心理治疗焦虑症效果分析研究

焦虑症是一种常见的焦虑障碍,给患者带来难以忍受的痛苦,严重影响了患者的社会功能和生活质量.为探讨心理干预对焦虑症患者治疗和复发的预防效果,我们采用药物联合心理干预治疗进行了对照研究,现将结果报告如下.目的:探讨心理干预以及心理行为护理对焦虑症患者治疗效果以及对复发的预防效果.方法:药物治疗的基础上对焦虑症患者进行心理行为护理,将64例广泛性焦虑症患者随机分为两组,干预组31例给予药物联合心理干预治疗,对照组33例单用药物治疗.分别于入组前及治疗9 mo末采用焦虑自评量表及汉密顿焦虑量表评定临床疗效.结果:干预9 mo末,干预组焦虑自评量表及汉密顿焦虑量表评分较干预前均有极显著下降(P＜0.01),均显著低于对照组(P＜0.01);对照组焦虑自评量表评分较干预前有显著升高(P＜0.01),汉密顿焦虑量表评分无显著性差异(P＞0.05).干预组再次复发率为21.5%,对照组为47.3%,两组比较差异有极显著性(X2=9.46,P＜0.01).心理行为护理后MAMA评分(18.63±3.82)分,显著低于护理前(27.25±5.12)分(X2=7.01,P<0.01).结论:心理干预对焦虑症患者的治疗以及复发具有积极的效果:心理行为护理可改变焦虑症患者的不良认知,协调医患关系,提高患者对治疗的依从性和疗效.     

男性精神分裂症住院患者攻击行为分析及护理对策

目的:探讨有攻击行为的住院男性精神分裂症患者的症状特征,制定相应的护理对策.方法:对85例男性住院精神分裂症患者以外显攻击行为量表(MOAS)及简明精神病量表(BPRS)评定;比较有、无攻击行为的精神分裂症患者的BPRS评分.结果:85例患者中,有攻击行为44例(51.80%),无攻击行为41例(48.20%);两组BPRS评分比较,有攻击行为组的总分及敌对猜疑、激惹性、行为紊乱等因子分均明显高于无攻击行为组(P<0.01),思维障碍因子分前者高于后者(P<0.05).结论:精神分裂症患者攻击行为受精神症状支配,尽早根据临床表现并对患者实施有效的护理对策.     

脑卒中后焦虑障碍和抑郁障碍的影响因素研究

目的 探讨脑卒中后焦虑障碍和抑郁障碍的影响因素.方法 评估360例脑卒中患者的神经功能缺损程度(NIHSS)、日常生活能力(BI)、汉密尔顿焦虑量表(HAMA)及汉密尔顿抑郁量表(HAMD)评分并进行记录.结果 360例患者中,脑卒中后焦虑障碍的发生率为11.7%,抑郁障碍为18.6%.额叶组与非额叶组脑卒中后焦虑和抑郁障碍的发生率比较差异不显著,不同卒中类型间脑卒中后抑郁障碍的发生率比较有显著性差异(P＜0.05),且脑出血组较脑梗死组高(P＜0.05).脑卒中后抑郁障碍组较无抑郁障碍组NIHSS评分高,BI评分低(P＜0.01).脑卒中后焦虑和抑郁障碍患者NIHSS评分、BI评分分别与卧MD评分、HAMA评分呈正、负相关.结论 脑卒中后抑郁障碍与卒中类型、NIHSS评分及BI评分有关.     

家庭治疗对精神病患者家属焦虑抑郁的影响

目的 探讨家庭治疗对精神病患者家属焦虑抑郁情绪的影响.方法选取100例精神分裂症患者家属为观察组,50例一般内科患者家属为对照组,比较2组亲属应激量表(RSS),自评抑郁量表(SDS)和焦虑自评量表(RSS),自评抑郁量表(SDS)和焦虑自评量表(SAS)的评分.对观察组RSS及其三个维度与SAS、SDS进行相关性分析.由心理治疗师对观察组家属采取护理干预和家庭治疗,比较干预前后患者家属的RSS、SAS、SDS量表评分.结果精神病住院患者家属比普通内科患者家属存在更严重的焦虑、抑郁情绪(P<0.01);精神病患者家属在治疗前后应激反应和焦虑、抑郁情绪存在显著差异,干预后3个量表评分明显低于干预前,有统计学差异(P＜0.01).结论对精神病患者家属采取护理干预和家庭治疗,能够缓解家属焦虑抑郁情绪,提高患者和家属生活质量.     

外科住院患者家庭关怀度与疼痛的相关性分析

目的 探讨外科住院患者家庭关怀度与疼痛之间的相关性.方法 采用wong-Baker面部表情疼痛量表和家庭关怀度指数量表对115名外科住院患者在入院前、入院时、住院24h、手术后3～5天进行调查.结果 外科住院患者家庭功能良好者占72.2%.入院前.在家庭关怀度量表总分、适应度、合作度、情感度和亲密度等方面,疼痛明显组比不明显组分数低(t＝2.32～4.68,p<0.05).手术后3～5天,合作度、成长度等方面,疼痛明显组比不明显组分数高(r＝2.62～2.67,P<0.05),而亲密度则表现为疼痛明显组比不明显组分数低(t=2.40,P<0.05).相关分析发现,手术后3～5天疼痛程度与家庭合作度呈正相关(r=0.203,P<0.05),与亲密度呈负相关(r=-0.246,p<0.01).结论 外科住院患者合作度高者疼痛表现明显,亲密度低者疼痛感明显,应积极采取护理措施,提高患者家庭关怀度水平,以达到减轻疼痛、尽快康复的目的.     

满时间行为护理对焦虑症患者的影响

目的 探讨满时间行为护理对精神疾病中的焦虑患者的效果.方法 将住院的102例焦虑症患者随机分为研究组和对照组,各51例.研究组采用满时间行为护理,对照组采用一般护理.2组分别在2周、4周、6周进行汉密尔顿焦虑量表(HAMA)评定、焦虑自评量表(SAS)及医生临床效果评定.结果 2组疗效及焦虑症状评分比较均有显著性差异(p<0.01).结论 满时间行为护理优于一般精神科护理,能够帮助患者提高治疗效果.     

系统性红斑狼疮患者血清增殖诱导配体水平的检测及其临床意义

目的:检测系统性红斑狼疮(SLE)和类风湿性关节炎(RA)患者血清中增殖诱导配体(APRIL)的水平,探讨APRIL水平与SLE患者临床指标的相关性及APRIL在SLE发病中的作用.方法:采用ELISA法检测SLE患者组(48例)、RA患者组(16例)和正常对照组(16例)血清APRIL水平,并与SLE活动指数(SLEDAI)及实验室指标进行对比分析.结果:SLE组和RA组血清APRIL水平高于正常对照组(P<0.01),SLE组高于RA组(P<0.01).SLE组中抗Sm抗体阳性患者APRIL水平高于阴性患者( P<0.05).抗U1-RNP抗体阳性患者APRIL水平高于阴性患者( P<0.05),抗SSA /SSB抗体、抗ACL抗体、抗ds-DNA抗体阳性和阴性患者APRIL水平差异无统计学意义.SLE患者血清APRIL水平与其补体C3、C4呈负相关关系(r1=-0.819,P<0.01;r2=-0.549,P<0.01),与SLEDAI评分、免疫球蛋白、抗核抗体谱等免疫学指标无相关性.结论:APRIL在SLE患者中特异性升高,可能在狼疮发病中起重要作用;血清APRIL水平可能与SLE患者疾病活动程度有关联,但尚不能确定是否可作为疾病活动性指标.     

解郁调护方案改善手术应激状态抑郁质型的应用效果

目的 探讨解郁调护方案改善手术应激状态抑郁质型的应用效果.方法 运用症状自评量表(SCL-90)、焦虑量表(SAS)、汉密尔顿抑郁量表(HAMD)筛查中、高度手术焦虑的抑郁质患者100例,将受试对象随机分为实验组与对照组,每组各50例,实验组采用解除抑郁调护方案进行调节,对照组采用常规护理措施,比较干预前后2组的SCL-90和SAS评分.结果 实验组干预后SCL-90各因素得分和SAS各因素得分显著低于干预前(P<0.05),对照组干预后SCL-90躯体症状、强迫症状、焦虑以及精神症状等4个因子得分显著低于干预前(P<0.05).干预后实验组SCL-90各因素得分和SAS得分显著低于对照组(P<0.05).结论 解除抑郁护理调节方案能够显著改善抑郁质型手术期焦虑应激状态,提高患者应对手术压力因素的能力以及身心健康.     

护理干预对癫痫患者生活质量的影响

目的 通过评价癫痫患者综合护理前后生活质量评分的变化,探讨护理干预对癫痫患者生活质量的影响,为提高癫痫患者生活质量提供理论依据.方法研究对象为2009年3月～2011年3月来本院就诊的200例成人癫痫患者,给予护理干预,评价其对生活质量的影响.生活质量评定工具:①成人癫痫患者生活质量量表-31中文版(QOLIE-31中文版);②焦虑自评量表;③抑郁自评量表.结果综合护理后的生活功能评分、心理功能评分、生活质量平均得分均明显高于综合护理前 (P<0.01);综合护理前后焦虑自评得分无显著性差异(P>0.05);综合护理前后抑郁自评得分有显著性差异(P<0.05).结论对癫痫患者实施的综合护理,充分发挥社会、家庭支持系统的作用,加强患者及家属的健康教育,对提高癫痫患者的生活质量具有重要意义.     

电针配合小脑电刺激治疗对小脑梗塞患者平衡障碍的疗效观察

目的:观察电针配合小脑电刺激治疗对小脑梗塞患者平衡障碍干预的作用.方法:选择48例小脑梗塞患者,随机分为治疗组,对照组.2组均予小脑电刺激治疗,治疗组在此基础上还进行电针治疗.治疗前及治疗1个月后均采用Berg平衡量表,改良Barthel指数评分评定.结果:与对照组比较,治疗组Berg平衡量表,改良Barthel指数评分均有较大改善,有显著性差异(P<0.01).结论:电针配合小脑电刺激治疗能有效改善小脑梗塞患者平衡功能的恢复.     

Examining the evidence for anxiety-related cognitive biases in obsessive-compulsive disorder

In light of current concerns about the diagnostic classification of obsessive-compulsive disorder (OCD), this article critically examines recent experimental research on anxiety-related cognitive biases in OCD in order to determine whether it provides grounds for OCD's differentiation from other anxiety disorders. This small body of work is found to be fraught with defects, anomalies, and inconsistencies. These findings contrast dramatically with the robust results obtained with other clinical anxiety disorders. When biases are in evidence it tends to be with a select group of subjects, that is, those with contamination concerns. It is suggested that only this subtype of OCD, or some core characteristic underlying it, may be associated with cognitive tendencies comparable to those found in other anxiety disorders (i.e., biases at the attentional level associated with the emotional tone, or content, of information). Cognitive tendencies in other subtypes likely require different explanatory frameworks. This review provides evidence for the partial uniqueness of OCD from other anxiety disorders.     

Serotonin receptor 1A knockout: an animal model of anxiety-related disorder

To investigate the contribution of individual serotonin (5-hydroxytryptamine; 5-HT) receptors to mood control, we have used homologous recombination to generate mice lacking specific serotonergic receptor subtypes. In the present report, we demonstrate that mice without 5-HT1A receptors display decreased exploratory activity and increased fear of aversive environments (open or elevated spaces). 5-HT1A knockout mice also exhibited a decreased immobility in the forced swim test, an effect commonly associated with antidepressant treatment. Although 5-HT1A receptors are involved in controlling the activity of serotonergic neurons, 5-HT1A knockout mice had normal levels of 5-HT and 5-hydroxyindoleacetic acid, possibly because of an up-regulation of 5-HT1B autoreceptors. Heterozygote 5-HT1A mutants expressed approximately one-half of wild-type receptor density and displayed intermediate phenotypes in most behavioral tests. These results demonstrate that 5-HT1A receptors are involved in the modulation of exploratory and fear-related behaviors and suggest that reductions in 5-HT1A receptor density due to genetic defects or environmental stressors might result in heightened anxiety.     

Age- and stimulus-dependent changes in anxiety-related behaviour of transgenic mice with GR dysfunction

Transgenic mice expressing antisense directed against glucocorticoid receptor (GR) mRNA were used for a longitudinal study on the effects of hypothalamic-pituitary-adrenocortical dysfunction on anxiety-related behaviour and locomotor activity. Compared with age-matched controls and 5-week-old transgenic animals, 13- and 36-week-old transgenic mice made significantly more entries into and spent significantly more time on the open arms of the elevated plus-maze thereby indicating reduced basal anxiety. In contrast, time spent in the central area of the open field was significantly reduced in transgenic animals indicating an enhanced anxiety under conditions of increased stress. Locomotor activity did not differ between transgenic and control animals. Our results indicate that behavioural changes in transgenic mice differ according to the age of the animals and the behavioural paradigm used. Transgenic animals with an impaired GR function may be of help in studying the interaction of ageing, GR function and the development of behavioural abnormalities.     

Behavioral and neurophysiological evidence for altered processing of anxiety-related words in panic disorder.

Body-related and nonsomatic words were presented tachistoscopically to 15 panic patients and 15 healthy controls at each participant's threshold for correctly identifying 50% of neutral words. Behavioral (proportion of words correctly recognized) and electrocortical (event-related brain potentials [ERPs]) measures were registered. Panic patients recognized more body-related than nonsomatic words, and body-related as compared with nonsomatic words elicited, in these patients, significantly larger P300 amplitudes and enhanced positive slow waves (600 to 800 ms after stimulus presentation) . In healthy controls, the number of correct recognized words and the ERPs were not differentially affected by the 2 word types. These results are grossly consistent with cognitive models of panic disorders, assuming that certain bodily sensations are perceived and processed in an affective manner that differentiates panic patients from healthy controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of emotion regulation for the shift from normative fear-relevant learning to anxiety-related psychopathology.

Replies to the article by Mineka and Zinbarg (see record 2006-00920-002), which illustrated how a contemporary learning theory informs the etiology and maintenance of anxiety disorders. In our view, the challenge facing contemporary learning theory is to explain how and why potentiated fear conditioning is problematic and capable of yielding an anxiety disorder. Neither potentiated fear and fear learning itself, nor individual differences that potentiate both, explain how an anxiety disorder develops. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oxytocin receptor activity in the ventrocaudal periaqueductal gray modulates anxiety-related behavior in postpartum rats.

Postpartum rats are less anxious than diestrous virgin females, a phenomenon requiring that mothers have recent contact with their infants. Oxytocin (OT) is one of many neurochemicals released intracerebrally while mothers interact with infants, and we investigated whether OT receptor activity in the ventrocaudal periaqueductal gray (cPAGv) contributes to mothers' reduced anxiety. Infusion of the highly specific OT receptor antagonist, desGly-NH?,d(CH?)?[D-Tyr2,Thr?]OVT, into the cPAGv reduced the percentage of time dams spent in the open arms of an elevated plus-maze, but had no effect on the open-arm behavior of diestrous virgins. Conversely, after separating dams from their litters for 4 hr to increase anxiety, a lower (2 ng) but not higher (5 ng) dose of OT infused into each hemisphere of the cPAGv doubled the percentage of time dams spent in open arms, but did not do so in virgins. OTergic manipulations inconsistently affected risk-assessment behaviors (stretch-attend postures, head dips) in both virgins and dams. Therefore, OT receptor activation in the cPAGv is an important consequence of contact with infants that reduces some anxiety-related behaviors in mother rats. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential genetic regulation of motor activity and anxiety-related behaviors in mice using an automated home cage task.

Traditional behavioral tests, such as the open field test, measure an animal's responsiveness to a novel environment. However, it is generally difficult to assess whether the behavioral response obtained from these tests relates to the expression level of motor activity and/or to avoidance of anxiogenic areas. Here, an automated home cage environment for mice was designed to obtain independent measures of motor activity levels and of sheltered feeding preference during three consecutive days. Chronic treatment with the anxiolytic drug chlordiazepoxide (5 and 10 mg/kg/day) in C57BL/6J mice reduced sheltered feeding preference without altering motor activity levels. Furthermore, two distinct chromosome substitution strains, derived from C57BL/6J (host strain) and A/J (donor strain) inbred strains, expressed either increased sheltering preference in females (chromosome 15) or reduced motor activity levels in females and males (chromosome 1) when compared to C57BL/6J. Longitudinal behavioral monitoring revealed that these phenotypic differences maintained after adaptation to the home cage. Thus, by using new automated behavioral phenotyping approaches, behavior can be dissociated into distinct behavioral domains (e.g., anxiety-related and motor activity domains) with different underlying genetic origin and pharmacological responsiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic predisposition to anxiety-related behavior determines coping style, neuroendocrine responses, and neuronal activation during social defeat.

Genetic background may influence an individual's susceptibility to, and subsequent coping strategy for, an acute stressor. When exposed to social defeat (SD), rats bred for high (HAB) or low (LAB) trait anxiety, which also differ in depression-like behavior, showed highly divergent passive and active coping behaviors, respectively. HABs spent more time freezing and emitted more ultrasound vocalization calls during SD than LABs, which spent more time rearing and grooming. Although the behavioral data confirmed the prediction that heightened trait anxiety would make rats more prone to experience stress, adrenocorticotropin and corticosterone were secreted to a higher extent in LABs than in HABs. In the latter, Fos expression upon SD was enhanced in the amygdala and hypothalamic areas compared with LABs, whereas it was diminished in prefrontal and brainstem areas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal care, isolation-induced infant ultrasonic calling, and their relations to adult anxiety-related behavior in the rat.

In the rat, variations in maternal care affect the development of stable individual differences in anxiety-related behavior. Here, it was asked whether such experience-dependent differences can be detected already during early life. As a measure for anxiety in pups, isolation-induced ultrasonic vocalizations were used, and their dependency on different maternal behaviors, namely licking, retrieval behavior, and responsiveness to playback of pup calls, was tested. Consistent with reported differences of adult rats with high or low levels of maternal care experienced, the rarely licked offspring appeared to be more anxious, since they emitted more calls when separated from their mother and litter. Based on these findings, it was examined whether infant calling can be used as a predictor of adult anxiety-related behavior. Results show that infant call emission was negatively correlated with immobility and calling during fear conditioning. These relationships seem to be mediated at least partly by maternal care. In total, measuring ultrasonic vocalizations can provide information about an affective trait of infant and adult rats, which gives the opportunity to study the development of emotionality from early life onward. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of film modeling on the reduction of anxiety-related behaviors in individuals varying in level of previous experience in the stress situation.

Evaluated the influence of film preparation on 80 4–11 yr old children undergoing 3 dental sessions (prophylaxis, examination, and restorative treatment) with respect to (a) peer modeling vs demonstration of procedures and (b) amount of information. It was found that, by evaluating self-report (Children's Fear Survey Schedule), and behavioral (Behavior Profile Rating Scale), and visceral-arousal indices in a factorial design, Ss exposed to a peer-model videotape presentation immediately preceding their own restorative treatment exhibited fewer disruptive behaviors and reported less apprehension than those watching a videotaped demonstration without a peer model. The modeling film elicited less heart rate activity in the Ss than the demonstration. 4–6 yr old Ss had lower self-reports of fear after viewing a more complete synopsis of what to expect, whereas the 8–21 yr old Ss had the lowest report of fears after viewing the peer model receiving a local anesthetic and brief intraoral examination. Ss with previous treatment experience benefitted most from viewing the peer model undergoing the entire restorative procedure or a demonstration of the administration of local anesthetic in the absence of a peer model. Ss with no prior experience were sensitized by being shown the demonstration. It is concluded that the age and previous experience of the viewer are important factors in determining childrens' fear-related behaviors after exposure to preparatory stimuli. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)