首发精神分裂症患者社会功能缺陷与社会支持的对照比较

目的 了解首发精神分裂症患者社会功能缺陷和社会支持状况。方法 采用社会功能缺陷筛选量表(SDSS)和社会支持评定量表对106例首发精神分裂症患者的社会功能和社会支持进行评定，用非首发精神分裂症患者和非精神疾病患者作对照。结果 （1)首发精神分裂症患者客观支持(8．1&;#177;2．1)、主观支持(19．8&;#177;3．5)、对支持的利用度(7．3&;#177;1．7)、社会支持总分(35．3&;#177;5．7)均明显低于对照组(t=2．28—5．02．P&;lt;0．01-0．05)，高于非首发精神分裂症组患者(t=3．78—6．02．P&;lt;0．01)。(2)首发精神分裂症患者各项社会功能缺陷程度均明显低于非首发精神分裂症患者(χ^2=4．20-18．43．P&;lt;0．05—0．001)。结论 首发精神分裂症患者社会功能和社会支持均优于非首发精神分裂症患者，社会支持差于非精神疾病患者。     

利培酮与氯氮平对首发精神分裂症患者社会功能的影响

目的:探讨利培酮与氯氮平对首发精神分裂症患者社会功能的影响。方法:采用社会功能缺陷筛选量表(SDSS)对106例(脱落23例,83例完成研究)首发精神分裂症患者的社会功能进行评定,并比较利培酮(n=43)与氯氮平(n=40)治疗首发精神分裂症患者对其社会功能的影响。结果:利培酮治疗的首发精神分裂症患者家庭内活动过少(3%,7/43)、家庭职能(3%,7/43)、个人生活自理缺陷发生率(5%,3/43)和SDSS分均显著低于氯氮平治疗的患者(χ2=4.847,4.847,4.295;t=0.718-2.684;P均<0.05);利培酮治疗的患者对外界的兴趣和关心SDSS分显著低于氯氮平治疗的患者(0.12±0.39和0.33±0.66,t=1.771,P<0.05)。结论:利培酮对首发精神分裂症患者社会功能的影响优于氯氮平。     

健康教育对精神分裂症自尊、社会功能及应激能力的影响

目的通过对精神分裂症患者实施健康教育,探讨健康教育对精神分裂症自尊、社会功能及应激能力的影响。方法将96例精神分裂症患者随机分配至研究组和对照组各48例,其中脱落5例。对照组行常规抗精神病药治疗,研究组在此基础上实施健康教育,疗程均为8周,随后进行为期6个月的随访。采用自尊量表(SES)及社会功能缺陷筛选量表(SDSS)分别于健康教育前及随访结束时进行评定,并于随访结束时进行简易应对方式问卷(SCSS)评定。结果随访结束时,①研究组患者的SES评分为(28±5)分,明显高于对照组的(19±4)分(t=9.49,P<0.01),而SDSS评分为(6±3)分,则明显低于对照组的(8±4)分(t=2.69,P<0.01);②研究组患者的SCSS中积极应对因子评分为(1.8±0.5)分,明显高于对照组的(1.5±0.7)分(t=2.35,P<0.05),而消极应对因子评分为(1.6±0.6)分,则明显低于对照组的(1.9±0.6)分(t=2.38,P<0.05)。结论健康教育可提高精神分裂症患者的自尊水平、社会功能及心理应激能力。     

健康教育对恢复期精神分裂症患者社会功能及其防御机制的作用

目的:探讨健康教育对恢复期精神分裂症患者社会功能及其防御机制的影响。方法:将120例恢复期精神分裂症按入院顺序随机分为研究组和对照组各60,对照组行常规抗精神病药治疗,研究组在此基础上实施健康教育。采用社会功能缺陷筛选量表(SDSS)、住院精神病患者康复疗效评定量表(IPROS)及防御方式问卷(DSQ)对所有患者分别于健康教育前及健康教育8周末进行效果评估。结果:同健康教育前比较,健康教育8周末研究组患者的SDSS评分由6.48±2.79降为4.18±2.26(t=4.96,P<0.01),IPROS评分由49.46±10.19降为41.92±12.58(t=3.61,P<0.01);不成熟防御机制评分由4.79±0.93降为4.12±1.07(t=3.66,P<0.01),成熟防御机制评分由4.85±1.17升为5.37±0.96(t=2.66,P<0.05);而对照组上述改变均不明显(P>0.05)。与对照组比较,健康教育前社会功能缺陷程度及防御机制的应用差异均无显著性意义(P>0.05);但健康教育8周末,研究组患者的SDSS及IPROS评分分别为4.18±2.26,41.91±12.58,均明显低于对照组的5.86±2.63,48.56±11.47(前者t=3.75,3.02;P均<0.01),不成熟防御机制评分为4.12±1.07,明显低于对照组的4.61±1.19(t=2.37,P<0.05),而成熟防御机制评分为5.37±0.96,明显高于对照组的4.91±1.24(t=2.25,P<0.05)。结论:健康教育可有     

生活事件、社会支持及防御方式在精神分裂症发生中的作用

目的:从生活事件、社会支持和防御方式3个方面来探讨精神分裂症发生的个体易感素质和心理社会因素。方法:采用生活事件量表、社会支持调查表和防御方式问卷对45例首次发作的康复期精神分裂症患者进行测试,并与42名正常人做对照研究。结果:研究组的生活事件负性刺激量(23.58±16.37)和总刺激量(37.31±32.87)较高,社会支持总分(32.78±8.33)、客观支持分(9.94±3.16)、主观支持分(17.82±5.20)及支持利用度(5.02±1.98)得分明显较低,与对照组比较,差异有显著性意义(t=2.59～4.88,P<0.05～0.01);防御方式在不成熟(4.75±1.38)和神经症性(4.98±1.42)方面高于对照组,差异有显著性意义(t=3.44,2.88,P<0.01)。结论:精神分裂症的发生与负性生活事件、社会支持系统缺乏以及防御方式的不成熟和神经症性密切相关。     

系统性早期干预对首发精神分裂症患者康复效果的1年随访

目的:探讨早期干预对首发精神分裂症患者的康复效果。方法:将76例首发精神分裂症患者随机分为观察组和对照组(各38例,观察组脱落3例,对照组脱落2例)。对照组常规用氯氮平治疗,观察组在此基础上实施为期8周的心理社会干预措施,并随后进行为期1年的随访。采用阴性和阳性症状评定量表(PANSS)、住院病人护士观察量表(NOSIE-30)和复发率对康复效果进行评估。结果:随访结束时,观察组患者的PANSS总分、阳性症状及阴性症状的减分值分别为50.72±14.26,18.75±5.92,13.50±5.72,均高于对照组(41.25±13.93,15.21±6.58,9.07±6.83),差异有显著性意义(t=2.86,2.38,2.96;P<0.05～P<0.01);观察组患者的积极因素、消极因素及总评分的减分值分别为-38.58±10.14,30.47±13.26,-68.51±15.41,亦均明显高于对照组(-6.53±11.37,7.12±14.52,-11.09±22.15),差异有显著性意义(t=12.52,7.07,12.87;P<0.01);观察组1年内复发率为8.6%,明显低于对照组(30.6%),差异有显著性意义(χ2=5.42,P<0.05)。结论:对首发精神分裂症患者辅以综合性早期干预措施,可有助于改善患者的精神症状,提高患者的社会功能,并降低其复发率。     

脑外伤后出院回归社会患者迟发性抑郁与社会支持的相关性

目的:分析脑外伤后出院回归社会患者远期迟发性抑郁发病与社会支持的相关性。方法:选择2002-05/2003-05在中国医科大学第四临床学院神经外科门诊就诊和住院治疗的脑外伤患者106例为调查对象。脑外伤发病后1年接受汉密顿抑郁量表和社会支持评定量表测评。采用汉密顿抑郁量表(包括:躯体化;体重变化;认知障碍;昼夜变化;迟缓;睡眠障碍;绝望感7个方面24项内容,采用5级评分,即0无、1轻度、2中度、3重度和4极重度。抑郁测试总得分>8分为抑郁状态,>20分为中度抑郁,>35分为重度抑郁)评估抑郁状态。以汉密顿抑郁量表为分组依据,分为无抑郁组(n=115)和迟发性抑郁组(n=31)。采用社会支持评定量表(包括主观支持、客观支持、个人利用度3个维度10个项目)评定患者自我感觉获得的和实际获得的支持情况及个人利用别人支持和帮助的程度。采用统一指导用语,于发病后1年进行检测。问卷应由测试对象自行填写。当场收回。组间显著性检测采用t检验。结果:①脑外伤患者146例出院1年后,迟发性抑郁患病率为21.2%(31例),无抑郁患者115例(78.7%)。迟发性抑郁组患者社会支持总分明显低于无抑郁组犤(37.41±10.53),(42.73±12.18),t=2.634,P<0.05犦。平均年龄明显大于无抑郁组犤(46.96±13.51),(40.22±14.08)岁,t=3.327,P<0.01犦,但两组患者的性别和文化程度等数据分布接近。②脑外伤后迟发性抑郁组患者主观支持各条目得分(您与朋友,您与邻居,您与同事,您与家庭成员)及主观支持总分均明显低于无抑郁组(t=2.262～3.211,P均<0.01～0.05)。③脑外伤后迟发性抑郁组患者客观支持条目得分(遇到困难时获得的经济来源,精神安慰来源及客观支持总分均明显高于无抑郁组(t=2.237～3.428,P<0.05～0.01),但两组间“近1年对外联系”条目得分无明显区别(P>0.05)。④脑外伤后迟发性抑郁组患者个人利用度条目(您遇到烦恼时的倾吐方式,求助方式)评分及总分均明显低于无抑郁组(t=2.237～3.428,P均<0.05～0.01),但两组间“参加各类团体组织活动”条目无明显区别。结论:本调查结果说明脑外伤回归社会患者的社会支持与迟发性抑郁患病呈负相关,拥有较多社会支持的脑外伤出院回归社会患者社会功能较好。因此寻求增加社会支持的可降低其患病率。     

住院康复期精神分裂症患者心理趋势与应对方式及社会支持的关系

目的:探讨康复期精神分裂症患者心理趋势与应对方式、社会支持的相关性,为制定社会心理康复干预提供理论依据。方法:采用症状自评量表(SCL-90)、应对方式量表、社会支持量表对100例广州市脑科医院康复期住院精神分裂症患者进行测评,并与常模比较。结果:①SCL-90的9个因子得分研究组的躯体化(1.41±0.46)、强迫症状(1.73±0.48),人际关系(2.13±0.61)、抑郁(1.94±0.58)、焦虑(1.73±0.45)、敌对(2.03±0.59)、恐怖(1.51±0.41)、偏执(1.78±0.42)、精神病性(1.39±0.42)均较常模高,差异有显著性(u=2.04～9.17,P<0.05～0.01)。②研究组的SCL-90的9个因子分,与消极应对方式呈正相关(r=0.24～0.33,P<0.05～0.01),除精神病性因子外,其他因子与积极应对方式呈负相关(r=-0.24～-0.33,P<0.05～0.01)。与社会支持呈负相关(r=-0.19～-0.33,P<0.05～0.01)。结论:康复期分裂症患者心理健康状况较差,应加强心理健康教育,强化应对知识和应对技能训练以及社交技巧训练,增加社会支持。     

康复护理干预对精神分裂症患者社会功能缺陷的影响

目的:探讨康复护理干预对精神分裂症患者社会功能缺陷的影响。方法:将211例精神分裂症患者随机分为研究组105例和对照组106例,研究组实施住院康复及综合护理干预;对照组实施住院康复和常规护理。应用社会功能缺陷评定量表(SDSS)在康复前和干预3个月后各评定1次,比较两组患者社会功能恢复情况。结果:研究组SDSS总分康复前为6.34±1.67,康复后降为4.22±1.06,前后比较差异有显著性(P<0.01),且均显著优于对照组(P<0.01)。其中,以职业功能、社会活动、家庭活动、生活能力等功能的改善较明显(P<0.05,P<0.01)。结论:精神分裂症患者存在不同程度的社会功能缺陷,住院康复及综合护理干预对精神分裂症患者社会功能缺陷有显著改善作用。     

利培酮与氯氮平对首发精神分裂症患者社会功能的影响

目的：探讨利培酮与氯氮平对首发精神分裂症患者社会功能的影响。方法：采用社会功能缺陷筛选量表(SDSS)对106例(脱落23例，83例完成研究)首发精神分裂症患者的社会功能进行评定，并比较利培酮(n=43)与氯氮平(n=40)治疗首发精神分裂症患者对其社会功能的影响。结果：利培酮治疗的首发精神分裂症患者家庭内活动过少(3％，7／43)、家庭职能(3％，7／43)、个人生活自理缺陷发生率(5％，3／43)和SDSS分均显著低于氯氮平治疗的患者(χ^2=4．847，4．847，4．295；t=0．718-2．684；P均&;lt;0．05)；利培酮治疗的患者对外界的兴趣和关心SDSS分显著低于氯氮平治疗的患者(0．12&;#177;0．39和0．33&;#177;0．66，t=1.771，P&;lt;0．05)。结论：利培酮对首发精神分裂症患者社会功能的影响优于氯氮平。     

Social standards and social withdrawal

This study examined the effects of social standards on withdrawal from social interactions. Subjects with high or low perceptions of their social ability were provided with either a high, a low, or no social standard prior to an interaction. High-efficacy subjects persisted in the interaction when they could meet the standard and terminated the interaction when they could not. Low-efficacy subjects, on the other hand, withdrew from the interaction whether they matched the social standard or not. For high-efficacy individuals, these results were congruent with theories of social cognition, which emphasize discrepancies between standards and perceived ability. For low-efficacy individuals, a sense of goal attainment was not sufficient to overcome their habitual social withdrawal. Low-efficacy subjects recognized when they did or did not meet the social standard, but perceived themselves to lack control over the interaction. These subjects appeared to believe others held nonarticulated expectations for them that they were unable to meet.The research was supported by a grant to the first author from the Social Sciences and Humanities Research Council of Canada. The second author was supported by fellowships from the Social Sciences and Humanities Research Council of Canada and the University of British Columbia.     

Perception of social functioning in dysphoria

This study examined diverse aspects of social functioning relevant to depressives' interpersonal difficulties, including the realism of perceptions of social competency. Sixteen dysphoric clients, 25 dysphoric students, and 25 nondepressed students evaluated their social distress and avoidance, and self-efficacy expectations prior to an interaction task with confederates. Following the interaction, subjects rated their social competency and were rated by their partners and external observers, who also assessed subjects' specific behavioral skills. Dysphorics relative to nondepressives reported significantly greater social distress and avoidance, as well as lower social performance expectancies, which were negatively correlated. However, neither self-, partner, nor observer ratings discriminated between the groups' social performance or specific verbal and nonverbal skills. Moreover, dysphoric students' self-evaluations were in accord with observers' ratings, whereas clients and nondepressed students overestimated their social competency. All subjects' self-ratings were in agreement with the perceptions of their interactive partners. Results are discussed in relation to previous research, and support the potential role of negative expectancies and situational determinants in accounting for dysphoric/depressive social functioning.This article is based on a Master's thesis submitted by the first author to the Ecole de psychologie, Université Laval, under the direction of the second author. The authors would like to acknowledge the contributions of research assistants N. Dutil, M. Guimond, L. Nadeau, and M. Renaud.     

腹膜透析患者社会功能与社会支持的相关性研究

目的探讨腹膜透析患者社会功能和社会支持之间的相关性。方法应用社会功能缺陷筛选表和社会支持评定量表对171例终末期肾病患者进行评定。结果 129例患者存在社会功能缺陷,占75.44%;社会功能缺陷得分与社会支持总分(r=-0.289,P0.05)、主观支持得分(r=-0.189,P0.05)、对支持的利用度(r=-0.569,P0.01)呈负相关。结论临床护理中应加强腹膜透析患者的社会支持,促进其社会功能的改善。     

An integrated model of social environment and social context for pediatric rehabilitation

This article considers the conceptualization and operationalization of “social environment” and “social context” with implications for research and practice with children and youth with impairments. We first discuss social environment and social context as constructs important for understanding interaction between external environmental qualities and the individual's experience. The article considers existing conceptualizations within psychological and sociological bodies of literature, research using these concepts, current developmental theories and issues in the understanding of environment and participation within rehabilitation science. We then describe a model that integrates a person-focused perspective with an environment-focused perspective and that outlines the mechanisms through which children/youth and social environment interact and transact. Finally, we consider the implications of the proposed model for research and clinical practice. This conceptual model directs researchers and practitioners toward interventions that will address the mechanisms of child–environment interaction and that will build capacity within both children and their social environments, including families, peers groups and communities. Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love [p.2].

• Implications for Rehabilitation

• Understanding how social environment and personal factors interact over time to affect the development of children/youth can influence the design of services for children and youth with impairments.

• The model described integrates the individual-focused and environment-focused perspectives and outlines the mechanisms of the ongoing reciprocal interaction between children/youth and their social environments: provision of opportunities, resources and supports and contextual processes of choice, active engagement and collaboration.

• Addressing these mechanisms could contribute to creating healthier environments in which all children, including children with impairments, have experiences that lead to positive developmental benefits.

     

Clarifying the social support theory-research linkage

Social support is a multi-faceted concept that has been difficult to conceptualize, define and measure. Although this concept has been extensively studied, there is little agreement among theoreticians and researchers as to its theoretical and operational definition. As a result, the concept remains fuzzy and almost anything that infers a social interaction may be considered social support. Social support researchers have consistently ignored the complexity of the concept and have measured the variable in a simplistic manner. The purpose of this article is to analyse the linkage between theory and research related to social support by categorizing definitions of social support, exploring the theoretical aspects and conceptualizations of the concept, proposing models of social support, and examining how social support is measured in current social support research (1993–1996). The inadequacy of current research and directions for future study are discussed.     

Representations of the self in social phobia: Vulnerability to social threat

A revised Stroop color-naming task was used to test hypotheses derived from Beck's cognitive theory of anxiety disorders which proposes that social phobics are hypervigilant to social-evaluative threat cues. Color-naming latencies for social and physical threat words were compared to matched neutral words for both social phobics and individuals with panic disorder. As predicted, social phobics showed longer latencies for social threat words, and panickers had longer latencies for physical threat words. Latency for color-naming social threat words correlated with self-reported avoidance among social phobics. These results are consistent with Beck's notion of self-schemata which facilitate the processing of threat cues. Methodological issues and clinical implications are discussed.Portions of this paper were presented at the World Congress of Behaviour Therapy, Edinburgh, September 1988, and at the annual meeting of the Association for the Advancement of Behavior Therapy, Boston, November 1988.     

社会技能训练对社区精神分裂症患者社会功能的影响

目的探讨社会技能训练对社区精神分裂症患者社会功能的影响。方法将96例社区精神分裂症患者分为训练组和对照组,各48例,对照组按常规治疗休养,训练组进行社会技能训练,并进行1年随访观察。结果两组患者随访1年后,遵医情况复发率、简明精神病评定量表及社会功能缺陷筛选量表评分比较,差异均具有统计学意义(P0.01)。结论社会技能训练能提高社区精神分裂症患者的坚持服药率,巩固疗效和减少疾病复发有效改善了患者受损的社会功能提高患者的生活质量和良好的社会适应有利于患者自立和重返工作。     

Employment, social inclusion and mental health

Whereas unemployment is clearly linked to mental health problems, employment can improve quality of life, mental health, social networks and social inclusion. Yet in the UK only 15% of people with serious mental health problems are employed--despite an overwhelming consensus from surveys, case studies and personal accounts that users want to work. This paper aims to challenge common misconceptions surrounding employment, work and mental health problems. Drawing on a range of research evidence and legislative guidance it discusses significant barriers to work and proposes feasible solutions. The need for mental health staff and services to become involved in the provision of work opportunities is considered, as is the vital role they can play in changing communities. The potency of work as a vehicle for improving the social inclusion and community tenure of people with mental health problems is highlighted.     

高职护生社交焦虑与应对方式、社会支持的关系研究

[目的]探讨应对方式、社会支持对高社交焦虑高职护生的影响。[方法]采用社交焦虑量表、简易应对方式量表和社会支持评定量表对494名高职护生进行调查。[结果]高职护生社交焦虑总分为（40.57±5.96）分,高焦虑护生占14.4%,社交焦虑现象严重。高社交焦虑与主观支持呈负相关（r=-0.314）。二分类 Logistic 回归分析显示,高职护生采用积极应对越多、消极应对越少时遭受高社交焦虑的可能性越小。[结论]培养护生积极的应对方式,纠正其消极应对方式,通过建立护生良好的主观支持促进其形成积极的应对方式,将有利于降低高社交焦虑水平。     

Living with a disability: a qualitative study of associations between social relations,social participation and quality of life

Purpose: We explored which shared aspects of social relations were considered important to the quality of life of persons between the ages of 10 and 40?years living with a disability. We examined how social relations were experienced as affecting quality of life and social participation.

Materials and methods: Fifteen focus groups involving 48 persons with disabilities were conducted using photo elicitation, preference ranking and props. Focus group interviews were supplemented with seven individual interviews with individuals unable to participate in focus groups. All focus group interviews and individual interviews were audiotaped, transcribed, and thematic data analysis was conducted.

Results: We identified caregiving, dependency, and understanding as essential for quality of life. Acceptance from society, discrimination and prejudice, and the ability to participate in society were also highlighted as affecting quality of life. The use of social tactics to avoid confrontation with certain aspects of their disability was common among participants.

Conclusions: Across disabilities, caregiving, dependency, understanding and acceptance, and discrimination and prejudice were all important aspects for the quality of life of the individuals. Social relations were closely related to social participation, and the latter affected the quality of life of the participants. Social tactics were used to navigate social relations.

• Implications for rehabilitation

• We suggest to formalize the concept of social tactics and use it in patient education to enhance quality of life in individuals living with disabilities.

• People may accept and learn to cope with the impact of their disability, but how they maintain their social participation and social relations also impact on their quality of life. In their assessment, professionals working with individuals with disabilities should, therefore, give more priority to analyze the impact of social relations.

• When intervening, an effort to establish and maintain social relations should be considered along with psychological help, allocation of aids and economical support aiming to enhance quality of life and social participation among individuals with disabilities.

• When evaluating efforts to improve quality of life, it is important to investigate whether the intervention has improved the social relations.