Acute Angle-closure Glaucoma Patients With Psychological And Social Factors Related Research And Analysis

Objective: Primary acute angle- closure glaucoma (primary acute angle-closure glaucoma PACG) is a ocular disease that serious hazard visual function . Its causes complex. It is recognized one of the psychosomatic diseases of the ocular disease. In addition to abnormality of anatomic structure on the patients'eye and the genetic deficiency, social and psychological factors can not be overlooked. It has become the main causative factor .The study is to investigate :â‘ The mental health and psychological personality characteristics of the PACG patients;â‘¡The associativity of the levels of the cortisol, T-cell subsets and PACG;â‘¢The curative effect and contribution of mental intervention in the treatment and prognosis in PACG.Methods: 40 cases of patients which diagnosed as PACG as case group (A group), which in the department of ophthalmology in the Second Affiliated Hospital of Dalian Medical University from April 2007 to December 2007 . 20 cases were healthy as the control group (B group). Detect the level of cortisol and blood T-cell subsets (CD4, CD8, CD4/CD8) of the A group patients.When the patients are willing to accept the survey, fill out the questionnaire by the patients themself or special messenger, including: SCL-90 , EPQ , life events Scale (LES). A group of patients are investigated with mental health and psychological personality . Group A patients were randomly selected 20 cases as a psychological intervention group (group A1), and the other 20 cases as a non-psychological group (group A2) . Group A1 are given one time the treatment of psychological intervention by psychological counseling staff's office in our hospital . Both group A1 + A2 are given the same anti-glaucoma surgery (conventional trabeculectomy) . The treatment of psychological intervention are given on the 1st day, on the 3rd day and on the 5th day after the surgery. Group A are rechecked the the level of cortisol and blood T-cell subsets (CD4, CD8, CD4/CD8) on the 7th day after the surgery. Implementating the same blood index and completing the questionnaires to the group B , the outcome for analysis.Results: (1) The comparison of SCL-90 between the group A and B indicates : the score in total, total average, interpersonal relationships, depression, anxiety, fear, bigotry and Psychotic of group A is higher than those in group B significantly, the differences between the two groups are significant (P<0.01). The differences between the two groups in somatization, obsessive symptoms and hostility score are not significant (P> 0.05). (2) The comparison of EPQ between group A and B ,the findings shows that: the scores in mental illness, nervous or emotional stability and personality of group A are higher than those in group B significantly, the differences between the two groups are significant (P <0.05). The difference between the two groups in extraversion scores are not significant (P> 0.05). (3) Life Events Scale (LES) survey findings show that: psychological stress-related factors: the scores in family events, social intercourse and other events, life events, stress response total are higher than those in group B, the difference between the two groups are significant (P <0.05). The difference between the two groups scores in learning events, economic events are not significant (P> 0.05) (4) In the acute stage of PACG , the level of cortisol and T-cell subsets (CD4, CD8, CD4/CD8) in patients'body is abnormal;(5) After the trabeculectomy, the level of cortisol and T-cell subsets in A1 group changes significantly less than those in group A2, intraocular pressure in patients of group A2 fluctuates significantly more than those in group A2, the differences between the two groups are significant (P <0.05).Conclusion: (1) PACG patients with mental illness, neurotic tendencies, short of emotional and psychological stability of personality characteristics; (2) In the acute stage of PACG , the level of cortisol and T-cell subsets (CD4, CD8, CD4/CD8) in patients'body is markedly abnormal; the system of endocrine and immune disorders ; (3) Mental intervention treatment can improve the body endocrine, immune disorders, play a positive role in maintain equability of intraocular pressure after the operation.