应激的基本理论与难治性慢性胃炎

内源性,外源性应激因素都会对人体心理和神经内分泌系统造成影响,在同一应激因素下由于人格不同可能有不同的应激反应.过度的应激是导致心身疾病的重要原因.多数难治性慢性胃炎和医源性应激关系密切,对慢性胃炎和FD在处理上应作为一种病去对症处理,不必过度强调抗Hp.医生在临床工作中,要注意规范言行,合理解释病情,避免医源性应激给患者带来心理创伤,减少医源性心理疾病的发生.     

亚临床甲状腺功能减退与冠状动脉粥样硬化性心脏病

对冠心病高危因素积极地预防及治疗,可降低冠心痛的患病率和病死率.已经得到公认的临床甲状腺功能减退通过引起代谢及血流动力学紊乱而参与了冠状动脉粥样硬化的发生与发展.目前,国内外许多临床研究显示亚临床甲状腺功能减退通过多种途径参与冠心病的发生和发展,是冠心病的重要危险因素之一.     

应激的基本理论与难治性慢性胃炎

内源性,外源性应激因素都会对人体心理和神经内分泌系统造成影响,在同一应激因素下由于人格不同可能有不同的应激反应。过度的应激是导致心身疾病的重要原因。多教难治性慢性胃炎和医源性应激关系密切,对慢性胃炎和FD在处理上应作为一种痛去对症处理,不必过度强调抗Hp。医生在临床工作中,要注意规范言行,合理解释病情,避免医源性应激给...     

大学生考期应激的特征及原因分析

旨在研究考期应激的表现特征,并探讨其产生的原因和影响因素。以问卷方法测量了261名在校大学生。结果发现47．89％的被试有不同程度的考期应激症状,其中以睡眠症状为最典型的特征。考期应激症状很少受性别、专业、年级、是否担任班干部和个性倾向等因素的影响,且具有较明显的时间特征。诱发考期应激的主要因素有：考生“对考试目的的认知”、“对考试内容的认知”及“生恬和学习环境”等。结论为,考期应激是一种大学生中较普遍且具有多重原因的应激现象。     

心理行为干预对心血管活动的影响

早在本世纪初．Cannon(1936)等人的研究就已经证明：心理压力和情绪应激可使自主神经系统发生改变,从而导致心率、心输出量、血压等发生明显的变化。情绪应激一方面可以引起自主神经,尤其是交感神经的变化．从而激活交感一肾上髓质系统;另一方面,情绪应激可使下丘脑释放促肾上腺皮质激素释放因子,从而激活垂体一肾上皮质系统。心理实验研究表明,上升的交感一肾上髓质活动或垂体一肾上皮质活动与动脉硬化过程和临床冠心病的许多病理生理状态联系在一起,例如由应激引起的紧张引起交感神经水平升高,这可能是高血压形成的一个重要因素。     

溃疡性结肠炎患者的心理治疗策略

溃疡性结肠炎是一种病因未明、反复发作的肠道慢性炎症.其发生除与遗传、环境和免疫因素有关外,也与精神心理因素有关.精神心理因素可能是通过改变下丘脑-垂体-肾上腺轴、细菌黏膜间相互作用和肥大细胞的活性增加等途径导致该病的发生或复发.药物治疗的同时进行心理干预治疗可能有利于该病的康复.     

亚临床甲状腺功能减退与冠状动脉粥样硬化性心脏病

对冠心病高危因素积极地预防及治疗,可降低冠心病的患病率和病死率。已经得到公认的临床甲状腺功能减退通过引起代谢及血流动力学紊乱而参与了冠状动脉粥样硬化的发生与发展。目前,国内外许多临床研究显示亚临床甲状腺功能减退通过多种途径参与冠心病的发生和发展,是冠心病的重要危险因素之一。     

几种主要的应激理论模型及其评价

随着社会的迅速发展,人们面临的应激（ｓｔｒｅｓｓ）因素越来越多,并日趋复杂,引起了国内外社会学家、心理学家和医学家的广泛关注。有关应激的研究由来已久,并渐渐形成了几种不同的理论模型。了解这几种应激理论模型,对于我们全面研究人类应激现象,指导人们应对（ｃｏｐｅ）现代各种紧张因素,具有重要的理论和现实意义。应激的研究最早可追溯到古希腊时代。“医学之父”Ｈｉｐｐｏｃｒａｔｅｓ早已清醒地认识到人体有一种自愈力（Ｖｉｓｍｅｄｉｃａｔｒｉｘｎａｔｕｒｅ）,近代法国生理学家Ｂｅｒｎａｒｄ（１８７９）、德国生理…     

影响应激障碍治疗方案确立的临床特征

急性应激障碍和创伤后应激障碍是近些年创伤后研究的重要内容.为了更加全面地评估遭遇创伤事件患者的情况,本文将从年龄、性别、种族和文化因素、生理与心理共病、过去受伤史、攻击行为、自伤和自杀行为7个方面阐述影响应激障碍的因素,以期在影响应激治疗因素层面为临床治疗提供依据.     

早期应激对抑郁相关行为及神经内分泌反应的长期影响

临床研究发现,早期创伤性经历是导致成年抑郁症易感性增加的高风险因素之一。但早期应激通过何种途径对抑郁发病产生长期的影响,目前尚不清楚。本文综述了近年来有关的实验动物研究,从早期应激的动物模型建立、早期应激对成年动物抑郁相关行为及神经内分泌反应的长期影响等方面进行了系统论述和分析,进而提出了早期应激并不影响动物的本能行为,但早期应激影响与行为动机和应激应对等认知相关的行为的观点,进一步论证了早期应激是通过增加个体潜在的易患病素质对抑郁症发病产生影响     

Health Related Quality of Life in Children with Congenital Heart Disease

Health-related quality of life in children with congenital heart disease (CHD) was compared to that of healthy children. Furthermore, agreement between child and parent reports was examined. In addition, differences in quality of life related to the severity of CHD were evaluated. One hundred children with CHD aged between 8-18 years and their parents answered a health-related quality of life-questionnaire during their visit to the paediatric cardiology outpatient department. CHD children reported reduced motor functioning and autonomy compared to healthy children. Parents of children with CHD reported their children to have a reduced quality of life in the domains of: motor functioning, autonomy and cognitive functioning. Agreement between child and parent reports was moderate. Children systematically reported lower health related quality of life on the domain of positive emotions than did parents. Health related quality of life in children with CHD appeared not to be influenced by severity of the disease. In conclusion, regardless of the severity of the disease, children with CHD reported their health related quality of life on several domains to be lower than that of healthy children. This means that on several domains, the emotional impact of problems in health status is greater for children with CHD than for healthy children. When CHD patients visit the clinic, it is important that physicians actively ask patients as well as parents about the child's motor functioning, autonomy and cognitive functioning. Children with problems in these domains can then be identified, and psychological interventions can take place at an early stage.     

Biobehavioral aspects of cardiovascular disease: progress and prospects

Cardiovascular disorders pose a major health problem for industrialized societies in terms of excess morbidity and mortality. Hypertension (HT) is a major risk factor for coronary heart disease (CHD) and cerebrovascular disease. The impact of psychosocial factors, personality traits, genetic-behavioral interactions, sodium sensitivity, obesity, insulin metabolism, and psychophysiology on HT status is discussed. An understanding of pathophysiologic processes is needed to provide a better basis for risk factor reduction and other aspects of treatment. The study of myocardial ischemia appears to provide an important link between the development of coronary artery disease and the occurrence of CHD. Further studies are needed to assess the clinical significance of stress-induced myocardial ischemia as well as whether mental stress is predictive of future CHD. Associations have been made between behavioral risk factors and CHD, but the exact nature of the relationship remains to be clarified. Hostility has been identified as an important aspect of coronary-prone behavior, but considerable research will have to be completed before a comprehensive understanding of coronary-prone behavior and the manner in which it has an impact on disease can be fully understood.     

Attentional bias and anxiety in individuals with coronary heart disease

This study examined whether in an emotional Stroop task, individuals with coronary heart disease (CHD) would show greater attention towards the threatening words related to their disease than healthy persons, and if such an attentional bias is associated with anxiety. An emotional Stroop task with threatening words related to CHD as well as positive, negative and neutral words was administered to 35 individuals with CHD and 35 healthy controls. Additionally, the original Stroop task, the Beck anxiety inventory and the state-trait anxiety inventory were administered. The results indicated an attentional bias towards threatening words related to CHD in the individuals with CHD. They experienced higher interference than healthy participants from threatening words related to CHD but not from positive or negative words. Moreover, the level of interference was associated with their level of anxiety, and a vicious circle may exist in this association. In addition, results indicated a possible deficit of executive functioning among individuals with CHD. Attentional bias, as well as its association with anxiety, and an indication of deficit in executive functioning among individuals with CHD might be the risk factors for these individuals’ quality of life and for further development of their disease.     

Socioeconomic Differences in Psychosocial Factors Contributing to Coronary Heart Disease: A Review

Psychosocial factors have been shown to play an important role in the aetiology of coronary heart disease (CHD). A strong association between CHD and socioeconomic status (lower-level education, poor financial situation) has also been well established. Socioeconomic differences may thus also have an effect on psychosocial risk factors associated with CHD, and socioeconomic disadvantage may negatively affect the later prognosis and quality of life of cardiac patients. The aim of this study was to review the available evidence on socioeconomic differences in psychosocial factors which specifically contribute to CHD. A computer-aided search of the Medline and PsycINFO databases resulted in 301 articles in English published between 1994 and 2007. A comprehensive screening process identified 12 empirical studies which described the socioeconomic differences in CHD risk factors. A review of these studies showed that socioeconomic status (educational grade, occupation or income) was adversely associated with psychosocial factors linked to CHD. This association was evident in the case of hostility and depression. Available studies also showed a similar trend with respect to social support, perception of health and lack of optimism. Less consistent were the results related to anger and perceived stress levels. Socioeconomic disadvantage seems to be an important element influencing the psychosocial factors related to CHD, thus, a more comprehensive clarification of associations between these factors might be useful. More studies are needed, focused not only on well-known risk factors such as depression and hostility, but also on some lesser known psychosocial factors such as Type D and vital exhaustion and their role in CHD.     

The Psychosocial Vulnerability Model of Hostility as a Predictor of Coronary Heart Disease in Low-income African Americans

The current study examined social support and stress as mediators of the hostility—coronary heart disease (CHD) relationship as suggested by the psychosocial vulnerability model in a sample of low-income African Americans. Among 95 CHD patients and 30 healthy controls, hostility was negatively correlated with social support, but was not related to minor stress. CHD patients endorsed higher levels of hostility; however, the relationship between hostility and CHD status was diminished once stress and social support were included in the model. This study lends partial support for the psychosocial vulnerability model of hostility in African Americans, but suggests that the relationship between hostility and stress may be impacted by socioeconomic status.     

冠心病患者的抑郁和焦虑

许多临床研究表明,冠心病患者常发生抑郁及焦虑。而在严重精神症状（如抑郁或/和焦虑）者中有较高的冠心病发生率。抑郁增加冠心病患者的不良心血管事件发生率,影响预后。其机制有如下几个方面：对医疗措施及生活方式改变的依从性差、血小板功能异常、血管内皮功能紊乱以及心率变异性降低。选择性5-羟色胺再摄取抑制剂由于其较好的耐受性且无明显的心血管副作用而应用于冠心病合并抑郁及焦虑的药物治疗并改善患者的生活质量。但仍需要更大规模的临床研究以确定抑郁及焦虑对冠心病预后的影响。临床上应更加关注焦虑对冠心病的影响,进一步探讨焦虑能否作为冠心病的危险因素。     

Congenital heart disease: A primer for the pediatric neuropsychologist

Congenital heart disease (CHD) affects millions of people worldwide, including over one million children in the United States. Approximately 25% of children born with CHD require intensive surgical intervention within the first year of life. Despite improved rates of survival into adulthood – rates that exceed 90% in the modern era – children and adolescents with CHD remain at risk for neurological injury and a range of neurobehavioral and psychosocial challenges that pose a threat to quality of life across the lifespan. Consequently, as experts in both clinical psychology and brain development, neuropsychologists are becoming increasingly involved in cardiac follow-up and monitoring to promote optimal developmental outcomes. The primary objective of this paper is to provide an evidence-based, clinically-oriented primer on CHD for pediatric neuropsychologists working with this growing population of survivors. Following an introduction to current standard-of-care guidelines for managing children and adolescents with CHD, we present an overview of brain development within the context of CHD, review neuropsychological outcomes, examine factors influencing variability in outcomes, and discuss implications and strategies for clinical assessment.     

Developing physical activity interventions for youth with cystic fibrosis and congenital heart disease: Learning from their parents

Despite the benefits of physical activity for youth with cystic fibrosis (CF) and congenital heart disease (CHD), most are insufficiently active. More information is required on how to facilitate physical activity in these populations. Although there are no studies that provide information about participation in CF and CHD youth from the perspective of parents, the involvement of caregivers may be an important facilitator to physical activity in youth with chronic diseases.

Objective

This qualitative study explored how the parents of youth with CF and CHD experience physical activity, and parents commented on both their own and their child’s physical activity.

Methods

Twenty-nine parents from a CHD and CF clinic participated in a semi-structured interview, and a thematic analysis of the transcribed data was undertaken.

Results

Parents discussed the numerous benefits and barriers associated with physical activity for both child and self. Role modeling was a critical social process to overcoming barriers. Parents experiences were situated within the broader family context characterized by a prevailing sense of stress and complexity.

Conclusion

By illustrating how the parents of youth with CF and CHD understand the role of physical activity in their and their child’s life, this study provides valuable information regarding the development of interventions to increase physical activity among children with CF and CHD.     

The synergistic effect of smoking and serum cholesterol on coronary heart disease

Cigarette smoking is a strong predictor of coronary heart disease (CHD), but much of the variance in determining which smokers will, and which will not, suffer from CHD remains unexplained. This review examines evidence of a synergistic interaction effect of smoking and elevated serum cholesterol on CHD morbidity and mortality. Evidence is also presented to support the notion that, in part, serum cholesterol, like smoking, is an index of a behavioral risk factor. Such a synergistic interaction is determined to exist, although improvements in methodology are needed to more clearly identify its magnitude. The review suggests that behavioral treatments aimed at smoking cessation and dietary modification should be focused specifically on the more than 25 million young and middle-aged Americans who smoke and have elevated serum cholesterol. In this way, such treatments may increase their effectiveness in lowering the risk of CHD (benefit) without necessarily increasing their effort (cost).     

The Incremental Validity of Self-Report and Performance-Based Methods for Assessing Hostility to Predict Cardiovascular Disease in Physicians

We evaluated the utility of an integrative, multimethod approach for assessing hostility-related constructs to predict premature cardiovascular disease (CVD) and premature coronary heart disease (CHD) using participants from the Johns Hopkins Precursors Study, which was designed to identify risk factors for heart disease. Participants were assessed at baseline while in medical school from 1946 to 1962 (M age = 24.6) and have been followed annually since then. Baseline assessment included individually administered Rorschach protocols (N = 416) scored for aggressive imagery (i.e., Aggressive Content, Aggressive Past) and self-reports of 3 possible anger responses to stress. Cox regression analyses predicting morbidity or mortality by age 55 revealed a significant interaction effect; high levels of Aggressive Content with high self-reported hostility predicted an increased rate of premature CVD and CHD, and incrementally predicted the rate of these events after controlling for the significant covariates of smoking (CVD and CHD) and cholesterol (CHD) that were also assessed at baseline. The hostility and anger measures, as well as other baseline covariates, were not predictors of CVD risk factors assessed at midlife during follow-up. Overall, this integrative model of hostility illustrates the potential value of multimethod assessment to areas of health psychology and preventive medicine.