以家庭为基础的心理护理对老年痴呆患者家庭复原力安全感的影响

目的 探讨以家庭为基础的心理护理对老年痴呆患者家庭复原力、安全感的影响。方法 选取2018-01—2019-05郑州市第七人民医院收治的老年痴呆患者112例,随机分为观察组(n=56)、对照组(n=56)。对照组采取常规护理,观察组在常规护理基础上采取以家庭为基础的心理护理,均护理3个月。比较2组护理3个月后Cornell痴呆抑郁量表(CSDD)、安全感评分(SQ)、家庭复原力评分、社会支持程度评分(SRRS)、家庭功能评定量表评分(FAD)、简易智力状态检查量表(MMSE)、老年痴呆生活质量量表(QOL-AD)评分。结果 护理3个月后观察组CSDD评分低于对照组,SQ量表人际安全感、确定控制感评分高于对照组(P0.05);观察组护理3个月后清晰交流、困境解读、秩序井然、正向前瞻、社会支持、生活卓越、亲密和谐、问题解决、情感分享、合作协调维度评分高于对照组(P0.05);观察组护理3个月后SRRS、FAD评分高于对照组(P0.05);观察组护理3个月后MMSE、QOL-AD评分均高于对照组(P0.05)。结论 以家庭为基础的心理护理可改善老年痴呆患者抑郁情绪与认知功能,增加患者安全感,提高患者家庭复原力、社会支持度与家庭功能,改善患者生活质量。     

D型人格对脑血管疾病患者睡眠质量的影响

目的了解D型人格脑血管疾病患者的睡眠质量,探讨D型人格对脑血管疾病患者睡眠质量的影响。方法选取300例确诊为脑血管病患者进行调查,调查工具包括D型人格量表、一般资料量表、匹兹堡睡眠质量指数问卷。结果 300例患者中,40.9%患者睡眠质量差,D型人格患者占34.94%,D型人格脑血管病患者在多个维度睡眠质量评分高于非D型人格患者,日间功能维度二者差异有统计学意义(P0.05),入睡时间、催眠药物与D型人格中的负性情感显著正相关。结论脑血管病患者普遍睡眠差,D型人格中负性情感会延长入睡时间、增加催眠药物的使用。提示脑血管科医务人员采取护理干预,提高脑血管病患者的睡眠质量,并及时识别D型人格患者,给予相应的护理干预。     

青少年抑郁障碍患者心理社会学特征

目的探讨青少年抑郁障碍患者的心理社会学特点。方法收集符合《国际疾病分类(第10版)》(ICD-10)抑郁障碍诊断标准的96例青少年抑郁症患者。所有患者均未经治疗,且均为首次就诊。正常对照组按性别、年龄等一般特征与病例组进行1∶1匹配。采用自编一般资料调查表、艾森克人格问卷(EPQ)、家庭环境量表中文版(FES-CV)、父母教养方式评价量表(EMBU)、青少年生活事件量表(ASLEC)和抑郁自评量表(SDS)进行测评。结果病例组EPQ的神经质(N)维度评分高于对照组,内外向(E)维度评分低于对照组(P0.01);病例组中独立性、亲密度、知识性、娱乐性、情感表达、成功性评分均较对照组低,差异均有统计学意义(P均0.01);父母情感温暖与理解因子评分低于对照组,差异有统计学意义(P0.01)。结论青少年抑郁障碍可能与其成长环境、父母因素、人格、应激生活事件、社会支持、同伴关系等有关。     

生活事件、社会支持与双相情感障碍患者症状复发的相关研究

目的探讨生活事件和社会支持与双相情感障碍患者症状复发的关系,为有针对性地实施干预提供依据。方法选取在中山市第三人民医院住院的符合《国际疾病分类(第10版)》(ICD-10)双相情感障碍诊断标准的70例患者为研究组,将研究组的健康家庭成员中与患者在性别、年龄、受教育程度等方面相近者作为对照组,共70人。采用生活事件量表(LES)和社会支持评定量表(SSRS)对两组人群进行测评。结果双相情感障碍患者与对照组人群的社会支持的情况差异有统计学意义(P0.05),这种差异主要体现在客观支持方面(P0.05),在主观性评价和对支持的利用度方面差异无统计学意义(P0.05)。生活事件对双相情感障碍患者的影响与对照组相比差异有统计学意义(P0.05)。经历负性生活事件,尤其是在家庭和工作方面发生的负性生活事件,对患者有明显的影响(P0.05)。回归分析显示患者症状复发的可能性与SSRS的客观支持评分呈负相关(OR=0.69)、与负性生活事件呈正相关(OR=1.05)。结论负性生活事件的影响程度和能够获得的客观社会支持程度是影响双相情感障碍患者症状复发的重要因素。     

以家庭为基础的心理护理在鼻咽癌患者手术治疗中的护理干预及效果

目的观察以家庭为基础的心理护理在鼻咽癌患者手术治疗中的护理干预及护理效果。方法选取2015年5月~2016年7月我院诊治的鼻咽癌手术治疗患者70例,采用随机方法分为对照组(n=35)和观察组(n=35)。对照组采用常规方法护理,观察组采用以家庭为基础的心理护理,比较两组护理效果。结果两组患者护理前汉密尔抑郁量表、焦虑评分差异无统计学意义(P0.05);观察组护理后汉密尔抑郁量表评分、焦虑评分,显著低于对照组(P0.05);两组患者在护理前社会客观、主观支持及社会支持利用度及社会支持总分差异无统计学意义(P0.05);观察组护理后社会客观、主观支持及社会支持利用度及社会支持总分,显著低于对照组(P0.05);观察组主观感受的恐惧率,显著低于对照组(P0.05);观察组照料主动、积极和有信心率,显著高于对照组(P0.05)。结论鼻咽癌患者采用手术治疗时实施以家庭为基础的心理护理效果理想,值得推广应用。     

接纳与承诺疗法联合帕罗西汀对伴有轻度焦虑、抑郁的不孕症患者负性情绪和生活质量的影响

目的 探讨接纳与承诺疗法联合帕罗西汀对伴轻度焦虑、抑郁的不孕症患者负性情绪及生活质量的影响。方法 按照门诊就诊顺序将我科2017年7月1日至2019年7月1日期间收治的127例轻度焦虑抑郁不孕症患者作为研究对象,对照组63例给予帕罗西汀治疗,观察组64例增加接纳与承诺疗法,2周为一疗程,三个疗程后对比两组患者治疗效果,采用抑郁自评量表(SDS)和焦虑自评量表(SAS)评定患者干预前后患者的负性情绪,采用健康状况调查量表(SF-36)评价患者干预前后的生活质量,采用社会支持评定量表(SSRS)评价家庭与社会的支持程度。结果 观察组治疗后有效率90.63%(57/64)高于对照组74.60%(48/63)(X2=5.6903,P0.05);两组患者治疗后SAS评分和SDS评分均下降,但观察组SAS评分和SDS评分更低(P0.05);两组患者治疗后的生活质量和家庭支持程度评分均增加,但观察组生活质量和家庭支持评分高于对照组(P0.05)。结论 接纳与承诺疗法联合帕罗西汀能够更好的改善伴有轻度焦虑抑郁的不孕症患者的负性情绪,提高生活质量和家庭支持程度。     

失眠症患者心理社会因素分析

目的:探讨失眠症患者的应付方式,心理健康状况和社会支持状况.方法:采用应付方式问卷(CSQ)、症状自评量表(SCL-90)和社会支持量表(SSS)对失眠症患者和正常对照者各88例进行测评.结果:失眠症组自责、幻想和退避分量表的得分显著高于对照组,求助分量表的得分显著低于对照组(P＜0.01);失眠症组SCL-90总分及躯体化、抑郁、焦虑、睡眠障碍各因子分与对照组比较,有显著差异(P＜0.01).失眠症组社会支持总分、客观支持和对社会支持的利用度评分显著低于正常对照组(P＜0.05).失眠症组自责与躯体化症状、焦虑、抑郁等因子及总分呈显著正相关,而求助与焦虑、抑郁、偏执和总分呈显著负相关(P＜0.05).结论:失眠症患者多采用不成熟的应付方式,且有较多的心身症状,应付方式和身心健康有相关性.失眠症患者缺乏社会支持.     

自尊在大学生社会支持和负性情绪关系中的中介作用

目的探讨社会支持、自尊与负性情绪之间的关系,揭示自尊在社会支持与负性情绪间的中介作用。方法采用自尊量表(SES)、社会支持量表(PSSS)、抑郁-焦虑-压力自评量表(DASS-21)对4208名大学生进行问卷调查。结果①PSSS得分和DASS-21三维度得分均在不同性别、年级、家庭居住地、学习成绩及家庭经济状况间差异有统计学意义(P0.05),SES得分在不同年级、家庭居住地、学习成绩和家庭经济状况间差异均有统计学意义(P0.05)。②社会支持与自尊呈显著正相关(P0.05),社会支持、自尊与负性情绪呈显著负相关(P0.05)。③Bootstrap检验显示:自尊在社会支持与抑郁、焦虑及压力负性情绪之间的中介效应分别为-0.18、-0.16、-0.15,分别占总效应的52.94%、57.14%、55.56%。结论自尊是大学生社会支持与负性情绪间的中介变量,社会支持主要通过自尊间接作用于负性情绪。     

抑郁症患者家属的社会支持及家庭功能研究

目的:探讨抑郁症患者家属感知的的社会支持和家庭功能特征。方法:采用社会支持量表(MSPSS)和家庭功能量表(FAD)对50例抑郁症患者的家属(抑郁症患者家属组)及50名正常人(对照组)进行调查。结果:①抑郁症患者家属组MSPSS评分中的社会支持总分(45.1±11.8)分明显高于正常对照组(25.5±9.7)分,两组间比较,差异有显著性(P<0.05);②抑郁症患者家属组的FAD评定除情感卷入维度外,其他5个维度(问题解决、交流、角色、情感反应、行为控制)和总体功能均在不健康家庭功能范围之内;并与社会支持均呈正相关[问题解决(r=0.228,P<0.05),交流(r=0.250,P<0.05),角色(r=0.209,P<0.05),情感反应(r=0.291,P<0.01),行为控制(r=0.289,P<0.01)和总体功能(r=0.217,P<0.05)]。结论:抑郁症患者家属体验到社会支持程度较低,家庭功能有缺陷;社会支持可能影响到家庭功能。     

失眠症相关因素的调查

目的探讨失眠症病人的人格特性、负性情绪等相关因素.方法采用自制失眠一般情况调查(其中包括影响睡眠相关因素调查表)、匹兹堡睡眠质量指数量表(PSQI)、EPQ、焦虑自评量表(SAS)、抑郁自评量表(SDS)对106例门诊失眠症病人进行调查,与90例健康对照组进行比较.结果①失眠组的E分低于正常组,N分、L分高于正常组(P＜0.01);②失眠组SAS、SDS评分高于正常对照组;③E分与N、SAS、SDS评分呈负相关,N分与SAS、SDS评分呈正相关,P分与SAS、SDS评分呈正相关,SAS与SDS评分呈正相关(P＜0.01);④对影响睡眠质量相关因素进行多元逐步回归分析得出焦虑、病程、经济状况、轮班制进入回归方程.结论失眠患者的人格具有内倾性和不稳定性,其负性情绪与人格特征有关,失眠可受病程、经济状况、轮班制、负性情绪的影响.     

女性失眠症患者心理健康状况及相关因素分析

目的探讨女性失眠症患者心理健康状况及其影响因素,为改善其心理健康提供参考。方法选取2012年1月-6月在中山大学附属第三医院就诊的符合《国际疾病分类(第10版)》(ICD-10)诊断标准的女性失眠症患者42例,采用匹兹堡睡眠质量指数量表(PSQI)、症状自评量表(SCL-90)、焦虑自评量表(SAS)、抑郁自评量表(SDS)和艾森克人格问卷(EPQ)评定患者睡眠质量、心理健康状况、人格特征,并分别对SCL-90和PSQI、EPQ评分进行相关分析。结果除人际关系敏感因子外,42例患者的SCL-90总评分及其他8个因子评分均高于常模,差异均有统计学意义(P0.05或0.01);PSQI总评分及7个因子评分、SAS、SDS评分均高于常模,差异均有统计学意义(P均0.01);PSQI的睡眠质量因子评分与SCL-90总评分及其9个因子评分均呈正相关(r=0.605～0.934,P均0.01);EPQ的精神质因子评分与SCL-90总评分及其8个因子评分(除恐怖因子外)均呈正相关(r=0.413～0.725,P0.05或0.01),神经质因子评分与SCL-90总评分及其9个因子评分均呈正相关(r=0.642～0.868,P均0.01)。结论女性失眠症患者的心理健康状况较差且常伴有焦虑、抑郁症状,其心理健康状况与睡眠质量和个性特征相关。     

Relationship between Personality and Insomnia in Panic Disorder Patients

Objective

Panic disorder (PD) is frequently comorbid with insomnia, which could exacerbate panic symptoms and contribute to PD relapse. Research has suggested that characteristics are implicated in both PD and insomnia. However, there are no reports examining whether temperament and character affect insomnia in PD. Thus, we examined the relationship between insomnia and personality characteristics in PD patients.

Methods

Participants were 101 patients, recruited from 6 university hospitals in Korea, who met the DSM-IV-TR criteria for PD. We assessed sleep outcomes using the sleep items of 17-item Hamilton Depression Rating Scale (HAMD-17)(item 4=onset latency, item 5=middle awakening, and item 6=early awakening) and used the Cloninger''s Temperament and Character Inventory-Revised-Short to assess personality characteristics. To examine the relationship between personality and insomnia, we used analysis of variance with age, sex, and severity of depression (total HAMD scores minus sum of the three sleep items) as the covariates.

Results

There were no statistical differences (p>0.1) in demographic and clinical data between patients with and without insomnia. Initial insomnia (delayed sleep onset) correlated to a high score on the temperamental dimension of novelty seeking 3 (NS3)(F_1,96=6.93, p=0.03). There were no statistical differences (p>0.1) in NS3 between patients with and without middle or terminal insomnia.

Conclusion

The present study suggests that higher NS3 is related to the development of initial insomnia in PD and that temperament and character should be considered when assessing sleep problems in PD patients.     

The relationship between social functioning and psychiatric symptomatology in primary care

Summary The relationship between social functioning measured by an interview schedule, psychiatric symptoms, alcohol abuse and personality was examined in 171 patients with conspicuous psychiatric morbidity seen in primary care. Social functioning was significantly better in older patients and in those with no alcohol abuse or personality disorder. A close relationship was shown between social functioning and psychiatric diagnosis, social impairment increasing with severity of disorder. This relationship was not obtained for depressive disorders in which social functioning was similar across all diagnostic groups. There was a high correlation between social functioning score and total psychiatric symptomatology, although social functioning appeared to be a more important determinant of referral to psychiatric services than Present State Examination (PSE) total score. The results support the view that social functioning measures can convey additional useful information to that of symptom measures, and might be of use in a multiaxial classification.     

Factors associated with outcome in major depression: a 6-month prospective study

A number of authors have indicated in recent years that the course of depression is not as favourable as previously expected. Research conducted in order to identify predictors of recovery has shown widely different results. In this paper a sample of 90 consecutive patients with non-chronic major depressive disorders (index episode <6 months) attending four mental health centres in Madrid were followed up prospectively for 6 months, and clinical social and cognitive variables were studied. The patients were treated pharmacologically and controlled. The rate of recovery was measured according to the Hamilton Rating Scale for Depression (HAM-D). Other tools used were: Life Events and Chronic Difficulties, Global Assessment Functioning in the 6 months prior to the onset of episode, Brown Rating Scale for Self-Esteem and Mannheim Interview of Social Support. The results showed that 41 cases recovered (HAM-D score <8), 29 cases achieved a partial remission, and major depressive disorder persisted in 17 cases (HAM-D score ≥18). The presence of personality disorders, having suffered a previous episode, GAF score and some aspects of social support were the variables most associated with non full remission in the logistic regression analysis. Personality disorders and the initial HAM-D score were related to non-improvement. Some clinical and cognitive variables maintain a weak relation to outcome and are rejected in logistic regression. This study emphasizes the relationship of personality, and social variables such as social support and previous global functioning, with incomplete recovery in major depression. Accepted: 11 May 1998     

创伤性脑损伤患者创伤后成长与创伤后应激障碍的调查研究

目的分析创伤性脑损伤（TBI）患者创伤后成长（PTG）与创伤后应激障碍（PTSD）的现况及其影响因素。 方法通过便利抽样的方法,选取首都医科大学附属北京天坛医院神经外科自2019年7月至2020年1月就诊的85例TBI患者为研究对象,使用创伤后成长评定量表（PTGI）、创伤后应激障碍量表平民版（PCL-C）调查TBI患者的PTG水平、PTSD情况,并进一步分析TBI患者PTG的影响因素。 结果TBI患者PTGI总分为（58.41±23.05）分,处于低水平。PCL-C得分为（36.18±16.52）分,PCL-C阳性症状检出率为41.2%。多元线性回归分析结果显示,文化程度、性格类型、社会支持、警觉性增高、创伤再体验是TBI患者PTG的影响因素。TBI患者文化水平低、外向型性格、社会支持水平越高其PTG水平越高。TBI事件后警觉性反应低者,PTG水平较高,创伤再体验症状促进PTG的发生。 结论TBI患者创伤后早期同时出现PTG及PTSD,通过调动患者个体内部因素及外在社会联系等方面积极因素,可能提高患者PTG水平。     

The influence of personality and dysfunctional sleep-related cognitions on the severity of insomnia

Previous findings suggest that personality traits and dysfunctional sleep-related cognitions may perpetuate insomnia, but findings concerning this have been scarce. Thus, we hypothesized that personality and sleep-related cognitions influence the severity of insomnia, and investigated the association personality and sleep-related cognitions had with various sleep-related parameters, including severity of insomnia. Forty-four patients with psychophysiological insomnia were assessed using The Temperament and Character Inventory, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Dysfunctional Belief and Attitudes toward Sleep Scale, the Pre-Sleep Arousal Scale and the Hospital Anxiety and Depression Scale. Insomnia severity was significantly and positively correlated with harm avoidance, self-transcendence and sleep-related cognitions, and negatively correlated with novelty seeking, reward dependence, and cooperativeness. Dysfunctional sleep-related cognitions were positively correlated with insomnia severity and sleep quality. Stepwise multiple regression analysis showed that sleep-related cognitions, depression and reward dependence scores were significant determinants of insomnia severity, and that sleep-related cognitions and self-transcendence were significant positive determinants of sleep quality. Reward dependence, depression and sleep-related cognitions were associated with insomnia severity, and comparison with previous findings implied that 'internalizing behavior' and depression may be more plausible candidates for the link between personality and insomnia than anxiety. Considering the major role of cognitive-behavioral treatment (CBT) in the treatment of insomnia, assessment of these factors and management of sleep-related cognitions may help alleviate symptoms in patients with insomnia.     

门诊老年失眠症患者生活质量及苯二氮类药物使用情况

目的：了解门诊老年失眠症患者生活质量与睡眠的关系及使用苯二氮类药（BZDs）改善睡眠的情况。方法：对老年失眠症患者和来自社区的无失眠症状的老年人各88例,采用生活质量综合评定问卷（GQOLI-74）、匹兹堡睡眠指数（PSQI）和进行测评。结果：老年失眠症患者的GQOLI总分及物质生活维度、心理功能维度和社会功能维度的得分均显著低于无失眠症状的老年人;而PSQI得分显著高于无失眠症状的老年人。老年失眠症患者总体生活质量及心理功能、社会功能与睡眠质量存在显著负相关。平均使用BZDs时间（12.10±4.40）个月,依赖发生率71.59%,使用较多者为艾司唑仑、阿普唑仑。结论：老年失眠症患者的生活质量较差,多数人服用BZDs改善睡眠,存在使用时间过长,有较高药物依赖发生。     

产后抑郁症与社会心理因素

目的：经前不适、社会支持和心理应激对产后抑郁症发生的影响。方法：对88例产妇评定Edinburgh产后抑郁量表（EPDS）、社会支持评定量表（SSRS）、艾森克人格问卷（EPQ）。结果：产后抑郁症发生率为17％；产后抑郁症的既往经前不适率比正常对照组的明显为高；EPDS总分与SSRS的客观支持呈显著负相关性；产后抑郁症的住房拥挤率比正常对照组明显为低。结论：有经前不适史的产妇易感产后抑郁症；产后抑郁症病人感到客观支持减少是抑郁的结果；产妇在小家庭受到的照顾不如大家庭周到。