Brans B, van den Eynde F, Audenaert K, Vervaet M, van Daele K, van Heeringen C, Dierckx R A
Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
Nucl Med Commun. 2003 Aug;24(8):881-6. doi: 10.1097/01.mnm.0000084586.29433.83.
The combination of a diagnosis of malignancy and hospitalization, isolation and radioactivity of a radionuclide therapy may have an important effect on the psychological equilibrium of patients and may hamper compliance and acceptability. We performed a psychiatric evaluation in order to study psycho-pathological manifestations and underlying personality related vulnerabilities. During radioisolation, 48 patients (24 male, 24 female; mean age 57.8 years) with a malignant (n=26) or non-malignant (n=22) pathology who needed isolation for radionuclide therapy, completed a series of questionnaires in order to assess anxiety (Spielberger State and Trait Anxiety Inventory; STAI), depression (Beck Depression Inventory; BDI), hopelessness (Beck Hopelessness Scale; BHS), personality characteristics (Temperament and Character Inventory; TCI) and coping strategies (Utrecht's Coping List; UCL). Compared to patients with low state anxiety, patients who experienced a high level of state anxiety showed higher levels of depression (t=-2.10; P=0.04) and hopelessness (t=-4.20; P=<0.001). Their personality was characterized by significantly higher scores on harm avoidance (t=-2.78; P=0.008) and lower scores on self-directedness (t=3.12; P=0.003). Coping strategies were more passive (t=-2.43; P=0.02), avoiding (t=-2.15; P=0.04) and less well aimed (t=2.64; P=0.01). Surprisingly, the nature of disease (malignant versus non-malignant) did not influence these results, nor was there a difference between males and females, age, years of education, having a relationship or not, or the duration of hospitalization. Thus, contrary to what may be expected in isolation with radionuclide therapy, subgroups such as women, elderly, cancer patients or lower educated people do not, a priori, exhibit a higher state anxiety level. Our study shows these levels to be closely related to individual personality traits and coping strategies that are inadequate for the situation. Screening for trait anxiety before admission can be easily done and may guide interventions aimed at increasing patient comfort and acceptability.
恶性肿瘤诊断与住院治疗、放射性核素治疗的隔离及放射性相结合，可能会对患者的心理平衡产生重要影响，并可能妨碍其依从性和可接受性。我们进行了一项精神病学评估，以研究心理病理表现及潜在的与人格相关的脆弱性。在放射性隔离期间，48例（24例男性，24例女性；平均年龄57.8岁）患有恶性（n = 26）或非恶性（n = 22）疾病且需要进行放射性核素治疗隔离的患者，完成了一系列问卷，以评估焦虑（斯皮尔伯格状态-特质焦虑量表；STAI）、抑郁（贝克抑郁量表；BDI）、绝望感（贝克绝望量表；BHS）、人格特征（气质与性格量表；TCI）和应对策略（乌得勒支应对清单；UCL）。与状态焦虑水平低的患者相比，经历高水平状态焦虑的患者表现出更高水平的抑郁（t = -2.10；P = 0.04）和绝望感（t = -4.20；P < 0.001）。他们的人格特征表现为在伤害回避方面得分显著更高（t = -2.78；P = 0.008），而在自我导向方面得分更低（t = 3.12；P = 0.003）。应对策略更消极（t = -2.43；P = 0.02）、回避性更强（t = -2.15；P = 0.04）且针对性更差（t = 2.64；P = 0.01）。令人惊讶的是，疾病的性质（恶性与非恶性）并未影响这些结果，男性与女性、年龄、受教育年限、是否有伴侣或住院时间之间也没有差异。因此，与放射性核素治疗隔离时可能预期的情况相反，女性、老年人、癌症患者或受教育程度较低的人群等亚组， priori 并未表现出更高的状态焦虑水平。我们的研究表明，这些水平与个体人格特质和应对策略密切相关，而这些特质和策略并不适合这种情况。入院前筛查特质焦虑很容易做到，并且可以指导旨在提高患者舒适度和可接受性的干预措施。
