Personality Disorders in Older Adult Inpatients with Chronic Mental Illness

It has been hypothesized that some types of personality disorders tend to remit with age whereas others may become more prominent. The present study determined the prevalence and nature of 13 personality disorders with a self-report inventory (Coolidge Axis II Inventory) in an older group of chronically mentally ill inpatients (N = 30, mean age = 63 years) and a younger group of similar patients (N = 30, mean age = 39 years). All patients met DSM-IV criteria for either Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, or recurrent severe Major Depression with psychotic features. The prevalence rate of personality disorders was high for both groups: 58% for the older sample and 66% for the younger group. The younger group was more likely to be diagnosed Antisocial, Borderline, Passive-Aggressive, Sadistic, and Schizotypal, but the groups were not different in the rates of Obsessive-Compulsive Disorder. This study supports the hypothesis that some personality disorders remit with age. However, no evidence was found to suggest that other personality disorders become more prominent in older adult psychiatric populations. Suggestions for future research are offered.     

现代医学模式形成与疾病治疗

现代生物心理社会医学模式已经成为卫生界领导及广大医务人员的共识 ,并以此指导临床医疗实践。临床诊断正在增添新的内容 ,疾病治疗这个概念也拓宽了她的外延 ,人文科学在医学中越来越显示出她独特的不可替代的地位和作用 ,生物治疗、心理治疗、哲学治疗是未来的三大块治疗模式     

Flanker compatibility effects in patients with Parkinson's disease: impact of target onset delay and trial-by-trial stimulus variation

Parkinson’s disease (PD) patients and healthy controls were administered a flanker task that consisted of the presentation of colored targets and distractors. Participants were required to attend to the center target and identify its color. The stimulus displays were either congruent (i.e., the target and flankers were the same color) or incongruent. The time between the onset of the flanker and the target color (the target onset delay) was either short or long. Results indicated that PD patients and controls did not differ in the magnitude of the flanker effect within individual trials in that both groups demonstrated a typical flanker effect at the short target onset delay and neither group demonstrated a flanker effect at the longer delay. However, when performance was examined on a trial-by-trial basis, PD patients demonstrated a slowing of reaction time relative to controls when having to make the same response across consecutive trials at longer inter-trial intervals when the flankers were incongruent across consecutive trials and the display on the second of two trials was incongruent. These results indicate that PD patients are impaired in inhibiting the distractors over an extended delay and that this deficit may impact motor responding in these patients, suggesting that the basal ganglia contribute to the interface of attention and action.     

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.     

Marital role strain,illness intrusiveness,and their impact on marital and individual adjustment in end-stage renal disease

Abstract

A marital role theory approach was used to investigate individual psychosocial well-being and marital adjustment in 89 end-stage renal disease (ESRD) patients and their spouses. Four different patient groups were selected according to a continuum of clinical milestones in the treatment of ESRD, including pre-dialysis (n=17), incenter dialysis (n=18), home dialysis (n=19), and posttransplant patients (n=17). A nephrology clinic control group (n=18) was also included. Standardized instruments were employed to investigate marital role strain (Marital Role Questionnaire, KDS-15), marital adjustment (Locke-Wallace Marital Adjustment Test), subjective well-being (Affect Balance Scale, Rosenberg Self-Esteem Inventory), and psychopathology (Symptom Checklist 90-R). Hierarchical multiple regression analyses provided strong and consistent support for the major hypotheses relating elevated marital role strain to compromised marital adjustment and individual well-being. Further analyses demonstrated that increased perceived intrusiveness of ESRD was significantly related to greater marital role strain, poorer marital adjustment, and decreased individual well-being. This is consistent with the idea that perceived intrusiveness may be an important mediator of marital role strain and of coping with chronic illness. “Objective” intrusiveness, defined in terms of patient group, was not significantly related to marital or individual well-being. These findings support a dyadic approach to the psychosocial study of chronic illness.     

Coping among children and adolescents with chronic illness

The present study was aimed to investigate age and gender effects on coping with everyday stressors among children and adolescents with chronic illness and healthy controls. Patients (8–13 years of age) with asthma (n=47), atopic dermatitis (n=52), and cancer (n=57) were compared to healthy controls (n=158) matched by age, gender, and grade. Self-report data on coping with academic and interpersonal stressors were collected. The primary results indicated that coping with everyday stressors was improved in children and adolescents with chronic illness compared to healthy controls. Thus, patients reported less passive avoidance on cross-situational coping and tended to show more situation-specific coping with social and school-related stressors than healthy controls. Additionally, among the clinical groups, patients with atopic dermatitis and cancer scored higher on positive self-instructions than patients with asthma. Conclusively, the results suggest that coping with a chronic illness may lead to more effective coping with everyday stressors. Implications for evaluating coping styles in patients with chronic illness are discussed.     

Normal values for Type A behaviour patterns in Danish men and women and in potential high-risk groups

The Jenkins Activity Survey (JAS) was administered to a normal population of randomly selected Danish adults, to patients consulting a cardiologist, and to physicians in order to compare those groups in terms of their coronary-prone (Type A) behaviour patterns. The standard procedure of rating the JAS was used in order to obtain scores for each of the four subscales: Type A (time urgency and ambitiousness), Factor S (speed and impatience) Factor H (hard-driving and competitive) and Factor J (job involvement). Gender differences were observed in the normal population for each of the four subscale scores, and age-related differences were obtained for Factor J. Elevated scores for Factor S were obtained by physicians and by people in the population who had a cardiovascular disorder. Physicians had also elevated scores for Factor J, whereas their Factor H scores tended to be reduced. No reliable differences in JAS subscale scores were observed between four groups of heart patients (i.e. angina pectoris, arterial hypertension, atrial fibrillation and atherosclerosis), although there was a tendency for Factor J to be elevated in atherosclerosis. The findings provide normal values for JAS scores in Danish men and women, and suggest that some facets of coronary-prone behaviour may be enhanced in Danish high-risk groups.     

冠心病多支血管病变完全血运重建的长期疗效观察

为分析冠心病多支血管病变(MVD)患者经皮冠状动脉介入治疗(PCI)进行完全血运重建术后长期的临床疗效,我们收集了2004年5月~2008年5月589例接受PCI的冠心病患者,其中实施完全性血运重建(CRV)461例(78.3%),不完全性血运重建(IRV)128例(21.7%),对比分析两组病例PCI术后随访1年以上的结果。结果显示IRV组患者中完全闭塞病变、3支血管病变的比例均高于CRV组(P0.01);CRV组PCI成功率明显高于IRV组(94.8%vs87.5%,P0.05)。提示多支冠状动脉病变完全性血运重建能够获得更好的长期临床疗效论。     

中药在心血管疾病中应用现状与反思

具有悠久历史的中医药在现代医学中有鲜明的时代特点。心血管疾病是现代社会严重威胁生命及健康的病患。本文总结分析了古老中药在现代心血管疾病中应用的现状,并深入分析其影响因素,从而提出扬长避短的未来心血管疾病应用中药的思路。     

青年颈心综合征避免误诊为冠心病的临床诊疗策略

通过对临床收集的187例青年(≤45岁)颈心综合征患者的临床资料进行分析。探讨青年颈心综合征临床误诊为冠心病的原因及避免误诊的诊疗策略。目的在于帮助临床医师对青年颈心综合征进行识别,注意如何与冠心病心绞痛相鉴别,对防止病情延误,尽早明确诊断积极治疗,排除冠心病,减少诊疗费用及避免冠脉造影的风险意义很大。