灼口综合征患者心理学相关因素的临床分析

的　对 98例灼口综合征 (BMS)患者进行心理学相关因素研究 ,以了解BMS与心理障碍关系 ,为进一步心理行为治疗提供理论依据。方法　对 98例非病理性BMS患者进行心理学病因、心因性躯体症状观察 ,并对BMS患者组和相配对的正常组进行SAS、SDS和SCL90量表的分析。结果　 98例BMS患者中 ,有 95 %有各种心理学病因 ,所有患者存在各种心因性躯体症状 ,最常见的为睡眠障碍 ( 90 .8% ) ;有 96 %患者存在中重度的抑郁 ,75 %患者存在中重度的焦虑 ;SCL90量表主要以躯体化、强迫症状、抑郁、焦虑、精神病性为主。结论　BMS是一类以抑郁为主的心理障碍症状群 ;心理学病史、心因性躯体症状具有临床诊断的参考价值 ,心理量表分析则可进一步明确心理障碍的类型和程度 ,心理行为治疗可能是治疗精神性BMS的有效方法。     

颞下颌关节紊乱病不同症状患者心理因素调查

目的研究颞下颌关节紊乱病（TMD）不同症状患者心理社会因素,尤其是焦虑的差别,为心理治疗对策提供试验依据。 方法206例就诊于天津医科大学口腔医院的TMD患者和201名无症状志愿者,填写症状自评量表（SCL-90）和状态-特质焦虑问卷（STAI）,根据患者主诉分组。采用SPSS 17.0统计软件,采用独立样本t检验和单因素方差分析对所有数据进行统计学分析。 结果（1）TMD患者SCL-90量表中的躯体化、抑郁、焦虑、敌对、精神病性因子得分及总分高于无症状志愿者,差异有统计学意义（t_躯体化 = 3.79,P_躯体化 = 0.000;t_抑郁 = 2.14,P_抑郁 = 0.033;t_焦虑 = 2.91,P_焦虑 = 0.004;t_敌对 = 3.93,P_敌对 = 0.000;t_精神病性 = 2.48,P_精神病性 = 0.013;t_总分 = 2.80,P_总分 = 0.005）;女性TMD患者的状态焦虑及特质焦虑得分均高于女性无症状志愿者（t_状态焦虑 = 3.52,P_状态焦虑 = 0.001;t_特质焦虑 = 4.26,P_特质焦虑 = 0.000）,两组男性之间差异无统计学意义（t_状态焦虑 = 0.36,P_状态焦虑 = 0.718;t_特质焦虑 = 0.76,P_特质焦虑 = 0.453）;（2）不同症状TMD患者在躯体化和状态焦虑方面差异有统计学意义（F_躯体化 = 2.714,P_躯体化 = 0.046;F_特质焦虑 = 3.007,P_特质焦虑 = 0.031）,具有单纯疼痛症状者躯体化得分高于单纯弹响患者（P = 0.005）,单纯弹响及疼痛伴弹响患者的特质焦虑得分高于疼痛伴开口受限者（P = 0.016）。 结论TMD患者心理健康水平比无症状人群低,主要表现在躯体化、抑郁、焦虑、敌对和精神病性方面。女性TMD患者有明显焦虑特征。单纯疼痛TMD患者躯体化比单纯弹响者更为明显。     

颞下颌关节紊乱病患者的症状自评量表调查

目的通过对颞下颌关节紊乱病（TMD）患者的症状自评量表（SCL-90）各因子进行分析，了解其精神心理状态。方法338例就诊于北京大学口腔医学院颞下颌关节病及口颌面痛诊治中心的TMD患者填写SCL-90，采用t检验和单组设计定量资料的多元方差分析，将患者和普通人群的SCL-90各因子得分进行比较。结果①TMD患者SCL-90中的躯体化、强迫、焦虑、敌意、恐怖、精神病性因子得分高于普通人群，差异有统计学意义（P〈0．05）；②伴有精神心理障碍的TMD患者比例为23％；③对338份患者SCL-90进行可靠性分析，得出可靠系数为0．958。结论我国TMD患者的精神心理障碍问题不容忽视。SCL-90作为判断TMD患者是否伴有某些精神心理障碍的量表，在我国同样具有较好的适用性。     

A case–control study on etiological factors involved in patients with burning mouth syndrome

Objective:  To evaluate and analyze the risk factors for burning mouth syndrome (BMS).
Methods:  Eighty-seven consecutive patients with BMS and a randomly selected control group ( n  = 82) were comprehensively investigated with a self-designed questionnaire, Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS). A complete blood count and serum sex hormone were also examined in patients with BMS and control subjects. All the data obtained were transferred to a data bank and analyzed statistically in spss 11.5 for windows.
Results:  No statistical difference between the BMS group and the control group was found in blood analyses including white blood cell count, red blood cell count, hemoglobin and platelet count. Among the menopausal or postmenopausal women with BMS, the follicle stimulating hormone (FSH) level was significantly higher, but the estradiol level was significantly lower. The BMS group reported adverse life events more frequently than the control group. Patients with BMS significantly exhibited symptoms of somatization, and both the scores of anxiety, depression in patients with BMS were higher than those of the control group ( P  < 0.05). A regression equation which included six variables had been established by using logistic regression analysis, indicating that the habit of tongue thrusting, lip sucking, periodontitis, smoking, outcome of recent medication, depression were the principal risk factors, among which tongue thrusting was the most significant.
Conclusion:  Our study indicated that BMS may be of psychological origin, and the measures such as refraining from oral parafunctional activities, removing local irritating factors, stopping smoking, good mental health status could help in the prevention of BMS.     

精神压力与牙周炎关系的临床调查

目的：探讨精神压力与牙周炎临床指标的关系。方法：选择慢性牙周炎患者44例和牙周健康者42例．采用评估就诊者心理卫生问题的90项症状自评量表,研究精神压力和牙周临床指标的关系．以SPSS10．0软件包进行相应分析。结果：2组受教育水平、婚姻状况、经历重大生活事件有明显差异（P〈0．05或P〈0．01）。牙周炎组患者躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对及其他（饮食睡眠等影响）的分值显著高于对照组（P〈0．05或P〈0．01）．牙周治疗需要指数（CPITN）、牙石指数（CI）等临床参数与抑郁、人际关系敏感等因子呈显著性相关（P〈0．05或P〈0．01）。结论：精神压力与牙周健康状况密切相关,可能是牙周炎的重要危险因子。     

口腔异感症患者的心理学相关研究

目的 了解口腔异感症（OPS）与心理障碍关系，为进一步心理行为治疗提供依据。方法 对31例非病理性OPS患者进行心理学病因、躯体化症状观察，并对24例OPS和相配对的正常组进行SAS、SDS和SCL90量表的分析。结果 31例OPS患者中，95％有各种心理学病因，所有患者存在各种躯体化症状，最常见为睡眠（90．3％）；全部患者存在中、重度的抑郁，83．4％患者存在中、重度的焦虑；SCL90是表主要以躯体化、强追症状、抑郁、焦虑、精神病性为主。结论 OPS是一类以抑郁为主的心理障碍症状群；心理学病史、躯体化症状具有临床诊断的参考价值，心理是表分析则可进一步明确心理障碍的类型和程度，心理行为治疗可能是治疗精神性OPS的有效方法。     

在校学生颞下颌关节紊乱病与心理因素关系的研究

目的:探讨心理因素对在校生颞下颌关节紊乱病(TMD)的影响.方法:对52例14～ 26岁确诊为颞下颌关节紊乱病(TMD)及53名健康在校生进行颞下颌关节紊乱病专科检查,并填写症状自评量表(SCL-90).患者组分为咀嚼肌功能紊乱(MD)组26例、关节盘移位(TD)组14例、关节盘移位咀嚼肌功能紊乱并存(MD+TD)组12例,按病程分为急性组32例(病史≤6个月),慢性组20例(病史＞6个月).用SPSS 17.0对各分组SCL-90总分及因子分进行比较分析.结果:TMD组SCL-90总分及各因子得分高于健康对照组(P＜0.05).MD组得分与TD组得分差异无统计学意义(P＞0.05),MD+ TD组的SCL-90总分及除抑郁、恐怖和精神病性外的其他因子得分显著高于前2组(P＜0.05).急性组躯体化得分高于慢性组(P＜0.05),其他项目2组差异无统计学意义(P＞0.05).TMD患者SCL-90总分与疼痛等级呈正相关关系.结论:心理因素对患TMD的在校生影响显著,可影响TMD相关疼痛的程度,对在校生的TMD进行治疗时应考虑心理的相关治疗.     

唇腭裂患儿母亲心理健康状况的城乡对比研究

目的：对来自城乡的唇腭裂患儿母亲的心理健康状况分组进行评估和对比,为对其进行心理支持和治疗提供依据。方法：采用症状自评量表（SCL-90）对168名（农村124,城市44）唇腭裂患儿的母亲在住院期间进行问卷调查。以82名正常儿童的母亲作为对照组。结果：试验组患儿母亲在躯体化、强迫症状、抑郁、焦虑等9个维度上分值均显著高于对照组（P ＜0．05）;农村组患儿母亲在躯体化、强迫症状、抑郁、焦虑等9个维度上分值均高于城市组,其中敌对、精神病性、总分差异有统计学意义（P ＜0．05）;结论：唇腭裂患儿母亲的心理健康状况较差,农村的唇腭裂患儿母亲心理健康状况比城市的更差,应予以特别关注。     

Clinical and psychological characteristics of TMD patients with trauma history

Oral Diseases (2010) 16 , 188–192 Objective: The purpose of this study was to investigate clinical and psychological characteristics of temporomandibular disorders (TMD) patients with trauma history. Materials and methods: The clinical and psychological characteristics of 34 TMD patients with trauma history were compared with those of 340 TMD patients without trauma history. Craniomandibular index (CMI) was used for clinical characteristics of TMD patients. Symptom severity index (SSI) was used to assess the multiple dimensions of pain. Symptom checklist‐90‐revision (SCL‐90‐R) was used for psychological evaluation. Results: Temporomandibular disorders patients with trauma history displayed significantly higher CMI and palpation index. TMD patients with trauma history also exhibited higher values in duration, sensory intensity, affective intensity, tolerability, scope of symptom, and total SSI score. In addition, these patients showed significantly higher values in symptom dimensions of somatization, depression, anxiety, phobic anxiety, and paranoid ideation. Among the symptom dimensions of SCL‐90‐R, somatization showed the most significant correlations with CMI and SSI. Conclusions: Temporomandibular disorders patients with trauma history displayed more severe subjective, objective, and psychological dysfunction than those without trauma history. Pain of myogenous origin, history of physical trauma, and psychosocial dysfunction were all closely related.     

Cognitive profile of patients with burning mouth syndrome in the Japanese population

The present study investigated which cognitive characteristics, including cancer phobia, self-efficacy, pain-related catastrophizing, and anxiety sensitivity, affect burning mouth syndrome (BMS) symptoms in the Japanese population. A total of 46 BMS patients (44 women and 2 men; mean age, 59.98 ± 9.57 years; range, 30–79 years) completed a battery of questionnaires, including measures of pain severity, oral-related quality of life (QOL), stressresponse, pain-related catastrophizing, self-efficacy, anxiety sensitivity, and tongue cancer phobia. The Pain Catastrophizing Scale (PCS), General Self-Efficacy Scale (GSES), and Anxiety Sensitivity Index (ASI) scores in the BMS patients were compared with the scores of Japanese healthy participants (PCS, n = 449; GSES, n = 278; ASI, n = 9603) reported in previous studies. Catastrophizing and anxiety sensitivity were significantly higher in the BMS patients than in the healthy subjects (P < 0.001). In BMS patients, catastrophizing was significantly correlated with pain severity, stress-response, psychological disability, social disability, and handicap. Cancer phobia was significantly correlated with psychological disability and handicap. Since catastrophizing showed a higher correlation with BMS symptoms than cancer phobia, catastrophizing might be a more significant cognitive factor affecting symptoms than cancer phobia in BMS patients in the Japanese population.     

DC/TMD推荐心理量表在颞下颌关节紊乱病诊疗中的应用

目的: 采用新版DC/TMD推荐的心理量表,评估颞下颌关节紊乱病（temporomandibular disorders, TMD）患者焦虑、抑郁及躯体症状等心理状况,探讨新版量表作为TMD心理轴诊断依据的临床意义。方法: 选择100例TMD初诊患者作为实验组,100例无TMD症状的普通门诊患者作为对照组。收集2组患者的一般信息,包括年龄、性别、受教育程度、个人收入等。采用广泛性焦虑症量表（GAD-7）、抑郁症状量表（PHQ-9）和健康问卷量表15（PHQ-15）对患者心理因素进行评估。采用SPSS 20.0软件包对数据进行统计学分析。结果: <30岁组和30~50岁组TMD发病率显著高于50岁以上年龄组（P<0.05）。实验组高学历者比例显著高于对照组（P<0.05）,而收入水平不是罹患TMD的危险因素（P=0.642）。实验组焦虑发生率与平均得分显著高于对照组（P<0.05）,而两组间抑郁和躯体症状得分无统计学差异（P>0.05）。疼痛性TMD患者的焦虑和抑郁程度显著高于关节疾病患者（P<0.05）,而两组间躯体症状无显著差异（P>0.05）。结论: 性别（女）、年龄（<50岁）和高学历（本科及以上）是罹患TMD的高危因素,而与收入水平无关。TMD患者的焦虑发生率和评分均高于普通口腔门诊患者,但抑郁和躯体症状与普通患者的发生率无显著差异。     

Burning mouth syndrome (BMS) and the concept of alexithymia – a preliminary study

Twenty women suffering from burning mouth syndrome (BMS) were rated with regard to alexithymic traits, depressive symptoms and anxiety: values were compared to disability level assessed by interviews. Results confirm earlier reports that BMS symptomatology is associated with depression and anxiety. The majority of patients were rated as alexithymic and. supported by interview data; these results indicate that somatization should be taken into consideration during clinical evaluation of BMS symptoms. The study included a psychological analysis of the communication pattern in the patient-doctor relationship, leading to the assumption that the patient's appeal for somatic treatment, dependency and hopelessness may activate defensive reactions in the dentist. Such reactions can be either rejection of. or compliance with, the patient's demands. The importance of a differentiated assessment and treatment approach for these patients is emphasized. Due to lack of control data the report should be viewed as a pilot study.     

口腔颌面外科手术患者心理卫生状况调查

目的 调查口腔颌面外科手术患者的心理卫生状况，以便提供心理指导。方法 采用症状自评量表(SCL—90)对76例患者进行调查和统计分析。结果 术前躯体化因子分在年龄方面，偏执因子分在文化程度及病种方面有明显差异(P＜0．05)。术后焦虑、敌对以及偏执因子分在病种方面均有明显差异(P＜0．05)。术前术后各因子分的变化量比较显示：躯体化和抑郁因子分的变化量在性别方面，敌对因子分的变化量在职业方面有明显差异(P＜0．05)。术前、术后各因子分之间均无明显差异。结论 口腔颌面外科患者手术前后存在心理卫生问题，并与多种因素相关。医护人员应有针对性地进行围手术期的心理干预。     

口腔癌患者心理健康状况的调查分析

为探讨口腔癌发生与心理健康状况的关系。根据1:1配对原则,应用深入访谈法和症状自评量表,对41例口腔癌患者和41例正常人进行评定。结果,不良人际关系、不幸遭遇和不良应对策略与个体口腔癌的发生有非常明显的关系,不良家庭气氛和缺少社会支持,与其发生有一定关系。口腔癌患者的SCL-90总分及躯体化、忧郁、焦虑因子显著高于正常人(P<0.01),人际敏感因子显著低于正常人(P<0.05)。因此认为口腔癌的发生与个体的心理健康状况有一定关系,及时正确的心理治疗和干预,对口腔癌的发生有重要意义。     

灼口综合征心理药物综合治疗的临床观察

目的评价对40例灼口综合征(BMS)患者心理药物综合治疗疗效。方法对临床确诊的BMS患者采用氯硝西泮加盐酸氟西汀和心理疏导治疗,对口腔症状、躯体化症状、心理量表进行观察。结果总有效率为95%,其中治愈和显效为67.5%。躯体化症状大部分明显减少或消失(P<0.01),SAS、SDS、SCL90量表治疗前后比较有明显的改善(P<0.01)。结论心理药物对精神性BMS的治疗是一种有效的方法,必须严格掌握指征,坚持长期、持续、程序性治疗原则,医患的配合是治疗成功的关键。     

Burning mouth syndrome and saliva: detection of salivary trace elements and cytokines

Background: Burning mouth syndrome (BMS) is considered a syndrome with an unknown cause. Roles of various trace elements and cytokines in saliva have been implicated in the development of BMS. The aim of the present study was to compare the levels of salivary trace elements [magnesium (Mg), zinc (Zn), copper (Cu)] and interleukin (IL)‐2 and IL‐6, and to search for a correlation between depression/anxiety and salivary trace elements and cytokines in BMS patients and controls. Methods: Thirty patients with BMS and 30 matched healthy controls participated in the study. Unstimulated saliva was collected from participants and salivary flow rates were determined. Mg, Zn and Cu levels were determined by atomic absorbance spectrophotometry. Cytokine immunoassay kits were used to determine the concentration of IL‐2 and IL‐6 in the whole saliva samples. Anxiety and depression were analyzed by means of the Speilberger State‐Trait Anxiety Inventory (SAI‐TAI) and Zung Self‐Rating Depression Scale. Results: Although subjects in the control group had significantly higher mean levels for Mg compared with BMS patients (P < 0.01), no statistically significant differences were observed in relation to Zn and Cu levels between the two groups (P < 0.001). There were no statistically significant differences in IL‐2 and IL‐6 levels of BMS and control groups, but subjects in BMS group had slightly, not significantly, higher mean levels for IL‐6 compared with controls. Subjects in BMS group had significantly higher mean values for TAI compared with controls (P < 0.05). There were no statistically significant differences in relation to salivary levels of Mg, Zn, Cu, IL‐2, IL‐6 and depression/anxiety between BMS and control groups. Conclusions: The results of our study indicate that Mg levels could have an impact on symptoms of BMS and further studies are necessary to determine the importance of cytokines in the pathogenesis of BMS.     

BMS患者抑郁、焦虑状况及其与疼痛感受的相关性分析

目的：调查灼口综合征（BMS）患者的心理抑郁及焦虑状况,分析心理状况与疼痛感受的相关性.方法：收集2012年1月～2014年1月期间因灼口综合征就诊患者135例及100名健康志愿者.采用焦虑自评量表（SAS）和抑郁自评量表（SDS）对两组对象进行问卷测试.对BMS患者的主观疼痛程度进行分级.采用SPSS11.0统计分析软件分析BMS患者抑郁、焦虑状况及其与疼痛感受的相关性.结果：BMS患者SAS值及SDS值均高于对照组,差异具有统计学意义（P＜0.01）,SAS值及SDS值在不同疼痛程度的患者中有显著差异（P＜0.01）.结论：BMS患者具有明显的抑郁及焦虑心理,其心理抑郁及焦虑的严重程度与患者临床疼痛的主观感受有关.     

Anxiety and personality traits in patients with muscle related temporomandibular disorders

This study tested the hypothesis that muscle related temporomandibular disorder patients with cervical muscle pain exhibit greater degree of psychological distress compared with patients without cervical muscle pain and controls. Thirty-eight muscle related temporomandibular disorder patients including 10 patients with cervical muscle pain and 41 healthy individuals as controls participated in the study. State and trait anxiety levels were assessed with the Spielberger's state and trait anxiety inventory. Personality traits (extroversion, neuroticism, psychoticism and social desirability) were assessed using the Eysenck's personality questionnaire, and the pain intensities described over the muscles were recorded using a 100 mm visual analogue scale. The muscle related temporomandibular disorder patients, in general, exhibited significantly higher degrees of neuroticism and trait anxiety. The patients with cervical muscle pain demonstrated a significantly higher level of psychoticism compared with the patients without cervical muscle pain and the controls and a significantly higher state anxiety level than the controls. They also demonstrated higher pain intensities in masseter and temporalis muscles compared with patients without cervical muscle pain. It has been suggested that either subjects with psychological distress are prone to temporomandibular disorders, or psychological distress is a manifestation of existing chronic pain conditions. The present findings demand further investigations and broader approach in management, as muscle related temporomandibular disorder patients with cervical muscle pain were both physically and psychologically compromised to a greater degree compared with patients without cervical muscle pain.     

唇腭裂患儿父母心理健康状况对照研究

目的　了解唇腭裂患儿父母的心理健康状况 ,为对其进行心理支持和治疗提供依据。方法　采用SCL - 90症状自评量表对唇腭裂患儿的 6 0名父母及正常儿童的 6 0名父母进行心理调查。结果　患儿组父母SCL- 90总分、阳性项目数、抑郁、焦虑和恐怖明显高于对照组 (P <0 .0 5 )。患儿组母亲在躯体化、强迫、人际关系、抑郁、焦虑、偏执、精神病性诸因子分和阳性项目数上明显高于父亲 (P <0 .0 5 )。结论　唇腭裂患儿的父母心理健康状况较差 ,尤以患儿母亲较为突出     

Chronic TM Disorder and Non-TM Disorder Pain: A Comparison of Behavioral and Psychological Characteristics

The purpose of this paper is to determine whether patients with chronic temporomandibular disorder (TMD) pain manifest behavioral, experiential, and psychological characteristics similar to patients with other chronic pain illnesses. The Chronic Pain Battery^TM (CPB), a multidimensional assessment tool for chronic pain patients, was used to compare several important variables between 78 TM disorder (TMD) patients and 98 non-TMD chronic pain patients. The study found that chronic TMD patients had lower “usual” pain intensity and suffering levels, fewer vegetative symptoms associated with depression, higher pain tolerance, less impairment of activity, more hope about treatment outcome, lower health care system utilization, but higher reported stress levels than non-TMD chronic pain patients. The two groups manifested no significant differences in use of narcotics, sedatives, and sleeping pills; levels of depression, anxiety, somatization, hostility, or psychoticism; illness behavior reinforcement in their social surroundings; or ratings of problems with work, family, self-esteem, or suicidal impulses.

These findings suggest that chronic TMD pain patients (with a symptom duration of over six months) are behaviorally and psychologically similar to non-TMD chronic pain patients, but that they differ in their perceptions of their disorder, rendering them less handicapped by their problems. Psychological, social, and behavioral treatment methods useful for treating chronic pain syndrome may thus also be applied along with dental therapy for optimal treatment of TMD associated with chronic pain.