职业及经济收入对乳腺癌妇女人格和心理障碍的影响

背景：乳腺癌的诊断和治疗，会使人产生严重的负性应激反应和精神障碍。特别是自费和没有医疗保险的农村和低经济收入乳腺癌妇女的精神心理状况令人堪忧。国内外对这一弱势群体的研究少见报道。目的：找出农民与不同经济收人水平对乳腺癌妇女精神心理障碍的影响程度，为有效的临床干预治疗提供科研依据。设计：病例对照研究。地点、对象和方法：对大连医科大学附属一、二医院肿瘤科术后接受抗癌治疗的妇女216例采用临床晤谈、明尼苏达多项人格问卷(Minnesota multiphasic personality inventory。MMPI)和生活事件量表及基本情况问卷的方法进行精神心理状态和人格评定。主要观察指标：乳腺癌妇女MMPI评定结果。结果：①208例年龄为24～83岁乳腺癌妇女，平均47岁，89％为已婚妇女；受教育程度各水平均衡，其中农民40例，占19．2％，工人占35．6％，职员和干部比例为45．2％。接受乳房保留术22例，根除术186例；182例接受化疗，176例接受放疗；15．4％患者不知道自己患病真相；患病时间为术后1～204个月。②多元Logistic分析显示，农民是疑病和抑郁量表值增高的危险因素。农民与工人疑病、抑郁相对比，OR=3．64，4．42(P&;lt;0．05)；脑力劳动者与工人疑病、抑郁相对比，OR=1．05，1．11(P&;lt;0．05)。而年龄是抑郁的保护因素，随着年龄的增加抑郁反而减低，确诊时年龄与39岁以下各年龄段的OR分别为0．72，0．51，0．37，0．26(P=0．03)。结论：农民是疑病和抑郁增高的重要危险因素，尤其是贫穷的年轻农村妇女对患乳腺癌和抗癌治疗极度恐惧和抑郁，甚至产生自杀意念和自杀行为；而年龄大是抑郁的保护因素；经济收人水平对MMPI任何量表没有直接的影响和作用。     

乳腺癌术后放射治疗患者人格的调查

目的:探讨大连市乳腺癌患者放疗期间的人格。方法:采用艾森克(EPQ)人格量表。于2001-03/2001-12对正在大连市综合医院和肿瘤专科医院放射治疗的71例女性乳腺癌根治术后的患者在放疗前中后进行问卷调查。统计学方法采用配伍组方差分析。结果:乳腺癌患者放疗中后与放疗前比较,人格量表分值无显著差异,但人格量表的E因子(内外向)分值下降,治疗前后存在显著性差异,(P=0.035);N因子(神经质)、P因子(精神质)和L因子(掩饰)无显著性差异;乳腺癌患者在放疗过程中人格分值与放疗前人格分值比较呈显著正相关,(P<0.01)。结论:放疗对乳腺癌患者的人格无影响,人格的四个因子中,放疗对E因子(内外向)有影响,而对N因子、P因子和L因子无明显影响;放疗期间,患者人格分值的高低取决于患者放疗前人格的状况。     

乳腺癌患者58例心理障碍分析及干预

乳腺癌手术范围大、创伤大,加上术后各种治疗措施（如放疗,化疗）的影响,患者都会出现不同程度的心理障碍,其中部分患者会出现难以自我调节的心理障碍,而需要心理治疗。本院2005-02/2008-11对58例乳腺癌患者出现心理障碍,采取心理疏导等综合干预措施,取得良好效果,现报告如下。1临床资料本组均为女性,年龄35～64（平均47）岁。其中Ⅰ、Ⅱ期患者16例,Ⅲ、Ⅳ期患者16例。本组均手术治疗,术后化疗。其中54例术后放疗。乳腺癌患者精神障碍表现为不同程度的焦虑、恐惧、     

是否知道病情真相及其应对方式对乳腺癌妇女人格和精神障碍的影响

目的:研究乳腺癌患者是否知道自己所患疾病真相、对治疗的信心与期望及其应对方式等因素对人格和精神障碍影响。方法:乳腺癌妇女精神心理状态和人格评定采用临床晤谈、MMPI人格问卷和生活事件量表及基本情况问卷的方法,以SPSS10.0软件进行统计学处理。结果:①208例年龄为24～83岁乳腺癌妇女,MMPI测量结果高于70分的临床量表:疑病(Hs)为40.9%,抑郁(D)为72.6%,癔症(Hy)为38.5%,偏执(Pd)为17.8%;男女性能度(Mf)高于60分占50.0%,但都低于70分;妄想(Pa)和精神衰弱(Pt)分别有42.8%和54.8%高于70分,精神分裂(Sc)为76.9%,躁狂(Ma)为17.8%,而7例(3.4%)社会内向(Si)高于70分,58.6%高于60分。②多因素Logistic分析发现,知道自己所患癌症诊断真相和疾病的性质使Pa(OR=3.79,P=0.003)、Pt(OR=3.85,P=0.01)、Sc(OR=14.6,P=0.00001)量表分值增高,心理社会调节能力差,而对MMPI测量值其他量表没有影响。结论:知道癌症诊断真相和疾病的性质是Pa,Pt和Sc量表增高的重要危险因素;不知道疾病真相的乳癌妇女心理调节和社会责任能力良好,不支持径告患者癌症真相。     

乳腺癌患者的心理特征及其影响因素调查

目的：探讨乳腺癌患者的心理状况、人格特点。方法：通过发放52份病情调查问卷、症状自评量表（SCL-90）、艾森克人格问卷（EPQ）、Beck抑郁问卷（BDI）分析乳腺癌患者的心理状况、人格特点。结果：受测乳腺癌患者抑郁33人（63．5％），其中20人（38．5％）为轻度抑郁，4人（7．7％）为中度抑郁，9人（17．3％）为重度抑郁。结论：乳腺癌患者的总体精神症状、躯体化症状、精神病性症状、恐怖症状稍重于正常人．外向的乳腺癌患者较内向的乳腺癌患者抑郁程度轻，人际关系敏感症状轻；神经质程度高的患者较神经质程度低的患者在抑郁程度、症状自评量表（SCL-90）的总体精神症状及各因子症状上都更严重。     

心理障碍大学生人格特征与心理症状的相关分析

背景心理障碍者的人格特征与心理症状关系密切,此类研究亦有报道,但将高级统计方法偏相关分析、典型相关分析运用于这两者之间的相关研究颇为鲜见.目的通过了解心理障碍大学生的人格特征与心理症状的关系,为大学生心理障碍的干预提供科学依据.设计分层随机整群抽样调查.单位华中科技大学同济医学院儿少卫生研究室.对象采取分层随机整群抽样的方法,对武汉工业学院部分学生,运用症状自评量表(SCL-90)进行现况调查,以≥3项因子分在2.3以上138人(强迫症、焦虑症、恐怖症、神经衰弱)为心理障碍研究对象.预对心理障碍学生进行SCL-90及EPQ测试,由被试者独立答题,当场收回.主要观察指标心理障碍大学生EPQ测试的内外向、神经质、精神质、掩饰性分值与SCL-90测试的总均分及躯体化、强迫、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性9个因子分的偏相关和典型相关分析.结果SCL-90测试的总均分及各因子分均与神经质分呈正相关(r=0.225～0.417,P＜0.05),敌对、偏执、精神病性因子分与精神质分呈正相关(r=0.213～0.223,P＜0.05),总均分及强迫、人际关系敏感、恐怖因子分与内外向分呈负相关(r=-0.167～-0.278,P＜0.05).人格特征和心理症状评分的相关主要由这两组变量中的典型变量人际关系 敏感、焦虑与神经质的相关(r=0.459,P＜0.01)及偏执与精神质的相关(r=0.354,P＜0.05)所决定.结论大学生心理障碍多有一定的人格基础,了解心理障碍大学生人格特征与心理症状的内在联系,为探索有效的大学生心理障碍干预方案奠定了良好的基础.     

合理情绪疗法对乳腺癌根治术患者心理弹性及创伤性成长的影响

[目的]探讨合理情绪疗法对乳腺癌根治术患者心理弹性及创伤性成长的影响.[方法]本院收治的126例乳腺癌根治术患者随机分为观察组和对照组,各63例,对照组给予包括健康教育、生活指导等常规护理干预,观察组在此基础上联合应用合理情绪疗法.比较两组患者心理弹性、创伤性成长、生活质量等指标.[结果]观察组患者坚韧、自强、乐观及心...     

心理护理对乳腺癌围手术期患者的影响

目的:观察心理护理对乳腺癌围手术期的影响。方法:98例乳腺癌手术患者随机分为对照组和心理护理组,比较两组患者平均总住院天数及住院总费用、患者自信率及对护士的满意度。结果:心理护理组平均住院天数和总住院费用明显低于对照组,而自信率及对护士的满意度明显高于对照组(均P<0.05)。结论:心理护理使乳腺癌围手术期患者平均住院天数缩短、总住院费用减少,并提高了患者自信率及对护士的满意度。     

心理护理对73例乳腺癌根治术后心理康复的影响

目的：对乳腺癌根治术患者的心理问题提出相应干预措施,促进患者康复。方法：采用抑郁自评量表（SDS）与焦虑自评量表（SAS）对73例乳腺癌患者术后的心理状况进行分析。结果：心理护理干预前后,患者的SDS、SAS评分有统计学差异（P〈0.05）;有抑郁、焦虑症状的人数明显低于入院时（P〈0.05）。结论：通过对乳腺癌根治术患者心理分析及护理干预,改变患者不良心理状态和行为,达到心理康复的目的。     

同步支持干预对乳腺癌手术患者配偶心理健康及照顾行为的影响

[目的]探讨配偶同步支持干预对乳腺癌手术患者配偶心理健康及照顾行为的影响.[方法]选择2017年6月至2019年6月在本院接受治疗的乳腺癌手术患者的配偶72名为研究对象,随机分为观察组和对照组,各36名.对照组给予包括健康教育、心理干预、用药指导、并发症预防、出院指导等在内的常规护理干预;观察组在此基础上联合应用配偶同...     

年龄与家庭支持对乳腺癌妇女精神障碍影响的多因素 Logistic分析

目的探究年龄和家庭支持等因素对乳腺癌妇女精神障碍的影响程度,为有效的临床干预提供科研依据. 方法对乳腺癌妇女精神心理状态和人格评定采用临床晤谈、明尼苏达多项人格问卷( MMPI)和生活事件量表及基本情况问卷的方法,以 SPSS 10.0软件进行统计学处理. 结果①纳入术后续贯入住肿瘤科继续接受治疗的 208例乳腺癌妇女,年龄 24～ 83岁,平均 47岁 ,61例为文盲或初小文化, 19.2%为农民, 74例为工人, 94例为脑力劳动者.接受乳房保留术 22例,根除术 186例; 182例接受化疗, 176例接受放疗;自述患病时间为术后 1～ 17年. 89%为已婚妇女,婚姻时间平均 23年;感到自己得到家人悉心照顾和积极支持者占 70.7%, 15.4%患者不知道自己所患疾病真相. MMPI测量结果高于 70分的临床量表情况有 Hs为 40.9%, D为 72.6% ,Hy为 38.5%, Pd为 17.8%, Mf高于 60分占 50.0%,但都低于 70分; Pa和 Pt分别有 42.8%和 54.8%高于 70分, Sc为 76.9% ,Ma为 17.8%,而 Si有 7例( 3.4%)高于 70分, 58.6%高于 60分.②多因素 Logistic分析发现 , 确诊时年龄越大, D与 Pa得分越低,与 40岁以下相比 ,各年龄组 OR分别为 0.72,0.51,0.37,0.26(P=0.03)和 0.68,0.46,0.31,0.21(P=0.01);能够得到家庭和亲人的悉心照顾与支持,亦使 Pa ( OR=0.38, P=0.002)和 Pt( OR=0.38, P=0.01)分值减低. 结论年龄增大是 D与 Pa的保护因素 ,能够得到家庭和亲人的悉心照顾与支持亦是 Pa和 Pt的保护因素.而化疗、对疾病及其治疗的期望与信心、家庭经济收入、婚姻状态与质量等未发现与 MMPI测量值有直接的联系.     

Interpersonal well-being and mental health among male partners of women with breast cancer

The focus of this investigation was on the mental health of men whose partners had recently been diagnosed with breast cancer. In accord with theoretical models that specify the importance of interpersonal relationships in maintaining mental health, men's relationship satisfaction and perceptions of social support were predicted to be positively associated with their mental health during this stressful time. The sample included 63 male partners of women with breast cancer who participated in a three-wave panel study that assessed various indicators of mental health and interpersonal well being at T1, T1 + 6 weeks, and T1 + 10 weeks. Results indicated substantial distress in at least 25% of the men. However this distress subsided over time. Relationship satisfaction was both concurrently and prospectively associated with better mental health. Social support was negatively associated with concurrent mental health but post hoc analyses suggested that men's social networks perhaps provide greater social support to the extent that the men are emotionally distressed.     

Effects of tamoxifen on testosterone metabolism in postmenopausal women with breast cancer

Testosterone is a known estrogen precursor especially in postmenopausal women. Tamoxifen, an anti-estrogen, is used in the treatment of women with breast cancer in whom metastatic disease has been demonstrated. The action of Tamoxifen is thought to be to occupy the intracellular estrogen receptor sites in target tissues and thus block the action of the biologically active estrogen, estradiol. Effects of Tamoxifen on the production and metabolism of hormones have been postulated. We studied the kinetics of testosterone metabolism by the constant infusion of 3H-testosterone in six postmenopausal women with breast cancer prior to and during Tamoxifen therapy. The Tamoxifen did not produce any significant change in the metabolic clearance rate, the plasma concentration or the calculated blood production rate of testosterone. The only significant alteration in the conversion ratio of testosterone to metabolites was the reduction (p less than 0.02) in conversion to 5 alpha-dihydrotestosterone. A significant reduction in the plasma concentrations (p less than 0.05) of dehydroepiandrosterone and of luteinizing hormone (p less than 0.02) was found. Other steroid and peptide hormones did not show any significant changes. We conclude that Tamoxifen therapy has very little effect on the kinetics of testosterone metabolism in postmenopausal women with metastatic breast cancer.     

对"年龄与家庭支持对乳腺癌妇女精神障碍影响的多因素 Logistic分析"一文的评价

乳腺癌是常见恶性肿瘤,全球每年新发病例超过90万,死亡病例超过40万。中国乳癌患病率尽管尚低于北美、西欧等高发区,但女性乳腺癌的患病率有明显增加的趋势,1940～1980年发病率平均增长1.2%,20世纪80年代后平均增长2%。在上海、天津和北京城区乳腺癌已跃居女性恶性肿瘤首位。中国乳腺癌患者发病年龄较轻,35至45岁发病率大大增加,发病高峰期延长,且就诊时病期偏晚,而现有治疗方法对乳腺癌远期生存率以及生活质量提高尚不理想,给社会和家庭造成巨大损失犤1犦。从心理社会因素角度研究乳腺癌患者的病情特点,从而提出相应干预措施非常重要。作者…     

Health-related quality of life in women patients with borderline personality disorder

OBJECTIVES: The aims of the study were to: (i) test the reliability of a health-related quality of life (HRQOL) instrument [Swedish Health-Related Quality of Life Survey (SWED-QUAL)] on women patients with borderline personality disorder (BPD); (ii) compare their HRQOL to a normal population group comparable in age; and (iii) test for subgroup differences in HRQOL considering psychiatric DSM axis-I comorbidity. METHOD: The study was conducted in connection to a randomized, controlled trial of psychotherapy for women BPD patients. Seventy-five women with BPD diagnosis were administered the SWED-QUAL. Statistic reliability was evaluated with inter-item correlations, total-item correlations and internal consistency criterions. The BPD patients' SWED-QUAL results were compared with data extracted from a published study and subgroup differences due to axis-I comorbidity were analysed. RESULTS AND CONCLUSIONS: SWED-QUAL could be considered as an instrument with acceptable reliability when assessing HRQOL in BPD patients. The BPD patients suffered significant impairments in HRQOL overall health dimensions compared to normal population. There were no subgroup differences due to axis-I comorbidity, which indicate that BPD in itself might be a predictor of substantial HRQOL impairment.     

Effects of adjuvant treatment on cognitive function in women with early breast cancer

PurposeWhether adjuvant therapy impairs cognitive function in women with breast cancer (BC) is unclear. We determined the effects of adjuvant therapy on cognitive function in women with early BC.MethodsWe consecutively and prospectively enrolled women aged 40–69 years who had a positive radiographic finding from the mammography screening program at Stockholm South General Hospital. All women completed the Headminder Web-based neuropsychological battery Cognitive Stability Index (CSI) for response speed, processing speed, memory, and attention before diagnosis (T1), after surgery and before adjuvant treatment (T2), 6 months after start of adjuvant treatment (T3), and after another 3 months of follow-up (T4). Women with BC were divided into those receiving chemotherapy, hormone therapy, or no adjuvant medical therapy. Women without a diagnosis of BC served as healthy controls.ResultsOf the 146 women enrolled, 77 had BC of whom 18 received chemotherapy; 45, hormone therapy, and 14, no adjuvant medical therapy; 69 were healthy controls. Memory scores for women with BC were significantly lower than those for controls over time, even after controlling for age and education. Memory and response speed scores were lower after chemotherapy than before (P < 0.01 for both). Processing speed and attention improved significantly over time in all groups, a result consistent with a practice effect.ConclusionOur results indicate subtle changes related to time course and treatment. Especially, that chemotherapy may impair memory and response speed in women with BC, consistent with those reported by BC survivors after adjuvant medical treatment.