Dowson Claire A, Town G Ian, Frampton Christopher, Mulder Roger T
Canterbury Respiratory Research Group, Hagley Building, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand.
J Psychosom Res. 2004 Mar;56(3):333-40. doi: 10.1016/S0022-3999(03)00040-0.
To explore the influence of psychological characteristics in Chronic Obstructive Pulmonary Disease (COPD) self-management.
Patients admitted with an exacerbation of COPD were interviewed for psychiatric symptoms, illness beliefs and self-management behaviour using a new COPD Self-Management Interview (COPD-SMI). This comprised three scenarios to mimic a future evolving exacerbation. Responses were scored for knowledge and actions (adherence) for each scenario.
Of 47 people approached, 39 participated; 41% had panic attacks, 33% general anxiety, 35% a depression history, 31% an anxiety history and 21% an alcohol dependence history. Twenty-six (67%) had a self-management plan. When hypothetically "well" lower (poorer) COPD-SMI Knowledge Scores were associated with an alcohol dependence history (P=.025), no panic (P=.021) and males (P=.028). Those perceiving less influence over COPD had lower Action Scores during this scenario (P=.01) and the "early exacerbation" scenario (P=.05). Lower Knowledge Scores for the "early exacerbation" were associated with no panic (P=.01) and no self-management plans (P=.03). For the "severe exacerbation", lower Action Scores were associated with depression history (P=.004), panic (P=.002), higher FEV(1)% and no self-management plans (P=.005). Higher PaCO(2) was associated with lower confidence in symptom recognition, self-management ability and medical care influencing COPD.
Anxiety, depression, alcohol use and illness beliefs may differentially influence self-management. Depression, previous alcohol dependence and perceived less influence over COPD inhibited self-management. Those with panic demonstrated more self-management knowledge when "well" but performed poorly on actions during the "severe exacerbation". Those with self-management plans had better knowledge and actions.
探讨心理特征对慢性阻塞性肺疾病（COPD）自我管理的影响。
采用新的COPD自我管理访谈（COPD-SMI）对因COPD急性加重入院的患者进行精神症状、疾病认知和自我管理行为的访谈。该访谈包括三种情景，以模拟未来病情的逐渐加重。对每种情景下的知识和行为（依从性）回答进行评分。
在47名被邀请者中，39人参与；41%有惊恐发作，33%有广泛性焦虑，35%有抑郁病史，31%有焦虑病史，21%有酒精依赖病史。26人（67%）有自我管理计划。假设处于“病情稳定”状态时，较低（较差）的COPD-SMI知识得分与酒精依赖病史（P = 0.025）、无惊恐发作（P = 0.021）和男性（P = 0.028）相关。在这种情景下，那些认为对COPD影响较小的患者行动得分较低（P = 0.01），在“早期加重”情景下也是如此（P = 0.05）。“早期加重”情景下较低的知识得分与无惊恐发作（P = 0.01）和无自我管理计划（P = 0.03）相关。对于“重度加重”情景，较低的行动得分与抑郁病史（P = 0.004）、惊恐发作（P = 0.002）、较高的第1秒用力呼气容积百分比（FEV(1)%）和无自我管理计划（P = 0.005）相关。较高的动脉血二氧化碳分压（PaCO(2)）与对症状识别、自我管理能力以及医疗护理对COPD影响的信心较低相关。
焦虑、抑郁、饮酒情况和疾病认知可能对自我管理产生不同影响。抑郁、既往酒精依赖以及认为对COPD影响较小会抑制自我管理。有惊恐发作的患者在“病情稳定”时表现出更多的自我管理知识，但在“重度加重”时行动表现较差。有自我管理计划的患者知识和行动表现更好。
