康复中心与住院部乳腺癌患者的应付方式及人格对照研究

目的：探讨乳腺癌患者心理干预的方法。方法：对乳腺癌患者123例其中社区康复中心29例，住院部94例，采用1998年谢亚宁编制的简易应对方式问卷、1986年龚耀先修订的艾森克人格问卷（Eysenck personality questionaire,EPQ)进行对照研究。结果：两组调查对象的应付方式及人格均无显著性差异（P＞0．05）。康复中心应付方式积极因子项得分17&;#177;8，消极因子项得分8&;#177;5，住院部应付方式积极因子项得分16&;#177;9，消极因子项得分7&;#177;5；康复中心人格精神病质4．2&;#177;2．6，内外倾向9．7&;#177;5．2，神经质13．1&;#177;5．6，住院部人格精神病质4．3&;#177;2．4，内外倾向9．7&;#177;4．2，神经质11．1&;#177;5．3。结论：社区康复中心内外的乳腺癌患者应付方式和人格没有本质区别。     

紧张型头痛军人患者的人格特征、应对方式及心理控制源

目的:探讨紧张型头痛军人患者的人格特征、应对方式和心理控制源的特征。方法:选择2001-07/2003-07解放军第四六四医院诊断为紧张型头痛的35例住院军人患者作为紧张型头痛组,以35名正常军人作为对照组。人格评定采用艾森克人格问卷(共88项,包含神经质,内-外向,精神质,掩饰性4个人格维度,神经质,精神质,掩饰性分值越高表示性格越倾向该维度,内-外向分值越高,表示性格越倾向外向);应对方式评定采用应对方式问卷(是自评问卷,共有100个条目,分为解决问题、自责、求助、幻想、退避、合理化6个分量表。每个分量表分值越高表示越倾向使用该应对方式);心理控制源评定采用Rotter编制的内在-外在心理控制源量表犤含23个项目和6个插入题。得分范围在0(极端内控)到23(极端外控)之间犦。结果:纳入35例紧张型头痛患者,35例正常军人,均进入结果分析,无脱落者。①两组艾森克人格问卷各维度分值比较:紧张型头痛患者神经质和精神质得分高于对照组(57.83±7.27,49.17±7.14;55.36±8.93,47.96±8.78,P<0.05);而内-外向维度和掩饰性维度得分两组间差异不显著。②两组应付方式各因子分值比较:紧张型头痛组在解决问题和求助两个因子上的得分低于对照组(0.52±0.17,0.89±0.21;0.41±0.17,0.78±0.18,P<0.05);而紧张型头痛组逃避因子的得分高于对照组(0.63±0.17,0.31±0.16,P<0.05);两组在幻想、自责及合理化3因子上的得分差异不显著。③内在-外在心理控制源量表得分比较:紧张型头痛组得分高于对照组(11.76±0.29,9.39±0.46,P<0.01)。结论:紧张型头痛军人患者内在一外在心理控制源量表评分均高于健康人,证明他们有更强的神经质和精神质倾向,存在人格方面的问题。他们认为事件的结局主要由外部因素所影响,遇到问题更多采用逃避的应对方法,而较少采用问题解决和求助的方式。     

抑郁性神经症、焦虑、强迫和恐惧症患者心理健康状况及其性格特征的比较

目的:了解焦虑、抑郁、强迫和恐惧症4种神经症患者的心理健康状况和个性特征。方法:选择1998/2003到中山大学附属三院心理科门诊首次就诊的神经症患者1805例。用症状自评量表(以躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性9个因子作为观察指标。按照0～4的5级评分,0:无,l:轻度,2:中度,3:相当重,4:严重)和艾森克个性问卷(共88项,包含神经质,内外向,精神质,掩饰性4个人格维度,神经质,内-外向,精神质,掩饰性分值越高表示性格越倾向该维度,内-外向分值越高,表示性格越倾向外向)对患者的焦虑、抑郁、强迫和恐惧神经症患者进行评定。结果:1805例患者均进入结果分析,无脱落者。①神经症患者症状自评量表评定结果:抑郁性神经症患者的总分最高(223.55±62.77),其症状表现为抑郁、强迫、人际关系、躯体化(3.04±0.88,2.80±0.87,2.57±0.88,2.08±0.79);其次是焦虑症(208.07±79.67),症状为焦虑、躯体化(2.72±1.00,2.10±0.89),强迫症的主要症状为强迫、焦虑(2.79±0.97,2.59±0.97),恐怖症的主要症状为人际关系与恐惧(2.77±1.00,2.20±0.81)。②神经症患者的艾森克人格问卷评定结果:焦虑症在神经质分中比其他3种神经症低(56.15±18.94,60.18±15.50,58.34±16.72,57.98±15.60);在精神质维度量表分中抑郁性神经症与恐怖症明显高于焦虑症和强迫症(53.26±14.58,52.26±13.24,49.97±17.12,50.37±14.59);而内外向、掩饰性分值在4种神经症类型中评分接近。结论:不同神经症患者有不同心理症状和人格特征。躯体化症状以焦虑症和抑郁性神经症患者明显;强迫症状以强迫症和抑郁性神经症为主;人际紧张突出表现在恐怖症和抑郁性神经症;抑郁症状突出表现在抑郁性神经症患者;恐怖症状突出表现在恐怖症患者。4种神经症亚型的共同个性特征为神经质倾向和轻度精神病质倾向,其中抑郁性神经症和恐怖症的个性特征中精神病质倾向较高。     

海洛因成瘾者应付方式、社会支持及人格特征的分析

目的:了解海洛因成瘾者的应付方式、人格状况、心理健康以及社会支持状况。方法:研究对象为2003-02/2004-08在广东省某强制戒毒所收治的戒毒人员,使用应付方式问卷,社会支持评定量表,艾森克人格问卷以及SCL-90,对133名海洛因成瘾者(吸毒组)和正常对照组进行评估。结果:应付方式中,吸毒组在幻想、自责、求助、合理化、解决问题、退避分量表得分分别为(0.481±0.160),(0.503±0.210),(0.423±0.170),(0.470±0.180),(0.635±0.200),(0.555±0.200)分,解决问题,求助得分均低于对照组,而在自责、幻想、退避、合理化上则均高于对照组;艾森克人格问卷中,内外向、神经质犤(11.55±4.30),(16.47±4.56)分犦均高于对照组犤(9.85±4.36),(10.81±4.45)分犦,而精神质和社会掩饰性犤(7.85±3.04),(11.54±3.89)分犦则与对照组犤(7.86±3.05),(11.75±3.55)分犦相近;社会支持量表中,主客观支持分犤(19.77±4.80),(6.73±2.73)分犦均低于对照组犤(21.97±5.81),(9.03±2.79)分犦,而在SCL-90中,所有分值均高于对照组一个平均分。结论:海洛因成瘾者倾向使用退避、自责和幻想的不成熟应付方式,心理存在严重问题,情绪不稳定,社会支持不良。     

乳腺癌患者术前焦虑与人格特征及应对方式的相关性研究

目的探讨乳腺癌患者术前焦虑与其人格特征及应对方式的相关性。方法采用焦虑自评量表(SAS)、艾森克人格问卷简式量表中国版(EPQ-RSC)和特质应对方式问卷(TCSQ)在术前3~4d对100例乳腺癌患者进行调查,比较焦虑、非焦虑组乳腺癌患者人格特征及应对方式。结果乳腺癌患者术前焦虑得分(59.94士4.52)分,显著高于国内常模(P0.05);乳腺癌患者术前焦虑发生率为57.00%。焦虑组患者内外向、积极应对得分显著低于非焦虑组,神经质、消极应对得分显著高于非焦虑组(P0.05);乳腺癌患者术前焦虑得分与内外向、积极应对呈负相关,与神经质、消极应时呈正相关(均P0.05)。结论乳腺癌患者术前普遍存在焦虑情绪,且与患者的人格特征及应对方式相关。护理人员需针对性格内向、情绪不稳定及较多采用消极应对方式的患者进行针对性心理护理,以缓解其焦虑情绪,顺利完成手术。     

抑郁症患者焦虑症状、应付方式与人格特征的关系

背景:焦虑和抑郁的共病率各家报道不一,在抑郁症的病理心理学上,伴有焦虑症状的抑郁症患者的应付方式与人格及其与抑郁症状的关系等基本问题并不十分清楚。目的:分析伴有焦虑症状抑郁症患者的应付方式与人格的关系。设计:病例-对照观察。单位:中南大学湘雅二医院、湖南省脑科医院。对象:选择2002-06/2003-01在中南大学湘雅二医院、湖南省脑科医院住院的抑郁症患者88例。另选择中南大学湘雅二医院、中山大学部分职工及家属、临时工、学生中健康自愿者90人为正常对照组。方法:采用抑郁自评量表、焦虑自评量表、应付方式问卷、艾森克人格问卷进行调查评估。主要观察指标:①抑郁症组与正常对照组抑郁自评量表、焦虑自评量表、应付方式问卷、艾森克人格问卷评分比较。②有焦虑症状抑郁症组和无焦虑症状抑郁症组抑郁自评量表、焦虑自评量表、应付方式问卷、艾森克人格问卷评分比较。③抑郁症组各指标相关分析和逐步回归分析结果。结果:178名入选对象均进入结果分析。①抑郁症患者抑郁自评量表、焦虑自评量表、艾森克人格问卷的精神质、神经质两个维度的得分高于正常对照组,而艾森克人格问卷的内外向维度、积极应付方式得分低于对照组。②伴有焦虑症者抑郁自评量表、焦虑自评量表、艾森克人格问卷的精神质、神经质两个维度的得分明显高于不伴焦虑症者,积极应付方式得分低于无焦虑症组。③相关、回归分析表明抑郁症状的严重程度与焦虑自评量表、艾森克人格问卷的内外向维度及积极应付方式的关系更为密切。结论:①抑郁症患者的抑郁症状、焦虑症状、精神质较明显,偏内向,情绪不稳定,较少采用积极的应付方式。②有焦虑症状的抑郁症患者其抑郁症状较严重,精神质、神经质比较明显,较少采用积极的应付方式。③较少采用积极的应付方式可纳入人格特质的内外向维度之中。     

紧张型头痛军人患者的人格特征、应对方式及心理控制源

目的：探讨紧张型头痛军人患者的人格特征、应对方式和心理控制源的特征。方法：选择2001-07／2003-07解放军第四六四医院诊断为紧张型头痛的35例住院军人患者作为紧张型头痛组，以35名正常军人作为对照组。人格评定采用艾森克人格问卷（共88项，包含神经质，内-外向，精神质，掩饰性4个人格维度，神经质，精神质，掩饰性分值越高表示性格越倾向该维度，内-外向分值越高，表示性格越倾向外向）；应对方式评定采用应对方式问卷（是自评问卷，共有100个条目，分为解决问题、自责、求助、幻想、退避、合理化6个分量表。每个分量表分值越高表示越倾向使用该应对方式）；心理控制源评定采用Rotter编制的内在-外在心理控制源量表[含23个项目和6个插入题。得分范围在0（极端内控）到23（极端外控）之间]。结果：纳入35例紧张型头痛患者，35例正常军人，均进入结果分析，无脱落者。①两组艾森克人格问卷各维度分值比较：紧张型头痛患者神经质和精神质得分高于对照组（57．83&;#177;7．27，49．17&;#177;7．14；55．36&;#177;8．93，47．96&;#177;8．78．P〈0．05）；而内-外向维度和掩饰性维度得分两组间差异不显著。②两组应付方式各因子分值比较：紧张型头痛组在解决问题和求助两个因子上的得分低于对照组（0．52&;#177;0．17，0．89&;#177;0．21；0．41&;#177;0．17，0．78&;#177;0．18，P〈0．05）：而紧张型头痛组逃避因子的得分高于对照组（0．63&;#177;0．17，0．31&;#177;0．16，P〈0．05）；两组在幻想、自责及合理化3因子上的得分差异不显著。③内在-外在心理控制源量表得分比较：紧张型头痛组得分高于对照组（11．76&;#177;0．29，9．39&;#177;0．46，P〈0．01）。结论：紧张型头痛军人患者内在-外在心理控制源量表评分均高于健康人，证明他们有更强的神经质和精神质倾向，存在人格方面的问题。他们认为事件的结局主要由外部因素所影响，遇到问题更多采用逃避的应对方法，而较少采用问题解决和求助的方式。     

社会支持、应对方式、人格特征等因素与手术患者焦虑的关系

目的:确定手术患者的社会支持、应对方式、人格等因素与手术焦虑的关系。方法:使用简易应对方式问卷、社会支持评定量表、艾森克人格问卷(EPQ)对哈尔滨医科大学附属第二医院普外一科择期手术患者在术前1d,以自愿的方式进行问卷调查,排除不接受调查者,在2001-11-17/2002-01-31调查了160例患者,并对结果进行多因素分析。结果:人格各因子与应对方式的典型相关分析的两个相关系数均达到显著水准(ρ1=0.395,P<0.05;ρ2=0.246,P<0.05)。在第一典型因素分析中,主要是自变量中的内外向影响积极应对(P<0.05);精神质与第一典型因素有中等关系存在(P<0.05)。第二典型因素与神经质、消极应对相关较高(P<0.05)。社会支持量表各因子与EPQ各因子典型相关系数的显著性检验P值水平高于0.05,认为它们之间不存在相关关系。结论:外倾的术前患者倾向于采取积极应对方式;精神质得分较低的术前患者在中等水平上倾向于采取积极应对方式;神经质的术前患者倾向于采取消极应对方式。     

乳腺癌术后放疗期患者创伤后成长与人格特征的相关性分析

目的：了解乳腺癌术后放疗期患者心理症状与人格的关系。方法采用问卷调查法,采用艾森克人格问卷（ EPQ）和创伤后成长评定量表（ PTGI）对169例乳腺癌术后放疗期患者进行调查,了解乳腺癌术后放疗患者的人格状况及成长水平,并采用Pearson相关分析法和多重线性回归法对资料进行统计分析。结果患者PTGI总均分为（65．83±177;13．28）分,EPQ内外倾向、神经质和精神质3个维度不同得分组间的PTGI得分差异均有统计学意义（F值分别为14．353,9．343,10．534;P＜0．01）,内外倾向维度与PTGI总分呈正相关（r＝0．342,P＜0．01）,神经质和精神质维度与其呈负相关（r值分别为-0．250,-0．287;P＜0．01）。回归分析结果显示,乳腺癌患者的创伤后成长受人格特征内外倾向、神经质、精神质的影响（β值分别为0．343,-0．264,-0．273;P＜0．05）。结论乳腺癌术后放疗期患者存在一定程度的创伤后成长,不同人格特征的患者有不同的成长水平。     

不同人格特质直肠癌患者术前应对方式的调查分析

目的 调查和分析术前直肠癌患者人格类型和应对方式的关系,为临床心理干预提供依据.方法 对91例直肠癌患者采用特质应对方式问卷(TCSQ)和艾森克人格问卷简式量表中国版(EPQ-RSC)进行问卷调查,给予分析比对.结果 91例患者的精神质、神经质、掩饰性项目测量得分高于国内常模;术前内外向项目测量得分低于国内常模;患者外向性与积极应对方式呈正相关;神经质与积极应对方式呈负相关,与消极应对方式呈正相关.结论 男性直肠癌患者较女性外向,女性患者较男性情绪稳定;文化程度越高患者越容易采取积极的应对方式;家庭位于乡村的农民患者较家庭位于城镇、有固定收入的直肠癌患者更易产生焦虑、情绪不稳定和消极应对的方式;性格外向、情绪稳定的直肠癌患者术前倾向采用积极的应对方式,情绪不稳定者倾向采取消极的应对方式.     

Measurement of L-carnitine and acylcarnitines in body fluids and tissues in children and in adults

We have developed a reliable and validated radio-enzymatic method for the assay of L-carnitine and acylcarnitines, using a modification of existing methods. The sensitivity of the assay is 10 mumol/l using 10 microliters of plasma or urine. It is also suitable for measurements of carnitine in a 10 mg sample of liver or muscle obtained by percutaneous biopsy. The use of N-ethylmaleimide in the reaction mixture together with an excess of [1-14C]acetyl CoA ensures that the reaction proceeds to completion and a linear response is obtained. Using this method control ranges have been established for plasma and urine carnitine concentrations in healthy children and adults, and for the carnitine content of liver and muscle in adults. No significant difference was found between fasting and post-prandial plasma carnitine levels. An age-related increase was found in urinary total carnitine and acylcarnitine concentration throughout childhood. These data provide a reliable basis for studies of patients with abnormal carnitine and acylcarnitine metabolism, distribution and excretion.     

Erythropoietin and uremic platelet aggregation in vivo and in vitro

Erythropoietin treatment is known to correct anemia and to improve hemostasis. Since platelets may contribute to thromboembolic complications, we assessed platelet aggregation in whole blood and platelet-rich plasma from chronically hemodialyzed patients treated with erythropoietin and evaluated in vitro effects of this drug on aggregatory responses of uremic and normal platelets. Recombinant human erythropoietin was given to uremic patients at a dose of 2.000 IU subcutaneously three times a week. Platelet aggregation in whole blood and platelet-rich plasma was induced by collagen, ADP, arachidonic acid, and ristocetin. In uremic patients, erythropoietin therapy resulted in an enhancement of platelet sensitivity to various agonists, particularly in platelet-rich plasma, reaching values comparable to those of healthy volunteers. In vitro studies we were unable to show any direct effect of erythropoietin, used at concentrations that occurred post intravenous administration, on platelet aggregation both in whole blood and in platelet-rich plasma.     

Responses in extracellular and intracellular calcium and magnesium in aldosteronism

We hypothesized the hypercalciuria and hypermagnesuria that accompany aldosteronism could be pharmacologically attenuated to prevent shifts in extracellular and intracellular levels of these divalent cations and the adverse outcomes associated with them. Accordingly, rats administered aldosterone/salt treatment (ALDOST) were cotreated with either hydrochlorothiazide (Hctz), to selectively reabsorb urinary Ca2+, or with Hctz plus spironolactone (Hctz+Spi), where Spi retards the excretion of these cations in both urine and feces. We monitored urinary excretion and responses in extracellular and intracellular Ca2+ and Mg2+, together with indices of oxi/nitrosative stress in plasma and ventricular tissue. At 4 weeks ALDOST we found the following: (1) hypercalciuria was reduced by Hctz and normalized by Hctz+Spi, and this combination, unlike Hctz alone, also rescued hypermagnesuria; (2) the decrease in plasma-ionized [Ca2+]o was not seen with Hctz or Hctz+Spi, whereas Spi cotreatment protected against a decline in [Mg2+]o; (3) the Ca2+ loading of peripheral blood mononuclear cells and cardiac tissue was not seen with Hctz+Spi; and (4) the induction of oxi/nitrosative stress, expressed as reduced plasma alpha1-antiproteinase activity and activation of gp91(phox) subunit of NADPH oxidase in inflammatory cells invading intramural coronary arteries of the right and left ventricles, together with vascular fibrosis, was completely prevented by Spi cotreatment. In rats with aldosteronism, cotreatment with Hctz+Spi more effectively (vis-à-vis Hctz alone) protects against adverse iterations in extracellular and intracellular concentrations of Ca2+ and Mg2+, as well as the appearance of oxi/nitrosative stress to prevent the proinflammatory vascular phenotype.     

Rosamicin in Urethral and Vaginal Secretions and Tissues in Dogs and Rats

In animal studies we investigated the distribution of rosamicin in plasma and urethral and vaginal tissues in rats as well as in urethral and vaginal secretions in dogs. We found concentration ratios between urethral secretion and plasma of 1.9 and between vaginal secretion and plasma of 2.4. The rosamicin concentrations in urethral and vaginal tissue significantly exceeded the levels of all other tissues investigated. Because rosamicin could be valuable for the treatment of bacterial urethritis and the colonization of the vaginal introitus with fecal bacteria in women, it should be investigated clinically in this respect.     

Similarities and differences in clients treated and in medications prescribed by APRNs and psychiatrists in a CMHC

This study is part of a larger study comparing prescribing practices of psychiatrists and advanced practice psychiatric nurses (APRNs) using the following three groups of patients: patients treated by psychiatrists, those treated by APRNs, and those treated by both APRNs and psychiatrists at different times in 1 year. Demographics for 5507 patients were examined. A subsample of APRNs and psychiatrists prescribed similar total numbers of medications. Psychiatrists prescribed more types of antidepressant medications other than the SSRI antidepressants, and they prescribed more than twice the number of benzodiazepines. APRNs prescribed more SSRIs and spent more time with clients during medication visits.     

Postural strategies and falls in elderly and in parkinsonism]

OBJECTIVE: To use a posture analysis to show the evolution of postural pattern connected with falls.MATERIAL AND METHOD: It is a prospective study on two groups of 16 persons of more than 60 years. A group concerns 16 small disability off drug parkinsonian patients, a group concerns 16 healthy witnesses. All the persons benefited from a posture recording by means of a force platform and were followed during 1 year. RESULTS: Data analysis underlines three groups of persons corresponding to three postural patterns, independently of the presence of Parkinson disease. A group (n = 18) did not contain fallers, the second (n = 10 ) contained 20% of fallers, the third (n = 4) contained 100% of fallers. Differences between the groups were identified on 16 posturographic parameters. DISCUSSION: A group has a good functional value and one does not record any fall. Its characteristics, which correspond to a category of persons who compensate well for the phenomena of ageing, are found in the literature. A group has an intermediate functional value and regrets 20% of fallers. Kinetic profile reveals a tendency to the stiffness of the posture. This group is going to operate rather ankle strategies. A group has an inferior functional value and regrets 100% of fallers. Kinetic profile seems disrupted and not to be able to adapt itself in a satisfactory way to the situation otherwise than by stereotypical reactions. This group is going to operate systematically much less stabilizing hip strategies. CONCLUSION: A close determinism between physiological neuromotor ageing and Parkinson disease does exist. We showed with a prospective follow-up, the arisen of fall and showed the evolution of postural patterns related to fall. It appears as well that evolution mainly follows three stages leading from a small risk of fall gait pattern to a major risk of fall gait pattern.