慢性严重疼痛对酒依赖患者生活质量的影响

目的:探讨慢性严重疼痛对酒依赖患者生活质量的影响。方法:根据简明疼痛评估量表评分及疼痛病史将243例出院后的酒依赖患者分为慢性严重疼痛组(疼痛组75例)和非慢性严重疼痛组(非疼痛组168例),采用自编的一般情况问卷、Zung氏抑郁自评量表和简明健康调查量表(SF-36)对两组患者进行的评估,采用多元线性回归分析慢性严重疼痛对生理及心理生活质量的影响。结果:疼痛组SF-36评分显著低于非疼痛组[生理:(131.1±50.9)分vs.(160.3±49.3)分,t=4.222,P0.001;心理:(148.8±55.6)分vs.(178.7±62.5)分,t=3.561,P0.001]。控制协变量后,慢性严重疼痛是生理和心理生活质量下降的独立危险因素(β=-0.385,-0.397;P均0.001)。结论:慢性严重疼痛是酒依赖患者生活质量下降的重要原因之一。     

Measuring readiness to change and locus of control belief among male alcohol-dependent patients in Taiwan: comparison of the different degrees of alcohol dependence

Aims: The purpose of the present study was to evaluate the Drinking‐Related Health Locus of Control scale (DRIE) and the three aspects of readiness to change (i.e. ambivalence, recognition, and taking action), in response to the degree of dependence. Methods: This study was carried out based on data collected from 160 male alcohol‐dependent patients, and the degree of alcohol dependence was divided into three categories: light, moderate, and severe, on the basis of the total scores of the short‐form Severity Degree Alcohol Dependence Data questionnaire (SADD). Results: There were significant differences between the different degrees of dependence on drinking‐related locus of control, feelings of ambivalence toward drinking, recognition of problematic drinking, and readiness to take action to change. Patients with more severe dependence usually had higher scores of drinking‐related locus of control, indicating a tendency toward external locus of control, feelings of ambivalence, and recognition of their drinking problem; patients with light dependence usually had higher scores for taking action. Conclusions: Clinicians can strengthen readiness to change problematic drinking if the importance of degree of dependence and drinking‐related locus of control are taken into consideration when devising interventions.     

Alternative medicine and allergies: life satisfaction, health locus of control and quality of life

OBJECTIVES: Little is known on psychosocial characteristics of subjects with allergies who use or do not use alternative medicine (AM). We aimed to assess health-related quality of life (QoL), life satisfaction and health locus of control of adults with allergies and to compare users and nonusers of AM in a population-based setting. METHODS: In a population-based nested case control study, computer-assisted telephone interviews were performed in subjects (n=351, age median 46 years, response 76.1%) who had reported allergies (hay fever, asthma, atopic eczema and food hypersensitivity) in a previous survey. Questions on health-related QoL and evaluated instruments measuring life satisfaction ("Questions on Life Satisfaction" (FLZ(M))) and health locus of control ("Fragebogen zur Erhebung von Kontrollüberzeugungen zu Krankheit und Gesundheit" (KKG)) were applied. RESULTS: A total of 93 subjects (26.6%), who were younger and better educated than the remaining participants (n=257), reported experiences with AM. General and health-related life satisfaction was not statistically different between users (71.5 and 71.6) and nonusers (68.5 and 67.0) of AM. Nonusers scored significantly higher for fatalistic externality (21.6) than users (19.0) of AM (P=.005, adjusted age, gender and school education). The impact on overall health-related QoL was significantly higher for users (11.7) than nonusers (10.3) of AM. This difference was also significant for the domains "physical," "psychological," "friends and family" and "leisure activities" (adjusted P<.001). CONCLUSIONS: Users and nonusers of AM with allergies can be distinguished by psychosocial characteristics such as health locus of control and QoL.     

Antidepressant treatment of co-occurring depression and alcohol dependence.

The use of antidepressant pharmacotherapy to treat patients with co-occurring depression and alcohol dependence is controversial. There is a stigma attached to giving medications to alcohol-dependent persons. Also, empirical evidence is sparse and inconsistent, which discourages the use of antidepressants in these patients. Historically, it has been a challenge to accurately diagnose a depressive disorder in the presence of alcohol dependence. In addition, early clinical studies were fraught with methodological problems; however, improved diagnostic assessments are now available, and in the last decade, results from well-controlled trials appear to support the use of antidepressants in this patient population in the specific role of relieving depressive symptoms. The majority of these trials also demonstrate that antidepressants have relatively little impact on reducing heavy drinking in this patient population, even though the medications reduce depressive symptoms. Newer approaches to treating patients with co-occurring depression and alcohol dependence suggest adding to the antidepressant a pharmacotherapy that directly impacts drinking. The findings from this review better define the action of antidepressants in patients with co-occurring depression and alcohol dependence as specific to reducing depressive symptoms, and these medications and their action on mood have little impact on treating the co-occurring alcohol dependence.     

负性生活事件对抑郁症患者血清细胞因子水平的影响

目的　探讨负性生活事件对抑郁症患者血清细胞因子水平的影响。方法　采用酶联免疫吸附法 (EL SIA)对有负性生活事件诱因的抑郁症患者 2 3例、无诱因的抑郁症患者 2 9例和 2 9名正常人的血清白介素 2 (IL 2 )、可溶性白介素 2受体 (sIL 2R)、白介素 10 (IL 10 )和白介素 12 (IL 12 )水平进行检测。结果　 3组间IL 2、sIL 2R及IL 12水平存在显著性差异 ,而IL 10则 3组间无显著性差异 ,有负性生活事件诱因组IL 2及sIL 2R水平明显低于无诱因组和对照组 (P <0 0 1) ;有诱因组其负性生活事件对患者心理活动影响的严重程度与IL 2和sIL 2R水平呈负相关(P <0 0 5 )。结论　负性生活事件对抑郁症患者的细胞免疫激活系统有抑制作用 ,IL 2可能是起主要的中介作用。     

Locus of control in chronic anxiety disorders

The relationship between psychopathology and the personality trait, locus of control, was examined in 116 adult outpatients diagnosed as having chronic anxiety disorder. Measures consisted of state and trait scales, a measure of social adjustment, and a measure of disturbance during childhood. Patients with an external locus of control were more depressed, had higher levels of state anxiety, and exhibited more indecisiveness, fatigue and agoraphobia than those with an internal locus of control. Externally oriented patients also scored higher on neuroticism and trait anxiety and scored lower on social adjustment. On the somatic scales, externally oriented patients rated themselves, in contrast to physician's rating, as being more symptomatic than internal patients, suggesting the presence of a help-seeking attitude. Locus of control may be of importance in the formulation of therapy and prognosis in patients with anxiety disorders.     

Health-related quality of life and health locus of control beliefs among HIV-infected treated patients

Obsjective:This study examined the relations between health locus of control (HLOC) beliefs and health-related quality of life (HRQL) in 302 HIV-infected patients enrolled in a French cohort, 44 months (M44) after they began highly active antiretroviral therapy (HAART). Methods: HLOC beliefs were measured with the Multidimensional Health Locus of Control (MHLOC) scale and HRQL, with the Medical Outcome Study Short-Form Health Survey (MOS-SF-36). Results: Internal HLOC beliefs at the initiation of treatment were associated with both physical HRQL in multivariate analysis, while chance HLOC beliefs on beginning HAART were associated with mental HRQL at M44. Conclusion: These findings suggest the importance of considering the psychological characteristics and psychosocial beliefs of patients at the initiation of ARV treatment to optimise the long-term HRQL of HIV-infected patient and to develop adaptive intervention on coping strategies.     

Quality of life as a measure of rehabilitation outcome in patients with multiple sclerosis

A total of 43 patients with multiple sclerosis (MS) consecutively admitted to the Multiple Sclerosis Rehabilitation Hospital in Haslev completed a Danish version of the Laman & Lankhorst Questionnaire (LLQ) on quality of life (qol), and the Beck Depression Inventory (BDI). Twenty-one of the 43 pts completed the questionnaires at discharge as well. All patients received the standard multidiciplinary rehabilitative treatment. The purpose was to evaluate the LLQ as a measure of qol and as an outcome measure. The 43 MS-patients had low weighted qol scores on the following items: readily tired, fatigue, dependence on other people, worry about deterioration and walk. Correspondingly, the BDI showed high scores on fatigability, work difficulty and somatic preoccupation. The correlation between LLQ and BDI was statistically significant (0.54, p<0002), but weak. ANOVA with repeated measures (LLQ and BDI at admission and discharge) was applied to evaluate rehabilitation outcome in 21 patients. LLQ: The patients experienced a significant reduction in disability on fatigue and mood; and in the importance of being able to climb stairs and to work. The weighted qol-scores increased significantly on physical endurance, work and mood. BDI scores showed a significant decrease on pessimism, irritability, loss of libido and total BDI-score. The changes measured by the LLQ were mainly on behavioral aspects. As the correlation coefficient was only 0.54, the LLQ and the BDI seem to address different aspects of quality of life.     

Antecedent life events,social supports and response to antidepressants in depressed patients

We evaluated 355 subjects who entered one of six double-blind placebo-controlled antidepressant drug trials with respect to the occurrence of antecedent adverse life events and their meaning to the patient. Patients were also assessed with regard to the degree of social support they received for the negative life event. The groups differed as to whether they did or did not meet the criteria for melancholic depression; 43 one-week placebo responders were statistically significantly more likely to believe that adverse life events predisposed them to depressive illness and that such life events precipitated their current depression, compared to 312 one-week placebo non-responders. Of the 312 patients who went on to the double-blind phase in which they were treated with either drug (n= 204) or placebo (n= 108), it was noted that, for both melancholic and non-melancholic patients, responders to drug treatment (but not placebo) had a more favourable ratio of social support received/social support desired than non-responders. Non. melancholic responders to both drug and placebo were statistically significantly more likely to report fewer adverse life events and have a less strong belief that adverse life events predispose one to depressive illness than non-responders. Melancholic patients did not show this trend.     

The role of life events in the myasthenia gravis outcome: a one-year longitudinal study

We examined 51 patients suffering from myasthenia gravis (MG) and studied the relevance of stressful life events in relation to the course of the disease. Life events were assessed by means of the Paykel's Interview for Recent Life Events. The stage severity of MG was assessed by means of the Osserman and Genkins scale, twice per patient, at one year intervals. Simultaneously, life events were assessed for the 12 months preceding each of the 2 assessments of MG. Over the 2 MG evaluations 16 patients improved, 6 worsened and in 29 no change took place. Using life events data collected at the first interview, and applying a prospective design, no difference was found between patients who improved and those who remained unchanged or worsened. Life events reported at the second interview, as having occurred during the inter-assessment year, and collected according to a retrospective design, were significantly fewer in improvers than in non-improvers.     

Locus of control and coping strategies in older persons with and without depression

Objectives: To compare locus of control and coping strategies in older persons with and without depression.

Method: This cross-sectional study included 144 depressed in-patients from seven psychogeriatric hospital units, and 106 community-dwelling older persons without depression. All participants were 60 years and older. Locus of control was assessed by a 17-items self-report questionnaire with six response categories. Coping strategies were assessed by a 26-items self-report questionnaire with five response categories. For analytical purposes, age (<75 years vs. ≥75 years), level of education (<10 years vs. ≥10 years) and general medical health (poor vs. not poor) were categorized.

Results: In linear regression analysis, controlling for demographics, health, and social variables, the depressed in-patients showed a higher external locus of control orientation and a less frequent use of problem-focused coping strategies compared with the non-depressed group. No differences in use of emotion-focused strategies were found between the two groups.

Conclusion: Compared with the non-depressed old persons, the depressed hospitalized older persons were characterized by perceptions of less personal control, and less use of problem-focused strategies, what also might have brought positive alterations into their situation.     

Hallucination focused integrative treatment improves quality of life in schizophrenia patients

OBJECTIVE: Psychosocial treatment seems to be effective in the management of schizophrenia, although less in the area of quality of life and social functioning. To study the effectiveness of a hallucination focused integrated treatment with cognitive-behaviour therapy and coping training among schizophrenia patients suffering from 'hearing voices'. METHOD: In a randomized controlled trial (RCT) with 31 patients in the integrated treatment condition and 32 patients in the routine care condition, quality of life was assessed with the self-report questionnaire of the WHO (Bref), and social role functioning with an interviewer based schedule, at entry and 9 (post-treatment) and 18 months later. RESULTS: Follow-up data suggest a significant improvement of quality of life and in particular in social role functioning (effect size 0.64) in favour of the integrated treatment. CONCLUSION: The integrated treatment seems to be effective in reducing overall disability levels and number of patients with serious disabilities.     

Assessment of quality of life with the WHOQOL-BREF in a group of Turkish psychiatric patients compared with diabetic and healthy subjects

Abstract  Decreased quality of life is often an important cause or consequence of psychiatric illness, and needs to be included in a comprehensive treatment plan. The authors aimed to identify how psychiatric patients characterize the quality of their lives compared to others who are suffering from a chronic physical illness (diabetes) and healthy individuals. A total of 100 psychiatric patients were recruited from Dokuz Eylül University Psychiatry Department outpatient clinic. Of these, 34 had 4^th edition Diagnostic and Statistical Manual diagnosis of alcohol dependence, 38 had schizophrenia, and 28 had bipolar disorder. A total of 35 patients with diabetes and 49 healthy individuals were also included in the study. The World Health Organization's Quality of Life Questionnaire was used to measure the quality of life. Patients with alcohol dependence, bipolar disorder, and schizophrenia scored lower than healthy subjects on the physical aspects of quality of life. Patients with schizophrenia had lower scores in the psychological domain compared to patients with bipolar disorder, patients with diabetes, and healthy subjects. In the social relationship domain, patients with schizophrenia and alcohol dependence scored lower compared to healthy subjects. Patients with schizophrenia were worse with respect to social relationships than bipolar patients and diabetics. World Health Organization's Quality of Life Questionnaire is useful for evaluating the needs and targets for interventions in psychiatric patients.     

Postural control and lifetime alcohol consumption in alcohol-dependent patients

Objectives - The aim of this study was to examine the relationship between alcohol consumption and postural control in alcohol-dependent patients. Material and methods - Posturographic measurements were performed in 82 abstinent patients and in 54 healthy controls. The findings in the patients were compared with those in the controls as well as with the daily alcohol consumption, the consumption during 6 months before the admission for alcohol withdrawal therapy and the estimated lifetime alcohol consumption. Results - Postural control was impaired in alcohol-dependent patients compared to healthy controls. This impairment was related with the lifetime alcohol consumption, but not with the alcohol consumption per day and prior to admission, respectively. Comparing healthy controls, and alcohol-dependent patients with an estimated lifetime alcohol consumption of < 1000 kg and ± 1000 kg revealed a significant increase in 6 of 8 sway parameters. Furthermore, the lifetime alcohol consumption increased significantly from patients with normal posturographic and clinical findings to those with abnormalities in both examinations. Conclusion - This study suggests that postural imbalance in abstinent alcohol-dependent patients is related to the lifetime alcohol consumption.     

酒依赖患者戒酒1年内复饮原因分析

目的:探讨酒依赖患者戒酒1年内复饮的危险因素。方法:228例戒酒治疗后1年的酒依赖综合征患者按过去1年内是否有复饮分为复饮组(128例)及非复饮组(100例);比较两组患者人口学及临床资料,并给予艾森克个性量表(EPQ)及汉密尔顿抑郁量表(HAMD)评分。结果:复饮组受教育年限明显少于非复饮组(t=9.92,P=0.00);饮酒年限明显长于非复饮组(t=-2.05,P=0.042);既往饮酒量明显多于非复饮组(χ2=17.21,P=0.00);EPQ-精神质评分(t=-15.14,P=0.00)、神经质评分(t=-7.36,P=0.00)以及HAMD评分(t=-14.12,P=0.00)明显高于非复饮组。多因素非条件Logistic回归分析显示,EPQ-精神质评分、HAMD-24评分和教育年限的回归系数β分别为0.476、0.296、-0.509,具有统计学意义(P均0.01)。结论:不良人格及抑郁特征是酒依赖患者戒酒1年内复饮危险因素,较高的文化教育水平是复饮的保护因素。     

Recent life events and their role in suicide as seen by the spouses.

The occurrence of recent life events during the last 3 months and their significance in the suicide process as subjectively perceived by the surviving partners were studied among a subpopulation of suicide victims (n = 400) who had a spouse or a cohabitant as the informant. This subpopulation was drawn from a total suicide population (n = 1397) of 1 year in Finland. According to the partners' reports, life events during the last 3 months were reported in 85% of the suicides. Job problems (33%), family discord (32%) and somatic illness (29%) were most commonly reported. More male than female victims had experienced recent life events, and the mean number of events was higher among men than among women. There were differences between single life events in terms of how often the partners perceived them as precipitants of suicide. Separation was seen as the most critical event: in 68% of suicides with reported separation during the last 3 months the partner also rated it as a precipitant, followed by somatic illness in 57%, family discord in 44%, financial trouble in 44%, unemployment in 34%, death in 29%, job problems in 19% and illness in family in 14%.     

Locus of control as an indicator of risk for suicidal behaviour among adolescents

Using a sample of high school students, this pilot study investigated the relationship between locus of control and a range of suicidal behaviours, the proportion of high school students in an Australian sample who report having engaged in such behaviours and the proportion of suicide attempters who received medical attention following an attempt. Two hundred male and 205 female students aged between 13 and 19 years (mean = 15, SD = 1), attending one randomly chosen metropolitan state high school, completed a questionnaire that included demographic details, the Nowicki-Strickland Locus of Control Scale for Children and questions concerning suicide. The findings indicated that a substantial proportion of individuals in the sample have suicidal ideation. A smaller proportion have engaged in a range of more serious and overt self-destructive and suicidal behaviours. Further, a majority of attempters in the sample had not received medical attention following their attempt. There was also a clear association between locus of control and suicidal behaviour, with the individuals who had engaged in suicidal behaviours characterized by a more external locus of control orientation. This study adds further weight of evidence to the suggestion that the locus of control construct is useful in identifying adolescents at risk of engaging in suicidal behaviour.     

Quality of life in obsessive-compulsive disorder: an evaluation of impairment and a preliminary analysis of the ameliorating effects of treatment

Despite the substantial impairments in life functioning associated with obsessive-compulsive disorder (OCD), treatment outcome evaluations have focused almost exclusively on symptom reduction, a focus that may be too narrow to determine whether clinically significant change has occurred. Quality of life (QOL) impairment was evaluated in a clinical OCD sample (N=188) using a multidimensional life satisfaction measure. Relationships between treatment response and QOL change also were evaluated with a subsample of participants (n=120). Congruent with previous studies of OCD, substantial pretreatment QOL impairment was found across all life domains. Distinct treatment change subgroups were identified: a group reporting strong symptom reduction and very good QOL gains, a second group with significant symptom reduction but less robust QOL improvements, and a third group with limited symptom gains and QOL decreases. Implications for understanding OCD-related impairment and the clinical significance of treatment outcomes are discussed.