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Gastrointestinal symptoms in psychiatry: comparison of direct applications and referrals - 精神病学胃肠道症状:直接应用与转诊的比较
Pub Date : 2016-09-26 DOI: 10.5350/DAJPN2016290301
S. Batmaz, M. Yıldız, E. Songur
Objective: Clinical experience and observations suggest that there are some discrepancies between patients who directly apply to psychiatry clinic, and who are referred from gastroenterology clinic to psychiatry clinic. Thus, we aimed to investigate differences related to the demographic and clinical characteristics of these patients. Method: The study included 115 consecutive patients aged between 18-65 years. Sixty-one of the patients applied directly to the psychiatry clinic, and 54 patients were referred for consultation to the psychiatry clinic. Primary gastrointestinal complaints, psychiatric diagnoses and personality features were recorded on the scoiodemographic data form, and the severity of psychiatric disorders were assessed by the Clinical Global Impression Scale - Severity Subscale. Results: Patients who directly applied to psychiatry clinic were more likely to be female, older, and married. They attributed their gastrointestinal symptoms also more likely to be of psychogenic origin. Patients who directly applied to psychiatry clinic suffered more likely from a sense of fullness/abdominal tension, while patients who were referred to psychiatry clinic more frequently complained of bloating, abdominal pain, and constipation. Patients who directly applied to psychiatry clinic were more frequently diagnosed with depressive disorders, trauma related disorders, and personality disorders, whereas referrals were more frequently diagnosed with psychotic disorders. Directly admitted patients were also more likely to exhibit impulsivity as a personality feature. Conclusion: Patients with gastrointestinal symptoms who directly presented to psychiatry differed from those who were referred from gastroenterology clinics on some of their demographic aspects, primary psychiatric diagnoses and personality traits.
目的:临床经验和观察表明,直接到精神科门诊就诊的患者与从胃肠科转诊到精神科门诊就诊的患者存在一定的差异。因此,我们的目的是调查这些患者的人口学和临床特征的差异。方法:研究纳入115例年龄在18-65岁之间的连续患者。61例患者直接向精神科诊所申请,54例患者被转介到精神科诊所咨询。主要胃肠疾患、精神病学诊断和人格特征记录在精神病学数据表上,并通过临床总体印象量表-严重程度亚量表评估精神障碍的严重程度。结果:直接申请精神科门诊的患者以女性、年龄较大、已婚者居多。他们认为他们的胃肠道症状也更有可能是由心理原因引起的。直接到精神科就诊的患者更容易出现饱腹感/腹部紧张感,而转诊到精神科就诊的患者更常出现腹胀、腹痛和便秘。直接到精神科就诊的患者被诊断为抑郁症、创伤相关障碍和人格障碍的频率更高,而转诊的患者被诊断为精神障碍的频率更高。直接入院的病人也更有可能表现出冲动的性格特征。结论:直接到精神科就诊的胃肠道症状患者与从胃肠科转诊的患者在人口学、初级精神病学诊断和人格特征等方面存在差异。
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引用次数: 4
Development of Anger Regulation Scale for Adolescents (ARS-A): Validity and Reliability Studies 青少年愤怒调节量表(ARS-A)的编制:效度与信度研究
Pub Date : 2016-09-26 DOI: 10.5350/DAJPN2016290306
M. Yildiz
Development of Anger Regulation Scale for Adolescents (ARS-A): validity and reliability studies Objective: The purpose of this study is to develop an Anger Regulation Scale for Adolescents (ARS-A), and investigate its validity, and reliability for Turkish adolescents. Method: The participants were 630 secondary school students from 6th to 8th grade. Data were collected from four different sample groups attending the school. Exploratory factor analysis and confirmatory factor analysis for ARS-A were employed to examine validity of the scale. In order to check the criterion-related validity of ARS-A, the State-Trait Anger Expression Inventory was used. Convergent and differential reliability of the scale was examined, and parallel analysis was performed to determine number of factors of the scale. To test the reliability of the scale, Composite reliability, Cronbach’s alpha coefficient, item-total correlation values and test-retest values were computed. Results: Exploratory factor analysis yielded a three factor solution explaining 50.17% of variance. Moreover, confirmatory factor analysis performed with 18 items of ARS-A supported the three-factor solution and the model had good fit values. Cronbach’s alpha values indicating internal dysfunctional anger regulation subdimensions, were determined as 0.77 and as 0.78 for functional anger regulation and 0.76 for externaldysfunctional anger regulation subdimensions. The scale was applied to 97 students with two weeks’ interval, and test-retest reliability values were determined as r=0.74 for internal dysfunctional anger regulation, r=0.62 for both external dysfunctional anger regulation and functional anger regulation subdimensions. Conclusion: The present study indicates that the Anger Regulation Scale for Adolescents (ARS-A) is a valid and reliable instrument to asses anger regulation strategies in Turkish adolescents.
《青少年愤怒调节量表》(ARS-A)的编制:效度和信度研究目的:本研究的目的是编制《青少年愤怒调节量表》(ARS-A),并对其在土耳其青少年中的效度和信度进行调查。方法:以630名6 ~ 8年级中学生为调查对象。数据收集自该学校的四个不同样本组。采用探索性因子分析和验证性因子分析对ARS-A量表进行效度检验。为了检验ARS-A量表的效度,我们采用了状态-特质愤怒表达量表。对量表的收敛信度和差分信度进行了检验,并进行了平行分析,确定了量表的因子数。为检验量表的信度,计算复合信度、Cronbach’s alpha系数、项目总相关值和重测值。结果:探索性因子分析产生三因子解,解释50.17%的方差。用ARS-A量表的18项进行验证性因子分析,支持三因素解,模型拟合值较好。表明内部功能失调愤怒调节子维度的Cronbach α值为0.77,功能性愤怒调节子维度为0.78,外部功能失调愤怒调节子维度为0.76。量表以两周为间隔对97名学生进行测试,重测信度值为内部功能失调愤怒调节r=0.74,外部功能失调愤怒调节和功能失调愤怒调节子维度r=0.62。结论:本研究表明,青少年愤怒调节量表(ARS-A)是评估土耳其青少年愤怒调节策略的有效和可靠的工具。
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引用次数: 0
Anti-NMDA receptor encephalitis: a neuropsychiatric entity - 抗nmda受体脑炎:一种神经精神疾病
Pub Date : 2016-09-26 DOI: 10.5350/DAJPN2016290312
Andac Topkan, S. Bilen, E. Eruyar, Y. Karadag
Anti-NMDA receptor encephalitis: a neuropsychiatric entity AntiNMDA receptor encephalitis is a form of autoimmune encephalitis which manifests itself with acute or subacute onset psychiatric symptoms, seizures, autonomic dysfunction, and movement disorders. It is a rather recently described form which may progress fatal at about 20%, and which may recover with aggressive immunosuppressive treatment without any sequela. Multifocal, non-specific, subcortical white matter lesions can be observed in cranial magnetic resonance imaging. Since mostly it has paraneoplastic etiology, it is crucial to screen for malignancies after the diagnosis. Its diagnosis is very important, because it will lead early diagnosis of a possible mallignancy. In the present article, a case which applied to our outpatient clinic with noisy neuropsychiatric clinical picture, and was diagnosed with anti-NMDA receptor encephalitis after evaluations, and treated with complete recovery, was presented.
抗nmda受体脑炎是一种自身免疫性脑炎,表现为急性或亚急性发作的精神症状、癫痫发作、自主神经功能障碍和运动障碍。这是一种最近才被发现的疾病,大约20%的患者可能会死亡,并且可以通过积极的免疫抑制治疗而恢复,没有任何后遗症。颅磁共振成像可观察到多灶性、非特异性皮层下白质病变。由于它大多有副肿瘤病因,诊断后筛查恶性肿瘤是至关重要的。它的诊断是非常重要的,因为它将导致早期诊断可能的恶性肿瘤。本文报告一例应用于我们门诊的神经精神临床图像嘈杂,经评估后被诊断为抗nmda受体脑炎,并经完全康复治疗的病例。
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引用次数: 3
Determination of beliefs, attitudes of consulting teachers towards mental diseases, and referral reasons of their students to a child and adolescent psychiatrist 确定咨询教师对精神疾病的信念、态度和学生转介给儿童和青少年精神科医生的原因
Pub Date : 2016-09-26 DOI: 10.5350/DAJPN2016290304
M. Kutuk, Emine Durmuş, C. Gokcen, F. Toros, G. Guler, Erkan Evegu
Determination of beliefs, attitudes of consulting teachers towards mental diseases, and referral reasons of their students to a child and adolescent psychiatrist Objective: In the present study, the aim was to evaluate the beliefs and attitudes of school counselors about mental illnesses, and reasons why counselors referred students to psychiatrists. Method: The study was carried out with 118 school counselors. Data were collected with sociodemographic information form and Beliefs toward Mental Illness Scale (BMIS). Results: According to study results, 15.3% of school counselors stated that they referred to a psychiatrist for their own psychological problems at some time, and 32% of subjects referred their own children to a child and adolescent psychiatrist. The proportion of teachers who referred their students to a child and adolescent psychiatrist was 89.8%. Scores of school counselors were 80.41±9.32 in overall BMIS, 28.82±5.35 in dangerousness, 43.83±4.93 in poor social and interpersonal skills, and 7.76±1.81 points in incurability subscales. No statistically significant relationship was determined between mean scores of participants and gender, age, marital status, institution where they work, working duration, and graduate program they attended. The four most frequent student referral causes were conduct disorder (31.10%), attention deficit (16.10%), depressive mood (14.72%) and hyperactivity (12.20%). Conclusion: It is noticed that school counselors have negative beliefs about mental disorders, feel shame because of them, and they regard these patients dangerous. On the other hand, participants believe that these disorders lead to despair in individuals and impair interpersonal communication. According to the literature search, this study is the first investigating beliefs and attitudes of school counselors about mental illnesses, and reasons why they refer students to psychiatrists.
心理咨询教师对心理疾病的信念、态度和学生转介给儿童青少年心理医生的原因的确定目的:本研究旨在评估学校辅导员对心理疾病的信念和态度,以及辅导员将学生转介给心理医生的原因。方法:对118名学校辅导员进行调查。采用社会人口学信息表和心理疾病信念量表(BMIS)收集数据。结果:根据研究结果,15.3%的学校辅导员表示曾因自身的心理问题向精神科医生咨询,32%的被试将自己的孩子向儿童和青少年精神科医生咨询。教师将学生转介给儿童青少年精神科医生的比例为89.8%。学校辅导员总体bmi得分为80.41±9.32分,危险性得分为28.82±5.35分,社交及人际交往能力差得分为43.83±4.93分,不可治愈性得分为7.76±1.81分。参与者的平均得分与性别、年龄、婚姻状况、工作机构、工作时间和参加的研究生课程之间没有统计学上显著的关系。四种最常见的转诊原因分别是品行障碍(31.10%)、注意力缺陷(16.10%)、抑郁情绪(14.72%)和多动(12.20%)。结论:注意到学校辅导员对精神障碍存在消极的信念,并因此感到羞耻,认为这类患者是危险的。另一方面,参与者认为这些障碍会导致个人绝望并损害人际沟通。根据文献检索,本研究首次调查了学校辅导员对精神疾病的信念和态度,以及他们将学生转介给精神科医生的原因。
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引用次数: 5
The Relationships Between Self-Handicapping Tendency and Narcissistic Personality Traits, Anxiety Sensitivity, Social Support, Academic Achievement 自我设限倾向与自恋人格特质、焦虑敏感性、社会支持、学业成就的关系
Pub Date : 2016-09-26 DOI: 10.5350/DAJPN2016290305
Ayşe Kalyon, İbrahim Dadandı, H. Yazıcı
The relationships between self-handicapping tendency and narcissistic personality traits, anxiety sensitivity, social support, academic achievement Objective: Successful experiences in life increase motivation of individuals and support their efficacy perceptions, whereas unsuccessful experiences reduce their motivations. Individuals who generally avoid failures can sometimes prefer to be unsuccessful as a self-handicapping strategy. The basic psychological reason underlying this situation is individual’s effort to protect him/herself through attributing reasons of failure to external factors. The main aim of this study is to examine relationships between self-destroying tendency and narcissistic personality traits, anxiety sensitivity, perceived social support and academic achievement. In this context, expression of “narcissistic personality traits, anxiety sensitivity, social support and academic achievement explain self-handicapping tendency significantly” is the main hypothesis of the study. Methods: Sample size consists of 483 university students (female=351 [72.7%]); male=132 [27.3%]). The mean age was 21.25±3.44 years. The data collection tools were Anxiety Sensitivity Index-3, Self-handicapping Scale, Narcissistic Personality Inventory, Multidimensional Perceived Social Support Scale and the Personal Information Form. Results: Established regression model explained 31% of total variance in self-handicapping tendencies (F [9;482]=25.16, p<0.01). As narcissistic personality inventory subscales, authority (ß=0.08, p<0.05), self-sufficiency (ß=-0.18, p<0.01) and entitlement (ß=0.11, p<0.01) contributed to regression model significantly, while contribution of superiority (ß=-0.02, p>0.05), exhibitionism (ß=-0.01, p>0.05) and exploitation (ß=-0.03, p>0.05) was not significant. Additionally, anxiety sensitivity (ß=0.39, p<0.01), perceived social support (ß=-0.11, p<0.01) and academic achievement (ß=-0.19, p<0.01) had significant contributions to the model. Conclusions: Self-handicapping is explained significantly by anxiety sensitivity, perceived social support, academic achievement and subscales of narcissism, such as authority, self-sufficiency and entitlement.
自我设限倾向与自恋人格特质、焦虑敏感性、社会支持、学业成就的关系目的:成功的生活经历增加了个体的动机,支持了个体的效能感感知,而不成功的生活经历则降低了个体的动机。通常避免失败的人有时更喜欢失败,作为一种自我设限的策略。这种情况的基本心理原因是个体试图通过将失败的原因归咎于外部因素来保护自己。本研究旨在探讨自我毁灭倾向与自恋人格特质、焦虑敏感性、感知社会支持和学业成就之间的关系。在此背景下,“自恋型人格特质、焦虑敏感性、社会支持和学业成就显著解释自我阻碍倾向”的表达是本研究的主要假设。方法:样本量为483名大学生,其中女生351人[72.7%];男= 132[27.3%])。平均年龄21.25±3.44岁。数据收集工具为焦虑敏感性指数-3、自我障碍量表、自恋人格量表、多维感知社会支持量表和个人信息表。结果:所建立的回归模型解释了自我妨碍倾向(F [9;482]=25.16, p0.05)、暴露倾向(ß=-0.01, p>0.05)和剥削倾向(ß=-0.03, p>0.05)总方差的31%。此外,焦虑敏感性(ß=0.39, p<0.01)、感知社会支持(ß=-0.11, p<0.01)和学业成绩(ß=-0.19, p<0.01)对模型有显著贡献。结论:焦虑敏感性、感知社会支持、学业成就和权威、自我满足和权利等自恋分量表对自我阻碍有显著影响。
{"title":"The Relationships Between Self-Handicapping Tendency and Narcissistic Personality Traits, Anxiety Sensitivity, Social Support, Academic Achievement","authors":"Ayşe Kalyon, İbrahim Dadandı, H. Yazıcı","doi":"10.5350/DAJPN2016290305","DOIUrl":"https://doi.org/10.5350/DAJPN2016290305","url":null,"abstract":"The relationships between self-handicapping tendency and narcissistic personality traits, anxiety sensitivity, social support, academic achievement Objective: Successful experiences in life increase motivation of individuals and support their efficacy perceptions, whereas unsuccessful experiences reduce their motivations. Individuals who generally avoid failures can sometimes prefer to be unsuccessful as a self-handicapping strategy. The basic psychological reason underlying this situation is individual’s effort to protect him/herself through attributing reasons of failure to external factors. The main aim of this study is to examine relationships between self-destroying tendency and narcissistic personality traits, anxiety sensitivity, perceived social support and academic achievement. In this context, expression of “narcissistic personality traits, anxiety sensitivity, social support and academic achievement explain self-handicapping tendency significantly” is the main hypothesis of the study. Methods: Sample size consists of 483 university students (female=351 [72.7%]); male=132 [27.3%]). The mean age was 21.25±3.44 years. The data collection tools were Anxiety Sensitivity Index-3, Self-handicapping Scale, Narcissistic Personality Inventory, Multidimensional Perceived Social Support Scale and the Personal Information Form. Results: Established regression model explained 31% of total variance in self-handicapping tendencies (F [9;482]=25.16, p<0.01). As narcissistic personality inventory subscales, authority (ß=0.08, p<0.05), self-sufficiency (ß=-0.18, p<0.01) and entitlement (ß=0.11, p<0.01) contributed to regression model significantly, while contribution of superiority (ß=-0.02, p>0.05), exhibitionism (ß=-0.01, p>0.05) and exploitation (ß=-0.03, p>0.05) was not significant. Additionally, anxiety sensitivity (ß=0.39, p<0.01), perceived social support (ß=-0.11, p<0.01) and academic achievement (ß=-0.19, p<0.01) had significant contributions to the model. Conclusions: Self-handicapping is explained significantly by anxiety sensitivity, perceived social support, academic achievement and subscales of narcissism, such as authority, self-sufficiency and entitlement.","PeriodicalId":136580,"journal":{"name":"Düşünen Adam: The Journal of Psychiatry and Neurological Sciences","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134546073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 11
Relationship Between Drug Compliance, Coping with Stress, and Social Support in Patients with Bipolar Disorder 双相情感障碍患者药物依从性、压力应对和社会支持的关系
Pub Date : 2016-09-26 DOI: 10.5350/DAJPN2016290302
A. Aksoy, M. Kelleci
Relationship between drug compliance, coping with stress, and social support in patients with bipolar disorder Objective: In bipolar disorder, recurrence rate is relatively high. With each episode, the risk of a new episode is increased. The first choice is drug treatment. However, patients have serious difficulties in drug compliance. This study was conducted to investigate drug compliance of patients with bipolar disorder, and to determine relationships between drug compliance, coping with stress, and social support. Method: The target population of the study included 280 patients registered in a state hospital with the diagnosis of bipolar disorder in 2011, residing in the city center, and having no other psychiatric disorders. Of these 280 patients, 150 who agreed to participate in the study and accepted to be visited at home after they were telephoned comprised the study sample. Of the patients in the target population, phone numbers and addresses were changed in 112 patients, and 18 refused to have a home-visit, so they were excluded from the study. Data were collected using the personal information form, Morisky Medication Adherence Scale, Multidimensional Scale of Perceived Social Support and Ways of Coping Scale. Results: In this study, it was determined that 55.3% of the patients did not comply with drug treatment. The patients with poor drug compliance preferred mainly desperate approach and submissive approach subdimensions of the Ways of Coping Scale more. There was no difference between patients with and without drug compliances in terms of social support. Conclusions: It is considered that development of effective coping strategies would promote drug compliance in patients with bipolar disorder.
双相情感障碍患者药物依从性、应激应对与社会支持的关系目的:双相情感障碍复发率较高。每发作一次,新发作的风险就会增加。第一选择是药物治疗。然而,患者在药物依从性方面存在严重困难。本研究旨在调查双相情感障碍患者的药物依从性,并确定药物依从性、应对压力和社会支持之间的关系。方法:该研究的目标人群包括280名2011年在一家州立医院登记的诊断为双相情感障碍的患者,居住在市中心,没有其他精神疾病。在这280名患者中,有150名同意参加研究并接受电话拜访的患者构成了研究样本。在目标人群的患者中,有112名患者的电话号码和地址发生了变化,18名患者拒绝家访,因此被排除在研究之外。采用个人信息表、Morisky药物依从性量表、感知社会支持多维度量表和应对方式量表收集数据。结果:本研究确定55.3%的患者不遵守药物治疗。药物依从性差的患者更倾向于绝望方式和顺从方式的应对方式子维度。药物依从性与非药物依从性患者在社会支持方面没有差异。结论:认为制定有效的应对策略可以促进双相情感障碍患者的药物依从性。
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引用次数: 6
Pedophilic disorder and incest: a case report - 恋童癖和乱伦:一例报告
Pub Date : 2016-09-26 DOI: 10.5350/DAJPN2016290311
Hüseyin Bulut
Pedophilic disorder is defined as having recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving sexual activity with a prepubescent child or children over a period of at least 6 months. Incest, on the other hand, is a sexual activity or assault between family members or close relatives and when towards a child can be defined as the sexual abuse of the child. The concomitance of pedophilic disorder and incest is an important detail which is usually ignored. We would like to emphasize in this case presentation that concomitance of these two pictures are significant in targeted medical and social aspects.
恋童癖障碍的定义是,在至少6个月的时间里,对青春期前的儿童有反复出现的、强烈的性唤起幻想、性冲动或涉及性活动的行为。另一方面,乱伦是家庭成员或近亲之间的性活动或攻击,对儿童的性行为可定义为对儿童的性虐待。恋童癖和乱伦的伴随是一个通常被忽视的重要细节。我们想在这个案例中强调,这两种情况的共同性在有针对性的医疗和社会方面具有重要意义。
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引用次数: 1
Validation study of the Turkish version of the Craving Typology Questionnaire (CTQ) in male alcohol-dependent patients - 土耳其版渴求类型问卷(CTQ)在男性酒精依赖患者中的验证研究
Pub Date : 2016-09-26 DOI: 10.5350/DAJPN2016290303
C. Evren, G. Umut, Ruken Agachanli, B. Evren, M. Bozkurt, Y. Can
Validation study of the Turkish version of the Craving Typology Questionnaire (CTQ) in male alcohol-dependent patients Objective: Alcohol craving is considered a core symptom of alcohol use disorder and a strong predictor of relapse in alcohol-dependent adults. The Craving Typology Questionnaire (CTQ) allows dimensional selfrating assessment of craving according to a three-pathway psychobiological model of craving (reward, relief, and obsessive craving). Aim of the present study was to evaluate psychometric properties of the Turkish version of the CTQ in a sample of inpatients and outpatients with alcohol use disorder (AUD). Method: Participants included 157 inpatients and outpatients with AUD. Participants were evaluated with the CTQ and the Obsessive-Compulsive Drinking Scale (OCDS), which includes items to evaluate both total craving and its obsessive and compulsive components. Results: The obsessive, relief, and reward craving components accounted for 27.91%, 8.17% and 7.23% of total variance, respectively. Items 7 and 8 were included in obsessive craving and item 10 was included in relief craving instead of reward craving. Obsessive craving had a Cronbach’s α of 0.87, whereas the coefficients were 0.64 for relief craving and 0.42 for reward craving. Items were moderately correlated with their subscales. All types of craving were moderately correlated with OCDS and the obsessive dimension of OCDS, whereas they were mildly correlated with the compulsion dimension of OCDS. Conclusion: Our findings confirm the Turkish version of the CPQ to be a reliable and valid instrument that measures three dimensions of craving among patients with AUD.
目的:酒精渴望被认为是酒精使用障碍的核心症状,是酒精依赖成人复发的有力预测因子。渴望类型问卷(CTQ)允许根据渴望的三途径心理生物学模型(奖励、缓解和强迫性渴望)对渴望进行维度自我评估。本研究的目的是评估土耳其版CTQ在酒精使用障碍(AUD)住院和门诊患者样本中的心理测量特性。方法:纳入住院和门诊AUD患者157例。参与者用CTQ和强迫性饮酒量表(OCDS)进行评估,其中包括评估总渴望及其强迫和强迫成分的项目。结果:强迫、缓解和奖励渴望成分分别占总方差的27.91%、8.17%和7.23%。项目7和8包含在强迫性渴望中,项目10包含在缓解渴望中,而不是奖励渴望中。强迫渴望的Cronbach′s α为0.87,而缓解渴望的Cronbach′s α为0.64,奖励渴望的Cronbach′s α为0.42。项目与其子量表有中度相关。所有类型的渴望与强迫症和强迫症的强迫维度存在中度相关,而与强迫症的强迫维度存在轻度相关。结论:我们的研究结果证实了土耳其版的CPQ是一种可靠和有效的工具,可以测量AUD患者的三个维度的渴望。
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引用次数: 2
Emerging behavioral and psychotherapeutic interventions for schizophrenia 精神分裂症的新兴行为和心理治疗干预
Pub Date : 2016-09-26 DOI: 10.5350/DAJPN20162903001
B. O’Donnell, Ashley M. Schnakenberg Martin
INTRODUCTION S ince the introduction of typical antipsychotic medications in the 1950s and subsequent development of novel or atypical antipsychotic medications in the 1990s, pharmacological treatment has been central to the management of schizophrenia (1,2). Both typical and novel antipsychotic medications decrease hallucinations and delusions in patients, and reduce relapse rates compared to placebo. A meta-analysis of 65 trials demonstrated that antipsychotic drugs reduced relapse rates at one year (27%) compared to placebo (64%), with evidence also suggesting better quality of life, and fewer aggressive behaviors in treated patients (3). Nevertheless, the long term course of schizophrenia remains disappointing, with only a minority of patients sustaining high levels of psychosocial and occupational function after the first episode of illness. Hegarty conducted a meta-analysis of the pre-and post-chlorpromazine era (1895 to 1992) comparing outcomes at an average of 5.6 years of follow-up (4). Improvement was defined as recovery with minimal to mild clinical symptoms and good psychosocial functioning as indicated by work or independent living. Hegarty found that the proportion of patients diagnosed with narrow criteria (at least six months of illness) who improved increased after the mid-20 th century from 35% to 48%, suggesting that while antipsychotic medication had a modest positive effect on long term outcomes, many patients still failed to show good recovery. A more recent meta-analysis applied a definition of recovery that required both clinical remission and good social functioning that persisted at least two years and included studies from the novel antipsychotic period (5). Using the criteria of sustained clinical and psychosocial recovery, the median proportion of patients who met recovery criteria was only 14%. The recovery rates did not differ by gender, duration of follow-up, time of data collection or strictness of diagnostic criteria. Because the onset of schizophrenia is typically early in adulthood, the disability and diminished quality of life in the disorder takes an enormous toll on affected individuals and caregivers. Moreover, schizophrenia is associated with a 2 to 3-fold increase in mortality rates compared to the general population (6) with life expectancy reduced up to two decades (7-9). Common causes of death include cardiovascular mortality, Emerging behavioral and psychotherapeutic interventions for schizophrenia cancer mortality, chronic obstructive pulmonary disease, influenza and pneumonia, substance-induced death, accidental death and suicide (10,11). Factors that likely contribute to increased mortality in schizophrenia include tobacco smoking, alcohol dependence or addiction, obesity, lack of adequate medical care, lack of …
自20世纪50年代引入典型抗精神病药物以及随后在20世纪90年代开发新型或非典型抗精神病药物以来,药物治疗一直是精神分裂症治疗的核心(1,2)。与安慰剂相比,典型和新型抗精神病药物都能减少患者的幻觉和妄想,并降低复发率。一项对65项试验的荟萃分析表明,与安慰剂(64%)相比,抗精神病药物在一年内降低了复发率(27%),也有证据表明,接受治疗的患者的生活质量更好,攻击行为更少(3)。然而,精神分裂症的长期病程仍然令人失望,只有少数患者在首次发病后保持高水平的社会心理和职业功能。Hegarty对使用氯丙嗪前和使用氯丙嗪后(1895年至1992年)进行了荟萃分析,比较了平均5.6年的随访结果(4)。改善的定义是临床症状轻微至轻微的恢复,并通过工作或独立生活表明良好的社会心理功能。Hegarty发现,在20世纪中期之后,被诊断为狭义标准(患病至少6个月)的患者改善的比例从35%增加到48%,这表明虽然抗精神病药物对长期结果有一定的积极作用,但许多患者仍然没有表现出良好的恢复。最近的一项荟萃分析应用了康复的定义,要求临床缓解和良好的社会功能持续至少两年,包括从新型抗精神病药期开始的研究(5)。使用持续临床和社会心理康复的标准,符合康复标准的患者中位数比例仅为14%。康复率不因性别、随访时间、数据收集时间或诊断标准的严格程度而异。由于精神分裂症通常在成年早期发病,这种疾病的残疾和生活质量下降对受影响的个人和照顾者造成了巨大的损失。此外,与一般人群相比,精神分裂症患者的死亡率增加了2至3倍(6),预期寿命缩短了20年(7-9)。常见的死亡原因包括心血管死亡、针对精神分裂症和癌症死亡的新出现的行为和心理治疗干预、慢性阻塞性肺病、流感和肺炎、物质导致的死亡、意外死亡和自杀(10,11)。可能导致精神分裂症死亡率增加的因素包括吸烟、酒精依赖或成瘾、肥胖、缺乏足够的医疗保健、缺乏……
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引用次数: 2
Tardive Dyskinesia in Long Term Hospitalized Patients with Schizophrenia 长期住院精神分裂症患者的迟发性运动障碍
Pub Date : 2016-09-26 DOI: 10.5350/DAJPN2016290307
A. Nalbant, A. Can, H. Burhan, A. Cansız, K. F. Yavuz, M. Delice, E. Kurt
Objective: Tardive dyskinesia (TD) is a group of delayed-onset iatrogenic movement disorders caused by dopamine receptor-blocking agents. TD prevalence is estimated as 20-50% of all patients treated with neuroleptics. This study aimed to investigate the prevalence rate of TD in long-term hospitalized patients with schizophrenia. Method: We recorded age, gender, duration and type (first/second generation or mixed) of medication both at the time of interview and over preceding years. Dyskinesia was assessed by using the Abnormal Involuntary Movements Scale (AIMS). We also used the Simpson–Angus Scale for tardive parkinsonism. Akathisia was measured using the Barnes Akathisia Rating Scale (BARS). Results: Mean duration of the longest used antipsychotic was 206.63 months. Probable TD was found in 18 (22.5%) of patients. None of the patients had tardive akathisia. Relation between type of the longest used treatment and prevalence of TD was not statistically significant. Relationship between type of ongoing treatment and prevalence of TD was not determined statistically significant either. There was a statistically significant relationship between the mean age and TD. Discussion: Despite very long duration of antipsychotic use, 22.5% rate of prevalence is still lower than expected. This can be explained that these patients are under direct and close follow-up of healthcare providers and in hospital conditions, so that risky conditions can be intervened rapidly. Another noteworthy finding of our study is that there is no statistically significant difference betwen first and second generation antipsychotic use and TD prevalence.
目的:迟发性运动障碍(TD)是一组由多巴胺受体阻滞剂引起的迟发性医源性运动障碍。在所有接受抗精神病药物治疗的患者中,TD患病率估计为20-50%。本研究旨在探讨长期住院精神分裂症患者TD的患病率。方法:我们记录了访谈时和前几年的年龄、性别、持续时间和用药类型(第一代/第二代或混合用药)。运动障碍的评估采用异常不自主运动量表(AIMS)。我们也用辛普森-安格斯量表来评估迟发性帕金森病。用Barnes Akathisia评定量表(BARS)测量无运动能力。结果:抗精神病药平均最长使用时间为206.63个月。18例(22.5%)患者可能发现TD。所有患者均无迟发性静坐症。使用时间最长的治疗方式与TD患病率的关系无统计学意义。正在进行的治疗类型与TD患病率之间的关系也没有统计学意义。平均年龄与TD之间存在显著的统计学关系。讨论:尽管抗精神病药物的使用时间很长,但22.5%的患病率仍低于预期。这可以解释为,这些患者受到医疗保健提供者的直接和密切的随访,并且在医院条件下,因此可以迅速干预危险情况。我们研究的另一个值得注意的发现是,第一代和第二代抗精神病药物使用和TD患病率之间没有统计学上的显著差异。
{"title":"Tardive Dyskinesia in Long Term Hospitalized Patients with Schizophrenia","authors":"A. Nalbant, A. Can, H. Burhan, A. Cansız, K. F. Yavuz, M. Delice, E. Kurt","doi":"10.5350/DAJPN2016290307","DOIUrl":"https://doi.org/10.5350/DAJPN2016290307","url":null,"abstract":"Objective: Tardive dyskinesia (TD) is a group of delayed-onset iatrogenic movement disorders caused by dopamine receptor-blocking agents. TD prevalence is estimated as 20-50% of all patients treated with neuroleptics. This study aimed to investigate the prevalence rate of TD in long-term hospitalized patients with schizophrenia. \u0000Method: We recorded age, gender, duration and type (first/second generation or mixed) of medication both at the time of interview and over preceding years. Dyskinesia was assessed by using the Abnormal Involuntary Movements Scale (AIMS). We also used the Simpson–Angus Scale for tardive parkinsonism. Akathisia was measured using the Barnes Akathisia Rating Scale (BARS). \u0000Results: Mean duration of the longest used antipsychotic was 206.63 months. Probable TD was found in 18 (22.5%) of patients. None of the patients had tardive akathisia. Relation between type of the longest used treatment and prevalence of TD was not statistically significant. Relationship between type of ongoing treatment and prevalence of TD was not determined statistically significant either. There was a statistically significant relationship between the mean age and TD. \u0000Discussion: Despite very long duration of antipsychotic use, 22.5% rate of prevalence is still lower than expected. This can be explained that these patients are under direct and close follow-up of healthcare providers and in hospital conditions, so that risky conditions can be intervened rapidly. Another noteworthy finding of our study is that there is no statistically significant difference betwen first and second generation antipsychotic use and TD prevalence.","PeriodicalId":136580,"journal":{"name":"Düşünen Adam: The Journal of Psychiatry and Neurological Sciences","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126876987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
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Düşünen Adam: The Journal of Psychiatry and Neurological Sciences
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