耻感。结果两组抑郁自评量表(SDS)、焦虑自评量表(SAS)、社交回避及苦恼量表(SAD)、症状自评量表(SCL-90)因子评分(除偏执、精神病性外)比较,差异有统计学意义(均P0.05)。结论病耻感可造成网络成瘾患者的负性情绪和心理障碍。实施针对病耻感心理护理干预对网络成瘾患者心境障碍和社交障碍具有良好的治疗效果。     

慢性病毒性乙型肝炎患者病耻感及其影响因素的调查与分析

目的描述慢性乙型肝炎患者的病耻感现状;探讨影响慢性乙型肝炎患者病耻感的相关因素。方法采用描述性研究设计,便利抽样的方法,问卷调查广州某三甲医院普通外科住院的34名慢性乙型肝炎患者的病耻感。结果 4个维度的平均得分从高到低分别为:内在羞耻、社会排斥、经济歧视、社会隔离;不同婚姻状况、受教育程度及家庭人月均收入水平的慢性乙肝患者的病耻感的差异具有统计学意义(P0.05);单身者(含未婚/丧偶/离异)病耻感较已婚者明显,文化程度越低越明显;家庭人均月收入水平越低病耻感越明显。而不同的性别、年龄、民族、宗教信仰及职业的慢性乙型肝炎患者的病耻感的差异不具有统计学意义(P0.05)。结论慢性乙型肝炎患者的病耻感处于较高水平,且以内在羞耻感最为突出。单身(含未婚、离异和丧偶)的慢性乙肝患者,其病耻感水平明显高于已婚者;患者的受教育水平越低,其病耻感越高;人均月收入越低,其病耻感越高。     

书写表达积极情绪干预对中青年2型糖尿病患者病耻感的影响

目的 探索书写表达积极情绪干预减轻中青年2型糖尿病患者病耻感的效果。方法将100例中青年2型糖尿病患者随机分为对照组和干预组各50例。对照组实施常规护理,干预组在常规护理基础上实施持续8周的书写表达积极情绪干预。采用2型糖尿病病耻感评估量表、糖尿病自我效能量表、WHO-5幸福感指数量表评估干预效果。结果最终对照组45例、干预组47例完成研究。干预8周后,干预组病耻感得分显著低于对照组,糖尿病管理自我效能、幸福感得分显著高于对照组（均P＜0.05）。结论书写表达积极情绪干预可减轻中青年2型糖尿病患者病耻感,提高患者疾病管理自我效能和主观幸福感。     

良性前列腺增生患者病耻感护理研究进展

良性前列腺增生常发于中老年男性,影响生理健康的同时,也会引发不同程度的病耻感,导致患者治疗依从性和生活质量降低。本文从病耻感的概念发展、良性前列腺增生患者病耻感现状、病耻感来源及影响、病耻感调查工具、干预措施方面进行阐述,以期提高医务人员对病耻感的认识,为采取有效护理干预提供依据。     

农村精神分裂症患者精神卫生知晓率与病耻感相关分析

目的：了解重性精神疾病管理治疗项目救助的农村精神分裂症患者精神卫生知晓率与病耻感相关因素,为社区综合干预提供基础资料。方法随机抽取新乡县2011年重性精神疾病管理治疗项目救助的107例精神分裂症患者为调查对象。测查患者精神卫生知识知晓率、评估获得社会支持及病耻感状况,分析相关因素。结果对精神卫生知识知晓的有47例,占43.9%,与对照组相比较在价值否定和社交退缩方面差异具有显著性（P＜0.01）。结论影响精神分裂症患者病耻感存在多方面因素,应强化社区综合干预,提高精神卫生公众教育与知晓率。     

2型糖尿病患者病耻感与抑郁和血糖控制的关系

目的分析2型糖尿病患者病耻感现状及其与抑郁和血糖控制的关系。方法对209例2型糖尿病住院患者采用2型糖尿病病耻感评估表、Zung抑郁自评量表(SDS)进行调查,收集患者一般资料和血糖控制指标。结果2型糖尿病患者病耻感总分为(52.52±10.75)分,其中区别对待、责怪与评判、自我耻辱维度得分分别为(16.29±3.99)、(18.70±3.69)、(17.54±5.12)分。抑郁得分(44.06±9.69)分,其中有抑郁症状66例(31.58%)。不同抑郁状态和血糖水平患者病耻感得分比较,差异有统计学意义(均P0.01)。2型糖尿病患者FPG、HbA1c水平与抑郁得分呈正相关(均P0.01);抑郁得分和血糖值分别与病耻感总分及各维度得分呈正相关(均P0.01)。结论 2型糖尿病患者病耻感处于中等偏低水平,其病耻感与抑郁和血糖控制呈正相关。医护人员应多关注2型糖尿病患者病耻感,采取有效措施尤其是做好血糖控制、心理疏导,有助于降低2型糖尿病患者病耻感和抑郁症状。     

慢性前列腺炎患者病耻感现状及影响因素分析

<正>慢性前列腺炎(chronic prostatis,CP)是中青年男性的常见病、多发病,躯体表现为骨盆区或会阴部疼痛或不适,极易产生病耻感~([1])。病耻感是指由于患病患者内心产生的一种的耻辱感觉,是一种负性的心理应激反应,感觉被标签化、被疏远、被歧视,这不仅给患者带来精神上的困惑,而且会对疾病的治疗产生负面影响~([2])。本研究通过问卷调查,了解患者病耻感的严重程度及相关影响因素,为治疗CP和减轻患者痛苦提供帮助。     

首发精神障碍青少年患者父母心理社会轨迹探究

目的 探索首发精神障碍青少年患者父母心理社会轨迹,为针对性干预提供参考。方法 对42例首发精神障碍青少年患者的43名父母,采用一般资料调查表、应付方式问卷、SCL-90问卷于确诊2周内进行调查,于6个月、12个月再用SCL-90问卷调查;于上述3个时间段对患者父母进行半结构化访谈,归纳分析其心理社会轨迹。结果 父母3个时间段SCL-90得分呈下降趋势,差异有统计学意义（P＜0.05）;依据应付方式得分分为退避自责组（22人）与非退避自责组（21人）,两组SCL-90得分比较,第6个月及时间效应有统计学意义（均P＜0.05）;访谈资料呈现心理弹性、心理恢复、心理痛苦3种心理社会轨迹。结论 首发精神障碍青少年患者父母早期心理社会轨迹呈3种不同形式,大部分父母心理健康水平随患者病情好转而逐渐恢复,少部分父母心理痛苦持续存在。医护人员应同步对患者父母实施针对性干预,以提高其心理健康水平。     

Impact of serious mental illness on surgical patient outcomes

Background

People with comorbid mental illness have poorer health status and disparate access to healthcare. Several studies internationally have reported mixed findings regarding the association between mental illness and surgical patient outcomes. This study examines the surgical outcomes in people with decompensated serious mental illness (SMI) within the setting of the Australian universal healthcare system.

Methods

Retrospective cohort study involving elective overnight surgical patients aged 18 years and above who attended a large public tertiary referral hospital in Sydney, Australia, between 2010 and 2014. Patients were identified using ICD‐10‐AM diagnosis codes. Outcomes measure including in‐hospital mortality, post‐operative complications, morbidity, admission and time in intensive care, length and cost of hospitalization, discharge destination and 28‐day re‐admission rates were examined.

Results

Of 23 343 surgical patient admissions, 451 (2%) patients had decompensated comorbid SMI with a subset of 47 (0.2%) having a specific psychotic illness. Patients with SMI comorbidity had significantly higher in‐hospital mortality (2% versus 0%), post‐operative complications (22% versus 8%), total comorbidity (7.6 versus 3.4 secondary codes), admissions (29% versus 9%) and time in intensive care (34.6 h versus 5.0 h), stay in hospital (12.2 days versus 4.6 days), admission costs ($24 162 versus $12 336), re‐admission within 28 days (14% versus 10%) and discharges to another facility (11% versus 3%).

Conclusion

Patients with comorbid SMI had significantly worse surgical outcomes and incur much higher costs compared with the general surgical population. These results strongly highlight that specific perioperative interventions are needed to proactively improve the identification, management and outcomes for these disadvantaged patients.     

罗定市重性精神病疾病管理效果分析

目的：评估、分析罗定市重性精神疾病管理效果。方法选取罗定市重性精神疾病患者病情不稳定或基本稳定（危险性评估等级1～5级）的精神分裂症患者共125例作为研究对象,在实施重性精神疾病管理治疗工作前和后（3年）分别使用一般状况调查表、危险性评估量表及阳性和阴性综合征量表（ PANSS）、社会功能缺陷筛选量表（ SDSS）进行管理前后对比研究。结果实施管理3年时与管理前比较,125例患者的危险性评估等级下降（P＜0.01）,实施前后PANSS、SDSS总分比较均有显著性差异（P＜0.01）。结论重性精神疾病管理治疗工作对控制精神疾病患者危险性行为,减少患者社会功能缺陷,改善患者精神病性症状,促进患者社会康复的效果是明显的,此项工作值得进一步发展和推广。     

自杀未遂青少年自杀污名体验的质性研究

目的 深入了解自杀未遂青少年患者的污名化体验,为帮助自杀未遂青少年患者心身康复提供参考。方法 采用解释性现象学研究方法,选取2022年3～12月有自杀未遂经历的15例青少年患者进行半结构式访谈,使用Colaizzi 7步分析法提炼主题。结果 共提炼出3个主题和9个亚主题,即自我污名负性情绪体验(羞耻与自责,绝望与愤怒),公众污名负性体验(家人不理解加深羞耻和愤怒,老师、同学反应和期待有落差,网友言语冲击感受失落),负性体验后的消极应对(自我表露意愿低,产生再自杀想法,回避专业帮助,回避正常人际交往)。结论 自杀未遂青少年有强烈的自我污名负性情绪和公众污名负性情绪,由此产生消极应对。因此,应积极调整自杀未遂青少年对污名的片面认知,改善其应对污名的方式,促进自杀未遂青少年身心的康复,防止再自杀的发生。     

HIV,violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV

Introduction : Internalized HIV stigma is a key risk factor for negative outcomes amongst adolescents living with HIV (ALHIV), including non‐adherence to anti‐retroviral treatment, loss‐to‐follow‐up and morbidity. This study tested a theoretical model of multi‐level risk pathways to internalized HIV stigma among South African ALHIV. Methods : From 2013 to 2015, a survey using t otal population sampling of ALHIV who had ever initiated anti‐retroviral treatment (ART) in 53 public health facilities in the Eastern Cape, South Africa was conducted. Community‐tracing ensured inclusion of ALHIV who were defaulting from ART or lost to follow‐up. 90.1% of eligible ALHIV were interviewed (n = 1060, 55% female, mean age = 13.8, 21% living in rural locations). HIV stigma mechanisms (internalized, enacted, and anticipated), HIV‐related disability, violence victimization (physical, emotional, sexual abuse, bullying victimization) were assessed using well‐validated self‐report measures. Structural equation modelling was used to test a theoretically informed model of risk pathways from HIV‐related disability to internalized HIV stigma. The model controlled for age, gender and urban/rural address. Results : Prevalence of internalized HIV stigma was 26.5%. As hypothesized, significant associations between internalized stigma and anticipated stigma, as well as depression were obtained. Unexpectedly, HIV‐related disability, victimization, and enacted stigma were not directly associated with internalized stigma. Instead significant pathways were identified via anticipated HIV stigma and depression. The model fitted the data well (RMSEA = .023; CFI = .94; TLI = .95; WRMR = 1.070). Conclusions : These findings highlight the complicated nature of internalized HIV stigma. Whilst it is seemingly a psychological process, indirect pathways suggest multi‐level mechanisms leading to internalized HIV stigma. Findings suggest that protection from violence within homes, communities and schools may interrupt risk pathways from HIV‐related health problems to psychological distress and internalized HIV stigma. This highlights the potential for interventions that do not explicitly target adolescents living with HIV but are sensitive to their needs.     

淋巴瘤患者病耻感与生活质量的相关性研究

目的 探讨淋巴瘤患者病耻感和生活质量的现状及其相关性。方法 采用癌症患者生命质量测定量表及社会影响量表对120例淋巴瘤患者进行调查。结果 淋巴瘤患者的病耻感总分为（61.07±10.37）分,生活质量的总体健康状况得分为（55.07±22.46）分;多元线性回归分析结果显示,与医护人员的交流程度、病耻感是影响患者生活质量的因素（均P＜0.05）。结论 淋巴瘤患者存在较低的生活质量与较高的病耻感,病耻感与生活质量呈负相关。医护人员应及早识别病耻感较高的患者,并采取针对性措施,有效提升其生活质量。     

心理弹性对社区老年人心理压力与心理健康的中介效应

目的探讨心理弹性对社区老年人心理压力与心理健康的中介作用,尝试从新的角度为其缓解心理压力、促进心理健康提供干预的依据。方法采用心理弹性量表(RS-14)、中文版知觉压力量表(CPSS)和一般健康量表(CHQ-12),调查辽宁省锦州市凌河区、古塔区和太和区三个社区410名老年人,并运用SPSS17.0软件和AMOS17.0软件进行数据统计分析。结果心理弹性、心理压力和心理健康三者间存在线性相关关系,且心理弹性与心理健康、心理压力呈负相关。心理压力和心理弹性对心理健康都有预测作用,心理弹性亦可作为心理压力和心理健康之间的中介变量。结论心理弹性作为心理压力与心理健康的中介变量,使其不良影响有所下降。关注心理弹性的作用,并对其影响因素进行干预,是提升老年人心理健康的积极探索。     

The presence and impact of traumatic brain injury among clients in treatment for co-occurring mental illness and substance abuse

Objectives: To compare diagnostic and treatment-related differences between persons participating in treatment for dually diagnosed substance use disorders and severe mental illness who have or do not have a history of traumatic brain injury (TBI).

Design: Prospective cohort.

Interventions: Not applicable.

Primary measures: Demographic information, diagnostic data, pre-treatment status, treatment participation and staff assessment of functioning.

Results: Seventy-two percent of participants in treatment for dually diagnosed substance use disorders and severe mental illness reported a history of at least one TBI. Participants with TBI had greater morbidity as reflected in more complex psychiatric diagnoses and greater likelihood of being diagnosed with an Axis II personality disorder. Participants with a TBI showed tendencies toward earlier onset of substance use and worse current functioning. Both a greater number of injuries and earlier age at first TBI showed some indications of being associated with worse morbidity.

Conclusions: Individuals dually diagnosed with substance use disorders and severe mental illness may have a high rate of TBI, which in turn could contribute to important clinical and treatment differences. Results also suggested the need for validated methods of identifying aspects of a prior history of TBI that provide more information than presence/absence.