克罗恩病患者健康相关生存质量研究及其影响因素

为探讨克罗恩病（Crohn disease,CD）患者心理症状及影响生存质量（quality of life,QOL）的因素,调查CD组及健康对照组人群各50例,分别采用ZUNG焦虑自评量表（self?rating anxiety scale,SAS）、ZUNG抑郁自评量表（self?rating depression scale,SDS）、炎症性肠病专用量表（inflammatory bowel disease questionnaire,IBDQ）、健康调查简表（short from?36 health survey,SF?36）进行测评。结果显示,焦虑、抑郁发生率CD组SAS［（40.3±8.5）分］、SDS［（47.1±11.1）分］与健康对照组［SAS（37.6±7.0）分,SDS（41.8±9.6）分］比较,差异均有统计学意义（t=5.4,P<0.05;t=10.6,P<0.05）。IBDQ各维度得分,CD活动期患者为肠道症状（49.50±7.62）分,全身症状（23.92±5.07）分,情感功能（57.13±15.62）分,社会功能（22.15±9.08）分;CD缓解期患者为肠道症状（60.12±4.01）分,全身症状（26.24±3.97）分,情感功能（67.34±15.17）分,社会功能（25.44±2.03）分,2组各维度得分比较差异均有统计学意义（P均<0.05）。SF?36量表各维度如躯体功能、躯体疼痛、一般健康状况、情感角色、总的心理健康和总的躯体健康等方面得分,CD组均明显低于健康对照组,2组差异均有统计学意义（P均<0.05）;CD缓解期患者在躯体功能、一般健康状况和总的心理健康维度的得分均高于CD活动期患者（P<0.05）;出现营养不良的患者在总的躯体健康和活力维度的得分显著低于无营养不良组,差异有统计学意义（P<0.05）。对患者生存质量进行多因素分析显示,疾病分期、营养风险对IBDQ总分有明显影响（P<0.05）,其他因素如性别、年龄、婚姻状况、受教育背景、医疗费用、生物制剂治疗、手术治疗对IBDQ评分无明显影响（P>0.05）。综上,对CD患者进行心理疏导,活动期积极治疗,有望改善CD患者生存质量。     

心脏介入术前患者焦虑抑郁两种测量方法的研究

目的 将脑功能指标客观定量测量与目前临床广泛应用的9项病例健康问卷（PHQ-9）、7 项广泛性焦虑（GAD-7）、躯体化症状自评量表（SSS）三种量表联合应用对患者焦虑抑郁的评估结果进行对比,为心脏康复患者筛查、术后患者焦虑、抑郁的评估提供一种新的客观定量评测手段。方法 采取知情同意、自主填写问卷的方法对阜外医院心内科随机选取的31例拟行冠状动脉支架置入手术前患者进行PHQ-9、GAD-7、SSS的评估。根据量表评分结果将患者分为有焦虑抑郁组和无焦虑抑郁组两组,分别对两组患者的脑功能指标进行测量[1-2],分析两组患者的脑功能指标是否存在显著差异,并分析两种测量结果的一致性。结果 根据主观量表PHQ-9、GAD-7[3]总分进行分组,共分为两组：焦虑抑郁组13例（41.94%,PHQ-9≥5分或GAD-7≥5分）,无焦虑抑郁组18例（58.06%,PHQ-9<5分且GAD-7<5分）。焦虑抑郁组脑指标内专注为39.00±9.89,无焦虑抑郁组脑指标内专注为22.78±11.98,两组比较差异有统计学意义（P<0.05）。脑功能指标内专注与PHQ-9的spearman相关系数为0.5310（P<0.01）,与GAD-7的相关系数是0.5378（P<0.01）,故采用内专注筛查入选者焦虑抑郁（内专注>30为有焦虑抑郁组,内专注≤30为无焦虑抑郁组）,结果显示有焦虑抑郁的17例（54.84%）,无焦虑抑郁的14例（45.16%）,总符合率是75.65%。两种方法的诊断结果进行spearman相关分析,相关系数为0.5085,差异有统计学意义（P<0.01）,一致性很好。同时,采取内专注筛选焦虑抑郁患者,焦虑抑郁组的躯体化症状量表得分为36.3±2.7,无焦虑抑郁组的躯体化症状得分为30.3±2.2,两组间无显著性差异。 结论 脑功能指标与常规量表作为评测焦虑抑郁的两种方法,二者具有一致性,利用脑功能指标内专注评测焦虑抑郁,脑功能客观定量指标将有助于对焦虑、抑郁患者的临床评估。     

社会支持在抑郁老年人死亡焦虑和生活质量中的中介作用

目的 了解抑郁老年人死亡焦虑、生活质量及社会支持现状,探讨社会支持在抑郁老年人死亡焦虑与生活质量间的中介作用。方法 采用死亡焦虑量表、生活质量量表及社会支持量表对200例抑郁老年人进行相关数据收集,并使用Person相关分析各变量间的相关性,最后使用Bootstrap方法检验社会支持在死亡焦虑和生活质量中的中介效应。结果 抑郁老年人死亡焦虑得分为（50.89±8.01）分;社会支持总分得分为（37.10±5.65）分,主观社会支持得分为（19.06±3.46）分,客观社会支持得分为（11.28±2.63）分,社会支持利用度得分为（6.76±2.09）分;生活质量各维度得分分别为生理功能（69.00±23.75）分、生理职能（41.50±33.67）分、躯体疼痛（66.41±24.74）分、总体健康（38.44±15.51）分、活力（35.62±14.88）分、社会功能（35.38±20.05）分、情感职能（8.87±19.09）分、精神健康（30.89±15.95）分。抑郁老年人的死亡焦虑与生活质量中生理功能（r=-0.233）、生理职能（r=-0.150）、总体健康（r=-0.390...     

心脏起搏患者术前心理状况及其心理干预的作用

为了解心脏起搏患者术前的心理状态及心理干预的作用 ,采用症状自评量表 (SCL 90 )调查 86例心脏起搏患者 ,总分 >16 0分或单个因子分 >2分示有心理问题。用焦虑自评量表 (SAS) ,抑郁自评量表 (SDS)分别评价 86例心脏起搏患者心理干预前后的焦虑、抑郁得分变化及其与 39例对照组的差别。结果 :SCL 90调查显示 :86例心脏起搏患者存在以焦虑 (4 3人 )、躯体化 (36人 )、恐怖 (34人 )、抑郁 (2 5人 )、人际关系 (2 2人 )为主要表现的心理问题 ,其得分均高于国内常模 (分别为 2 .0 9± 0 .5 9vs1.39± 0 .4 3,2 .19± 0 .5 4vs 1.37± 0 .4 8,2 .2 0± 0 .6 1vs1.2 3± 0 .4 1,2 .0 2± 0 .6 2vs 1.5 0± 0 .5 9,P均 <0 .0 1;2 .12± 0 .4 8vs 1.6 5± 0 .5 1,P <0 .0 5 )。心理干预后患者焦虑、抑郁得分明显下降 ,与干预前相比有统计学显著性差异 (分别为 4 1.2 4± 7.2 6vs 4 6 .78± 9.2 5 ,38.6 9± 6 .14vs4 4 .5 6± 7.82 ,P均 <0 .0 1) ;而对照组焦虑、抑郁两次评分比较无统计学显著性差异。结论 :心脏起搏患者存在焦虑、躯体化、恐怖、抑郁、人际关系等明显心理问题 ,心理干预能明显缓解患者的焦虑、抑郁状况。     

幸福感指数对老年高血压患者社会功能的影响

【】目的 探讨幸福感指数对老年高血压患者社会功能的影响。方法2015年2月到2016年5月选择在社区卫生服务中心进行诊治的老年高血压患者240例,都进行人口社会学调查、社会功能测定、幸福感指数测定与相关性分析。结果240例患者SAS与SDS评分分别为45.24±3.19分和41.40±2.95分,焦虑与抑郁发生率分别为8.3%和5.4%。240例患者的主观幸福感总分是33.29±3.89分,正性因子与负性因子分别是23.56±4.82分和9.15±2.29分。直线相关性分析显示老年高血压患者的SAS与SDS评分与幸福感总分、正性因子分与负性因子评分都呈现明显负相关性(P<0.05);多元逐步回归分析结果显示婚姻状况、病程、SAS评分、文化程度为影响幸福感指数的主要影响因素(P<0.05)。结论老年高血压患者多伴随有焦虑抑郁等社会功能低下等状况,有着较低的主观幸福感,两者可互相影响,导致恶性循环,临床护理应重视患者的心理支持,降低负性情绪。     

心脏起博患者术前心理状况及其心理干预的作用

为了解心脏起搏患者术前的心理状态及心理干预的作用 ,采用症状自评量表 (SCL 90 )调查 86例心脏起搏患者 ,总分 >16 0分或单个因子分 >2分示有心理问题。用焦虑自评量表 (SAS) ,抑郁自评量表 (SDS)分别评价 86例心脏起搏患者心理干预前后的焦虑、抑郁得分变化及其与 39例对照组的差别。结果 :SCL 90调查显示 :86例心脏起搏患者存在以焦虑 (4 3人 )、躯体化 (36人 )、恐怖 (34人 )、抑郁 (2 5人 )、人际关系 (2 2人 )为主要表现的心理问题 ,其得分均高于国内常模 (分别为 2 .0 9± 0 .5 9vs1.39± 0 .4 3,2 .19± 0 .5 4vs 1.37± 0 .4 8,2 .2 0± 0 .6 1vs1.2 3± 0 .4 1,2 .0 2± 0 .6 2vs 1.5 0± 0 .5 9,P均 <0 .0 1;2 .12± 0 .4 8vs 1.6 5± 0 .5 1,P <0 .0 5 )。心理干预后患者焦虑、抑郁得分明显下降 ,与干预前相比有统计学显著性差异 (分别为 4 1.2 4± 7.2 6vs 4 6 .78± 9.2 5 ,38.6 9± 6 .14vs4 4 .5 6± 7.82 ,P均 <0 .0 1) ;而对照组焦虑、抑郁两次评分比较无统计学显著性差异。结论 :心脏起搏患者存在焦虑、躯体化、恐怖、抑郁、人际关系等明显心理问题 ,心理干预能明显缓解患者的焦虑、抑郁状况。     

5&#183;12地震灾区老年人的抑郁情绪和生活满意度及其相关因素调查

目的探讨5&#183;12地震灾区老年人的抑郁情绪、生活满意度及其相关因素。方法5&#183;12地震后8个月,采用Sel-90抑郁分量表、躯体化分量表、生活满意度量表以及心理韧性量表和社会支持量表对灾区的70名老年组被试和139名青年对照组被试进行施测。结果灾区老年人的抑郁得分略高于青年人（t=1.68,P=0.09）,躯体化得分显著高于青年人（t=3.198,P〈0.01）,生活满意度得分显著高于青年人（t=6.20,P〈0.001）,老年人的心理韧性得分也显著高于青年人（t=3.11,P〈0.01）,而社会支持得分显著低于青年人（t=-3.29,P〈0.01）;心理韧性正向预测生活满意度（β=0.34,P〈0.001）,而与抑郁、躯体化无关,社会支持负向预测抑郁情绪（β=-0.33,P〈0.001）,同时正向预测生活满意度（β=0.19,P〈0.001）和韧性（β=0.22,P〈0.001）。结论与灾区青年人相比,灾区老年人同时表现出较高的抑郁情绪、躯体化和较高的生活满意度,这与老年人拥有较低的社会支持和较高的心理韧性有关,但心理韧性并不能帮助他们缓解抑郁情绪和躯体化,甚至还受到社会支持减少的潜在影响。     

老年患者卧床不起的危险因素分析

目的探索老年人卧床不起的危险因素。方法应用病例对照研究方法，对卧床不起和非卧床不起老年患者各121例，采用自制结构式问卷进行躯体、心理和社会因素调查。结果脑卒中、晚期恶性肿瘤、器官功能衰竭、高龄、老年性痴呆等疾病的相对危险度（OR值）分别为4．94、1．72、8．34、5．65、11．99。老年卧床不起患者抑郁（12．3）、焦虑评分（47．0）明显高于对照组（7．5和40．1，P=0．00）；生活满意度评分（11．2）明显低于对照组（13．8，P=0．00）；社会支持总分（38．4）、主观支持评分（20．7）和支持利用度评分（7．6）明显低于对照组（分别为42．7、23．2和8．4，P〈0．01），而客观支持评分两组无差异（分别为10．1及11．1，P〉0．05）。结论脑卒中、晚期恶性肿瘤、器官功能衰竭、高龄、老年性痴呆等是导致老年人卧床不起主要的躯体危险因素；抑郁、焦虑是老年卧床不起的心理危险因素；社会支持水平低下是老年卧床不起的社会危险因素。     

神经内科门诊老年患者的心理状况评定

目的了解神经内科门诊老年患者的心理健康状况。方法用症状自评量表(SCL-90)对神经内科门诊416例60岁以上老年患者进行调查。结果神经内科门诊中老年患者的心理问题主要表现为抑郁合并焦虑和躯体化。其中抑郁合并焦虑的比例占27.16%,躯体形式障碍占16.35%。SCL-90各因子得分均显著高于中国成人常模(抑郁2.83±0.75/2.22±0.65,强迫2.78±0.64/1.62±0.58,焦虑2.60±0.66/1.39±0.43,躯体化2.61±0.63/1.37±0.48,P分别<0.001)。结论神经内科门诊老年患者的心理健康状况低于普通人群,在对神经系统疾病进行诊治时,应关注该群体存在的心理健康问题,特别是抑郁,强迫,焦虑和躯体形式障碍。     

心理社会因素对老年人高血压疗效的影响

目的　探讨心理社会因素对老年人高血压疗效的影响。　方法　采用抑郁自评量表(SDS)、焦虑自评量表 (SAS)、社会支持评定量表、生活事件评定量表分别对老年高血压住院患者治疗达标组 14 8例、治疗未达标组 6 2例进行有关心理社会因素评估。　结果　 (1)治疗达标组的抑郁症和焦虑症的发生率 (7 4 %和 5 4 % )明显低于治疗未达标组 (32 2 %和 2 7 4 % ,P <0 0 5 ) ;抑郁自评分和焦虑自评分治疗达标组 (36 4± 6 7和 33 9± 7 8)也显著低于未达标组 (5 8 5± 11 6和 5 1 3±10 5 ,P <0 0 0 1)。 (2 )治疗达标组负性生活事件数 (4 7± 3 9)、负性生活刺激量 (12 4± 5 5 )、生活事件总刺激量 (2 1 6± 8 1)分别显著性低于治疗未达标组 (7 3± 4 1、2 1 5± 7 9、2 9 7± 9 5 ,P <0 0 0 1) ;治疗达标组社会支持总分 (38 3± 9 0 )、客观支持分 (12 4± 4 3)、主观支持分 (2 1 2± 7 3)、支持利用度 (9 7± 3 1)均明显高于治疗未达标组 (2 7 2± 8 7、7 8± 3 8、13 5± 6 5、4 8± 2 2 ,P <0 0 5 )。 (3)多因素logistic分析证实SDS评分、SAS评分、负性生活事件刺激量、生活事件总刺激量、社会支持总分、主观支持分及支持利用度等 7因素对降压是否能达标有显著性影响 (P <0 0 5 )。　结论     

帕金森病患者自动思维的特征及与社会支持状况的相关性研究

目的了解帕金森病患者自动思维特点和社会支持情况。方法采用自动思维问卷（ATQ）、汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）,对98例帕金森病患者进行问卷调查及相关因素分析。结果本组患者ATQ得分为（50.63±13.56）分,42例存在抑郁状态,其抑郁状态与负性自动思维呈正相关,与社会支持呈负相关。结论 帕金森病患者抑郁状态与负性自动思维相关,应该重视社会支持系统对改善帕金森病患者抑郁状态的作用,以提高患者生活质量。     

Psychosocial situation and physical health in 50 patients > 1 year after lung transplantation

BACKGROUND: Lung transplants have been performed worldwide since the early 1980s. While numerous studies have been published on somatic aspects after lung transplantation, there is considerably less information available on psychosocial aspects and on the correlation between the physical and the psychosocial state of health after transplantation. METHODS: Between 1992 and 2002, 125 patients underwent lung transplantation at University Hospital Zurich. To be included into the study, patients had to have received a lung transplant > 12 months previously and to have good knowledge of the German or Italian languages. With the aid of standardized questionnaires, psychosocial variables such as levels of anxiety and depression, self-esteem, and social support were determined. In addition, self-assessments of physical and psychological health were obtained. The medical data included information on FEV1, complications such as pulmonary infections, acute or chronic allograft rejection, and assessment of the patient's physical and psychological health by the treating doctors. RESULTS: The overall degree of anxiety and depression of the lung transplant recipients was comparable to standard samples of an average population. However, male lung transplant recipients were significantly more depressed than female recipients. Self-esteem was higher than in clinical comparison samples. Preceding pulmonary complications had long-lasting effects on the level of anxiety, whereas nonpulmonary complications did not have such an effect. CONCLUSIONS: Overall, the psychological well-being of patients after lung transplantation is similar to the normal population. Subgroups of patients with increased psychological distress have been identified.     

Breakdown of blood pressure and body fluid homeostasis in heart transplant recipients

Objectives. This study was designed to investigate disturbances in arterial blood pressure and body fluid homeostasis in stable heart transplant recipients.Background. Hypertension and fluid retention frequently complicate heart transplantation.Methods. Blood pressure, renal and endocrine responses to acute volume expansion were compared in 10 heart transplant recipients (57 ± 9 years old [mean ± SD]) 20 ± 5 months after transplantation, 6 liver transplant recipients receiving similar doses of cyclosporine (cyclosporine control group) and 7 normal volunteers (normal control subjects). After 3 days of a constant diet containing 87 mEq/24 h of sodium, 0.154 mol/liter saline was infused at 8 ml/kg per h for 4 h. Blood pressure and plasma vasopressin, angiotensin II, aldosterone, atrial natiuretic peptide and renin activity levels were determined before and at 30, 60, 120 and 240 min during the infusion. Urine was collected at 2 and 4 h. Blood pressure, fluid balance hormones and renal function were monitored for 48 h after the infusion.Results. Blood pressure did not change in the two control groups but increased in the heart transplant recipients (+ 15 ± 8/8± 5 mm Hg) and remained elevated for 48 h (p ≤ 0.05). Urine flow and urinary sodium excretion increased abruptly in the control groups sufficient to account for elimination of 86 ± 9% of the sodium load by 48 h; the increases were blunted (p ≤ 0.05) and delayed in the heart transplant recipients, resulting in elimination of only 51 ± 13% of the sodium load. Saline infusion suppressed vasopressin, renin activity, angiotensin II and aldosterone in the two control groups (p ≤ 0.05) but not in the heart transplant recipients. Heart transplant recipients had elevated atrial natriuretic peptide levels at baseline (p ≤ 0.05), but relative increases during the infusion were similar to those in both control groups.Conclusions. Blood pressure in heart transplant recipients is salt sensitive. These patients have a blunted diuretic and natriuretic response to volume expansion that may be mediated by a failure to reflexly suppress fluid regulatory hormones. These defects in blood pressure and fluid homeostasis were not seen in liver transplant recipients receiving cyclosporine and therefore cannot be attributed to cyclosporine alone. Abnormal cardiorenal neuroendocrine reflexes, secondary to cardiac denervation, may contribute to salt-sensitive hypertension and fluid retention in heart transplant recipients.     

Anxiety and Depression in Ethnic Minorities With Chronic Heart Failure

BackgroundConsiderable evidence confirms the high prevalence of anxiety and depression in the patients with heart failure (HF). However, little is known about the relationship of race/ethnicity to psychosocial variables in this population. The purpose of this study was to examine and compare the incidence of anxiety and depression in a cohort of non-Hispanic blacks, Hispanics, and non-Hispanic whites with advanced systolic HF.Methods and ResultsTwo-hundred forty-one patients (7% non-Hispanic blacks, 22.8% Hispanics, 60.7% non-Hispanic whites) mean age 56.7 ± 13.0 years, male (70%), married (81%), retired (75%), New York Heart Association (NYHA) Class III (53.9%), and mean ejection fraction 31.2 ± 5.4%) from a single heart transplant facility were asked to complete a series of questionnaires to assess anxiety, depression, perceived control, social support, and financial stability. Non-Hispanic blacks had higher levels of anxiety (P = .048) and depression (P = .026) compared with Hispanics; a similar trend was noted when comparing non-Hispanic blacks and non-Hispanic whites, but these differences were not statistically significant. Perceived control was highest among Hispanics and lowest among non-Hispanic whites (P = .046). In a multivariate model race/ethnicity, perceived control, and social support accounted for 30% of the variance in anxiety while race/ethnicity, NYHA Class, perceived control, and social support accounted for 41% of the variance in depression.ConclusionsOur findings reveal that non-Hispanic blacks are more likely to be anxious and depressed than their counterparts. Because patient perceptions of control and social support are related to dysphorias known to influence morbidity and mortality, clinicians should regularly assess patients' concerns and assist in accessing appropriate services and treatments tailored to individual needs. Non-Hispanic blacks warrant increased scrutiny.     

Anxiety and depression in a community-based rheumatoid arthritis population

OBJECTIVE: To assess anxiety and depression and their explanatory factors in rheumatoid arthritis (RA) in a community-based population. METHODS: The subscales of the Arthritis Impact Measurement Scales (AIMS) for anxiety and depression were used, and the Health Assessment Questionnaire (HAQ) was used for the assessment of disability. Cross-tabulation and multivariate logistic regression analysis were used to evaluate which variables best describe the patients with either high or low depression and anxiety scores. RESULTS: Nearly 20% of our patients had probable depression (AIMS depression subscale score > or =4), a figure comparable to earlier hospital-based series. Most of the AIMS anxiety subscale variability was explained by poor physical function and the male sex, while the AIMS depression subscale variability was mostly explained by poor physical function, comorbidities, and social inactivity. CONCLUSION: In our cross-sectional, community-based RA series, depression was equal to the figures previously reported from hospital-based series. Poor physical function was a powerful explanatory factor of both depression and anxiety.     

Heart and brain interactions in heart failure: Cognition,depression, anxiety,and related outcomes

BackgroundCognitive impairment, anxiety and depression are common in heart failure (HF) patients and its evolution is not fully understood.ObjectivesTo assess the cognitive status of HF patients over time, its relation to anxiety and depression, and its prognostic impact.MethodsProspective, longitudinal, single center study including patients enrolled in a structured program for follow-up after hospital admission for HF decompensation. Cognitive function, anxiety/depression state, HF-related quality of life (QoL) were assessed before discharge and during follow-up (between 6^th and 12^th month) using Montreal Cognitive Assessment (MoCA), Hospital Anxiety and Depression Scale (HADS) and Kansas City Cardiomyopathy Questionnaire, respectively. HF related outcomes were all cause readmissions, HF readmissions and the composite endpoint of all-cause readmissions or death.Results43 patients included (67±11.3 years, 69% male); followed-up for 8.2±2.1 months. 25.6% had an abnormal MoCA score that remained stable during follow-up (22.6±4.2 vs. 22.2±5.5; p=NS). MoCA score <22 at discharge conferred a sixfold greater risk of HF readmission [HR=6.42 (1.26-32.61); p=0.025], also predicting all-cause readmissions [HR=4.00 (1.15-13.95); p=0.03] and death or all-cause readmissions [HR=4.63 (1.37-15.67); p=0.014]. Patients with higher MoCA score showed a greater ability to deal with their disease (p=0.038). At discharge, 14% and 18.6% had an abnormal HADS score for depression and anxiety, respectively, which remained stable during follow-up and was not related to MoCA.ConclusionsCognitive function, anxiety and depressive status remain stable in HF patients despite optimized HF therapy. Cognitive status shall be routinely screened to adopt attitudes that improve management as it has an impact on HF-related QoL and prognosis.     

社区老年高血压患者焦虑、抑郁与社会支持的相关性研究

目的探讨社区老年高血压患者情绪状态与社会支持之间的相关性。方法采用自行设计的一般情况问卷、焦虑自评量表（SAS）、抑郁自评量表（SDS）、社会支持评定量表（SSRS）对老年高血压患者500例进行评定分析。结果社区老年高血压患者焦虑评分与社会支持总分、主观支持总分、客观支持总分及对支持的利用度呈负相关（P〈0.05或P〈0.01）; 社区老年高血压患者抑郁评分与社会支持总分、主观支持总分、客观支持总分及对支持的利用度呈负相关（P〈0.05或P〈0.01）。结论社区老年高血压患者的焦虑、抑郁和社会支持密切相关,提高社区老年高血压人群的社会支持可能有助于促进其身心健康。