Adolescents coping with mood disorder: a grounded theory study

A grounded theory methodology was used to explore the phenomenon of coping as experienced by adolescents with a mood disorder. Mood disorders among children and adolescents are more persistent than previously thought and have numerous negative associated features, including further episodes of depression, impaired social, academic and vocational relationships, use of alcohol and other drugs, and an increased risk of suicide. Current literature offered little awareness of how adolescents cope with a mood disorder, as well as their perspective of how such an illness impacts their lives. A substantive theory regarding the process of coping for adolescents with a mood disorder was generated from the data collected from one male and eight female adolescents. Using grounded theory coding procedures, a four-phase coping theory identified by the categories feeling different, cutting off connections, facing the challenge/reconnecting, and learning from the experience was developed. The core category identified in this research was An Unplanned Journey: Coping Through Connections. Implications identified for nursing practice, research and education included greater attention on the prevention of adolescent mood disorder, and the education of adolescents about the development and enhancement of healthy coping skills.     

Pain perception in athletes compared to normally active controls: a systematic review with meta-analysis

This study systematically reviewed differences in pain perception between athletes and normally active controls. We screened MEDLINE, Sport-Discus, EMBASE, Web of Science, PsycINFO, PSYNDEX, and the citations of original studies and systematic reviews. All studies on experimentally induced pain that compared pain perception between athletes and normally active controls were eligible. The main outcome measures were pain tolerance and pain threshold. Effects are described as standardized mean differences and were pooled using random-effects models. Fifteen studies including 899 subjects met the inclusion criteria. Twelve of these studies assessed pain tolerance, and 9 studies examined pain threshold. A meta-analysis of these studies revealed that athletes possessed higher pain tolerance compared to normally active controls (effect size calculated as Hedges' g=0.87, 95% confidence interval [CI(95)] 0.53-1.21; P<0.00001), whereas available data on pain threshold were less uniform (Hedges' g=0.69, CI(95) 0.16-1.21; P=0.01). After exclusion of studies with high risk of bias, differences between groups in pain threshold were not significant any longer. Our data suggest that regular physical activity is associated with specific alterations in pain perception. Psychological and biological factors that may be responsible for these alterations are discussed.     

Evaluating the Illness Perception Questionnaire on patients with chronic kidney disease in Sweden

Scand J Caring Sci; 2012; 26; 474–484 Evaluating the illness perception questionnaire on patients with chronic kidney disease in Sweden Background: The Revised Illness Perception Questionnaire (IPQ‐R) measures illness perception according to the Common Sense Model of Self‐Regulation. Illness perception relates to coping, health management, treatment outcomes and health‐related quality of life. IPQ‐R has been used in many contexts. However, there is yet no Swedish version evaluated for validity, reliability and usability in the context of a Swedish, adult population with Chronic Kidney Disease (CKD). Objectives: To evaluate usability and psychometric properties of a Swedish translation of IPQ‐R on a group of adults in different stages of CKD. Methods:  Usability evaluation was carried out through cognitive interviews and psychometrics was assessed by internal consistency, test‐retest, inter‐correlations, correlations to health‐related quality of life and coping and testing for concurrent validity. Results: Content validity was strongly supported, but an uncertainty assessing symptoms attributed to CKD was indicated. All dimensions showed internal consistency, except the treatment control dimension. The IPQ‐R showed good stability over time except the personal control dimension. Most IPQ‐R dimensions distinguished illness representations between groups of different disease stages and symptom burden. The most supported IPQ‐R dimensions for inter‐correlations and convergent validity were identity, timeline cyclical, consequences and emotional representations. Conclusions: The evaluation of the Swedish version of IPQ‐R on patients with CKD showed support for construct validity, except for the dimensions controllability, illness coherence and timeline, which were less supported. These dimensions should therefore be interpreted with care in CKD patients. There is a need to capture uncertainty regarding illness identity. IPQ‐R should be interpreted with care in earlier stages of CKD or if few symptoms are reported. IPQ‐R may be applicable and useful as a tool in nursing practice to support healthy behaviour as well as assessing clinical interventions in patients with CKD.     

Illness perception in patients with coronary artery disease: A systematic review

The aim of this study was to conduct a systematic review that investigates the differences in illness perception with age and gender in patients diagnosed with coronary artery disease. Previous studies show some discrepancies regarding the influence of age and gender on the specific dimensions of coronary artery disease patients' illness perception. A systematic review using a narrative synthesis process included preliminary synthesis, exploration of relationships and assessment of the robustness of the synthesis and findings was conducted. Search terms were used to identify research studies published between 1996 and December 2014 across four key databases: CINAHL, Medline, PsycINFO and Web of Science. A total of 14 studies met the inclusion criteria of the review. The review found that men had a stronger perception that their own behaviour had caused their illness than women. In addition, older patients had lower perceptions of the consequences and chronicity of their illness. This analysis concludes that some dimensions of illness perception vary according to age and gender of patients with coronary artery disease. These differences should be taken into consideration, particularly when providing health education and cardiac rehabilitation.     

Increased sensitivity to heat pain after sad mood induction in female patients with major depression

Patients suffering from major depressive disorder (MDD) have been shown to exhibit increased thresholds towards experimentally induced thermal pain applied to the skin. In contrast, the induction of sad mood can increase pain perception in healthy controls. Here, we aimed to test the hypothesis that heat pain thresholds are further increased after sad mood induction in depressed patients. Thermal pain thresholds were obtained from 25 female depressed patients and 25 controls before and after sad mood induction applying a modified Velten Mood Induction procedure (MIP). Valence and arousal ratings were obtained using the self‐assessment manikin. The Montgomery Depression Rating Scale and the Beck Depression Inventory (BDI) were obtained at baseline from all participants. Pain thresholds at baseline did not significantly differ between groups. Pain thresholds and valence of mood significantly decreased both in patients and controls, while arousal showed an inverse time course between groups. Therefore, our hypothesis could not be confirmed. From these data, we propose that the depressed mood as seen in MDD patients influences pain experience differently as compared to the shorter‐lasting mood change after MIP. A differential interaction of both affective states with brain areas of the pain matrix might be assumed. Eventually, the induction of sad mood might mirror the increased number of pain complaints in depressed patients and thus adds to the current concept of adjuvant antidepressant treatment both in depressed patients with pain complaints and in chronic pain patients.     

Illness perceptions and activity limitations in osteoarthritis of the knee: A case report intervention study

This case report describes the process and outcome of an intervention where illness perceptions (IPs) were targeted in order to reduce limitations in daily activities. The patient was a 45-year-old woman diagnosed with posttraumatic secondary osteoarthritis of the lateral patella-femoral cartilage of the right knee. At baseline, the patient reported maladaptive IPs on the Brief Illness Perception Questionnaire Dutch Language Version and limitations in walking stairs, cycling and walking. Fewer limitations in daily activities are hypothesized by changing maladaptive IPs into more favourable IPs. In this case report, discussing maladaptive IPs with the patient was the main intervention. A participatory decision making model was used as a design by which the maladaptive IP were discussed. Six out of eight maladaptive IPs changed favourably and there was a clinically relevant decrease in limitations of daily activities. The Global Perceived Effect was rated as much improved.     

协同护理模式对改善老年心肌梗死患者疾病感知的干预效果

目的观察协同护理模式对改善老年心肌梗死患者疾病感知的作用。方法 2011年1月至2012年12月,解放军总医院对收治的100例老年心肌梗死患者实施协同护理,分别于实施前后采用疾病感知问卷(Chinese illness perception questionnaire revised edition,CIPQ-R)修订版对其测评。结果协同护理实施后,患者疾病感知各因子的得分与实施前比较,差异均有统计学意义(均P0.01)。结论实施协同护理模式可改善老年心肌梗死患者的疾病认知。     

Effects of spinal anesthesia and laryngeal mask anesthesia on mood states during hemorrhoidectomy

The present study was undertaken to compare the effects of laryngeal mask anesthesia (LMA) and spinal anesthesia on mood states in patients undergoing hemorrhoidectomy. A total of 46 patients who underwent hemorrhoidectomy for grade III and IV hemorrhoids were included in this study. LMA with fentanyl plus propofol was given to 23 patients, and spinal anesthesia with bupivacaine was administered to 23 patients. Mood changes were assessed preoperatively and 2 h postoperatively with the Profile of Mood States (POMS), which consists of 65 questions that are designed to measure 6 identifiable mood states (tension, depression, anger, vigor, fatigue, and confusion). No significant differences were noted between the 2 groups in terms of baseline POMS global and subscale scores, except for scores regarding vigor. No significant mood changes were observed after hemorrhoidectomy in patients who were given LMA; however, an increase in total POMS score was reported in patients given spinal anesthesia. These findings suggest that mood score is affected by spinal anesthesia but not by LMA in patients who are about to undergo hemorrhoidectomy.     

The Relationship of Illness Uncertainty, Illness Intrusiveness, and Asthma Severity to Depression in Young Adults with Long-Standing Asthma

This study examined the potential mediating/moderating influence of both illness intrusiveness and asthma severity on the association between illness uncertainty and depression in a college sample of older adolescents and young adults (N = 40) with histories of childhood asthma. There was a significant association between increased illness uncertainty and increased levels of depression. However, analyses indicated that neither illness intrusiveness nor asthma severity served as mediators in the uncertainty–depression relationship. Examination of moderator effects of intrusiveness and severity on the uncertainty–depression relationship revealed an interaction for severity only; thus, the significant effect of uncertainty on depression was at its maximim under conditions of increased illness severity. Results suggest that cognitive appraisal mechanisms involving decreasing ambiguity about illness may be worthwhile targets for intervention.     

某校护理本科生对精神病患者受贬低/歧视的感知状况调查

目的 了解护理本科生对精神病患者受贬低、歧视的感知状况。方法 运用贬低-歧视感知量表对北京某医科大学护理本科1～4年级的277名学生进行对精神病患者受贬低、歧视情况感知的调查。结果 144名护理本科生认同人们会看不起精神病患者,216名护生认同大部分人不愿意和患过精神病的人做好朋友,194名护生认同很少有人会雇用精神病患者为他们服务,158名护生认同人们对待精神病患者和普通人是不同的。不同年级、有无精神科临床见习经历和有无学习过精神科护理专业课程的护理本科生,其对精神病患者贬低/歧视态度的感知状况不同（P〈0.001）。结论 具备一定精神科专业知识、与精神病患者有过直接接触的护理本科生对患者存在消极认识,因此有必要对此开展相应的干预,针对性的反歧视项目值得探讨和研究。     

The utility of the Illness Perception Questionnaire in the evaluation of mental health practitioners' perspectives on patients with schizophrenia

Rationale, aims, objectives  The Illness Perception Questionnaire (IPQ) was designed as a measure of illness perception and has been used extensively for measuring the perceptions of people with physical illness. Latterly modified versions of the IPQ have been used to measure the illness perceptions of people with mental health problems and their carers. This study examined the utility of a modified version of the IPQ to measure changes in mental health practitioners' illness perceptions about schizophrenia after undertaking psychosocial intervention training.
Method  A total of 245 mental health practitioners who undertook psychosocial intervention training completed a modified version of the IPQ before and after training. The structure of the questionnaire was tested using confirmatory factor analysis. The internal consistency of sub-scales embedded in the instrument was also examined.
Results  The hypothesized structure failed to account for the data. Model fit indices revealed a poor fit to the data across all models evaluated. Cronbach's alpha revealed a number of sub-scales in the instrument to have mediocre internal consistency characteristics.
Conclusions  The modified version of the IPQ is not suitable for evaluating the impact of psychosocial intervention training on changes in illness perceptions of schizophrenia in mental health practitioners. However, the study has highlighted the need to develop a valid and reliable measure to assess the illness perceptions health professionals have of patients in their care.     

快速循环心境障碍患者的成因分析

目的探讨双相心境障碍患者快速循环发作的形成原因。方法对10例双相心境障碍快速循环发作患者的一般情况、治疗过程、药物种类、剂量、效果等进行统计分析。结果10例心境障碍快速循环发作患者中5例有家族史,4例个性内向,4例外向,以抑郁为首次发作者7例,平均使用药物4～11种,9例确诊时使用抗抑郁药物,5例联合使用过2种抗抑郁药物,5例明确诊断前联合使用心境稳定剂;控制快速循环时均使用心境稳定剂,其中使用2种者3例,单一使用丙戊酸钠2例;平均循环次数0.77±0.41次·mo-1。结论快速循环形成过程中使用抗抑郁药物可能是一个危险因素,未及早使用心境稳定剂也是可能因素之一。     

维持性血液透析患者的应对方式、社会支持及情感状态

目的从多角度了解维持性血液透析患者的社会心理状况,为进一步提高其生活质量提供资料。方法287例维持性血液透析患者来自武汉市4家血液透析中心。用医学应对问卷(MCMQ),社会支持度评定量表及情绪状态问卷(POMS)来评价患者的社会心理状况,并用pearsons’相关分析了解各变量间的关系。结果70%的患者无工作,经济收入低于1000元/月,但80%的患者医疗费自付比例大于20%,近20%的患者为100%自费。其MCMQ问卷中屈服分值明显高于常模,且与POMS问卷中负性情感因素如紧张-焦虑(T),忧郁-沮丧(D),愤怒-敌意(A),疲惫-惰性(F)及困惑-迷茫(C)呈正相关,而与活力-好动(V)呈负相关。社会支持评定量表中对支持的利用度及社会支持总分与患者的情感状态相关。面对、屈服与客观支持和对支持的利用度呈正相关,而回避则与两者呈负相关。结论维持性血液透析患者经济负担重,易采取消极的应对方式,易产生消极的情感。而好的社会支持可改善其应对方式及情感状态。