耳鸣患者的心理因素初步研究

发布时间：2018-05-19 02:28

本文选题：耳鸣 + 心理学　；参考：《中南大学》2010年硕士论文

【摘要】： 研究背景耳鸣通常被定义为没有外界声源或电刺激时所产生的声音的感觉,一种非常普遍的现象。流行病学表明大约6-17%的人经历过至少5分钟的耳鸣,但只有0.5-2.5%的人认为耳鸣严重影响他们的生活。目前普遍认为耳鸣病人由于耳鸣的干扰以及患者本身的认知水平,可能会出现抑郁、焦虑、睡眠障碍等症状,严重者社会功能受到损害,甚至可能会自杀。Jastreboff提出了耳鸣的神经生理学模型,指出耳鸣通过条件反射导致边缘系统和自主神经系统的持续兴奋,从而在临床上出现与耳鸣相关的抑郁等心理障碍。在这个基础上提出了耳鸣再训练疗法,让患者建立一个新的“耳鸣观”,不再因为耳鸣出现上述心理障碍。目的通过详细的耳鸣相关检测和心理学评估,详细的了解耳鸣患者的心理状态,是否存在抑郁、焦虑等,同时评估患者的生活质量和睡眠质量,并分析这些心理障碍在耳鸣患者中的分布,为临床上诊疗耳鸣提供参考。资料与方法患者均来自于中南大学湘雅医院耳鼻咽喉头颈外科门诊就诊的耳鸣患者。所有的患者均进行耳鸣的频率和响度测试,并使用90项症状清单(symptom checklist 90, SCL-90)、生活满意度量表、匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index, PSQI)、耳鸣残疾量化表(tinnitus handicap inventory, THI)对患者进行相关的评估。 90项症状清单(symptom checklist 90, SCL-90),由90个项目组成,可以概括为9个因子,分别为躯体化,强迫症状,人际关系,抑郁,焦虑,敌对,恐怖,偏执,精神病性,将此9个因子分别积分。量表协作组曾对全国13个地区1388名正常成人的SCL-90进行分析,主要结果如下：生活满意度量表包括三个独立的量表,其一是他评量表,即生活满意度评定量表(Life Satisfaction Rating Scale),简称LSR；另两个分量表是自评量表,分别为生活满意度指数A (Life Satisfaction Index A)和生活满意度指数B,简称LSIA和LSIB。文献表明国内常模得分为LSR=17.8±4.6,LSIA=12.4+4.4, LSIB=15.5+4.7。匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index, PSQI)适用于睡眠障碍患者、精神障碍患者的睡眠质量评价、疗效观察,一般人群睡眠质量的调查研究,以及睡眠质量与心身健康相关性研究的评定工具。国外Buysse博士等的研究表明,以PSQI总分5为划界分,灵敏度为89.6%,特异度为86.5%；国内刘贤臣等的测试表明以PSQI总分7为划界分,灵敏度为98.3%,特异度为90.2%。本研究采用国内的标准。耳鸣残疾量化表(tinnitus handicap inventory, THI)：由25个条目组成,每个条目有3个选择项,分别为否、有时、是,得分分别是O分、2分、4分。统计25个条目得分,进行分级。1级：无残疾,THI得分为0-16分；2级：轻度残疾,THI得分为18-36分；3级：中度残疾,THI得分为38-56分；4级：重度残疾,THI得分为58-76分；5级：极重度残疾,THI得分为78-100分。得分越高,级别越高,表示自觉耳鸣越严重。将所取得的数据建立数据库,采用SPSS11.0统计分析软件进行分析。结果1、耳鸣的频率、响度和患者的SCL-90、LSR、LSIA、LSIB、PSQI、THI得分均无直线相关。 2、76例耳鸣患者的SCL总分(X=165.72±53.68,t=5.808,P=0.000),总均分(X=1.84±0.59,t=5.866,P=0.000),阳性项目数(X=40.86±21.8,t=6.354,p=0.000),阳性症状均分(X=2.72±0.47,t=2.275,P=0.026),均高于国内常模。其中除人际关系因子(X=1.73±0.69,t=1.031,P=.306)外,躯体化(X=1.74±0.56,t=5.790,P=0.000),强迫(X=2.10±0.73,t=5.745,P=0.000),抑郁(X=1.94±0.73,t=5.299,P=0.000),焦虑((X=1.91±0.72,t=6.230,P=0.000)、敌对(X=1.87±0.84,t=4.092,P=0.000)、恐怖(X=1.55±0.59,t=4.776,P=0.000)、偏执(X=1.59±0.70,t=2.059,P=.043)、精神病性(X=1.74±0.71,t=5.495,P=0.000)这几项因子分高于国内常模。 76例患者的调查中共获得生活满意度量表(LSR)67份,生活满意度指数A量表(LSIA)64份,生活满意度指数B量表66份,与国内常模比较,其中LSR(X=16.63±3.90,t=-2.460,P=0.017),LSIA(X=10.69±4.29,t=-3.190,P=0.002),LSIB(X=13.74±4.18,t=-3.415,P=0.001),均低于国内常模。 76例患者共获得PSQI量表60份,其中大于7的患者有45例；睡眠障碍患病率为62%,高于普通人群。 3、根据THI分组,THI3级组的躯体化因子高于国内常模；THI4级组的生活满意度降低,SCL-90中躯体化、强迫、抑郁、焦虑、敌对、恐怖、精神病性这些因子分均高于国内常模；THI5级组的生活满意度明显降低,睡眠障碍患病率高于普通人群,而且SCL-90中躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执、精神病性各因子均高于国内常模。结论耳鸣的频率、响度和患者的SCL-90、LSR、LSIA、LSIB、PSQI、THI得分均无直线相关。根据THI得分对耳鸣患者进行分组,THI4级组、THI5级组的心理障碍明显,应给予重点关注。
[Abstract]:Background tinnitus is usually defined as the sound of sound produced without external sound sources or electrical stimuli. Epidemiology shows that about 6-17% people have experienced at least 5 minutes of tinnitus, but only 0.5-2.5% people think tinnitus seriously affects their lives.
At present, it is generally believed that the patients with tinnitus, due to the interference of tinnitus and the cognitive level of the patients themselves, may have symptoms such as depression, anxiety, sleep disorder, and so on. The social function of the serious people may be impaired, and even may commit suicide.Jastreboff to put forward the neurophysiological model of the tinnitus, pointing out that the tinnitus can lead to the marginal system and autonomy through the conditioned reflex. The persistent excitement of the nervous system leads to a psychological disorder, such as the depression associated with the tinnitus. On this basis, a retraining therapy for tinnitus is proposed to set up a new "tinnitus", no longer because of the psychological barriers to the tinnitus.
Objective to understand the mental state of the patients with tinnitus, whether there is depression and anxiety, and evaluate the quality of life and sleep of the patients, and analyze the distribution of these mental disorders in the tinnitus patients, and provide a reference for the clinical diagnosis and treatment of tinnitus.
Data and methods were all from the tinnitus patients in the outpatient of the otolaryngology and head and neck surgery in Xiangya Hospital of Central South University. All patients were tested for the frequency and loudness of the tinnitus and used 90 symptoms list (symptom checklist 90, SCL-90), the life satisfaction scale, and the Pittsburgh sleep quality index scale (Pittsburgh Sleep Quali). Ty Index (PSQI) and tinnitus handicap inventory (THI) were used to assess the patients.
The 90 symptom checklist (symptom checklist 90, SCL-90), composed of 90 items, can be summed up as 9 factors: somatization, compulsive symptoms, interpersonal relationships, depression, anxiety, hostility, terror, paranoia, psychosis, respectively. The scale collaboration group has analyzed the SCL-90 of 1388 normal adults in 13 regions of the country. The results are as follows:
The life satisfaction scale includes three independent scales, one is the scale of life satisfaction rating scale (Life Satisfaction Rating Scale), or LSR for short, and the other two subscales are the self-assessment scale, which are the life satisfaction index A (Life Satisfaction Index A) and the life satisfaction index B, referred to as LSIA and literature states. The score of internal norm was LSR=17.8 + 4.6, LSIA=12.4+4.4, LSIB=15.5+4.7.
The Pittsburgh sleep quality index (Pittsburgh Sleep Quality Index, PSQI) is suitable for the sleep quality of patients with sleep disorders, the quality of sleep in patients with mental disorders, the observation of curative effect, the study of the quality of sleep in the general population, and the assessment tool for the study of the correlation between sleep quality and psychosomatic health. The study of Dr. Buysse in foreign countries showed that PSQ The total score of I was 5, the sensitivity was 89.6%, the specificity was 86.5%. The national Liu Xianchen test showed that the total score of PSQI was 7, the sensitivity was 98.3%, the specificity was 90.2%., and the domestic standard was adopted.
Tinnitus disability quantitative table (tinnitus handicap inventory, THI): consists of 25 entries, each item has 3 options, respectively, and sometimes, the score is O, 2, 4. Statistics 25 entries to score, grade.1 grade: no disability, THI score 0-16 points; 2: mild disability, THI score 18-36; 3 grade: moderate disability The THI score was 38-56 points; level 4: severe disability, THI score 58-76; level 5: extremely severe disability and THI score of 78-100. The higher the score, the higher the level, the more serious the conscious tinnitus was.
The database was established and analyzed by SPSS11.0 statistical analysis software.
Results 1, there was no linear correlation between tinnitus frequency, loudness and SCL-90, LSR, LSIA, LSIB, PSQI and THI scores of patients.
The total score of SCL (X=165.72 + 53.68, t=5.808, P=0.000) in 2,76 patients with tinnitus, the total average score (X=1.84 + 0.59, t=5.866, P=0.000), the number of positive items (X=40.86 + 21.8, t=6.354, p=0.000). + 0.56, t=5.790, P=0.000), coercion (X=2.10 + 0.73, t=5.745, P=0.000), depression (X=1.94 0.73, t=5.299, P=0.000), anxiety (X=1.91 + 0.72, t=6.230, P=0.000), hostility (X=1.87 0.84, 0.59), paranoid (0.59, 0.70), psychosis The factor is higher than the domestic norm.
The survey of 76 patients received 67 copies of the life satisfaction scale (LSR), 64 copies of the life satisfaction index A scale (LSIA) and the life satisfaction index B scale, compared with the domestic norm, in which LSR (X=16.63 + 3.90, t=-2.460, P=0.017), LSIA (X=10.69 + 4.29, t= -3.190) were all lower than the domestic norm.
A total of 60 PSQI scales were obtained from 76 patients, of whom 45 were more than 7, and the prevalence rate of sleep disorders was 62%, which was higher than that of the general population.
3, according to the THI group, the somatization factor of the THI3 group was higher than the domestic norm, the life satisfaction of the THI4 group was lower, the somatization in the SCL-90, the compulsion, the depression, the anxiety, the hostility, the horror and the psychosis were all higher than the domestic norm; the life satisfaction of the THI5 group was significantly lower, and the incidence of sleep disorder was higher than that of the ordinary people, and SCL-9 0 somatization, compulsion, interpersonal relationship, depression, anxiety, hostility, terror, paranoia, psychotic factors were all higher than domestic norm.
Conclusion there is no linear correlation between the frequency and loudness of tinnitus and the scores of SCL-90, LSR, LSIA, LSIB, PSQI and THI of patients.
According to the THI score, the patients with tinnitus were grouped. The mental disorder of group THI4 and group THI5 was obvious and should be given priority attention.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R764

【参考文献】