Mental Health Nursing and First Episode Psychosis

The purpose of this literature review is to identify mental health nursing's contribution to the care and treatment of patients with a first episode of psychosis; A systematic literature review was undertaken, with 27 articles selected for study. Five domains were identified: development of therapeutic relation, relapse prevention, enhancement of social functioning, stimulation of medication adherence, and support of family members. The level of evidence of mental health nursing's contribution to the care and treatment of those undergoing their first episode of psychosis was low. Our review suggests that mental health nurses should reflect upon their own daily practices within the five domains.     

首发精神疾病和精神分裂症患者粒细胞水平变化及其与氯丙嗪当量的相关性分析

[目的]探讨首发精神疾病(FEP)和精神分裂症(SCHIZ)患者粒细胞水平变化及其与氯丙嗪当量的相关性分析.[方法]前瞻性选择2017年5月至2020年2月本院收治的首发精神病和精神分裂症患者作为研究对象,并选择同期成年健康志愿者作为对照组(n=62).记录研究对象入组时(T0)和治疗6周后(T6)相关粒细胞水平,并采...     

利培酮和奥氮平治疗首发精神分裂症的对照研究

目的探讨利培酮和奥氮平在治疗首发精神分裂症方面的临床疗效与安全性。方法选择2009年2月～2011年2月在我院就诊的86例首发精神分裂症患者,随机分为两组,研究组(43例)口服奥氮平治疗,对照组(43例)口服利培酮治疗,均治疗8周。在治疗前、治疗后第2、4、8周分别对两组患者采用PANSS量表和TESS量表进行疗效和副反应评定。结果研究组治疗的总有效率为90.6%,对照组为88.4%,两组比较统计学上无显著性差异(P>0.05);治疗前后两组PANSS评分比较差异无统计学意义(P>0.05)。两组不良反应发生率低,研究组体重增加和嗜睡的发生率显著高于对照组,对照组椎体外系反应发生率显著高于研究组,差异均有统计学意义(P<0.05)。结论利培酮和奥氮平在治疗首发精神分裂症方面临床疗效相当,但不良反应有差别,可以根据患者的不同情况进行选择。     

认知行为治疗首发精神分裂症的近期疗效

目的：探讨认知行为治疗对首发精神分裂症患者治疗依从性、白知力以及复发率的影响。方法：120例首发精神分裂症患者随机分为研究组和对照组各60例，均进行系统的抗精神病药物治疗，研究组并配合认知行为治疗。治疗前及治疗3、6个月时分别采用简明精神病评定量表（BPRS）、白知力与治疗态度问卷量表（ITAQ），康复状态量表（MRSS）及白编治疗依从性调查表评定。结果：治疗后BPRS及MRSS评分研究组显著低于对照组（P〈0．05、0．01），ITAQ评分显著高于对照组（P〈0．01），患者的治疗依从性在3及6个月时均显著高于对照组（P〈0．05、0．01）；6个月时复发率比较研究组低于对照组（P〈0．05）。结论：认知行为治疗能提高首发精神分裂症患者的治疗依从性，促进自知力恢复，降低复发率。提高整体康复水平。     

临床护理路径对首发精神分裂症患者康复效果的随访研究

目的探讨临床护理路径对首发精神分裂症患者的康复效果。方法将96例首发精神分裂症患者随机分为观察组和对照组各48例,脱落8例。两组均予以利培酮系统治疗,观察组在此基础上制订临床护理路径实施方案,执行各项康复护理程序,疗程均为8w,随后对两组患者进行了为期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PANSS总分、阳性症状及阴性症状的减分值分别为50.63±13.92、18.80±5.87、14.37±5.64,均明显高于对照组的41.38±13.77、15.49±6.43、8.90±5.09（t=3.13、2.52、4.78,P〈0.05或P〈0.01）;观察组积极因素、消极因素及总评分的减分值分别为-38.67±10.26、30.51±13.18、-68.52±15.37,亦均明显高于对照组的-6.47±11.28、7.02±14.39、-11.06±21.78（t=13.99、7.97、14.24,P〈0.01）;观察组1年内的复发率为13.3%,明显低于对照组的34.9%（χ^2=5.62,P〈0.05）。结论临床护理路径有助于改善首发精神分裂症患者的精神症状,提高其社会功能,降低其复发率。     

Patients’ and Family Members’ Experiences of a Psychoeducational Family Intervention after a First Episode Psychosis: A Qualitative Study

The objective of this study is to explore patients’ and family members’ experiences of the different elements of a psychoeducational family intervention. A qualitative, explorative study was performed based on digitally recorded in-depth interviews with 12 patients and 14 family members. The interview data were transcribed in a slightly modified verbatim mode and analysed using systematic text condensation. Six themes that both patients and family members experienced as important in the family intervention were identified: alliance, support, anxiety and tension, knowledge and learning, time, and structure. A good relationship between the group leaders and participants was essential in preventing dropout. Meeting with other people in the same situation reduced feelings of shame and increased hope for the future. Hearing real life stories was experienced as being more important for gaining new knowledge about psychosis than lectures and workshops. However, many patients experienced anxiety and tension during the meetings. The group format could be demanding for patients immediately after a psychotic episode and for those still struggling with distressing psychotic symptoms. Group leaders need to recognise patients’ levels of anxiety before, and during, the intervention, and consider the different needs of patients and family members in regards to when the intervention starts, the group format, and the patients’ level of psychotic symptoms. The findings in the present study may help to tailor family work to better meet the needs of both patients and family members.     

Metacognitive Beliefs and Rumination: A Longitudinal Study

High prevalence and costs of depression underline the importance of understanding and treating vulnerability factors of depression such as rumination. Given the role of rumination in predicting the onset of new depressive episodes, it is important to learn why previously healthy people start to ruminate. One explanation is provided by the metacognitive model of depression, which assumes that positive beliefs about rumination initiate rumination. However previous research has been predominantly cross-sectional in nature. We investigated the effect of positive beliefs about rumination on engagement in rumination in a longitudinal design and tested the indirect effect of positive beliefs about rumination on depressive symptoms in 60 healthy university students. A hierarchical regression revealed a significant effect of Time 1 (T1) positive beliefs about rumination on Time 2 rumination, even after controlling for T1 rumination. Additionally, an indirect effect of positive beliefs about rumination on depressive symptoms via rumination was confirmed using a multiple regression and a Sobel test.     

心理干预对首发精神分裂症患者生活质量和社会功能的对照研究

目的探讨心理干预对首发精神分裂症患者生活质量和社会功能的影响。方法将120例本院住院首发精神分裂症患者随机分为观察组和对照组各60例,两组均予以利培酮系统治疗。观察组在此基础上给予8周的心理干预。随后对两组患者进行为期6个月的随访。采用阴性与阳性症状量表（PANSS）、世界卫生组织生活质量量表（WHO,QOL-100）、社会功能缺陷筛选量表（SDSS）分别于入组时及随访结束时进行评估。结果入组时,PANSS、QOL-100、SDSS评分两组间比较均无显著性差异（P〉0.05）;随访结束时,观察组PANSS总分及阴、阳性症状评分均明显低于对照组（P〈0.01）;而生活质量总评分,心理领域、独立性领域、社会关系领域评分及SDSS评分均高于对照组（P〈0.05或P〈0.01）。结论心理干预有助于缓解首发精神分裂症患者的精神症状,提高其生活质量及社会功能。     

医师家访对首发精神分裂症家庭康复的影响

目的：探讨医师家访对首发精神分裂症患者家庭康复的影响。方法：120例首发精神分裂症的住院患者随机分为家访组和对照组各60例，出院后家访组患者接受为期1年的医师家访。用阳性和阴性综合征量表（PANSS）、社会功能缺陷筛查量表（SDSS）和Morning Side康复状态量表（MRSS）评价2组康复效果。结果：家访组患者出院后第1年末PANSS、SDSS、MRSS评分及再入院率显著低于对照组。结论：医师家访能巩固首发精神分裂症患者的治疗效果，明显降低复发率。     

帕利哌酮缓释片与喹硫平治疗首发精神分裂症的对照研究

【目的】比较帕利哌酮缓释片与喹硫平治疗首发精神分裂症的临床疗效与安全性。【方法】106例首发精神分裂症患者随机分为两组,分别予以帕利哌酮缓释片与喹硫平治疗,疗程8周。采用阳性和阴性症状量表（PANSS）、副反应量表（TESS）评定疗效和不良反应。【结果】治疗8周,帕利哌酮组的有效率为81．1％,喹硫平组的有效率为79．2％,两组的差异无统计学意义。【结论】帕利哌酮缓释片与喹硫平治疗首发精神分裂症疗效相仿,能有效改善阳性症状及阴性症状,安全性高。     

齐拉西酮对精神分裂症患者社会功能和生活质量的影响

目的:评价齐拉西酮与氯氮平对首发住院精神分裂症患者社会功能和生活质量的影响。方法:79例精神分裂症患者随机分为齐拉西酮组40例与氯氮平组39例,分别给予口服齐拉西酮与氯氮平治疗12周。以阳性和阴性症状量表(PANSS)、副反应量表(TESS)、社会功能缺陷量表(SDSS)及生活质量综合评定问卷(GQOLI-74)分别评定2组患者的疗效、不良反应、社会功能缺陷和生活质量。结果:治疗后,2组的PANSS总分和各因子分均显著下降(P0.05,0.01),齐拉西酮组阴性症状评分低于氯氦平组(P0.01);SDSS各条目评分2组均明显下降(P0.05,0.01),齐拉西酮组在家庭内外活动、对外界兴趣、社会性退缩、婚姻职能、责任心和计划性6个条目评分明显低于氯氮平组(P0.05,0.01);齐拉西酮组的GQOLI-74总分及躯体维度、心理维度、社会功能维度评分明显高于氯氮平组(P0.01);齐拉西酮组的不良反应发生率明显小于氯氮平组(37.5%与66.7%,P0.01)。结论:齐拉西酮的疗效与氯氮平相当,但副作用小;对患者社会功能和生活质量的改善更明显。     

自知力教育和自信心训练对首发精神分裂症患者生活质量及幸福度的影响

目的探讨自知力教育和自信心训练对首发精神分裂症患者生活质量及幸福度的影响。方法将96例首发精神分裂症患者随机分为观察组和对照组各48例,两组均予以利培酮系统治疗,观察组在此基础上,予自知力教育和自信心训练8周,随后对两组患者进行为期0.5年的随访。采用阴性与阳性症状量表（PANSS）、世界卫生组织生活质量量表（WHO,QOL-100）、总体幸福感量表（GWB）及自尊量表（SES）分别于入组时及随访结束时进行评估。结果入组时,PANSS、QOL-100、GWB及SES评分两组间比较,均无显著性差异（P〉0.05）;随访结束时,观察组PANSS总分及阴、阳性症状评分均明显低于对照组（P〈0.01）;而生活质量总评分,心理领域、独立性领域、社会关系领域评分及GWB、SES评分均高于对照组（P〈0.05或P〈0.01）。结论自知力教育和自信心训练有助于缓解首发精神分裂症患者的精神症状,提高其生活质量及幸福度。     

The Effect of a Psychoeducational Course on Hypochondriacal Metacognition

Recently, it has become apparent that a metacognitive perspective may contribute to the understanding and treatment of psychopathology. In this study, the effect of a cognitive-behavioural psychoeducational group treatment for hypochondriasis on metacognitive aspects was examined. Furthermore, it was studied whether earlier found beneficial effects of the course on hypochondriacal complaints, depressive complaints and trait anxiety could be replicated. A total of 35 participants were randomized into either an immediate treatment group (n = 20), or a waiting list control group (n = 15). The participants in the waiting list control group were enrolled in the treatment after a period of 6 weeks. Results showed that the course had an effect on all subscales of the Metacognition-Cognitions about Health Anxiety questionnaire. Furthermore, in line with previous findings, the course proved to be effective in decreasing hypochondriacal complaints, depressive complaints and trait anxiety. It may be concluded that cognitive-behavioural psychoeducational treatment, in which a metacognitive level is implicitly addressed, shows beneficial effect on metacognitive aspects and hypochondriacal complaints.     

首次发病的分裂样精神障碍和精神分裂症的比较

比较分裂样精神障碍和精神分裂症在首次发病时的特点。将首次发病的符合CCMD-2诊断标准的分裂样精神障碍和精神分裂症患者各147例进行对照比较。结果显示:分裂样精神障碍患者多为急性起病、病前性格外向、病程短、疗效好;精神分裂症患者多为慢性起病、病前性格内向、病程长、疗效差,且两者存在临床症状上的差异。提示两者在病程之外,还存在其他多方面的差异。     

The First Peritonitis Episode Alters the Natural Course of Peritoneal Membrane Characteristics in Peritoneal Dialysis Patients

♦ Objective:

Little or no evidence is available on the impact of the first peritonitis episode on peritoneal transport characteristics. The objective of this study was to investigate the importance of the very first peritonitis episode and distinguish its effect from the natural course by comparison of peritoneal transport before and after infection.

♦ Participants:

We analyzed prospectively collected data from 541 incident peritoneal dialysis (PD) patients, aged > 18 years, between 1990 and 2010. Standard Peritoneal Permeability Analyses (SPA) within the year before and within the year after (but not within 30 days) the first peritonitis were compared. In a control group without peritonitis, SPAs within the first and second year of PD were compared.

♦ Main outcome measurements:

SPA data included the mass transfer area coefficient of creatinine, glucose absorption and peritoneal clearances of β-2-microglobulin (b2m), albumin, IgG and α-2-macroglobulin (a2m). From these clearances, the restriction coefficient to macromolecules (RC) was calculated. Also, parameters of fluid transport were determined: transcapillary ultrafiltration rate (TCUFR), lymphatic absorption (ELAR), and free water transport. Crude and adjusted linear mixed models were used to compare the slopes of peritoneal transport parameters in the peritonitis group to the control group. Adjustments were made for age, sex and diabetes.

♦ Results:

Of 541 patients, 367 experienced a first peritonitis episode within a median time of 12 months after the start of PD. Of these, 92 peritonitis episodes were preceded and followed by a SPA within one year. Forty-five patients without peritonitis were included in the control group. Logistic reasons (peritonitis group: 48% vs control group: 83%) and switch to hemodialysis (peritonitis group: 22% vs control group: 3%) were the main causes of missing SPA data post-peritonitis and post-control. When comparing the slopes of peritoneal transport parameters in the peritonitis group and the control group, a first peritonitis episode was associated with faster small solute transport (glucose absorption, p = 0.03) and a concomitant lower TCUFR (p = 0.03). In addition, a discreet decrease in macromolecular transport was seen in the peritonitis group: mean difference in post- and pre-peritonitis values: IgG: -8 μL/min (p = 0.01), a2m: -4 μL/min (p = 0.02), albumin: -10 μL/min (p = 0.04). Accordingly, the RC to macromolecules increased after peritonitis: 0.09, p = 0.04.

♦ Conclusions:

The very first peritonitis episode alters the natural course of peritoneal membrane characteristics. The most likely explanation might be that cured peritoneal infection later causes long-lasting alterations in peritoneal transport state.     

Talking About Real‐life Events: An Investigation Into the Ability of People with Intellectual Disabilities to Make Links Between Their Beliefs and Emotions Within Dialogue

Background This study compares how people with and without intellectual disabilities talk about events, beliefs and emotions in dialogues about real‐life, emotive events and in a structured task assessing understanding of cognitive mediation. Materials and Methods A cognitive‐emotive interview was used to assist 19 adults with intellectual disabilities and 19 adults without disabilities in generating an account of an emotive, interpersonal event. Participants also completed a cognitive mediation task and an assessment of intellectual and verbal ability. Results Between‐group analyses indicated that participants with intellectual disabilities scored significantly lower than those without disabilities on the cognitive‐emotive interview and the cognitive mediation task. Participants with intellectual disabilities generated fewer beliefs within their dialogues and were less likely to provide alternative perspectives on events. Within‐group comparisons showed no significant association between the ability to talk about events, beliefs and emotions within a dialogue and performance on a cognitive mediation task, or with Full Scale or Verbal IQ scores. Conclusions Participants with intellectual disabilities had more difficulties than those without disabilities in talking about events, beliefs and emotions. Within a therapeutic context, they are likely to require assistance to reflect on events and consider alternative interpretations, which take into account individual and environmental factors. Future therapeutic developments may benefit from placing greater emphasis on emotional understanding and the intuitive links that people make between events and emotions.     

Experiences of the First Days of Postpartum Psychosis: An Interview Study with Women and Next of Kin in Sweden

The aim of this study was to explore accounts of the first days of postpartum psychosis from different perspectives, that is, that of the women and their next of kin. Interviews were conducted with seven women with postpartum psychosis and six interviews were done with the next of kin. The overall theme was Shades of Black with A Ray of Light, revealing a difficult experience of darkness, despair, and suffering. For the women, the experience cannot be shared fully other than with those who have lived through it themselves. For the next of kin, the illness is incomprehensible and it proved difficult to express in words what these relatives believe the women were going through. The women and their next of kin spoke about loss of sleep, being in an unreal world, thoughts that moved from having a wanted to an unwanted baby, being infanticidal, and having suicidal ideation. The women and their next of kin described the situations in different ways. The women gave an account of their illness in the strongest of terms, while the language used by the next of kin was much milder. The findings underscore the importance of recognizing the next of kin as key sources in early recognition of the disorder, which would make early treatment possible and support recovery.     

长期住院精神病患者躯体疾病调查

目的调查我院长期住院精神病患者躯体疾病情况.方法以2005年3月8日为时点,对连续住院2年以上的350例精神病患者的精神科诊断及躯体疾病分项进行临床调查和统计分析.结果住院患者中精神科疾病诊断排在前3位的是：精神分裂症（61.32%）、阿尔采默病（15.26%）、心境障碍（4.74%）;躯体疾病前3位是：心脏病（8.68%）、糖尿病（8.42%）、高血压（4.47%）.结论长期住院精神病患者中老年患者越来越多,合并躯体疾病的发生率随之增高,在临床工作中应引起足够的重视.