X综合征患者疼痛及负性情绪的干预效果研究

目的探讨X综合征患者的有效护理方法。方法将2005年1月至2006年3月收治49例X综合征患者随机分为实验组28例，对照组21例，两组在诊断方法、治疗方案、护理方式相同的情况下，实验组给予综合心理干预．即心理支持法、认知心理和行为干预及睡眠模式干预。在出院前一天，用SDS、SAS、疼痛尺及问卷调查的方式测定．比较两组患者的抑郁、焦虑、疼痛的程度及睡眠质量的改善。结果两组患者抑郁、焦虑、疼痛情况以及睡眠质量改善程度，分别采用统计学处理，P〈0．05、P〈0．01、P〈0．05、P〈0．05，差异具有统计学意义。结论综合性心理干预能缓解X综合征患者的疼痛、阻断负性情绪、改善睡眠质量，有利于患者早日康复。综合心理干预是X综合征患者的有效护理方法。     

不良心境与冠心病患者血清氧化低密度脂蛋白相关性

目的探讨不良心境对冠心病(CHD)患者血清氧化低密度脂蛋白(ox-LDL)浓度影响,及其相关性。方法110例住院冠心病患者和40名健康体检者(对照组)作为研究对象。用焦虑自评量表(SAS)、抑郁自评量表(SDS)、焦虑状态-特质问卷(STAI)制定不良心境标准。以不良心境标准为分组依据,将入组的CHD患者分为严重不良心境组(31例)、一般不良心境组(37例)、无明显不良心境组(42例)。酶联免疫吸附试验(ELISA)法测CHD患者血清ox-LDL的水平。用t检验和Pearson直线相关分析法进行统计分析。结果1.严重不良心境组、一般不良心境组、无明显不良心境组CHD患者血清ox-LDL水平[分别为(0.63±0.20)mg/L,(0.52±0.14)mg/L,(0.51±0.11)mg/L]明显高于正常对照组[(0.44±0.19)mg/L],严重不良心境组CHD患者的血清ox-LDL浓度明显高于一般不良心境组、无明显不良心境组,差异有显著性(P<0.05)。一般不良心境组、无明显不良心境组血清ox-LDL差异无显著性(P>0.05);2.严重不良心境组CHD患者血清ox-LDL浓度与不良心境显著正相关(r=0.398,P<0.05)。3.冠心病患者血清ox-LDL与总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)浓度呈显著正相关(r=0.395~0.459,P<0.05),与高密度脂蛋白胆固醇(HDL-C)呈显著负相关(r=-4.07,P<0.05)。结论不良心境能促进CHD的发生发展,是诱发CHD的危险因素。     

The mental and physical health outcomes of green exercise

Both physical activity and exposure to nature are known separately to have positive effects on physical and mental health. We have investigated whether there is a synergistic benefit in adopting physical activities whilst being directly exposed to nature ('green exercise'). Five groups of 20 subjects were exposed to a sequence of 30 scenes projected on a wall whilst exercising on a treadmill. Four categories of scenes were tested: rural pleasant, rural unpleasant, urban pleasant and urban unpleasant. The control was running without exposure to images. Blood pressure and two psychological measures (self-esteem and mood) were measured before and after the intervention. There was a clear effect of both exercise and different scenes on blood pressure, self-esteem and mood. Exercise alone significantly reduced blood pressure, increased self-esteem, and had a positive significant effect on 4 of 6 mood measures. Both rural and urban pleasant scenes produced a significantly greater positive effect on self-esteem than the exercise-only control. This shows the synergistic effect of green exercise in both rural and urban environments. By contrast, both rural and urban unpleasant scenes reduced the positive effects of exercise on self-esteem. The rural unpleasant scenes had the most dramatic effect, depressing the beneficial effects of exercise on three different measures of mood. It appears that threats to the countryside depicted in rural unpleasant scenes have a greater negative effect on mood than already urban unpleasant scenes. We conclude that green exercise has important public and environmental health consequences.     

Diabetes-related symptoms and negative mood in participants of a targeted population-screening program for type 2 diabetes: The Hoorn Screening study

Objective: To determine the level of diabetes-related symptom distress and its association with negative mood in subjects participating in a targeted population-screening program, comparing those identified as having type 2 diabetes vs. those who did not. Research design and methods: This study was conducted within the framework of a targeted screening project for type 2 diabetes in a general Dutch population (age 50–75 years). The study sample consisted of 246 subjects, pre-selected on the basis of a high-risk profile; 116 of whom were subsequently identified as having type 2 diabetes, and 130 who were non-diabetic subjects. Diabetes-related symptom distress and negative mood was assessed ∼2 weeks, 6 months, and 12 months after the diagnosis of type 2 diabetes, with the Type 2 Diabetes Symptom Checklist and the Negative well-being sub scale of the Well-being Questionnaire (W-BQ12), respectively. Results: Screening-detected diabetic patients reported significantly greater burden of hyperglycemic (F=6.0, df=1, p=0.015) and of fatigue (F=5.3, df=1, p=0.023) symptoms in the first year following diagnosis type 2 diabetes compared to non-diabetic subjects. These outcomes did not change over time. The total symptom distress (range 0–4) was relatively low for both screening-detected diabetic patients (median at ∼2 weeks, 6 months, and 12 months; 0.24, 0.24, 0.29) and non-diabetic subjects (0.15, 0.15, 0.18), and not significantly different. No average difference and change over time in negative well-being was found between screening-detected diabetic patients and non-diabetic subjects. Negative well-being was significantly positive related with the total symptom distress score (regression coefficient β=2.86, 95% CI 2.15–3.58). Conclusions: The screening-detected diabetic patients were bothered more by symptoms of hyperglycemia and fatigue in the first year following diagnosis type 2 diabetes than non-diabetic subjects. More symptom distress is associated with increased negative mood in both screening-detected diabetic patients and non-diabetic subjects.     

Unprotected Anal Intercourse in HIV-Positive and HIV-Negative Gay Men: The Relevance of Sexual Arousability,Mood, Sensation Seeking,and Erectile Problems

Reduction of unprotected anal intercourse (UAI) in gay men infected with HIV is important in preventing further spread of this infection. In previous studies, personality trait measures relevant to sexual arousability and the effects of anxiety have been shown to relate to UAI in both gay and heterosexual men. Are HIV+ gay men similar in these respects or are there other personality-related factors that influence their sexual risk taking? This question was addressed using a convenience sample of 156 HIV+ gay men and 155 HIV? gay men, matched for age and UAI risk. There were no significant differences between these two groups on measures of sexual arousability, inhibition of sexual arousal in risky situations, sensation seeking, depression and anxiety proneness, or tendency to increased sexual interest in negative mood states. HIV+ men were, however, more likely to report erectile problems and higher scores on an associated trait measure, inhibition of arousal due to threat of performance failure. As this association was not anticipated, questions about whether erectile problems preceded the seroconversion were not asked. Such problems could be associated with reluctance to use condoms, thus increasing the likelihood of seroconversion and/or disease transmission. Alternatively, erectile problems could be a consequence of HIV infection. In each case, this has implications for prevention. The associations among HIV status, erectile problems, and UAI need to be specifically addressed in future research.     

Mood fluctuations in Parkinson's disease: a pilot study comparing the effects of intravenous and oral levodopa administration

OBJECTIVES: Parkinson's disease (PD) is associated with motor fluctuations that have been shown to improve when stable plasma levodopa levels are achieved with continuous levodopa infusions. Many patients also develop mood fluctuations. In this pilot study, we gathered preliminary information about the relationship between changing mood states and plasma levodopa levels. METHODS: Six patients with idiopathic PD and histories of motor and mood fluctuations participated in a double-blind levodopa infusion study. Subjects received active oral carbidopa/levodopa and a placebo levodopa infusion on one day and placebo oral carbidopa/levodopa and an active levodopa infusion on the other day, in a randomly determined order. Evaluations included serial plasma levodopa levels and assessments of mood and motor states. RESULTS: Only 4 of the 6 subjects demonstrated mood fluctuations on at least one of the treatment days. All subjects achieved more stable plasma levodopa levels on the active infusion day. Two subjects experienced fewer mood fluctuations on the active infusion day and two experienced fewer on the oral day. Conclusions The results of this pilot study suggest that the relationship between mood state and plasma levodopa level may vary among PD patients.     

Should bipolar disorder be viewed as manic disorder? Implications for bipolar depression

This paper proposes that the syndrome of mania rather than mood swings is the central distinguishing feature of bipolar disorder, which may be more appropriately viewed as manic disorder. The theoretical consequence of this change in perspective is to regard the depressive mood states as being a co-morbid condition. This may lead to a more profound and broader understanding of the variety of states of depression that complicate manic disorder. The paper also reviews diagnostic issues relating to bipolar depression. A broader approach may extend therapeutic choices, and open innovative research avenues.     

Co-existence of lycanthropy and Cotard's syndrome in a single case

OBJECTIVE: Lycanthropy is an unusual psychiatric syndrome involving the delusion of being an animal. Cotard's syndrome is another rare condition in which the patient has nihilistic delusions and ideation of immortality. We report a psychiatric patient who had both syndromes simultaneously. METHOD: A single case was reported. RESULTS: A patient meeting DSM-IV criteria for bipolar mood disorder, mixed type with psychotic feature had the delusion of being transformed into a dog. He also deluded that he was dead. He was restless and had a serious sense of guilt about his previous sexual contact with a sheep. CONCLUSION: Co-existence of lycanthropy and Cotard's syndrome has not been reported before. In this patient zoophilic orientation associated with a sense of guilt were concluded to be important factors causing his delusions.     

Cognitive generation of affect in hypomania: an fMRI study

OBJECTIVE: To identify the brain regions associated with the cognitive generation of affect in hypomanic bipolar patients. METHODS: The study examined 10 hypomanic female subjects with bipolar affective disorder, and 10 age- and sex-matched comparison subjects using functional magnetic resonance imaging (fMRI) while viewing alternating blocks of captioned-pictures designed to evoke negative, positive or no affective change. The activation paradigm involved the presentation of the same visual materials over three experiments alternating (a) negative and reference, (b) positive and reference and (c) positive and negative captioned-pictures. RESULTS: The stimuli produced activation in both patients and comparison subjects in brain regions previously implicated in the generation and modulation of affect, in particular the prefrontal cortex. Activation in patients involved additional subcortical regions namely the caudate and thalamus. CONCLUSIONS: This preliminary study suggests that hypomanic patients recruit additional subcortical limbic systems for emotional evaluation when advanced prefrontal cortical processing is no longer sufficient. The differential patterns of activation inform us about bipolar disorder and may have potential diagnostic and therapeutic significance.     

The Munich vulnerability study on affective disorders: premorbid psychometric profile of affected individuals

OBJECTIVE: We conducted a longitudinal high-risk study to identify psychometric vulnerability markers for affective disorders. METHOD: We examined 82 healthy subjects [high-risk probands (HRPs)] with at least one first-degree relative suffering from an affective disorder. The premorbid psychometric profile of 20 HRPs who developed a psychiatric disorder during follow-up was compared with the profile of control subjects without personal and family history of psychiatric disorders matched for age and gender. RESULTS: Somatization, complaints (vegetative lability), and perception of strain are increased in HRPs who developed a psychiatric disorder. These alterations were not influenced by the time interval until the onset of the disorder. CONCLUSION: The premorbid psychometric profile in subjects at high risk for affective disorders is characterized by somatization, complaints, and elevated perception of strain. Together with previous findings our results suggest that these alterations can be regarded as potential vulnerability markers for affective disorders.