非识字高龄患者住院中的需求对策相关性研究

探讨患者的需求与对策。应用会谈法收集资料,教育患者认知所患疾病相关知识、帮助患者和家属适应住院环境、支持家属对患者的生活护理、缓解患者心理紧张情绪、协助患者遵从医疗护理服务行为、照顾患者口服用药过程、满足患者治疗过程中的需求、加强护理操作周边作业的督导,进而提出了满足需求对策的依据。     

The Impact of Exposure to Internet-Based Information About the Rorschach and the MMPI–2 on Psychiatric Outpatients’ Ability to Simulate Mentally Healthy Test Performance

To examine the impact of Internet-based information about how to simulate being mentally healthy on the Rorschach (Exner, 2003) and the MMPI–2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), 87 psychiatric outpatients completed the tests under 4 conditions: uncoached and Internet-coached outpatients under faking healthy instructions (faking patients and Internet-faking patients) and patients and nonpatients under standard instructions (standard patients and standard nonpatients). On the Rorschach, faking patients and Internet-faking patients did not manage to portray healthy test performance and, like standard patients, revealed a significantly greater number of perceptual and cognitive disturbances than standard nonpatients. Faking patients scored in the psychopathological direction on most variables. Internet-faking patients produced constricted protocols with significantly higher F% (57%) and lower use of provoking and aggressive contents than the other groups. On the MMPI–2, faking patients and Internet-faking patients were able to conceal symptoms and, like standard nonpatients, scored in the normal range on the clinical scales. The validity scale L successfully detected the faking patients and the Internet-faking patients, whereas the F scale only distinguished the Internet-faking patients and K only the faking patients. We conclude that Internet-based information could threaten test validity.     

手外伤患者健康认知及康复行为的调查

了解手外伤患者健康认知与康复行为状况,为医院健康教育工作及相关部门决策提供可考依据。选取2013年1月～12月我院手外伤患者,随机分为城市患者100名、农村患者100名进行问卷调查。结果患者健康认知程度和健康的行为习·赁受家庭、教育程度和社会等诸多方面影响,接受健康教育行为养成率城区略好于乡村。本次的调查,反映出患者接受健康教育认知程度和健康的行为习惯受家庭、教育程度和社会等诸多的方面影响,只有患者康复意识不断累积增加时,术后手部运动功能恢复才能提高。     

Amygdalar Volume in Borderline Personality Disorder With and Without Comorbid Post-traumatic Stress Disorder: A Meta-analysis

IntroductionFour studies have found a smaller amygdalar volume in patients with borderline personality disorder (BPD) relative to controls, whereas four other studies have found similar amygdalar volume in BPD patients relative to controls. This study aims to compare amygdalar volumes of BPD patients with controls, and also to compare BPD patients with and without post-traumatic stress disorder (PTSD) with controls in order to determine whether PTSD can explain the heterogeneity of findings.MethodSystematic review and meta-analysis of magnetic resonance imaging studies that measured amygdalar volumes in BPD patients and healthy controls.FindingsA significant reduction of amygdalar volumes in BPD patients was confirmed (p < .001). However, data from the studies that discriminated BPD patients with and without PTSD indicated that amygdalar volumes were significantly smaller in BPD patients without PTSD relative to controls (left: p = .02; right: p = .05), but not in BPD patients with PTSD relative to controls (left: p = .08; right: p = .20).ConclusionThis meta-analysis suggests that amygdalar volumes are reduced in patients with BPD. This pattern is confirmed in BPD patients without PTSD, but not in BPD patients with PTSD, raising the possibility that reduced amygdalar volume in BPD patients cannot be explained by comorbid PTSD.     

癌症要告知实情吗？

面对癌症病人,应该不应该告知实情?这是临床医务人员常常面临的问题,目前尚无统一的标准。新的医疗事故处理条例规定、病人得知癌病的途径、临床治疗现状等方面分别论述告知癌症病人实情的理由。探讨了癌症告知策略:面对家属直言相告、面对病人通过交谈了解病人的性格特点、文化层次和情感类型,列举了不同类型的病人告知的方法。论述其告知病情后如何让病人走出误区,消除恐惧,把生存的压力转变成求生的动力,从而达到配合治疗,使病人敢于正视疾病,面对明天可能发生的任何事情。     

Dissociating the performance of cortical and subcortical patients on phonemic tasks

To assess cortical and subcortical contributions to phonemic processing, patients with left frontal, temporal-parietal, or cerebellar lesions as well as those with Parkinson's disease were tested on phonemic identification and production tasks. In Experiment 1, patients and controls were asked to identify syllables on both a voicing and place of articulation continuum. Subcortical patients were relatively unimpaired at this task whereas cortical patients were less accurate at identifying the endpoints of both continua and exhibited little evidence of categorical perception. For Experiment 2, controls and patients were asked to produce syllables. Subcortical patients were able to produce contrastive voice onset times (VOTs) for voicing cognates although VOT of the voiceless phoneme was more variable for cerebellar patients. Cortical patients showed greater overlap in the production of both VOT and formant transition intervals. These results are discussed in terms of the type of computations hypothesized to originate from each neural area.     

疑病者与疑似病者之比较研究

疑病者与疑似病者,在基础心理特征方面存在较大差异,也有一定的共性,两者都构成诊断结果,会给当事人带来心理上焦虑、不安等情绪。疑病者的心理问题是内生性的,与精神倾向及人格有关,疑似病者的心理问题是外生性的,与机体症状有关。疑病者与疑似病者的角色在一定条件下可以相互转化,疑病者在长期不良心境下可变为疑似病者,具有高神经质人格的疑似病者易转变为疑病者。在心理干预过程中,应该注意到这两者不同的特点,采取不同的措施。     

Negative and positive cognition in depressed and nondepressed chronic-pain patients

Several studies have suggested that depressed pain patients evidence more cognitive distortion than nondepressed pain patients and healthy controls. Although these studies have generally supported notions relating cognitive distortion to depressive functioning, other aspects of dysfunctional cognition have not been assessed in the chronic-pain population. The present study examined negative and positive automatic thoughts and attributional style in depressed pain patients, nondepressed pain patients, and healthy controls. Depressed chronic-pain patients were found to exhibit significantly more negative automatic thoughts than nondepressed pain patients and healthy controls. Conversely, nondepressed chronic-pain patients reported significantly more positive automatic thoughts than did depressed patients and healthy controls. No significant differences were found for attributional style. These results suggest that different cognitive-behavioral interventions might be considered for depressed compared to nondepressed chronic-pain patients.     

Depression,anxiety and social support in rheumatoid arthritic women without and with a spouse

Abstract

A comparison was made of income and physical, social and psychological aspects of health between 22 female patients who had never married, 127 patients living with a spouse and 53 patients who were widowed or divorced. No significant differences were found between never married patients and patients living with a spouse. The widowed or divorced patients however had a lower income, reported less potential support, more depression and anxiety than the patients who were never married and those living with a spouse. The relationship of social support to depression and anxiety was investigated in spouseless patients (n=75) and in those living with a spouse (n=127). In both groups of patients, less potential support was found to be related to more anxiety. In addition, pain was found to contribute significantly to depression and to anxiety only in the patients living with a spouse. With regard to the latter, it is suggested that the debilitating influence of pain on the relationship with the partner might have been the mediating factor.     

Retention of verbal information by rehearsal in relation to the fluency of verbal output in aphasia

The purpose of the present study was to determine if aphasic subject groups differentiated by the fluency of their verbal output employed rehearsal as a strategy for maintaining verbally coded information in primary memory. A task based upon the Brown-Peterson paradigm was administered to 10 fluent aphasic patients, 10 nonfluent aphasic patients, 10 right-brain-damaged patients, and 10 nonneurological patients. The findings indicate that the nonfluent aphasic patients did not rehearse the verbal information while the fluent aphasic, right-brain-damaged, and nonneurological patients did rehearse. In addition, both fluent and nonfluent aphasic patients encoded significantly less information into the memory system initially and performed worse on the task overall than right-brain-damaged and nonneurological patients.     

Application of the MacAndrew Alcoholism Scale to Alcoholics With Psychiatric Diagnoses

The MacAndrew Alcoholism scale scores of 140 mate patients from a large VA hospital were examined to assess whether the MAC scale can detect alcoholism among patients with psychiatric diagnoses. There were five diagnostic groups, each with 28 patients: alcoholics, alcoholics with neurotic disorders, alcoholics with personality disorders, nonalcoholic patients with neurotic disorders, and nonalcoholic patients with personality disorders. The MAC scale was able to differentiate alcoholics and nonalcoholic psychiatric patients, but was unable to differentiate either of the alcoholic psychiatric groups from its nonalcoholic psychiatric counterpart. Thus, it appears that the MAC scale may be unable to identify alcoholism among patients with combined alcoholic-psychiatric diagnoses.     

Application of the MacAndrew alcoholism scale to alcoholics with psychiatric diagnoses

The MacAndrew Alcoholism scale scores of 140 male patients from a large VA hospital were examined to assess whether the MAC scale can detect alcoholism among patients with psychiatric diagnoses. There were five diagnostic groups, each with 28 patients: alcoholics, alcoholics with neurotic disorders, alcoholics with personality disorders, nonalcoholic patients with neurotic disorders, and nonalcoholic patients with personality disorders. The MAC scale was able to differentiate alcoholics and nonalcoholic psychiatric patients, but was unable to differentiate either of the alcoholic psychiatric groups from its nonalcoholic psychiatric counterpart. Thus, it appears that the MAC scale may be unable to identify alcoholism among patients with combined alcoholic-psychiatric diagnoses.     

Negative support of significant others affects psychological adjustment in breast cancer patients

Significant others play an important role in providing support in patients’ lives, but some types of support negatively affect the patients. This study was conducted in early-stage breast cancer patients to examine the structure of support, which was provided by their significant others and assessed negatively by the patients, and to identify negative support relating to the psychological adjustment of these patients. Thus, we first conducted interviews among 28 breast cancer patients to identify these support items assessed as negative; next, we conducted a questionnaire survey using the resulting items in 109 postoperative patients who had early-stage breast cancer. We performed exploratory and confirmatory factor analyses and obtained a valid second-order factor structure, including superordinate factors (excessive engagement, avoidance of problems and underestimation) and subordinate factors (overprotection, encouragement and management). Among these factors, the avoidance of problems was the only factor to be negatively associated with psychological adjustment of the patients, suggesting that these patients receive problem-avoiding support. The results of our study suggest that such problem-avoiding support from significant others can be counter-productive and potentially worsen the psychological adjustment of breast cancer patients.     

Cathodal transcranial direct current stimulation of the right Wernicke's area improves comprehension in subacute stroke patients

Previous studies have shown the appearance of right-sided language-related brain activity in right-handed patients after a stroke. Non-invasive brain stimulation such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) have been shown to modulate excitability in the brain. Moreover, rTMS and tDCS have been found to improve naming in non-fluent post-stroke aphasic patients. Here, we investigated the effect of tDCS on the comprehension of aphasic patients with subacute stroke. We hypothesized that tDCS applied to the left superior temporal gyrus (Wernicke’s area) or the right Wernicke’s area might be associated with recovery of comprehension ability in aphasic patients with subacute stroke. Participants included right-handed subacute stroke patients with global aphasia due to ischemic infarct of the left M1 or M2 middle cerebral artery. Patients were randomly divided into three groups: patients who received anodal tDCS applied to the left superior temporal gyrus, patients who received cathodal tDCS applied to the right superior temporal gyrus, and patients who received sham tDCS. All patients received conventional speech and language therapy during each period of tDCS application. The Korean-Western Aphasia Battery (K-WAB) was used to assess all patients before and after tDCS sessions. After intervention, all patients had significant improvements in aphasia quotients, spontaneous speech, and auditory verbal comprehension. However, auditory verbal comprehension improved significantly more in patients treated with a cathode, as compared to patients in the other groups. These results are consistent with the role of Wernicke’s area in language comprehension and the therapeutic effect that cathodal tDCS has on aphasia patients with subacute stroke, suggesting that tDCS may be an adjuvant treatment approach for aphasia rehabilitation therapy in patients in an early stage of stroke.     

老年结直肠癌的治疗

老年患者占结直肠癌患者的70%,因此老年人是结直肠癌的主要患病人群。为了提高结直肠癌治疗的总体疗效,我们应当特别关注老年性结直肠癌的治疗。以往,手术治疗和化疗的应用随着年龄的增高而明显减少。我们一直以为老年人手术和化疗的效果不令人满意。近期的研究改变了这一认识。证据表明辅助化疗和姑息性化疗对一般情况良好的老年人是有效而安全的。即使存在一些与年龄相关的基础疾病的老年结直肠癌患者仍然能从合理的治疗方案中获益。所以我们尚有许多工作需做,以提高老年性结直肠癌患者的疗效。腹腔镜下结肠癌根治术是对老年人安全有效的手术技术。我们期待随着经腔道的内窥镜手术技术的发展,将来会使老年性结直肠癌患者受益。     

Optimizing preoperative expectations in cardiac surgery patients is moderated by level of disability: the successful development of a brief psychological intervention

Patients’ expectations have shown to be a major psychological predictor of health outcome in cardiac surgery patients. However, it is unclear whether patients’ expectations can be optimized prior to surgery. This study evaluates the development of a brief psychological intervention focusing on the optimization of expectations and its effect on change in patients’ expectations prior to cardiac surgery. Ninety patients scheduled for coronary artery bypass graft were randomly assigned to (1) standard medical care, (2) additional expectation manipulation intervention (EMI), and (3) additional attention control group. Therapists’ fidelity to intervention manuals and patients satisfaction with the intervention were assessed for both active intervention conditions. Patients’ expectations about post-surgical disability, treatment control, personal control, and disease duration were assessed before and after the psychological intervention. Demographical, medical, and psychosocial characteristics and disability were assessed at baseline. Treatment fidelity and patient satisfaction was very high in both intervention conditions. Only patients receiving EMI developed higher personal control expectations and longer (more realistic) expectations of disease duration. The effect of intervention group on patients’ disability expectations and patients’ personal control expectations was moderated by patient’s level of disability. EMI patients with low to moderate disability developed positive expectations whereas patients with high disability did not. This study shows the successful development of a short psychological intervention that was able to modify patients’ expectations, especially in those with low to moderate disability. Given the robust association of expectations and surgery outcome, such an intervention might offer the opportunity to enhance patients’ health following cardiac surgery.     

Investment behavior and the negative side of emotion

Can dysfunction in neural systems subserving emotion lead, under certain circumstances, to more advantageous decisions? To answer this question, we investigated how normal participants, patients with stable focal lesions in brain regions related to emotion (target patients), and patients with stable focal lesions in brain regions unrelated to emotion (control patients) made 20 rounds of investment decisions. Target patients made more advantageous decisions and ultimately earned more money from their investments than the normal participants and control patients. When normal participants and control patients either won or lost money on an investment round, they adopted a conservative strategy and became more reluctant to invest on the subsequent round; these results suggest that they were more affected than target patients by the outcomes of decisions made in the previous rounds.     

Comparison of metabolic rates, language, and memory in subcortical aphasias

Four patients with subcortical lesions and either aphasia or amnesia were compared to four patients with cortical lesions and aphasia. Each patient had [18F] fluorodeoxyglucose positron-emission computed tomography, language, and memory evaluations. Marked metabolic depression was found in the thalamus and caudate in all patients. The subcortical patients had only mild left-cortical changes, while the cortical patients showed marked cortical metabolic changes in the left hemisphere. Language changes were mild in the subcortical patients, while moderate to severe in the cortical patients. All patients showed severe verbal memory dysfunction. The only common abnormalities in the two groups were metabolic changes in the thalamus and severity of verbal memory dysfunction. These findings suggest a relationship between verbal memory and thalamic function.     

Quality of life in transplant patients, compared to other stressful health situations in pulmonary patients

Transplantation may imply severe biopsychosocial impairments. In order to know the quality of life of patients one year after transplantation, 58 subjects were compared to three different groups of patients (stabilized and acute COPD patients, and lung cancer patients in a surgery unit). Patients filled in two questionnaires: EORTC QLQ-C30 (quality of life) and HAD (anxiety and depression). The quality of life dimensions with inter-group differences were physical, role, emotional and cognitive functioning, global health status, and a number of symptoms (fatigue, dyspnea, insomnia and appetite loss). There were differences in depression, and but not in anxiety. Transplant and surgical patients showed better quality of life and affective status than chronic pulmonary patients. Discriminant analysis showed that the transplant group was the best described group. We conclude that patients, one year after transplantation, show similar quality of life as asymptomatic hospitalised patients, somewhat better than chronic patients in a stabilized stage of the disease, and much better than severe chronic patients.