糖尿病患者心理健康状况分析

目的分析Ⅱ型糖尿病患者心理状况的临床特征．方法应用焦虑自评量表（SAS）、抑郁自评量表（SDS）、症状自评量表（SCL-90）对综合医院就诊的327例Ⅱ型糖屎病患者进行调查。结果41．25%的糖尿病患者有焦虑症状，23．72％的糖尿病患者有抑郁症状；17．98%的糖尿病患者同时存在焦虑，抑郁症状；且SAS和SDS总分受性别、病程和有无并发症的影响；糖尿病患者的SCL-90总分及各因子分明显高于正常。结论糖尿病患者存在一定的心理问题，在控制血糖的同时给予一定的心理干预是必要的。     

Ⅱ型糖尿病患者的心理状况调查分析

目的 了解2型糖尿病患者的心理状况。方法 采用症状自评量表（SCL-90）、抑郁自评量表（SDS）和焦虑自评量表（SAS）对67倒2型糖尿病患者进行调查，并与62例体检正常者进行对照。结果 2型糖尿病患者在SCL-90总分、阳性项目分、躯体化、焦虑、抑郁、恐怖以及SAS、SDS得分与对照组相比，差异有显著性（P〈0．05～0．01）。结论：2型糖尿病患者存在明显的心理障碍，主要表现为躯体化、焦虑、恐怖、紧张、抑郁，因此对2型糖尿病患者在药物治疗的同时，还应进行积极的心理干预。     

糖尿病患者心理卫生调查分析

目的 探讨糖尿病患者心理卫生、心理障碍发生的相关因素。方法 采用ＳＣＬ－９０评定５４例糖尿病患者，并与５０例健康者作对照。结果 糖尿病组的躯体化、抑郁、焦虑三项因子分显著高于对照组，强迫、敌对、两项因子分均无显著差异，而人际关系敏感、恐怖、偏执、精神病性等四项因子分显著偏低；糖尿病组的“阳性”检出率为４０．７５％，显著高于对照组的２４％。结论 糖尿病患者有较高的心理、精神障碍发生率，并以躯体化症状     

糖尿病教育和心理治疗在2型糖尿病综合控制中的作用

目的：探讨糖尿病教育和心理治疗对2型糖尿病患者综合控制指标的影响。方法：对2型糖尿病患者按登记顺序随机分为观察组（A组）、对照组（B组），先对其血糖、血脂、体重等代谢指标进行检测，并进行糖尿病知识问卷、糖尿病生命质量问卷调查和症状自评量表评分，两组均给以降糖药物治疗。A组着重给予糖尿病教育和心理治疗。6个月后两组重复上述量表测评及代谢指标检测。结果：两组治疗后比较，生命质量问卷总分、生命质量满意度、影响程度、忧郁程度Ⅰ、忧郁程度Ⅱ得分均有显著性差异（P〈0．01）；A组治疗后躯体化症状、忧郁、焦虑评分均较治疗前降低显著（P〈0．05）．而B组治疗前后无显著性差异（P〉0．05）；FPG、2hPG、HbA1c、TCH、TG、LDL—C、BMI等，A组较B组均有显著性改善（P〈0．01）。结论：糖尿病教育和心理治疗对2型糖尿病患者的综合控制有重要意义，     

眼球摘除术患者焦虑抑郁状态调查

目的 了解眼球摘除术患者焦虑抑郁发生情况，实施有针对性的心理护理。方法 选择32例成年眼球摘除术患者，采用焦虑自评表（SAS），抑郁自评量表（SDS）进行问卷调查。结果 眼球摘除术患者焦虑症状发生率为（23／32）72％，抑郁症状发生率为（14／32）44％．外貌的改变和别人歧视与偏见为首要应激因素。结论 眼球摘除术患者焦虑、抑郁发生率明显高于正常人群，应引起足够的重视，并及时进行心理干预。     

60例冠心病患者心理状态分析

目的 了解冠心病患者的心理状况。方法 采用抑郁自评量表（ＳＤＳ），焦虑自评量表（SAS）和自编调查问卷进行调查，并与60名健康者作配对比较分析。结果 心理障碍发生率为71.6%。焦虑和抑郁症状共存者为31.6%，仅有焦虑症状的发生率为23.3%，差异无显著性。结论 心理障碍的发生与病程有一定的关系。应重视冠心病者的心理治疗。     

160例2型糖尿病患者焦虑情绪调查分析

目的 了解2型糖尿病（2-DM）患者焦虑情绪障碍及其影响因素 。方法 用Hamilton焦虑量表（HAMD）对160例2-DM患者进行测评，并总结分析性别、年龄、病程、糖尿病器质性并发症、血糖控制情况、治疗方式、健康教育与焦虑情绪障碍的关系。结果 2-DM患者常伴有焦虑情绪障碍（占35．6％），女性、老年人、新发病或病程长、有器质性并发症、血糖控制差、使用胰岛索治疗及缺乏健康教育者焦虑情绪发生率明显增高（P〈0．05）。结论 要关注糖尿病病人，特别是要关注有器质性并发症、新发病、病程长、血糖控制差及需要接受胰岛素治疗的老年女性患者的心理现状，积极开展糖尿病健康教育，对其实施认知行为心理治疗，有利于改善糖尿病患者的生活质量及预后。     

健康教育与心理社会干预对2型糖尿病合并抑郁的影响

目的 :调查 2型糖尿病患者抑郁症状发生率并探讨健康教育及心理社会干预对抑郁症状及糖脂代谢的影响。方法 :采用Zung抑郁自评量表 (SDS)对 10 0例 2型糖尿病患者及 10 0例正常人群进行测评。将抑郁指数≥ 0 5的 5 9例患者随机分为研究组 30例 ,对照组 2 9例。研究组药物治疗的同时合并为期 3个月健康教育加心理社会支持治疗 ,分别于治疗前、治疗后进行抑郁自评量表及代谢控制水平评估。结果 :2型糖尿病并抑郁情绪检出率为 5 9% ,显著高于正常组 (P <0 0 1)。经健康教育加心理社会支持治疗 3个月后 ,观察组抑郁指数显著降低 (P <0 0 5 ) ,糖脂代谢显著改善 (P <0 0 5 )。抑郁转归发生率高 ,与对照组比较有极显著差异 (P <0 0 1)。结论 :2型糖尿病患者常合并忧郁症状 ,健康教育加心理社会支持治疗可改善抑郁症状及糖脂代谢     

糖尿病教育对Ⅱ型糖尿病患者抑郁症状的影响

目的：了解Ⅱ型糖尿病患者抑郁情况并探讨糖尿病教育及心理干预等对抑郁症状的影响。方法：应用ＳＤＳ抑郁自评量表及ＨＡＭＤ抑郁量地６０例Ⅱ型糖尿病患者进行测评,同时与３０例正常人群对照。６０例Ⅱ型糖尿患者经三个月糖尿病教育及心理干预后再生测评。结果：糖尿病组ＳＤＳ与ＨＲＳＤ量表测评,抑郁情况明显高于正常人群组。经糖经病教育、心理干预等后,抑郁症状可明显改善且糖代谢控制更好。结论：糖尿病患者抑郁症状,糖尿     

焦虑与老年人便秘相关性研究

目的了解老年人便秘的发生及其焦虑对老年人便秘的影响。方法采用罗马Ⅱ便秘诊断标准及汉密顿焦虑量表对26省老年人进行调查。结果老年人发生便秘者占37．1％。其中焦虑者便秘的发生率占50．82％，可能有焦虑者43．98％，无焦虑者19．20％，有统计学意义（P〈0．01）。结论应做好老年人的心理指导，降低焦虑的发生率，从而降低便秘的发生率。     

综合性心理治疗对脑卒中患者心理障碍的干预效应

目的 探讨脑卒中后患者存在的心理障碍,综合性心理治疗对脑卒中后心理障碍的干预效果及其对患者生活质量的影响。方法 采用心理量表对225例卒中患者应用SCL-90、SDS、SAS进行心理评估。将存在,心理障碍的脑卒中患者随机分为实验组及对照组,实验组增加了阶梯式心理治疗。评定与比较两组患者SCL-90、SDS、SAS、SF-36的分值及其临床疗效。结果 70．67％脑卒中患者存在一定程度的心理障碍,以抑郁、焦虑多发。实验组SDS、SAS评分显著低于对照组,其临床疗效及生活质量评分显著高于对照组。结论 脑卒中后患者易出现心理障碍;综合心理治疗能显著改善脑卒中患者的心理障碍,可以提高临床疗效、患者的躯体功能及生活质量。     

Early metabolic defects in persons at increased risk for non-insulin-dependent diabetes mellitus

To identify early metabolic abnormalities in non-insulin-dependent diabetes mellitus (NIDDM), we measured sensitivity to insulin and insulin secretion in 26 first-degree relatives of patients with NIDDM and compared these subjects both with 14 healthy control subjects with no family history of NIDDM and with 19 patients with NIDDM. The euglycemic insulin-clamp technique, indirect calorimetry, and infusion of [3-3H]glucose were used to assess insulin sensitivity. Total-body glucose metabolism was impaired in the first-degree relatives as compared with the controls (P less than 0.01). The defect in glucose metabolism was almost completely accounted for by a defect in nonoxidative glucose metabolism (primarily the storage of glucose as glycogen). The relatives with normal rates of metabolism (mean +/- SEM, 1.81 +/- 0.27 mg per kilogram of body weight per minute) and impaired rates (1.40 +/- 0.22 mg per kilogram per minute) in oral glucose-tolerance tests had the same degree of impairment in glucose storage as compared with healthy control subjects (3.76 +/- 0.55 mg per kilogram per minute; P less than 0.01 for both comparisons). During hyperglycemic clamping, first-phase insulin secretion was lacking in patients with NIDDM (P less than 0.01) and severely impaired in their relatives with impaired glucose tolerance (P less than 0.05) as compared with control subjects; insulin secretion was normal in the relatives with normal glucose tolerance. We conclude that impaired glucose metabolism is common in the first-degree relatives of patients with NIDDM, despite their normal results on oral glucose-tolerance tests. Both insulin resistance and impaired insulin secretion are necessary for the development of impaired glucose tolerance in these subjects.     

心理干预对脑卒中后患者心理障碍的影响

目的探讨心理干预对脑卒中后患者心理障碍及生活质量的影响。方法采用心理量表对108例脑卒中患者应用SDS、SAS进行心理评估,将存在心理障碍的卒中患者随机分为实验组（加阶梯式心理治疗）及对照组。比较两组患者SDS、SAS及SF—36的分值及临床疗效。结果73.41%的脑卒中患者存在一定程度的心理障碍,以抑郁、焦虑多见。实验组SDS、SAS评分显著低于对照组,其临床疗效及生活质量评分显著高于对照组。结论脑卒中后患者易出现抑郁、焦虑、恐惧等心理问题,心理干预能显著改善脑卒中后患者的心理障碍,提高患者的生活质量,促进躯体功能的恢复。     

Perceived Threat of Illness and Health Protective Behaviors in Offspring of Adults With Non-Insulin-Dependent Diabetes Mellitus

Abstract

Self-reported measures of perceived threat of illness, health protective behaviors, psychological well-being, and family modeling of health behaviors of 30 adults with a parental history of non-insulin-dependent diabetes mellitus (NIDDM) were compared with responses from 29 adults with a parental history of hypertension and 30 adults with no parental history of chronic illness. The NIDDM risk group reported significantly more perceived threats of NIDDM and hypertension and more weight-control efforts than the controls did. Reports of the NIDDM risk respondents concerning physician screening, healthy diet, and exercise did not differ from reports of individuals without a family history of NIDDM. Perceived threat, psychological well-being, and family modeling did not correlate with health-protective behaviors. The findings suggest that offspring of adults diagnosed with NIDDM perceive themselves to be at risk of NIDDM and engage in health behaviors, such as weight control, to protect themselves from NIDDM onset.     

卒中后失语患者心理障碍影响因素及情欲顺势心理治疗

目的 探讨脑卒中后失语患者心理障碍的影响因素,并研究情欲顺势心理治疗对失语患者的临床效果.方法 选取2008月8月--2012年8月来我院住院治疗的83例脑卒中后失语症患者作为研究对象,随机分为观察组和对照组,对照组进行常规心理护理干预,观察组加用情欲顺势心理治疗,对比两组治疗后的GSI得分及临床疗效.选取同期来我院治疗的脑卒中无失语患者60例（无失语组）作为对比分析,研究影响失语患者心理障碍的影响因素.结果 失语症患者心理障碍主要表现为抑郁、焦虑、敌对、恐惧、偏执等,其中抑郁和焦虑情绪观察组比无失语组患者更为严重,两组差异具有统计学（t=2.858,2.909;P＜0.05）;其中脑部双侧病变发生心理障碍的严重程度最高.治疗后观察组总有效率为94.0％,对照组为81.7％,观察组明显高于对照组,两组相比差异具有统计学意义（x2=8.171,P＜0.05）,治疗8周后观察组GSI得分明显低于对照组,两组间差异具有统计学意义（t=6.898,P＜0.05）.结论 脑卒中后失语患者更容易出现心理障碍,发生心理障碍的机制与病变部位有关;通过情欲顺势心理治疗可以改善患者的心理状态,提高患者的生活质量.     

心理干预在心境障碍患者中的应用效果观察

目的 探讨心理干预在心境障碍治疗中的应用效果。方法 随机抽取我院精神2015年2月~2017年1月接收的90例心境障碍患者,随机分为对照组与干预组,各45例。对照组在抗抑郁治疗的同时辅助于常规护理,干预组则在此基础上又强化心理护理干预,随访3个月,比较两组患者的BPRS、ADLS评分情况及复发情况。结果 3个月后,干预组患者的BPRS评分（25.35±5.26）分、ADLS评分（15.95±2.43）分均优于对照组的BPRS评分（31.41±5.42）分、ADLS评分（20.23±4.15）分,差异有统计学意义（P＜0.05）;干预组复发率为2.22%,明显低于对照组的15.56%,差异有统计学意义（P<0.05）。结论 对心境障碍患者采用药物治疗同时辅助于心理干预,可以明显减少疾病的发作,控制病情的发展,提高患者日常生活能力,值得推荐。     

Microalbuminuria in non-insulin dependent diabetes mellitus

Non-insulin-dependent diabetes mellitus (NIDDM) is the commonest form of diabetes. The aim of this study was to evaluate the nature and prevalence of microalbuminuria (MAU) in NIDDM. One hundred and twenty-eight NIDDM patients participated in this study on the prevalence of microalbuminuria and albumin excretion rate (AER). An attempt was made to correlate them to the clinical profile, glycemic control and to diabetic complications. Eighteen patients had MAU with 14.1% prevalence (males--17.5% v/s females--10.8%; NS). Prevalence of MAU was higher in the third and fourth decades of age (28.6%) with a decrease in the fifth decade (12.5%). Prevalence of MAU also increased progressively with duration of diabetes--13 to 14% (< 10 yrs) to 25% (> 10 yrs). High AER in obese patients (13.4 +/- 5.5 v/s 7.9 +/- 1.4 micrograms/min) supports an association of obesity with albuminuria. The prevalence of MAU in patients with borderline and overt hypertension was not statistically different from that in normotensive NIDDM patients. However, NIDDM with borderline hypertension showed high AER 16.2 +/- 5.6 micrograms/min compared to 7.8 +/- 1.3 micrograms/min in normotensives. Prevalence to MAU and AER increased progressively with the deterioration of glycemic control--from 3.3% in well controlled to 18.9% in fairly controlled (P < 0.5) and 31% in poor controlled patients (P < 0.01). Also AER increased significantly from 3.9 +/- 0.8 to 12.3 +/- 4.1 and 18.4 +/- 4.6 micrograms/min, in patients with well to fairly and poorly controlled glycemia respectively. The prevalence of MAU and AER did not correlate with glycated hemoglobin (GHb) levels. The prevalences of peripheral neuropathy (PN) (42.6% v/s 55.6%) were similar in normo- and microalbuminuric patients. Patients with PN had high AER 11.9 +/- 2.7 micrograms/min. Diabetic retinopathy (DR) was equally prevalent in normo- and microalbuminuric NIDDM patients of (20.4% v/s 22.2), and AER was not significantly higher (12.1 +/- 4.3 micrograms/min) in NIDDM with retinopathy. High prevalences of cardiovascular disease (CVD) in MAU-NIDDM (22.2%; NS) was observed compared to normoalbuminuric (9.3%) patients. Also AER was significantly high in NIDDM associated with CVD (21.9 +/- 10.9 micrograms/min; P < 0.025). It can be concluded that, MAU is more prevalent in third and fourth decades and with longer duration of diabetes. Poor glycemic control was identified as a risk factor as in IDDM for development of MAU. MAU was a marker of generalised vascular dysfunction.     

The relationship of body fat distribution to non-insulin-dependent diabetes mellitus in a Navajo community

The relationship between non-insulin-dependent diabetes mellitus (NIDDM) and body fat distribution (BFD) as measured by waist/hip circumference (WHR) was investigated in a Navajo community. A sample of 136 females and 89 males, 20 years and older, was recruited using a cluster-sampling design. Fifty percent of the females and 30.3% of the males are overweight [body mass index (BMI) equivalent of >120% ideal body weight]. Prevalence of NIDDM is 14% in females and 10.1% in males. The sample is characterized by central BFD (mean WHR=0.897±0.075, females and mean WHR=0.963±0.071, males). WHR is significantly related to age and BMI in males (P < 0.05), but not in females. Adjusted odds ratios for risk of NIDDM prevalence with increasing WHR category were estimated from a multiple logistic regression model which controlled for age and BMI. The odds ratio and 95% confidence interval (95% CI) is 2.19 (1.14, 4.19) for risk of NIDDM prevalence for a female in the middle BFD category compared to a female in the low BFD category. Risk increases to 3.63 (95% CI=1.25, 10.52) for a female in the highest BFD category. Although there is an increased risk of NIDDM prevalence with central BFD for males, it is not statistically significant. Preferential energy storage in abdominal fat depots may be a phenotypic expression of the “Thrifty Genotype,” which places American Indians at greater risk for metabolic disorders.     

Influence of beta-blocking drugs on glucose metabolism in patients with non-insulin dependent diabetes mellitus

Two beta-blocking agents, non-selective propranolol and beta1-selective metoprolol, were investigated with respect to their effects on glucose metabolism in 10 hypertensive patients with non-insulin dependent diabetes mellitus (NIDDM). The patients were treated randomly for two weeks in double-blind cross-over manner with (a) propranolol, (b) metoprolol, and (c) placebo. Propranolol impaired glucose tolerance when compared to placebo. The increase in blood glucose was associated neither with changes in concentrations of serum insulin, plasma glucagon of free fatty acid nor with alterations in peripheral insulin sensitivity as measured by 125I-insulin binding to mononuclear leukocytes. Although metoprolol had no effect on blood glucose, it increased 125I-insulin binding to mononuclear leukocytes. The increase in insulin binding could contribute to blood glucose control during metoprolol treatment. In search for reasons for poor metabolic control in NIDDM, treatment with non-selective beta-blockers should be kept in mind.     

Defective activation of p21ras in peripheral blood mononuclear cells from patients with insulin dependent diabetes mellitus.

We previously reported that a decreased TCR mediated activity of the GTP-GDP binding p21ras protooncogene is associated with prediabetes in non-obese diabetic (NOD) mice. Furthermore, prevention of autoimmune diabetes is associated with reversal of the p21ras signaling defect in NOD T cells. Based on these animal studies we determined the activation of p21ras in PBMC from patients with Insulin Dependent Diabetes Mellitus (IDDM), Non-Insulin Dependent Diabetes Mellitus (NIDDM) and normal healthy controls. Stimulation by PHA induced a decrease of 3.7 +/- 1.4% and an increase of 2.44 +/- 2.3%, p < 0.02 and 2.6 +/- 1.6%,p < 0.003 in the basal unstimulated p21ras activity in the IDDM, NIDDM and normal control groups, respectively. Expression of p21ras and its regulatory elements, the GTPase activating protein p120ras-GAP and the guanine nucleotide releasing factor (GNRF) hSOS, was comparable in the three groups. The in vitro proliferative response to PHA was comparable in the IDDM and control groups: stimulation index (SI) of 8.6 +/- 2.5 and 9.4 +/- 3.5 respectively, p < 0.44. No correlations were found in the IDDM patients between the degree of p21ras activation and the mitogen induced in vitro proliferative response or the various clinical parameters including age, gender, disease duration, daily insulin requirements and metabolic control. Taken together these data indicate that PBMC from IDDM patients are characterized by a persistent impairment in the activation of their p21ras. They also suggest that p21ras stimulated activity is a sensitive and independent parameter of PBMC activation in these patients.