Psychological aspects of menopause.

There are no psychological symptoms specific to menopause, though minor psychological complaints such as irritability may increase in women aged 45 to 55. These symptoms seem to be related to psychosocial stress, social class, or cultural group rather than to hormone imbalance alone. Management requires careful assessment of the medical as well as the psychosocial situation.     

Chronic idiopathic pain syndrome

Chronic idiopathic pain syndrome is a common, disabling and costly condition. It is believed to be of psychological origin but may involve both cerebral and peripheral physiological mechanisms. It is often associated with depression. Its assessment and management need to be multifactorial, i.e., medical, psychosocial and psychiatric. A thorough initial medical assessment is crucially important in order to identify any organic contributory factors and to gain the patient's trust. It is also essential to carry out a psychosocial and psychiatric assessment so as to evaluate the role of psychological and socioeconomic factors and establish whether a diagnosable psychiatric disorder is present. The latter is most likely to be a depressive, anxiety, or somatoform disorder. If the medical assessment fails to come up with a plausible organic explanation for the patient's pain, he or she should be told so clearly. The patient should be told that the goal of the treatment is not to cure the pain but to help him/her improve his/her functioning and sense of control over pain and life generally. The type of management most likely to succeed in this goal is one that is multifactorial and comprehensive rather than focused on one treatment modality only.     

Global appropriateness of pain drawings: Blind ratings predict patterns of psychological distress and litigation status

Previous studies examining pain drawings of low back pain patients have shown conflicting results in predicting elevations of MMPI scores. A study of 82 patients whose drawings were rated only for overall, anatomical appropriateness was conducted using the SCL-90 rather than the MMPI as the psychological assessment instrument. Significant differences were found between appropriate and inappropriate drawings; however, these differences seem to reflect differences in cognitive style of coping with pain as opposed to psychopathology. The implications and limitations of the study are discussed.     

农村唇腭裂患者生活质量及其影响因素的研究

【目的】了解农村成年唇腭裂患者的生活质量状况,探讨影响生活质量的因素,为改善患者的生活质量提供理论依据。【方法】采用生活质量综合问卷(GQOLI-74)对78名农村成年唇腭裂患者及50名农村正常成年人的生活质量进行评价。【结果】农村成年唇腭裂患者生活质量总分及各维度均低于对照组。其中对生活质量影响作用最大的是:心理健康维度。农村唇腭裂患者的生活质量受多种因素影响。【结论】农村成年唇腭裂患者生活质量较差,患者的生活质量受多种因素影响。对唇腭裂患者临床治疗的同时,要重视心理、社会等因素。     

医护人员与癌症患者疼痛评价的比较研究

目的 探讨癌症患者和医、护3方对患者癌痛强度评估结果的差异,为临床应用、选择合适的止痛方案和护理手段提供依据.方法 采用Johnson量表收集55例住院癌症患者及相应管床的40名医生和55名护士对患者1周内最痛的癌症疼痛的感觉痛和反应痛的评估结果,并进行比较,同时调查患者对癌痛态度的相关问题.结果 多数癌症患者对疼痛治疗仍存在不恰当的认识,患者自我报告及护士评估的反应痛均高于其感觉痛(P<0.05),但两方面评价结果护士均较患者低(P<0.05),差异具有统计学意义.医生评价的感觉痛高于反应痛,两方面的评估均低于患者自评,但差异均未达统计学意义(P>0.05),医生较护士评价结果更准确.结论 建议常规建立患者疼痛评价表,指导患者如何记录疼痛强度,加强医护人员疼痛管理知识的规范化培训及对患者疼痛状况的及时沟通.     

Determination of loss of quality of life

Physiatrists are a valuable resource in legal settings, where assessment of functional capacity to perform work and of future medical needs must be determined. Physiatrists help determine what future medical care is needed to restore and maintain an individual at the maximum level of life function. This article focuses on the use of a quality of life (QOL) rehabilitation model, rather than a medical model, for enhancing functional performance, modifying environments, and facilitating patient coping. We discuss use of the QOL model to describe and influence a patient's physical, psychological, cognitive, vocational/economic, and social/leisure domains.     

New lessons of nurturing life for geriatric patients

Our new lessons of nurturing life to make happiness and well-being of geriatric patients suggest comprise several important steps. First, geriatric patient care should not be delegated to specialists who focus on individual organ system. Instead, we should respond to the patient's condition based on comprehensive assessment to identify the single pathogenesis. Second, we should appreciate that the behavioral and psychological symptoms of dementia (BPSD) often reflect the behavioral and psychological symptoms of the caregiver (BPSC), and in particular the caregiver's attitude. Third, pleasant stimulations to the limbic system should receive more emphasis than attempting brain training in atrophied portions of the neocortex. Fourth, we should aim not for "successful aging," but for "balanced aging." Fifth, we should rely less on drug-based therapy and utilize more non-pharmacologic approaches to appropriate therapy. Geriatric patients should be cared for based on our new lessons of nurturing life rather than the heavily medicalized treatment modalities that are in wide use today.     

Assessment of the quality of life of patients with advanced and end-stage cancer or serious infections with a symptom-based or an impact-based instrument

In 1992 a project was started in which home care technology was made available to patients with cancer or serious infections. Primary care providers were trained and supported to administer parenteral drugs and fluids in the home setting. Between 1992 and 1995 we applied the Rotterdam Symptom Checklist (RSCL) and the Sickness Impact Profile (SIP) as questionnaires for quality of life (QoL) assessment in a group of 112 hospitalized patients who were prepared to receive further treatment at home. Scores on the RSCL revealed a high level of symptomatology in both the physical and the psychological dimension. Factor analysis showed a five-factor rather than a two-factor structure. The SIP showed considerable restrictions in daily living, particularly in the physical dimension. Whereas the RSCL and the SIP correlated well in the psychological and physical dimensions in advanced cancer patients, this correlation disappeared in the group of end-stage cancer patients. The data indicate that the health-related QoL of end-stage cancer patients cannot be reliably be assessed with a symptom-based instrument alone; it needs to be supplemented by other instruments, such as the SIP.     

Recovery preference exploration: analysis of patient feedback after imagined scenarios

OBJECTIVE: To present a new assessment approach, referred to as recovery preference exploration (RPE), for exploring the personal meaning of functional loss and recovery. RPE determines how people would choose to recover from profound disability if they could control that recovery. DESIGN: Twenty-six patients with a variety of medical conditions and one or more limitations in the functions being addressed were recruited from an inner-city ambulatory care clinic. The patients imagined recovery from 15 functional limitations, beginning with severe problems in all functions and ending with complete independence. Individual-specific preferences for recovery in each function were calculated relative to the other 14 and were submitted for principal components analyses. RESULTS: Imagined difficulty in toileting and with depression were most troubling. Principal components analyses identified trade-off choices among domains of physical, psychological, and social functioning. Some people valued physical independence above psychological well-being or social abilities. Others had opposite patterns. Patients' narrative explanations, when triangulated, were consistent with their preferences. CONCLUSION: RPE makes visible the highly personal nature of feelings about ability and disability. Our results may help guide the selection of rehabilitation interventions in ambulatory care.     

住院冠心病患者心理护理专家共识

目的 形成住院冠心病患者心理护理专家共识,规范对冠心病患者的心理护理。方法 系统查阅国内外文献,组织多家医疗机构及院校领域相关专家进行评议,通过专家会议法和德尔菲专家函询法,结合文献查询结果,进行整理和总结,形成最终共识。结果 该共识包括住院冠心病患者心理护理的相关心理危险因素、心理筛查、心理评估工具选择、评估流程、评估技巧、评估记录以及心理护理干预。结论 该共识可为住院冠心病患者心理护理提供规范和指引。     

The significance of drinking context for home detoxification

AIM: A research study was conducted to examine the concordance between the severity of alcohol dependence and the nursing activity found in an episode of care for home detoxification. This article is based on an audit of clients' records which formed part of the research project. The aim was establish the degree of dependence through the application of a severity assessment instrument and to relate this to the level of nursing activity from the recorded client contacts. METHOD: Quantitative and qualitative data were obtained from a clinical audit of each client's nursing and medical notes. Examination of the data provided an insight into the client's drinking context. RESULTS: The findings demonstrated substantial levels of drinking at home, drinking alone, and all-day drinking. This could have significant implications for traditional methods of assessment and the routine practice of home detoxification. CONCLUSION: Evidence from the audit suggests that criteria such as environmental and psychosocial issues should be considered alongside physical and psychological aspects as part of the assessment criteria for home detoxification. Some clients might benefit from alternative strategies such as outpatient detoxification, day-patient attendance detoxification, or specialist inpatient treatment rather than home detoxification.     

Assessing altered body image

Assessing altered body image.
Like pain, altered body image remains highly personal, abstract and difficult to describe. It has taken nearly a century to define the concept of body image, and to construe a reasonable working definition of altered body image (ABI). During this time, the assessment of body image has focused upon the researcher and his/her needs, rather than the professional nurse, who must arrive at a practical means to understanding patients' distress, and identify possible solutions. In this paper the author suggests parameters for the assessment of ABI in the practical arena, based both upon ongoing asthma care research and the experience of practitioners developing body image counsellor roles. It is suggested that altered body image should be assessed as part of an integrated approach, and that the complicated risk or cathexis scales developed for psychological research have limited use within the clinical setting.     

对入院患者心理状态评估方法的比较

目的 :通过主观和量表评定法的比较 ,使临床心理评估更加省时、准确及具有科学性 ;方法 :对新入院 10 2例经主观评定法评估为焦虑、抑郁、正常的患者 ,同时采用量表评定法 (SAS SDS)进行心理测验。结果 :两种评估法差异非常显著。单纯为焦虑者仅占 1.96 % ,抑郁者占 32 .35 % ,二者同时存在者占 2 0 .5 9% ,与主观评定法的符合率为 9.80 % ;结论 :临床护士需要将主观评定法与量表评定法结合起来进行心理状态的评估 ,提出护理问题 ,进行有预见性地护理 ,制定相应的护理措施 ,保证心理护理具有科学性     

Investigation of the Rates of Comorbid Symptoms in Children with ADHD Compared to Children with ASD

There is a scarcity of research looking at how comorbid psychological disorders impact the assessment of children with autism spectrum disorders (ASD). The present study aimed to extend the literature in this area by evaluating rates of comorbid symptoms in both children with ASD and those with attention-deficit/hyperactivity disorder (ADHD). Children with ASD, ADHD, or no psychological diagnosis participated in this study. Internalizing and externalizing symptoms were assessed with the Autism Spectrum Disorders - Comorbidity for Children (ASD-CC). Multivariate and univariate main effect analyses with post-hoc comparisons were then conducted. Children with ASD evinced higher rates of comorbid symptoms than children with ADHD. Additionally, both children with ASD and those with ADHD exhibited more comorbid symptoms than children without a psychological disorder. These findings are in accordance with previous research and support the need for broadband assessment of psychiatric conditions in children presenting with developmental delays or externalizing behaviors. Other implications of these findings are discussed.     

Positioning mental health nursing practice within a positive health paradigm

Mental health service provision has traditionally been dominated by biomedical models of illness and disorder, a problem‐based orientation, and the assessment and management of risk. While psychotherapeutic approaches are numerous and have been widely utilized, psychotropic medications, either as monotherapy or in conjunction with psychological therapies, remain the mainstay for the ‘treatment’ of mental health problems. This is despite growing uncertainty over the effectiveness of psychotropic medications (particularly antidepressants), as well as their potential for enduring and debilitating side‐effects. This discussion paper outlines the emerging field of positive health, which eschews a psychiatric disorder and illness focus, and is instead oriented towards the identification of strengths, abilities, hopes, and the individual's preferred future. The shift in positive health, from illness towards wellness, aims to build health literacy and the capacity of individuals to make decisions conducive to health, and thereby make more effective the use of health‐care services. A positioning of mental health nursing practice within a positive health paradigm is promoted. By illustration, a number of solution‐focused mental health assessment questions are tabled to contrast the current format for mental health assessment, which rather than being ‘comprehensive’, is predominantly concerned only with problem and risk identification, and the search for pathology in the individual.     

Psychological aspects of pain

Manual therapy is based on a biomedical model of illness and places considerable reliance on the patient's report of pain. Reported pain intensity is assumed to bear a close relationship with underlying nociception but research has shown that the experience of pain is also influenced by a wide range of psychological factors. Firstly, response to pain provocation (whether palpation or induction of biomechanical stress) can be affected by fear of an adverse outcome (such as pain) and fear of injury. Secondly, a patient's global rating of their pain may be widely influenced by factors in addition to nociception such as distress, fear and mistaken beliefs about the nature of pain and likely outcome of treatment. The manual therapist needs, therefore, to conduct and understand biomedical assessment within a biopsychosocial framework. In appraising the patient's response, the therapist may find it helpful to incorporate specific assessment of subjectively reported fear or behavioural indicators of fear such as guarded movements or behavioural signs. Therapists need to understand that in manual therapy, they are frequently managing the patient's pain behaviour and distress, rather than simply the nociceptive component of their pain.     

标准化患者在护生术前心理护理教学中的应用

目的探讨标准化患者(standardized patients,SP)在护生术前心理护理教学中的应用效果。方法便利抽样法选择2014年1-6月在复旦大学附属华山医院北院手术室实习的某卫校护理本科2010级护生40名,按实习先后将其分为观察组和对照组各20名,分别进行SP教学和传统教学,评价并比较两组护生的患者满意度及术前心理护理技能考评得分。结果观察组护生的患者满意度及术前心理护理技能考评得分均优于对照组(均P0.05)。结论 SP在手术室术前心理护理教学中切实可行,有助于快速让护生进入状态,更好地给术前患者做心理疏导,提高手术室术前心理护理教学效果。     

The Headache Scale: a new approach to the assessment of headache pain based on pain descriptions

A Headache Scale was developed to provide an assessment of both the quality and intensity of headache pain. Responses of 150 headache-prone subjects (49 migraine, 101 tension headache), were examined. Using a cluster analysis the adjectives were grouped into 7 clusters including 5 sensory and 2 affective subgroups. Headache was most commonly described in terms of clusters which reflected discomfort and aching pain sensations. Migraine and tension sufferers did not differ markedly in pain quality but intensity of pain differentiated these groups. The results did not support the traditional typology of headache, i.e., migraine/tension. An alternative method of classifying headache cases in terms of their psychological experiences rather than headache symptoms was put forward and implications for future research and treatment were discussed.     

Helping student nurses to identify and respond to the psychological needs of physically ill patients: implications for curriculum design

It is universally accepted that nursing practice is predicated upon the notion of holistic care, in that nurses need to address not only the physical needs of ill patients but also their psychological, social, spiritual, and environmental needs. However, there is considerable evidence to suggest that nurses often inadequately identify and respond to patients' psychological needs, sometimes with adverse consequences for physical health and recovery. This may be because they do not fully understand the concept of psychological care, or have been inadequately prepared or educated to deliver it in practice. Following a summary of relevant literature and an overview of findings from a larger study of the nature and experience of psychological caregiving, this paper discusses specific findings on preparing nurses for their psychological caregiving role. The paper proposes a curriculum framework designed to enhance awareness, knowledge, and skill in effective psychological caregiving in nursing practice, to the ultimate benefit of physically ill patients. For the purposes of this paper, psychological care is taken to mean one element of the broader concept of care, rather than being synonymous with it.     

Psychological Characteristics of Chronic Pain: a Review of Current Evidence and Assessment Tools to Enhance Treatment

Purpose of Review

The complicated nature of chronic pain involves an interplay between psychological and physical factors, often resulting in increased emotional distress and reduced quality of life. This review is designed to help the medical practitioner who is working with chronic pain patients to be aware of psychological assessment techniques that can add to comprehensive patient understanding and more effectively guide treatment. Enhanced ability to assess and understand the emotional life of the chronic pain patient provides a basis for intervening and treating more successfully.

Recent Findings

There are a broad range of assessment techniques, some of which require a background in psychology and some that do not, that can identify psychological differences in chronic pain patients and serve to guide intervention strategies. Chronic pain is often comorbid with depression, anxiety, catastrophizing, and various ineffective coping strategies. Some patients, however, have demonstrated more adaptive and effective strategies for cognitively and behaviorally coping with pain and normalizing their lives. Proper assessment enables the individualization of treatment to overcome and/or build upon each patient’s psychological frame of mind to maximize the potential for effective functioning.

Summary

The use of standardized and documented psychological assessment techniques can lead to a better understanding of chronic pain patients and contribute in ways that can enhance response to medical treatment and improve quality of life. It is recommended that certain psychological tools be included to supplement the medical assessment of patients who have chronic pain. A basic assessment can include a short psychological-based clinical interview along with brief measures of depression, anxiety, and coping strategies. It is also recommended that the pain physician have access to professional psychological practitioners as a resource for more complicated assessments and psychological intervention services.