精神分裂症患者与正常人应对方式的对照研究

目的探讨精神分裂症患者与正常人应对方式的不同,以及精神分裂症患者应对方式的特点。方法以山东省18岁及以上人群精神障碍流行病学调查数据库中筛查出的151例精神分裂症患者作为研究组,按同性别、同年龄组(相差±3岁)、同村1∶1配对选择151名无任何精神科疾病诊断者作为对照组,全部患者用SCID-I-P进行诊断。研究工具有一般资料调查问卷、简易应对方式问卷。结果 (1)精神分裂症患者的积极应对因子评分明显低于正常人的评分(P<0.01),消极应对评分显著高于正常人的评分(P<0.05)。(2)所有受试者不同职业之间积极应对因子和消极应对因子评分的差异有统计学意义(P<0.05)。(3)瓦解型精神分裂症患者的消极应对评分最高,而偏执型患者的消极应对评分最低,差异有统计学意义(P<0.01)。结论精神分裂症患者的应对方式与正常人有明显不同。     

应激有关因素与缓解期精神分裂症患者应对方式的相关研究

目的探讨应激有关因素与缓解期精神分裂症患者应对方式的相关性。方法选取142例缓解期精神分裂症患者为研究组,85例正常人为对照组,采用应对方式问卷对研究组和对照组进行评定,对研究组患者单独评定症状自评量表（SCL-90）、领悟社会支持量表（PSSS）、自动思维问卷（ATQ）及艾森克人格问卷（EPQ）。结果研究组解决问题分低于对照组,自责、回避、合理化分高于对照组,成熟应对方式得分明显低于对照组,不成熟应对方式得分明显高于对照组（P〈0.05）。研究组中,ATQ与应付方式问卷中除合理化外各因子均有相关性（P〈0.05）,PSSS量表中的家庭外社会支持和社会支持总分与解决问题、求助、成熟应对方式有相关性（P〈0.05）,SCL-90与所有应对方式因子均有相关性（P〈0.05）,EPQ中的内外向与解决问题、自责、求助、成熟应对方式有相关性（P〈0.01）,神经质与除解决问题外各因子均有相关性（P〈0.01）,精神质与除回避外各因子均有相关性（P〈0.05）,掩饰与所有因子均有相关性（P〈0.05）。多元逐步回归分析结果显示,与成熟应对相关的因子包括内外向、家庭外支持、家庭内支持、精神质,与不成熟应对相关的有ATQ、掩饰因子,与混合型应对方式相关的有SCL-90总分。结论缓解期精神分裂症患者存在不成熟应对方式,其与应激因素相关。     

利培酮与氟哌啶醇对女性首发精神分裂症患者血清催乳素水平的影响

目的探讨女性首发精神分裂症患者血清催乳素(PRL)水平,利培酮与氟哌啶醇对PRL水平的影响,以及PRL水平与疗效的关系.方法用酶联免疫法测定66例女性首发精神分裂症患者利培酮与氟哌啶醇治疗前后的PRL水平,与25名正常人对照,并在治疗前后进行阳性和阴性症状量表(PANSS)评定.结果女性首发精神分裂症患者的基础PRL水平与正常对照组无差异;两组患者治疗后血清PRL水平较治疗前显著升高,但两组比较无明显差异;两组患者基础PRL水平与患者年龄、病程、基线PANSS总分及各因子分无明显相关性,与治疗后PANSS总分及各因子分无明显相关性.两组患者PRL增加值与PANSS减分值和各因子减分、药物剂量无明显相关性.结论利培酮和氟哌啶醇都能使女性首发精神分裂症患者PRL水平显著升高,但PRL水平与疾病严重程度及疗效无关.     

精神分裂症患者亲属应对方式、心理健康状况及健康教育需求的研究

目的探讨精神分裂症患者亲属应对方式、心理健康状况及其相关性以及健康教育需求情况。方法应用特质应对方式问卷、症状自评量表(SCL-90)、自制健康知识知晓情况及健康教育需求情况调查表对100名精神分裂症患者亲属进行调查。结果精神分裂症患者亲属积极应对因子分低于常模,消极应对因子分高于常模,其SCL-90总分及各因子分均高于常模,差异有显著性(P<0.05或0.01),相关分析表明,精神分裂症患者亲属SCL-90躯体化、敌对因子分与积极应对分呈显著负相关(P<0.05),SCL-90总分、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性因子分与消极应对分呈显著正相关。97%的患者亲属知道疾病的诊断,但缺乏护理知识与技能,94%的患者亲属希望医务人员传授健康知识,对健康知识的需求侧重于安全护理、疾病症状、沟通方法、用药指导、疾病预防及康复知识、日常生活护理指导等。92%的亲属希望提供个别指导,83%的亲属选择提供科普手册。出院后健康教育方式调查发现,78%的亲属选择护士家访,63%选择电话咨询。结论精神分裂症患者亲属多采用消极应对的方式,而较少采用积极应对的方式,其心理健康状况较差,且与应对方式密切相关。     

住院精神分裂症患者生活质量的影响因素探讨

目的探讨住院精神分裂症患者生活质量的影响因素。方法对符合入组标准的52例精神分裂症患者记录一般资料,并进行生活质量综合评定问卷（GQOLI-74）、应对方式问卷、社会功能缺陷的评定、阳性与阴性症状量表（PANSS）的评定。结果（1）精神分裂症患者应对方式中回避对生活质量的心理功能有显著的影响;（2）社会功能缺陷程度对生活质量中社会功能维度有显著影响;（3）病程、精神症状对生活质量的各个维度无明显影响。结论住院精神分裂症患者的应对方式、社会功能缺陷与生活质量关系（较之症状、病程）更密切。     

精神分裂症首次发病未用药患者认知功能的改变

目的:探讨精神分裂症首次发病未用药患者认知功能改变的相关性。方法:124例首发未治疗精神分裂症患者为研究组,同期健康体检者60名作为对照组,采用MCCB、Stoop色词测验对两组的认知功能进行评价,采用阳性和阴性症状量表(PANSS)评估症状。结果:研究组患者认知功能各项评分均显著低于对照组,差异有统计学意义(P0.05);相关因素分析结果显示,首发未治疗精神病患者MCCB总分、Stroop色词测验与患者受教育年限呈正相关,与PANSS总分及各因子分呈负相关;数字广度测试与教育年限呈正相关;与阳性症状分、PANSS总分成负相关。回归分析表明精神分裂症患者认知功能与受教育年限及PANSS总分相关。结论:首发未治疗精神分裂症患者认知功能明显低于正常人,且患者的认知受损程度和其精神病症状有关。     

伴有被害妄想的精神分裂症患者症状归因风格研究

目的:探讨伴有被害妄想的精神分裂症患者症状归因风格及其相关影响因素。方法:采用精神分裂症症状归因问卷(SAQS)和简明精神病评定量表评估136例伴有被害妄想的精神分裂症患者(病例组),并与132名正常人(正常对照组)进行分析比较。结果:两组SAQS问卷中内在-外在、局部-整体和可控-不可控归因维度的组别效应显著(F=49.14,F=49.01,F=36.88;P均=0.00)。多元回归分析显示,患者内在-外在维度得分受首发年龄、病程、敌对性因子和宗教因素的影响(β=-0.205、-0.189、-0.556、-0.170;P0.001或P0.05);暂时-持久维度得分受住院次数、焦虑忧郁因子分和迟滞因子分的影响明显(β=0.313、0.342、-0.266;P0.05);局部-整体维度得分受敌对性因子分影响较大(β=0.227,P0.05)。结论:与正常人相比,伴有被害妄想的精神分裂症患者症状归因特点趋于外在的、整体的和不可控的归因风格,且可能会随某些因素的变化而发生改变。     

首发精神分裂症的P50感觉门控与临床症状的关系

目的探讨精神分裂症患者P50感觉门控与临床症状的关系。方法运用条件-测试刺激模式和刺激序列模式检测72例首发精神分裂症患者抗精神病药物治疗6周前后的P50听觉诱发电位,并以36名正常人为对照组。采用阳性和阴性症状量表(positive and negative syndrome scale,PANSS)评定治疗前后的临床症状,比较阳性症状为主组(阳性组)与阴性症状为主组(阴性组)患者的P50;采用多元回归分析P50抑制及其治疗前后变化与PANSS评分的关系。结果治疗前,条件-测试刺激模式下阳性组与阴性组患者均较对照组的T-P50波幅升高而P50抑制降低(P0.05),而刺激序列模式下有较高的高频刺激P50波幅和较低的P50抑制(P0.05)。但无论是治疗前还是治疗后,两个患者亚组之间两种模式P50诱发电位各成分、P50抑制的差异均无统计学意义(P0.05),而多元回归分析显示,总的患者组中治疗前两种模式P50抑制与PANSS总分及各因子分均无明显相关(P0.05),但条件-测试刺激模式P50抑制的变化率与PANSS的激活性因子分变化率相关(b=0.39,P0.05),刺激序列模式P50抑制变化率分别与激活性因子分和抑郁因子分的变化率相关(b=0.44,P0.05;b=0.49,P0.05)。结论本研究未发现精神分裂症患者的P50感觉门控异常与其主要临床症状群相关,但P50抑制的变化可能是反映患者的激越或抑郁情绪变化有关的电生理标记。     

精神分裂症的共情缺陷及其影响因素

目的探讨精神分裂症患者共情缺陷特点及其影响因素。方法采用人际反应指针量表(IRI-C)对208例精神分裂症患者和213名正常对照的共情能力进行评估,同时作艾森克人格问卷(EPQ)、罗森伯格自尊量表(SES)、一般自我效能感量表(GSES)、简易应对方式问卷(SCSQ)、社会支持量表(SSRS)、多伦多述情障碍量表(TAS-20)和阳性与阴性症状量表(PANSS)等评估,分析影响患者共情能力的相关因素。结果与对照组相比,患者组IRI-C总分、观点采择、幻想力和同情关心因子分均明显减低(P0.01)。患者EPQ的神经质(N)分(r=-0.22)和精神质(P)分(r=-0.18)、TAS因子III分(r=-0.30)、SCSQ积极应对分(r=0.21)、SSRS主观支持分(r=0.16)及GSES分(r=0.21)均与IRI-C总分相关(P0.05)。以IRI-C总分为因变量的回归分析结果显示,SCSQ积极应对分、EPQ的N分和P分、TAS的因子III得分进入回归模型,标准化回归系数分别为0.28、0.30、-0.18、-0.18。结论精神分裂症患者存在广泛的共情缺陷,患者个性特质及其应对方式对共情能力具有影响。     

女性性生活质量问卷在精神分裂症患者中的信度和效度

目的探讨女性性生活质量问卷在精神分裂症患者中的信度和效度。方法将3所医院门诊常规就诊并符合入组标准的180名女性精神分裂症患者作为研究人群,给予女性性生活质量问卷、Olson婚姻质量问卷中的婚姻满意度、性生活和夫妻交流分量表进行评估,并对测试结果进行了信度分析和效度分析。结果问卷总的Cronbaehs α系数为0．919,重测信度为0．875（P〈0．01）;验证性因子分析统计检验结果显示该模型的各项重要统计指标均达到了统计学要求;各因子之间的相关在0．181～0．697之间,各因子与总分之间的相关在0．421～0．841之间,均P〈0．01;问卷的总分与ENRICH的三个分量表得分相关在0．388—0．688之间（P〈0．01）,其中总分与性生活分量表相关程度最高。结论女性性生活质量问卷在精神分裂症患者中具有较好的信度和效度。     

Factor Structure of Zung Self-Rating Depression Scale for Workers

Abstract: The Zung self-rating depression scale (SDS) was applied to workers of a railway company. A total of 1,784 night-shift workers responded to the questionnaire and 1,394 daytime workers were set as the control group. The average age of the subjects was 39.9. The SDS index decreased with age. A factor analysis was conducted and two factors were obtained having an initial eigenvalue over 2.0. Factor 1 was the group of 8 positive items, accounting for 18.2%. Factor 2 was the group of 8 depressive items, accounting for 18.1%. Four items including "loss of weight,""constipation,""good appetite," and "partner coping" did not construct a distinct factor. The factor structure of SDS items of the night-shift workers was similar to those of the control group.     

Self-reported coping strategies in families of patients in early stages of psychotic disorder: an exploratory study

Aim: Coping by families of patients with schizophrenia include ‘approach’ strategies considered to be adaptive (e.g. reinterpretation) and potentially maladaptive ‘avoidant’ strategies (denial/disengagement, use of alcohol and drugs). Little is known about coping strategies used by families of individuals with incipient or emergent psychosis. Methods: Self‐reported coping styles were assessed in family members of 11 ultra high risk and 12 recent‐onset psychosis patients, using a modified version of Carver's Coping Orientations to Problems Experienced questionnaire. Results: Families reported moderate use of ‘approach’ coping (e.g. planning, seeking social support, positive reinterpretation, acceptance and turning to religion) and rare use of ‘avoidant’ coping strategies (denial/disengagement and use of alcohol and drugs). Conclusions: The greater endorsement of ‘approach’ coping by these families is consistent with findings for families of first episode psychosis patients, and it is in contrast to more prevalent ‘avoidant’ coping by families of patients with more chronic psychotic illness. Early intervention could plausibly help families maintain the use of potentially more adaptive ‘approach’ coping strategies over time.     

Psychometric qualities of the French version of the Heinrichs quality of life rating scale.

The quality of life concept has been increasingly used as a major tool for patient care and clinical investigations. The Heinrichs quality of life scale (QLS) is the quality of life assessment method widely used in schizophrenic patients. The QLS was translated into its French version by J.D.Guelfi according the back-translation method. This version of the validation study included 60 schizophrenic inpatients. The scale possesses acceptable psychometric qualities. The test-retest reliability is good for nearly all items of the scale and for the categories and overall score. The internal consistency alpha-coefficients were 0.9 for the global score and varied between 0.6 and 0.9 according to the category. Factor analysis elicited four factors. Convergent validity is good. Recommendations for future use of the QLS are proposed.     

Autoprotective mechanisms in patients with schizophrenic psychoses--compensation and coping

For a long time, the coping and compensatory mechanisms of patients with schizophrenic psychoses have mostly been neglected by the psychiatric research. We extended the six categories of coping mechanisms described in the Bonn Scale for the Assessment of Basic Symptoms (BSABS) by three further categories. With fifty schizophrenic patients in different stages of their disease semistructured interviews concerning these categories were done. The main sociodemographic and historical parameters were registered as well. Then the protocols of the interviews were analyzed, the coping strategies were quantified, and it was tried to disclose relations between the disease progress and sociodemographic parameters. Patients used to a certain degree of autonomy e. g. unmarried patients had--compared to less independent patients--stronger coping strategies. Patients with a strong interest for their disease and a positive opinion about neuroleptic therapy had--compared to patients without interest for their disease and/or negative opinion about neuroleptic therapy--stronger coping and compensatory psychisms. It is concluded that the coping strategies might be reinforced by influencing these parameters.     

Five-factor model of schizophrenic psychopathology: how valid is it?

Aim of the study was to examine the consistency of the five-factor model of schizophrenic symptoms, assess its validity and evaluate its dimensional factor structure using confirmatory factor (CFA) analysis. A sample of 258 randomly assigned DSM-III R patients with schizophrenic disorders were studied by means of the structured clinical interview for the Greek validated Positive and Negative Syndrome Scale (PANSS) and were rated on its 30 items. Patients' scores were subjected to principal component analysis (PCA) with varimax rotation. Internal consistency for each of the components was determined by the use of Cronbach's alpha. External validity of the model derived was investigated by searching for possible relationships between the components and sociodemographic characteristics with the aid of canonical correlation analysis. Confirmatory factor analysis (CFA) was also performed. Using the scree plot criterion PCA revealed a five-factor model. These factors were interpreted as representing--in a decreasing order of relative importance--the following dimensions of schizophrenic psychopathology: negative, excitement, depression, positive and cognitive impairment. The model was comparable with six previous factor analytic studies. Internal consistency was quite satisfactory whereas external validity was found to be not so powerful. CFA did not show that the proposed model yields an adequate factor structure.     

The development and preliminary validation of an instrument to assess patients' attitudes toward pain

This paper describes the development and preliminary validation of a questionnaire designed to assess five attitudes considered important in the long-term adjustment of chronic pain patients. The specific subscales of the questionnaire were chosen to represent attitudes believed to influence the ways by which chronic pain patients manage their pain. Following the development of five reliable subscales, correlations of the subscales with self-reported pain behaviors and coping strategies were calculated, providing preliminary support for the concurrent validity of the instrument.     

A new questionnaire assessing coping strategies in relatives of patients with schizophrenia: development and factor analysis

This paper describes the development and validation of a questionnaire assessing the coping strategies adopted by relatives of patients with schizophrenia. The final version of the questionnaire includes 27 items, grouped into seven subscales (information, positive communication, social interests, coercion, avoidance, resignation and patient's social involvement), the intra-rater reliability of which ranges from 0.46 to 0.76. Cronbach's alpha coefficient, which tests the content validity of the subscales, ranges from 0.68 to 0.83. Factor analysis identifies three factors (problem-oriented coping strategies, emotionally focused strategies, and maintenance of social interests in association with patient's avoidance), accounting for 70.9% of the total variance. This questionnaire may be particularly useful for targeting and monitoring psychoeducational interventions in the families of patients with schizophrenia.     

青少年强迫症与应激等的关系研究

目的：了解青少年强迫症发病与生活事件、应对方式和社会支持的关系.方法：对44例青少年强迫症患者和214名正常对照者进行一般社会人口学资料表、青少年生活事件量表（ASLEC）、特质应对方式问卷（TCSQ）和领悟社会支持量表（PSSS）的测评.结果：与对照组相比,强迫症组在人际关系、学习压力、受惩罚、健康适应、应激总量的得分上均显著较高（P＜0.05）;强迫症组患者较多采用消极应对方式,较少采取积极应对方式,获得较少社会支持,与正常对照者比较差异非常显著（P＜0.01）.结论：青少年强迫症的发病与负性生活事件、不良应对方式和缺乏社会支持有关.     

Coping strategies in epilepsy: 50 drug-resistant and 50 seizure-free patients.

We investigated the coping styles and their correlation to psycho-social functioning in two groups of patients, the first group with drug-resistant epilepsy and the second with well-controlled epilepsy. The instruments administered were the following: the Raven's Coloured Progressive Matrices (non-verbal intelligence), the Echelle Toulousaine de Coping, ETC (coping styles), the Self-esteem Questionnaire (self-esteem), the Self-efficacy Questionnaire (social self-efficacy), a Quality of Life Measure and a semi-structured interview on psycho-social adjustment. We found a significant difference in coping responses between the two groups: drug-resistant patients seemed to adopt the "denial" and the "exclusion" strategies more (P<0.05). On the contrary, seizure-free subjects used the "control" strategy more (P<0.05). A significant correlation between disengagement patterns and poorer social outcomes was pointed out, while "control" was associated with better social adaptation. Our findings provide evidence of the importance of coping assessment, considering the influence of these strategies on the well being of patients. Offering psychological support to epilepsy patients should be considered when orientating the effectiveness of the patients' coping styles.