关注干眼患者的心理问题

干眼是最常见的眼表疾病，长期慢性眼表疼痛、刺激感、视疲劳等症状严重影响患者的生活质量。部分患者对治疗失去信心、对工作和生活缺乏热情，流行病学研究显示干眼与焦虑、抑郁具有明显的相关性。干眼的积极治疗有利于患者抑郁状态的缓解，而有效的抑郁治疗又有助于干眼症状的缓解，因此眼科医生应关注干眼相关抑郁、焦虑等心理障碍的类型、机制及预防治疗措施。     

中小学教师干眼与身心健康的关系

目的:评估教师群体干眼(DED)与身心健康之间的关系,探讨其机制并提出干预措施。方法:横断面研究。将山东省临沂市市区3所中小学校教师183人纳入研究。采用眼表疾病指数(OSDI)问卷对DED症状进行量化。采用精简版抑郁、焦虑和压力量表(DASS-21)评估心理状态。采用定量变量独立样本t检验和分类变量的χ²检验来评估潜在影响因素与DED之间的关系。采用Logistic回归分析进行多因素分析,以确定DED的影响因素。采用Pearson相关分析进行OSDI评分与抑郁、焦虑、压力的相关性分析。结果:共183名教师,其中男44人(24.0%),女139人(76.0%),年龄22-57(平均34.2±8.6)岁。DED的患病率为60.0%(109/183,95%CI 52.4%-66.7%)。抑郁患病率为26.2%(48/183,95%CI 19.8%-32.7%);焦虑患病率为39.3%(72/183,95%CI 32.2%-46.5%);压力患病率为23.0%(42/183,95%CI 16.8%-29.1%)。单因素分析显示,年龄增加、工作年限增加、视频终端(VDT)...     

精神压力与心因性结膜炎58例的心理治疗

目的:了解心因性结膜炎患者的心理状态,并探讨心因性结膜炎心理治疗的效果.方法:确诊心因性结膜炎的患者58例.采用焦虑自评量表(SAS)和抑郁自评量表(SDS)进行临床前瞻性评估,应用认知干预,情绪干预,行为干预调整患者心理状态,并将患者治疗前后心理SAS和SDS评分与结膜炎同期症状和体征作相关分析.随访时间6～29(平均17.8±7.3)mo.结果:本组所有结膜炎患者抑郁(67.8±2.5)或焦虑(63.8±2.4)自评量表评分与正常人(＜50)有显著性差异.呈抑郁心理状态(男18,女30)48例,焦虑状态10(男4,女6)例,既有焦虑又有抑郁心理25例.经过心理治疗后所有患者精神状态改善,同时结膜炎症状和体征减少或消失.SAS与结膜炎充血程度(P＜0.05)和分泌物量(P＜0.01)呈正相关;SDS与结膜炎异物感呈正相关.心理治疗前后结膜炎充血、分泌物(P＜0.01)以及异物感(P＜0.05)的变化有极显著性差异.SAS和SDS评分的下降值与结膜炎充血、分泌物和异物感的好转程度呈正相关(P＜0.01).结论:与正常人比较,心因性结膜炎患者SAS和SDS评分明显增高.结膜炎症状严重程度与抑郁或焦虑评分相关.单纯的心理治疗可降低SAS和SDS评分,并改善心因性结膜炎的症状和体征.     

原发性闭角型青光眼患者心理及人格特征关系的临床观察

目的分析闭角型青光眼患者心理、个性特征与疾病的关系。方法选择在西安市第四医院门诊及住院的西安市青光眼患者100例,分别运用艾森克个性问卷、A型行为问卷以及焦虑和抑郁自评量表对其人格、行为特征和焦虑、抑郁状态进行测试,并与正常对照组进行比较。结果A型行为问卷,青光眼组TH量表得分高于对照组,差异有统计学意义（P〈0.05）,青光眼组TH＋CH和CH得分与对照组无明显差异（P〉0.05）。艾森克个性问卷中青光眼组的精神质（P）、神经质或情绪（N）得分明显高于对照组（P〈0.05）,而内外向、掩饰两项得分青光眼与对照组无显著性差异（P〈0.05）。焦虑和抑郁自评量表中,青光眼组的评分均明显高于对照组（P〈0.05）,并且急性闭角型青光眼患者的焦虑评分与慢性闭角型青光眼患者也有明显差异（P〈0.05）。在相关分析中,青光眼患者的焦虑和抑郁情绪与精神质（P）、神经质（N）、TH和CH＋TH成明显正相关。结论闭角型青光眼患者主要表现为A型性格,患者具有典型的精神性和神经质倾向人格特征;闭角型青光眼患者的情绪受人格和行为特征的影响。     

心理干预对青光眼患者生存质量影响的临床研究

目的 探讨心理干预对青光眼患者生存质量的影响,为青光眼的护理干预提供科学依据和对策.方法 采用视功能损害眼病患者生存质量量表、健康促进生活方式量表和自行设计的焦虑相关因素调查问卷对患者分别在人院前、手术前后、出院前进行评估.结果 实验组和对照组比较,心理干预后实验组与对照组焦虑评分、生存质量总评分、精神与心理方面评分、症状与视功能方面评分以及医患顺应性有显著差异(P<0.01).身体机能、社会活动方面评分无显著差异(P>0.05).健康行为与婚姻家庭状况、文化教育程度、心理干预、经济状况、社会支持、青光眼症状发作显著相关(P<0.01).结论 心理干预可以明显缓解青光眼患者住院期间情绪波动所造成的发作性症状,改善焦虑情绪及心理状态,提高住院期间视功能及相关生存质量.     

眼科围手术期患者的心理问题及影响

目的对眼科围手术期患者的心理问题的产生、影响与缓解作初步探讨。方法采用状态-特质焦虑问卷(STAI)作为评定工具,以特质焦虑量表(T-AI)的均数为界,分为高T-AI亚组和低T-AI亚组。结果术前状态焦虑量表(S-AI)评分极显著高于术后,术后S-AI减分率为25.71%,且术前S-AI评分显著高于T-AI。结论精神性焦虑直接产生于眼科手术本身,即眼科手术所致的焦虑为一急性发作且维持短暂的现象。     

糖尿病性视网膜病变患者并发焦虑抑郁状态的临床分析

目的:了解糖尿病性视网膜病变患者伴发焦虑抑郁状态的临床特征。方法:应用HAMD/HAMA对糖尿病性视网膜病变伴发焦虑抑郁状态患者的抑郁及焦虑和一般情况及治疗前后进行比较分析。结果:与糖尿病眼底无明显改变患者比较,糖尿病视网膜病变患者在躯体症状的表现上更为明显,其差别有统计学意义,而在抑郁的其他症状上,二者无明显统计学差别。两者在HAMD方面均表现为轻中度抑郁,比较无明显统计学意义。两组患者在HAMA评分上均以肯定有焦虑和明显焦虑为主,而DR患者在明显焦虑这一分组上与糖尿病无明显眼底改变患者比较有统计学意义。结论:糖尿病性视网膜病变患者常伴有焦虑抑郁状态,在治疗糖尿病性视网膜病变的同时应适当配合抗焦虑抑郁治疗,减轻患者的痛苦,提高患者生活质量。     

视频终端工作人群干眼流行特征分析

目的 探讨视频终端工作人群干眼症患病率及其相关影响因素.方法 调查研究.分层随机选取某传媒集团20岁以上的视频工作人群为受检对象.所有受检者均接受干眼症状、体征及眼表疾病指数问卷调查.依据目前公认的国内干眼诊断标准进行诊断,采用t检验、卡方检验、ANOVA、Logistic回归分析法对数据结果进行统计分析.结果 共计516人进入本次研究,应答率为94.2％.诊断为干眼246例,患病率为47.7％,其中男性患病率为51.1％,女性患病率为44.0％.不同性别、年龄患病率差异无统计学意义.干眼患者的眼表疾病指数评分均高于无干眼者.多因素Logistic回归分析结果提示角膜接触镜配戴情况、瞬目次数、屏幕放置位置、放置距离、工间休息时间、视觉环境与干眼相关.结论 视频终端工作人群干眼患病率与性别、年龄相关性较小,其主要相关因素有角膜接触镜配戴情况、瞬目次数、屏幕放置位置、放置距离、工间休息时间、工作环境.     

原发性青光眼患者抑郁与焦虑心理状况调查分析

目的 评价原发性青光眼患者抑郁与焦虑心理状况并分析其影响因素.方法 对24例原发性闭角型青光眼(PACG)、26例原发性开角型青光眼(POAG)和对照组(n=24)进行患者健康问卷(PHQ)调查,并对问卷评分进行比较和对年龄、性别等因素进行多重线性回归分析.结果 PACG、POAG和对照组抑郁症状阳性率分别为33.3％、19.2％和8.3％,焦虑症状阳性率分别为37.5％、26.9％和8.3％.PACG组抑郁(P =0.027)、焦虑(P=0.004)程度高于对照组,POAG与PACG和对照组差异不明显(P＞0.05).抑郁焦虑评分呈正相关(P＜0.01),抑郁(β=m.149,P=0.029)焦虑(β=-0.204,P=0.025)分别与年龄呈负相关,与性别无关.结论 PACG抑郁焦虑程度高于正常人,PACG与POAG之间无明显差异.青光眼患者抑郁焦虑状况与年龄相关,与性别无关.     

云南省怒江州贡山县翼状胬肉的流行病学调查

目的:调查云南省贡山县人群翼状胬肉患病率,通过问卷调查,获取相关信息,了解当地翼状胬肉的人群分布特点及可能相关危险因素。方法:采用整群抽样方法在云南省贡山县抽取26个调查点共3070例调查对象,对其翼状胬肉患病情况进行分析。结果:该地区人群中发现翼状胬肉患者108例,患病率为4.4%;男女间患病无统计学差异,分别为1.6%和2.8%;随年龄增长患病率逐渐增加。结论:翼状胬肉是云南贡山地区常见的眼表疾病,年龄、职业、紫外线暴露情况是该地区翼状胬肉发生的主要危险因素。     

Anxiety and Depression among Patients with Uveitis and Ocular Inflammatory Disease at a Tertiary Center in Southern Thailand: Vision-Related Quality of Life,Sociodemographics, and Clinical Characteristics Associated

Purpose: To estimate the prevalence of positive anxiety and depression screening in patients with ocular inflammatory disease (OID). The predictors associated with anxiety and depressive symptoms were investigated.

Methods: A cross-sectional study was conducted. The Thai Hospital Anxiety and Depression Scale (HADS), a sociodemographic questionnaire, and the Thai Visual Functioning Questionnaire 28 were administered to all participants. Associations were estimated using the Cox regression.

Results: Of the 86 participants, 12.8% and 8.1% screened positive for anxiety and depression, respectively. Predictors of an increase in both HADS-Anxiety and HADS-Depression scores comprised poor understanding of OIDs [adjusted relative probability (aRP) = 1.56; p = 0.021 and 1.59; p = 0.012, respectively], and low overall composite score (aRP = 1.45; p = 0.022 and 1.6; p = 0.002, respectively).

Conclusions: Approximately one-tenth of our patients screened positive for anxiety and depression. Patients with poor understanding of their OID and poor self-reported visual function were at an increased risk.     

开角型青光眼药物对患者身心健康的影响

目的:评价原发性开角型青光眼(primary open angle glaucoma,POAG)患者的心理和生活质量状况并分析其影响因素。方法:采用前瞻性临床对照的方法,对60例POAG患者分别采用青光眼生活质量-15中文版(Glaucoma Quality of Life-15,GQL-15)和综合医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HADS)中文版评定患者最近1mo的生活质量和焦虑、抑郁状况,给予降压药物干预后1mo再次进行评定。60例健康自愿者作为对照,分析其心理和生活质量变化情况。结果:POAG患者焦虑、抑郁及共患患者发生率分别为33.3%,26.7%,13.4%。患者抑郁焦虑评分及GQL评分与病程、眼压、年龄、药物种类和价格成正相关(P<0.05),与平均月收入、视力成负相关(P<0.05)。通过降压药物干预,患者焦虑、抑郁评分及生活质量评分明显好转(F焦虑评分=9.54,F抑郁评分=6.88,FGQL评分=8.82;P<0.05)。结论:POAG患者焦虑、抑郁状况加重,生活质量明显降低。患者抑郁焦虑评分及生活质量评分与病程、年龄、平均月收入、药物种类、药物价格、视力、眼压、视野等方面紧密相关。降压药物干预有助于青光眼患者生活质量和心理逐步康复。     

心理干预在原发性闭角型青光眼治疗中的临床研究

目的探讨心理干预对原发性闭角型青光眼（PACG）患者焦虑、抑郁及眼内压的影响,探索将心理干预应用于PACG辅助治疗的具体方法。方法将48例PACG患者随机分为两组,除干预组给予心理干预及放松治疗外,其他术前准备、手术方式均相同。分别于入院时、术前1 d晚上、术后1 d和出院时检测汉密尔顿焦虑量表及抑郁量表评分,隔日测量眼内压,t检验分析组内及组间差异。结果两组入院时焦虑、抑郁评分及眼内压比较差异无显著性,在术前1 d,术后1 d及出院前干预组和对照组的焦虑值相比分别是24.85±4.22 vs 36.82±3.76（P〈0.01）,24.23±4.73 vs 37.82±3.23（P〈0.01）,22.27±4.16 vs 25.68±3.64（P〈0.01）,干预组明显低于对照组,差异有显著性;抑郁值相比分别是27.58±3.73 vs 29.86±4.35（P=0.02）,27.62±4.59 vs 30.45±4.77（P=0.02）,23.62±3.56 vs 26.5±3.6（P〈0.01）,干预组明显低于对照组,差异有显著性;干预组的眼内压仅在术前1d和出院前明显低于对照组,分别是31.27±7.30 vs 34.95±6.00（P=0.032）,18.23±2.32 vs 19.68±2.12（P=0.015）,差异有显著性。结论心理干预有助于缓解术前和术后的焦虑及抑郁情绪,维持术后平稳的眼内压。     

原发性青光眼患者术前术后心理特征变化

目的:探讨原发性青光眼患者术前术后心理特征的变化。方法:原发性青光眼患者62例,其中原发性开角型青光眼患者8例,原发性闭角型青光眼患者54例,术前、术后2d及术后1mo,分别用汉米尔顿(Hamilton)焦虑量表(HAMA)(同时附自评量表STAI)、汉米尔顿抑郁量表(HRSD)(同时设抑郁自评量表SDS)、燥狂评定量表(MRS)进行测评。结果:术前与术后2d比较:汉米尔顿焦虑量表(HAMA)中的躯体性焦虑因子(A2)得分结果(t=1.576,P>0.05)、汉米尔顿抑郁量表(HRSD)中的认识障碍因子(B3)得分结果(t=1.788,P>0.05)、汉米尔顿抑郁量表(HRSD)中的迟缓因子(B4)得分结果(t=1.880,P>0.05)、汉米尔顿抑郁量表(HRSD)中的睡眠障碍因子(B5)得分结果(t=1.727,P>0.05)无显著性差异,其余各项均有显著性差异(P<0.05);术前与术后1mo比较:汉米尔顿焦虑量表(HAMA)中的躯体性焦虑因子(A2)得分结果(t=1.972,P>0.05)、汉米尔顿抑郁量表(HRSD)中的认识障碍因子(B3)得分结果(t=0.382)无显著性差异,其余各项均有显著性差异(P<0.05),显示了青光眼患者术前与术后的心理特征有较明显的变化;术后2d与术后1mo组比较:汉米尔顿抑郁量表(HRSD)中的总分(B)(t=2.499,P<0.05)、汉米尔顿抑郁量表(HRSD)中的体重因子(B2)得分结果(t=2.257,P<0.05)、汉米尔顿抑郁量表(HRSD)中的睡眠障碍因子(B5)得分结果(t=3.131,P<0.05)、燥狂评定量表(MRS)总分(C)(t=5.515,P<0.05)、抑郁自评量表SDS总分(E)(t=3.788,P<0.05)有显著性差异,其余各项均无显著性差异。结论:原发性青光眼患者术前、术后的心理特征会发生较大的变化,术后随病情好转,其情绪也将趋于稳定。     

Health-related quality of life in Behçet patients with ocular involvement

PURPOSE: Health-related quality of life (HRQOL) is an important outcome factor in chronic diseases such as Beh?et syndrome. We aimed to investigate the relation of HRQOL to the duration of illness, mental state, and visual acuity of patients with Beh?et syndrome. METHODS: We conducted a cross-sectional clinical trial of 45 consecutive Beh?et patients with ocular involvement. The control group consisted of an age-, sex-, and education-matched group of 45 healthy individuals. All patients and the controls had been given a complete ophthalmic examination. In addition, they completed a questionnaire comprising the SF-36 Health Survey, Beck Depression Inventory, and Beck Anxiety Inventory. Eight multiple regression analyses were carried out in the patient group to determine whether total anxiety scores, total depression scores, duration of the disease, and visual acuity predicted the dependent variable SF-36 subscales. RESULTS: Using the analysis of variance statistical method, comparisons of the patient and the control groups for depression, anxiety, and the subscales of the SF-36 Health Survey indicated a statistical significance for this battery of tests. CONCLUSIONS: Beh?et patients with ocular involvement are susceptible to anxiety and depression when compared to age and sex matched controls. It is important for the ophthalmologist to know that changes in the mental state of his patient may trigger a new ocular attack, and to be aware that these changes may play a critical role in the management and preventive measures for Beh?et syndrome.     

Screening for Depression and Anxiety in Patients with Active Uveitis

Purpose: To screen for psychological disorders in patients with active uveitis.

Methods: Patients were screened for depression (BDI-II), state anxiety (STAI-I), VR-QOL (NEI-VFQ-25), and HR-QOL (SF-36). Association of depression and anxiety with sociodemographic and clinical parameters and with VR-QOL and HR-QOL were analyzed. Multivariate linear regression models were constructed for NEI-VFQ-25 and SF-36 subscales.

Results: Of 99 patients, 37.3% screened positive for depression and 52.5% for anxiety. Depressed patients had lower visual acuity in the better seeing eye (p = 0.013) and more frequently panuveitis (p = 0.018). Anxious patients were younger (p = 0.009), had earlier onset of uveitis (p = 0.015), and had more frequently panuveitis (p = 0.016). Bivariate comparisons showed significant associations between psychological disorders and VR-QOL and HR-QOL. Significant bivariate associations were mostly lost in multivariate analyses for anxiety, but were preserved for depression.

Conclusions: A positive screening test for depression and anxiety is common in patients with uveitis. Low vision and panuveitis are associated with depression. Depression is associated with impairment of VR-QOL and HR-QOL.     

Psychological distress in people with disfigurement from facial palsy

Aims

Psychological distress is well documented in people with facial disfigurement. However, the prevalence of psychological distress in patients with facial palsy has not been studied. This study aims to establish the prevalence of psychological distress and the extent of anxiety and depression in a sample of facial palsy patients from the Northwest of England.

Method

A total of 103 participants with facial palsy completed a questionnaire pack comprising the Illness Perception Questionnaire-Revised (IPQ-R), a demographic questionnaire, and the Hospital Anxiety and Depression Scale (HADS). The severity of participants'' facial palsy was measured by the House–Brackmann scale.

Results

In all, 32.7 and 31.3% of the sample had significant levels of anxiety and depression, respectively. The mean age of participants was 59, and 35.9% had grade 6 facial palsy. Significant associations were found between participants'' perception of consequences, duration, timeline, and the level of distress. No significant associations were found between clinical severity of facial palsy and levels of distress. Females had significantly higher levels of anxiety compared with males.

Conclusions

There was a significant level of distress in this study group. The levels of psychological distress were higher than the levels found in other outpatient attenders. There were significant associations between participants'' illness perceptions and their level of distress.     

原发性青光眼患者心理因素分析

目的探讨原发性青光眼患者的心理特征。方法41例原发性青光眼患者(其中POAG者12例,PACG者29例)和41例正常对照者分别用汉米尔顿焦虑量表(附自评量表STAI),汉米尔顿抑郁量表HRSD(附抑郁自评量表SDS)、躁狂评定量表MRS进行测评,记分项目包括:汉米尔焦虑量表总分A,包括2个因子,精神性焦虑(A1)、躯体性焦虑(A2);STAI表总分用D表示;HRSD表总分用B表示,包括5个因子,焦虑/躯体化(B1)、体重(B2)、认识障碍(B3)、迟缓(B4)、睡眠障碍(B5);SDS表总分用E表示;MRS表总分用C表示,病情程度用病情指数(C0)表示。结果评分并统计进行测评,所有受试者的各量表总分均在抑郁或焦虑症、燥狂状态的诊断分数以下,各量表包含的影响因子得分分析:对照组与原发性青光眼组比较:HRSD表中的体重因子(以体重减少0.5kg加1分记分)得分结果无显著性差异,t=0.47,P=0.643>0.05,青光眼患者体重不受疾病影响而变化,除此因子外,其余12项均有显著性差异(P<0.05),自评量表结果与调查者评分结果一致,显示出青光眼患者心理因素较对照组有明显不同;POAG和PACG比较:MRS表(C)分数有显著性差异,其中焦躁易激惹因子分突出(C0),POAG组因子分明显高于PACG组(P<0.05),其余11项无显著性差异(P>0.05);Logistic回归分析结果:HRSD表中的焦虑/躯体化因子B1、迟缓因子B4、以及SDS表得分结果进入回归方程,得到OR值分别为13.772,11.776,0·577。结论和正常人比较,青光眼患者群在心理评定量表中的多项因子有显著差异,青光眼患者的心理特征和正常人不同。     

心理干预对孔源性视网膜脱离患者焦虑抑郁状态的影响

目的:观察心理干预对视网膜脱离(retinal detachment,RD)手术患者焦虑、抑郁及心率、血压的影响。方法:将入选住院58例视网膜脱离患者随机分为心理干预组和对照组,给予2组患者常规视网膜脱离手术治疗,心理干预组同时实施支持性心理干预和放松训练等,观察治疗前后2组患者的焦虑、抑郁情绪及血压心率的变化。结果:心理干预组与对照组比较术前焦虑情绪(41.16±4.37,46.72±6.64,t=3.81,P<0.01),术中收缩压(15.60±0.38,16.29±0.51,t=5.80,P<0.01),术中舒张压(9.88±0.49,10.67±0.40,t=6.60,P<0.01),有明显差异,统计学有显著意义。结论:心理干预可降低手术应激引起的视网膜脱离患者的焦虑情绪,缓解患者术中的紧张情绪。     

Evaluation of maternal attachment,self-efficacy,levels of depression,and anxiety in mothers who have babies diagnosed with retinopathy of prematurity

Purpose: The aim of this study is to evaluate the emotional stress and its effects on parental self-efficacy and mother–infant attachment in mothers whose babies were diagnosed with retinopathy of prematurity (ROP).

Methods: Study sample was consisted of voluntarily participating 82 mothers whose babies were first diagnosed with ROP, 83 mothers of preterm babies without ROP, and 85 mothers of term babies admitting for their routine visits. Sociodemographic data form maternal attachment scale, state-trait anxiety inventory, Edinburgh postnatal depression scale, and parental self-efficacy scale were applied to study participants, and the overall results of three groups were statistically compared.

Results: The sociodemographic features of three study groups were similar. Statistical significant differences were found in depression and state anxiety levels among study groups, while maternal attachment scale and trait anxiety level scores and parental self-efficacy scale total score were similar in study groups. Maternal depression and state-anxiety levels were tend to be higher in mother of children diagnosed with ROP and prematurity; however, there were no statistically significant differences between levels of mothers’ of premature children with or without ROP.

Conclusion: This is the first study in literature assessing the additional effect of ROP on the anxiety and depression levels of recent mothers, as well as mother–infant attachment and parental self-efficacy. Supporting of mothers having an infant with diagnosed ROP is crucial because of feeling themselves inefficient and responsible for all interventions applied to their babies.