焦虑抑郁中学生的家庭环境和认知倾向

目的:探讨中学生抑郁和焦虑患者家庭环境、认知倾向因素的相关性。方法采用家庭环境量表(FES)、认知倾向问卷(CAOT)对205名中学生抑郁、焦虑患者(研究组)及115名健康对照进行测查,比较两组差异,并进行相关和回归分析。结果:(1)家庭环境量表中研究组在亲密度、情感表达、成功性、知识性、娱乐性、道德观、组织性、控制性等八个因子方面得分明显低于健康对照组(t=2.34～7.26,P<0.05或0.01),其中差距最大的是亲密度因子(5.7±2.6/7.5±1.8),差距最小的是控制性因子(3.0±1.8/3.4±1.9);而研究组矛盾性得分(4.4±2.5)则明显高于健康对照组(3.2±2.2),差异具有统计学意义(t=4.88,P<0.05)。(2)认知倾向量表中乐观因子(8.2±3.2)得分明显低于对照组(12.2±2.1),差异具有统计学意义(t=13.63,P<0.01)。悲观因子分男性(7.2±2.2)高于女性(6.5±2.1),差异有统计学意义(t=5.76,P<0.01)。(3)抑郁、焦虑与乐观因子、家庭亲密度等因子呈负相关(r=-0.37～-0.59,P<0.01)。(4)多元逐步回归分析发现,乐观因子、亲密度、情感表达等与抑郁、焦虑的关系更为密切。结论:家庭环境、认知倾向与中学生焦虑抑郁情绪的产生有密切关系,其中认知倾向可能有更重要的作用。     

首发精神分裂症患者家庭环境调查

目的 探讨首发精神分裂症患者家庭环境因子情况.方法 选择我院2008年4月～2009年5月住院的首发精神分裂症患者112例,采用家庭环境量表测评,结果与国内常模相比较.结果 患者家庭环境因子在亲密度、独立性、成功性、文化性、娱乐性、组织性方面低于国内常模(P＜0.05),在矛盾性、道德宗教性方面高于国内国内常模(P＜0.05).结论 首发精神分裂症家庭环境有较多问题,需进行干预.     

腰椎间盘突出症患者术前焦虑与术后恢复的关系

目的:探讨腰椎间盘突出症患者术前焦虑情绪与术后疼痛、术后恢复的关系.方法:用医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)评估行腰椎间盘手术的54例患者的焦虑情绪,以≥8分判为有焦虑情绪;用疼痛量表评估患者的疼痛程度,并记录病情恢复情况.用卡方检验,t检验比较焦虑组和非焦虑组的差异情况.结果:54例患者中有25例有焦虑;睡眠情况、对手术的认知程度、手术费用的承受能力与焦虑水平相关(OR=0.495,0.657,1.485).在术后6小时、2天、5天时,焦虑组的疼痛得分高于非焦虑组的疼痛得分[(9.0±4.1)vs.(6.0±3.4),(12.5±4.2)vs.(10.0±3.5),(4.5±1.6 )vs.(2.5±1.2);均P＜0.05].焦虑组患者的住院时间长于非焦虑组患者[(12.5±2.3)d vs.(9.7±2.1)d,P=0.008],排尿困难发生率高于非焦虑组患者(32% vs.17%,P=0.006).腰腿疼在术后第2天、第5天、1个月时焦虑组评分高于非焦虑组[(14.0±3.7)vs.(11.5±3.5),(9.5±4.2)vs.(6.5±3.3),(7.0±4.3)vs.(4.5±2.8);P＜0.05].结论:术前焦虑情绪影响术后刀口疼痛,术前焦虑与术后恢复有关.     

乳腺癌患者的焦虑、抑郁、幸福感指数及社会支持

目的:调查不同治疗阶段乳腺癌患者的焦虑、抑郁、幸福感指数和社会支持情况,分析社会支持与情绪状况的关系.方法:收集术前组、术后组与康复组的乳腺癌患者各105例为病例组,以及年龄与教育年限匹配的健康对照105例,应用汉密顿焦虑量表(HAMA,≥8分为可疑焦虑)、汉密顿抑郁量表(HAMD, ≥8分为可疑抑郁)、幸福感指数量表(Index of Well-being)和领悟社会支持量表(PSSS)进行有关测评.结果:病例组的可疑焦虑、抑郁发生率均高于健康对照(42.9％,61.9％,59.0％ vs.9.5％;33.3％,60.0％,46.7％ vs.5.7％;均P＜0.01),病例组的HAMA、HAMD得分均高于健康对照[(7.2±4.3),(9.4±5.1),(9.2±5.6)vs.(3.9±3.1);(6.2±3.8),(9.2±4.8),(7.9±4.6) vs.(3.1±2.4),均P＜0.01];术前组与术后组的幸福感指数低于健康对照[(10.6±2.3),(10.5±2.6) vs.(11.5±2.2),均P＜0.01].病例组中,有可疑焦虑患者的幸福感指数、PSSS得分均低于无焦虑组[如,术后组PSSS得分(63.0±10.1)vs.(70.4±9.1),P＜0.01];有可疑抑郁患者的幸福感指数、PSSS得分低于无抑郁组[如,康复组PSSS得分(63.8±10.6) vs.(70.1±8.4),P＜0.01].结论:本研究提示,不同治疗阶段的乳腺癌患者的可疑焦虑、抑郁发生率和焦虑、抑郁得分均高于健康人群;有可疑焦虑、抑郁患者的幸福感指数和社会支持相对更低.     

不同心理韧性高中生的日常情绪状态与情绪自我调节方式

目的:比较高、中、低心理韧性水平高中生的日常情绪状态及情绪自我调节方式.方法:选取202名高中生,施测青少年心理韧性量表(RSCA)、正负情绪情感量表(PANAS)和情绪调节方式问卷(ERQ).依据RSCA得分分为高(n=87)、中(n=61)、低心理韧性组(n=54),比较不同心理韧性组日常情绪状态及积极、消极情绪的调节方式差异.结果:高心理韧性组PANAS积极情绪情感得分高于中、低心理韧性组[(33.3±6.2)vs.(30.8±5.2),(29.4±6.9)；P＜0.001],低心理韧性组PANAS消极情绪情感得分高于高、中心理韧性组[(27.5±7.7)vs.(22.3±6.0),(24.0±7.3)；P＜0.001].在积极情绪调节方式上,高心理韧性组ERQ重视得分高于低心理韧性组[(3.4±0.6)vs.(3.0±0.8)；P＜0.05],宣泄得分高于中、低心理韧性组[(3.2±0.7)vs.(3.0±0.6),(2.8±0.9)；P＜0.01],而抑制得分低于中、低心理韧性组[(1.4±0.5)vs.(1.6±0.5),(1.8±0.8)；P＜0.01]；在消极情绪调节方式上,高心理韧性组抑制得分低于中、低心理韧性组[(2.2±0.7)vs.(2.5±0.6),(2.6±0.8)；P＜0.05],而低心理韧性组重视得分高于高、中心理韧性组[(2.1±0.7)vs.(1.8±0.5),(1.9±0.5)；P＜0.001)].结论:不同心理韧性高中生日常情绪状态存在差异,高心理韧性高中生倾向于对积极情绪采用更多的重视、宣泄和更少的减弱调节,对消极情绪则采用更少的重视和抑制调节.     

聚乙二醇干扰素α-2a联合利巴韦林治疗慢性丙型肝炎调查及心理干预

目的了解慢性丙型肝炎患者采用聚乙二醇干扰素α-2a联合利巴韦林治疗期间情绪障碍发生情况及心理干预效果。方法抗丙型肝炎病毒(聚乙二醇干扰素α-2a联合利巴韦林)治疗的96例慢性丙型肝炎患者分为心理干预组和对照组各48例,心理干预组每周1次心理干预。采用症状自评量表(SCL-90)对所有患者进行评定,分析两组患者SCL-90的分值变化并和中国成人常模对比。结果对照组SCL-90躯体化(t=2.68,P<0.01)、焦虑(t=1.99,P<0.05)、抑郁(t=1.72,P<0.05)、人际关系(t=1.71,P<0.05)和精神病性(t=1.85,P<0.05)等因子得分与中国成人常模比较有显著性差异。干预组SCL-90躯体化(t=2.72,P<0.01)、焦虑(t=1.97,P<0.05)、抑郁(t=2.02,P<0.05)、精神病性(t=1.93,P<0.05)等因子得分与中国成人常模比较有显著性差异。但心理干预组和对照组相比较,心理干预措施能显著性改善患者情绪障碍,心理干预组和对照组抑郁得分(t=1.74,P<0.05)、焦虑得分(t=1.82,P<0.05)和精神病性得分(t=1.91,P<0.05)有显著性差异。结论慢性丙型肝炎患者及其在聚乙二醇干扰素α-2a联合利巴韦林治疗期间存在躯体化、焦虑、抑郁等心理问题,心理干预对改善患者情绪障碍有积极作用。     

网络成瘾青少年家庭环境分析

目的探讨青少年网络成瘾者的家庭环境,为预防青少年网络成瘾提供科学依据。方法采用家庭环境量表(FESCV)对70名网络成瘾青少年进行测试。结果网络成瘾青少年在情感表达、独立性、成功性、知识性、组织性方面得分明显低于常模,矛盾性得分高于常模(P0.001);其娱乐性、道德宗教管、控制性与常模无明显差异。父亲文化程度的高低对网络成瘾青少年家庭的组织性有显著性影响(P0.05)。结论不良的家庭环境是导致青少年网络成瘾的心理社会因素之一。     

老年慢性充血性心力衰竭患者焦虑、抑郁情绪的心理干预

目的: 研究老年慢性充血性心衰(Chronic Heart Failure,GHF)患者焦虑、抑郁发生情况及放松疗法对其焦虑、抑郁情绪的干预效果.方法: 选择2004年9月-2007年9月在我院老年病科住院的老年CHF患者190例,按照其入院日的单双日随机分为实验组(基础心理护理 放松疗法,101例)和对照组(仅基础心理护理,89例);心理干预前及干预结柬1月后均用焦虑自评量表(SAS)、抑郁自评量表(SDS)测定;观察抑郁、焦虑情绪发生率、住院日及干预后两组SAS、SDS分数变化情况;随访出院后6月内再次因CHF住院率.放松疗法包括放松训练和音乐疗法,每日1小时,为期4周.结果: ①实验组及对照组问基线资料如年龄、性别、受教育程度、经济状况、照顾者身份、心功能分级、是否公费医疗、能否自理、CHF病程及心理干预前SAS、SDS分数的差异均无统计学意义;②我院老年CHF患者抑郁、焦虑情绪发生率分别是45.8%和52.6%,高于普通人群(抑郁、焦虑情绪发生率分别是5%～10%和5%);③心理干预后,实验组SAS得分由(42.3±6.8)降低至(32.8±6.1),SDS得分由(41.8±6.1)降低至(32.2±5.4);对照组SAS得分由(41.8±6.5)降低至(37.0±6.3),SDS得分由(41.0±5.9)降低至(36.4±5.9),实验组SAS、SDS得分降低程度均高于对照组(P＜0.05);④实验组平均住院日低于对照组[(29.8±1.4)vs.(32.6±2.6)],而随访结果显示:实验组出院后6月内再次因心衰住院率低于对照组(7.9%/20.2%,x2=6.064,P=0.014).结论: ①我院老年CHF患者抑郁、焦虑情绪发生率较高;②放松疗法对老年CHF患者焦虑、抑郁情绪的干预效果肯定并可改善预后.     

心理干预对精神发育迟滞儿童母亲情绪和生活质量的影响

目的探讨心理干预对改善精神发育迟滞(MR)儿童母亲焦虑抑郁情绪和生活质量的效果。方法将入组50例患儿母亲随机分为对照组和干预组各25例,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)和生活质量综合评定问卷-74(GQOLI-74),心理干预前后对两组母亲进行测评和对照研究,并将干预前两组母亲SDS、SAS评分分别与国内常模比较。结果 1两组母亲干预前SDS、SAS评分均明显高于国内常模,具有显著性差异(t=2.82,2.99,3.31,3.71;P0.01);2干预后干预组SDS、SAS评分均明显高于对照组,具有显著性差异(t=2.81,2.79;P0.01);3干预后干预组GQOLI-74因子评分均明显高于对照组,其中以躯体和社会功能差异显著(t=2.67,2.32;P0.05),心理功能差异非常显著(t=2.89;P0.01)。结论 MR儿童母亲存在严重的焦虑抑郁情绪,心理干预可明显改善MR儿童母亲的焦虑抑郁情绪,并显著提高其生活质量。     

烧伤患儿父母心理健康状况调查及心理干预

目的探讨烧伤患儿父母的心理健康状况及心理干预效果。方法采用症状自评量表(SCL-90)对78名烧伤患儿父母在干预前、干预后1周进行调查并作统计分析比较。结果烧伤患儿父母干预前躯体化、强迫、人际关系、抑郁、焦虑、敌对因子分均显著高于国内常模,差异有统计学意义(t分别为17.11,3.39,5.13,8.31,43.5,5.32;P<0.05)。干预后与干预前比较,患儿父母躯体化、强迫、人际关系、抑郁、焦虑、敌对因子分低于干预前,差异有统计学意义(t分别为3.41,2.21,3.52,3.08,3.96,3.56;P<0.05)。结论烧伤患儿父母存在不同程度的心理问题,心理干预能改善患儿父母的心理健康水平。     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.