创伤暴露后吸烟行为变化与创伤后应激障碍的相关性研究

目的 了解创伤暴露后吸烟情况的变化与创伤暴露、创伤后应激障碍(PTSD)之间的关系.方法 在汶川地震6个月后,采用目前美国PTSD流行病学调查和诊断工具,按整群分层抽样原则对1125名参加汶川抗震救灾现场救援军人在抗震救灾前后吸烟情况的变化及PTSD的患病情况进行调查.PTSD诊断分别采用Davidson创伤量表(DTS)和DSM-Ⅳ标准确定.结果 实查1 056人,共检出PTSD患者69例,患病率为6.53%.本调查发现:(1)创伤暴露未对吸烟产生不利影响.创伤暴露后总的吸烟人数仅增加5例,吸烟量由创伤暴露前的(9.43±6.13)支/天减少到创伤暴露后的(8.04±6.05)支/天(t=6.595,P=0.000).(2)PTSD对吸烟有显著影响.PTSD与非PTSD相比会增加创伤暴露后初始吸烟的危险性(31.3%vs12.9%,X2=4.394,P=0.036).虽然PTSD组创伤暴露前、后总的吸烟量无明显改变(t=1.802,P=0.077),但创伤暴露后自诉吸烟量增多者PTSD组显著高于非FTSD组(X2=17.127,P=0.000).(3)多元Iogistic回归分析表明,服役满意度低(OR=2.574,P:0.000)、创伤暴露后患PTSD(OR=2.529,P=0.001)、创伤暴露前为烟草依赖者(OR=1.334,P=0.002)、军龄长(OR=1.334,P=0.002)是地震现场救援军人创伤暴露后吸烟行为增加的显著危险因素.结论 创伤暴露对吸烟无明显影响,而患PTSD会增加吸烟的危险.     

汶川地震灾后8年高中学生外语课堂学习焦虑的影响因素

目的了解汶川地震灾后8年曾经历地震的高中生外语课堂学习焦虑情况及其影响因素,为进一步改善高中学生心理健康状况提供参考。方法采用整群抽样方法抽取汶川地震极重灾区绵竹中学高中生668人为研究对象,使用外语课堂学习焦虑量表(FLCAS)、创伤后应激障碍自评量表平民版(PCL-C)、领悟社会支持量表(PSSS)进行调查。结果高中生FLCAS评分为(101. 77±19. 78)分,Pearson相关分析显示,FLCAS评分与PCL-C评分呈负相关(r=-0. 154,P0. 01),与PSSS评分呈正相关(r=0. 225,P0. 01)。多元回归分析显示,FLCAS与性别(B=3. 380,P=0. 037)、年龄(B=-4. 510,P=0. 003)、创伤后应激障碍(B=-0. 359,P0. 01)和其他支持(B=0. 550,P=0. 038)之间均存在相关性。结论震后8年绵竹灾区高中生存在外语课堂学习焦虑,社会人口学因素、创伤后应激障碍和社会支持可能是外语课堂学习焦虑的相关影响因素。     

地震救援军人创伤后应激障碍及相关因素的研究

目的:调查汶川地震救援军人在震后7个月时创伤后应激障碍的检出率及相关因素。方法:在参与地震救援的部队中随机抽取600人,采用创伤后应激障碍症状自评量表(PTSD-SS)、社会支持评定量表(SSRS)、90项症状自评量表(SCL-90)、艾森克人格问卷(EPQ)进行调查。采用SPSS13.0统计软件对497份有效问卷的数据进行统计分析。结果:地震救援工作7个月后,创伤后应激障碍中、重度症状的时点检出率为2%。回归分析显示,救援中接触伤亡多(B=0.242,P=0.010)、遭遇威胁生命的情境多(B=0.280,P=0.006)、EPQ-N分高(B=0.106,P=0.000)是发生创伤后应激障碍的危险因素,而社会支持利用度(B=-0.095,P=0.035)是保护因素。结论:EPQ-N高分特征的军人是心理干预工作的重点,有效社会支持利用可减少PTSD发生。     

34例汶川地震灾区籍大学生创伤后应激障碍症状叙事疗法的疗效研究

目的 了解汶川地震2年后灾区籍大学生心理状况,观察叙事疗法对创伤后应激障碍（PTSD）患者症状的疗效.方法 采用方便取样.以四川某学院460例5·12地震灾区学生为研究对象,用创伤后应激障碍（PTSD）症状清单平民版（PTSD Checklist-Cicilian version, PCL-C）（分B、C、D三组症候群）,进行自填式调查.使用抑郁自评量表（SDS）、焦虑自评量表（SAS）对灾区籍大学生进行测评,采用叙事疗法对其中34例重度PTSD患者进行了治疗.结果 地震后2年灾区籍大学生PTSD患病率为7.39%,女性（4.78%）高于男性（2.61%）,叙事治疗前后除SDS总分外,其余各项差异显著（P＜0.05）.结论 叙事疗法对地震后灾区籍大学生PTSD治疗有效,在以后的叙事心理干预中应注意关注PTSD患者的抑郁症状.     

舟曲泥石流灾后儿童创伤后应激障碍与应对方式的关系

目的 探讨创伤后应激障碍(posttraumatic stress disorder,PTSD)与应对方式的关系,为早期预测创伤后应激障碍和心理干预提供科学依据.方法 采用整群抽样的方法用简易应对方式问卷(Simplified copingstyle questionnaire,SCSQ)和创伤后应激障碍17项筛查问卷(PTSD Checklist-Civilian version,PCL-C)对舟曲县的596名学生进行问卷调查,获得有效问卷592份.结果 PTSD症状阳性组共45人,占总人数的7.60%,其中男生15人,占男生人数的5.34%,女生30人,占女生人数的9.65%.男女生在PCL-C和SCSQ上的得分均存在统计学差异(P<0.05);PTSD筛查阳性组、阴性组在积极应对和消极应对上得分有统计学差异(P<0.05);控制性别、年级因素,PTSD总分与积极应对方式(β =-0.473,标准化β =-0.524,P<0.001)和消极应对方式(β =0.556,标准化β =0.427,P<0.001)有关联.结论 应对方式可作为PTSD发生率的预测因素,积极应对是PTSD的保护性因素,尽早引导学生采取积极的应对方式,对预防PTSD有重要作用.     

地震后半年未愈伤员创伤后应激障碍调查

目的：探讨汶川地震灾后半年,震伤未愈伤者创伤后应激障碍（PTSD）的发生率和相关因素。方法：选取成都市某医院地震伤员康复中心未愈伤者58例,采用自制一般情况问卷、心理健康自评问卷、分离性体验量表、PTSD自评量表和特质应对方式问卷进行测评。结果：未愈伤者在地震灾后半年患PTSD者占41.4%;男性伤者中残疾率28.6%和PTSD发生率28.6%明显低于女性伤者的46.7%和53.3%（P〈0.05）。创伤后应激水平与积极应对方式呈正相关（r=0.483,P〈0.01）;和消极应对方式呈负相关（r=-0.449,P〈0.01）。伤者中分离水平极低,遗忘和创伤后应激水平呈正相关（r=0.541,P〈0.01）;残疾、低社会支持和创伤后应激水平显著相关（r=0.642,P〈0.05）。结论：地震灾后半年,震伤未愈伤者PTSD患病率较高,残疾、社会支持差、遗忘水平高、消极的应对方式是震伤未愈者发生PTSD的主要相关因素,应给予充分的药物及心理治疗。     

颅内动脉瘤介入栓塞术后复发患者创伤后应激障碍状况及影响因素分析

目的 调查颅内动脉瘤介入栓塞术后复发患者创伤后应激障碍(PTSD)状况,并探讨其影响因素.方法 选取2019年1月至2021年1月于新疆医科大学第一附属医院接受治疗的290例颅内动脉瘤介入栓塞术后复发患者作为研究对象,采用创伤性应激障碍自评量表(PTSD-SS)评价PTSD状况,统计PTSD-SS总分及PTSD发生率....     

中国汶川地震现场救援军人创伤后应激障碍及相关因素的调查

目的 调查抗震救灾一线救援军人任务完成6个月创伤后应激障碍(PTSD)的患病率及相关因素.方法 采用目前美国PTSD流行病学调查和诊断工具,按整群分层抽样原则对1125名汶川抗震救灾现场救援军人PTSD的患病率及相关因素进行调查.PTSD诊断采用Davidson创伤量表(DTS)症状发生频率和严重程度总分≥40分标准确定,并使用美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准复查,使用SPSS13.0软件对调查资料和DTS诊断结果进行单因素和Logistic回归分析.结果 实际调查1056人;DTS诊断PTSD 69例,患病率6.53%;DSM-Ⅳ复查符合诊断63例,患病率5.97%;独生子女、服役满意度低、吸烟、创伤暴露阶段未进行心理干预及有饮酒习惯者PTSD患病率显著高于相对应的人群(P＜0.05);地震经历暴露程度高(P＜0.01,OR=6.258)、创伤暴露阶段未进行心理干预(P=0.019,OR=3.106)是抗震救灾现场救援军人PTSD的显著危险因素,而独生子女是PTSD潜在的危险因素(P=0.057,OR=2.235).结论 PTSD是抗震救灾现场军人常见的心理障碍,加强创伤暴露者的心理防护和危机干预十分必要.     

军人创伤后应激障碍治疗前后前额叶磁共振质子波谱的变化

目的探讨军人创伤后应激障碍(post-traumatic stress disorder,PTSD)患者治疗前后前额叶质子波谱的变化及临床疗效。方法纳入23例军人PTSD患者,并随机抽取某部25名健康官兵作为对照。采用前额叶氢质子磁共振波谱(proton magnetic resonance spectroscopy,1H-MRS)检查,测定两组前额叶N-乙酰基天门冬氨酸(N-acetylaspartate,NAA)、谷氨酰胺复合物(glutamate/glutamine,Glx)、胆碱复合物(choline-congtaining compounds,Cho)、肌醇(myo-inositol,m I)、肌酸复合物(creatine compounds,Cr)等化合物的含量。治疗前后采用创伤后应激障碍自评量表(post traumatic stress disorder self-rating scale,PTSD-SS)评估研究组症状。结果研究组治疗前左侧前额叶Cho/Cr与对照组存在统计学差异[(1.23±0.36)vs.(1.14±0.31),P0.05];研究组治疗前后左侧前额叶NAA/Cr存在统计学差异[(1.34±0.42)vs.(1.49±0.52),P0.05];相较治疗前,研究组治疗后PTSD-SS总分降低[(57.68±11.35)vs.(45.57±10.86)],各因子分亦均降低(P0.05)。结论军人PDST患者双侧前额叶均存在NAA/Cr、Cho/Cr等代谢物质的改变,且可能与患者精神症状的严重程度有关。     

汶川大地震后灾区基层干部职业生活质量量表中文版修订

目的修订中文版职业生活质量量表(Pro QOL)并检验其信效度,以发展适用于评估我国地震灾区基层干部职业生活质量的工具。方法于2009年9月-11月选取四川省北川县、绵竹市、什邡市、青川县、安县、都江堰市地震灾区的835名基层干部,完成中文版Pro QOL评定,同时进行创伤后应激障碍筛查表(PTSD-7)和心理健康自评问卷(SRQ-20)评定作为效标量表。获得有效问卷763份,随机抽取其中370份进行项目分析,剩余393份进行验证性因素分析,并检验所修订量表的效标效度、内部一致性信度和折半信度。结果修订后的中文版Pro QOL共23个条目,验证性因素分析结果符合心理测量学要求(χ2/df=2.53,RMSEA=0.06,CFI=0.86,GFI=0.89,AGFI=0.86,IFI=0.86,NFI=0.78)。中文版Pro QOL中职业倦怠和二次创伤压力与两效标量表评分相关(r=0.27~0.42,P均0.01),共情满足与两效标量表评分相关无统计学意义(r=-0.08、-0.01,P均0.05)。根据曼-惠特尼秩和检验,效标量表的阴性组和阳性组职业倦怠(PTSD-7:Z=-4.25,P0.01;SRQ-20:Z=-5.64,P0.01)和二次创伤压力分量表(PTSD-7:Z=-5.51,P0.01;SRQ-20:Z=-6.15,P0.01)评分差异有统计学意义,PTSD-7的阴性组和阳性组共情满足分量表评分差异无统计学意义(Z=-0.33,P=0.75),而SRQ-20的阴性组和阳性组共情满足分量表评分差异有统计学意义(Z=-2.35,P=0.03)。各分量表和总量表的Cronbach'sα系数为0.71~0.83,折半信度为0.65~0.79。结论修订后的中文版Pro QOL具有良好的信效度,较适合作为我国地震灾区基层干部职业生活质量评估工具。     

Diagnostic Difficulties and Treatment Implications

Summary: Differentiation between types of epileptic seizures has been aided in recent years by the introduction of intensive neurodiagnostic techniques and the development of increasingly detailed classification systems. Paradoxically, these developments have not simplified the task of matching the appropriate antiepileptic drug to a particular seizure type. It is reasonable to assume that anticonvulsant drugs will have different effects on different types of seizures, but faulty, circular reasoning can enter the picture if one also assumes that responses of seizures to different drugs signify different seizure types. There are several examples of differential diagnoses that can fall prey to this problem, including the diagnosis between partial seizures with secondary generalization and generalized tonic-clonic seizures, and the diagnosis between complex partial seizures and absence seizures with automatisms, among others. Considerations of etiology in future classification systems can further complicate the problem: should one then choose an anticonvulsant drug on the basis of individual seizure type or on the basis of the type of epilepsy? Ramifications of this issue extend even to the drug approval process. Official sanction is not given for use of a drug for a seizure type not included in the original efficacy studies, even if later scientific evidence shows that seizure type to be related to a type that is included. New trials must be undertaken. These problems arise from how we choose to classify seizures.     

Cognitive Dysfunction Associated with Antiepileptic Drug Therapy

Summary: Epilepsy is frequently associated with cognitive dysfunction. However, the reasons for this correlation are unclear. Possible influential factors include patient age; duration, frequency, etiology, and type of seizures; hereditary factors; psychosocial issues; and antiepileptic drug (AED) therapy. Whereas many of these factors are beyond the physician's control, AED therapy is one element that can be addressed in treatment decisions by recognizing the potential cognitive effects of particular AEDs. For example, phenobarbital impairs memory and concentration; phenytoin affects attention, problem solving ability, and performance of visuomotor tasks. In contrast, carbamazepine may affect concentration, while valproate would appear to have minimal effects on cognition. Moreover, cognitive effects of AEDs are amplified with coadministration of multiple anticonvulsants (polytherapy). A review of studies on the cognitive effects of monotherapy with AEDs, as opposed to those of polytherapy, provides evidence that drug-related cognitive dysfunction can be reversed if patients are switched to a simpler therapeutic regimen. Future research should be directed toward developing reliable measures for assessing and monitoring cognition, and understanding the particular cognitive side effects of each AED. Physicians also need to revise their opinions about which side effects are "tolerable" for epileptic patients.     

Carbamazepine Efficacy in Adults With Partial and Generalized Tonic-Clonic Seizures

Summary: Carbamazepine and phenytoin are drugs of choice in initial monotherapy for adult partial and secondarily generalized tonic-clonic seizures. These designations reflect the results of the Veterans Administration Epilepsy Cooperative Study Group of 1985. An earlier comparative study of carbamazepine and phenytoin by Ramsay and associates found both drugs equally effective in controlling new-onset seizures. Among the advantages of carbamazepine is that it causes relatively few cognitive and dysmorphic side effects. Its disadvantages are its unavailability in parenteral formulation and its metabolic autoinduction. The latter must be compensated for by planned dosage increases to maintain therapeutic plasma steady-state levels during the first 2 or 3 months of treatment. Carbamazepine is judged a drug of choice in the treatment of these secondarily generalized tonic-clonic seizures, and the drug of choice in children, adolescents, and women susceptible to the dysmorphic side effects associated with other anticonvulsant agents.     

Etiologic and Preventive Aspects of Epilepsy in the Child–Bridging the Gap Between Laboratory and Clinic

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of "kindling antagonism" may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.     

Treatment Considerations in Anticonvulsant Monotherapy

Summary: The long-standing practice of polypharmacy in treating epilepsy is giving way to use of monotherapy. Monotherapy can improve seizure control as well as reduce the risk of serious idiosyncratic reactions, dose-related side effects, and complex drug interactions. Monotherapy also offers improved compliance and cost-effectiveness. The basis of monotherapy is accurate diagnosis and assessment of the patient's seizure type(s), followed by selection of a single appropriate anticonvulsant drug. Many patients currently treated with multiple anticonvulsants can be successfully converted to monotherapy with a carefully monitored program in which troublesome and redundant drugs are gradually withdrawn from the therapeutic regimen.     

Predisposing and Causative Factors in Childhood Epilepsy

Summary: We review information from large studies of defined populations, examining the role of known factors and especially of prenatal and perinatal factors in contributing to nonfebrile seizure disorders of early childhood. We depend especially, but not exclusively, on the recently completed analyses from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, the NCPP. About 4% of children in the NCPP who had at least one non-febrile nonsymptomatic seizure by the age of 7 years had a previous seizure during acute neurologic illness, such as meningitis or during the acute illness after trauma. Many such seizures should potentially be preventable. Of children with seizures, 10% had had a neonatal seizure and 13% had had a febrile seizure. Among the hundreds of prenatal and perinatal factors explored as predictors of childhood seizure disorders, the principal predictors identified were congenital malformations of the fetus, cerebral and noncerebral; family history of certain neurologic disorders; and neonatal seizures. In agreement with the British National Child Development Study, labor and delivery factors in the NCPP appeared to contribute very little to childhood seizure disorders. Maldevelopment, rather than damage at birth to an initially intact nervous system, appeared to be the more common mechanism. Most seizure disorders of early childhood remained unexplained by the large set of prenatal and perinatal characteristics examined.     

Dextromethorphan: Cellular Effects Reducing Neuronal Hyperactivity

Summary: Dextromethorphan is a dextrorotary morphinan without affinity for opioid receptors, commonly used as an antitussive medication. During the past 5 years, interest in the compound and its demethylated derivative, dextrorphan, has been revived because additional neuroprotective and an-tiepileptic properties were found in in vitro studies, animal experiments, and a few clinical cases. Both morphinans are able to inhibit N -methyl-D-aspartate (NMDA) receptor channels and voltage-operated calcium and sodium channels with different potencies. The inhibition of the NMDA receptor is believed to be the predominant mechanism of action responsible for the anticonvulsant and neuroprotective properties of the compounds.     

Anticonvulsant Drugs and Cognitive Function: A Review of the Literature

Summary: Alterations of cognitive function are separate from disturbances of behavior seen in association with epilepsy. The nature of the cognitive disability may to a certain extent depend on the seizure type. Partial seizures, mainly derived from a temporal lobe focus, impair memory tasks, while generalized seizures seem to have more effect on attentional abilities. A number of studies, reviewed in this paper, suggest that anticonvulsant drugs further impair cognitive function. Maximal impairments are seen in patients receiving polytherapy: rationalization of polytherapy improves cognitive abilities. Studies in children and adults have allowed differentiation of the effects of various commonly used antiepileptic agents. Maximal cognitive deficits are seen with. phenytoin, while phenobarbital and sodium valproate induce moderate disturbances, and carbamazepine seems relatively free from such toxicity. Further research is needed on the interrelationship between types of seizure disorders, types of anticonvulsant medications, and cognitive function.     

Pediatric Epilepsy Surgery

Summary: The use of implantable arrays of epidural electrodes has made it possible to carry out extraoperative electrocorticography (ECoG) and functional localization in the awake child. This has permitted cortical excisions that are determined by criteria similar to those obtained during surgical procedures performed under local anesthesia in adults. In addition, the method also permits simultaneous ECoG and video monitoring during the child's symptomatic seizures, providing additional important localizing information that is impractical to obtain in operations under local anesthesia. We report our experience with 75 children, ages 5 months to 15 years, whom we have managed with epidural electrode arrays. The method of extraoperative ECoG is described and illustrative cases are presented to demonstrate its feasibility and utility in children. In addition, we call attention to gliomas as a common cause of chronic focal seizures in children. Of 49 children undergoing resection and followed for from 1 to 14 years (mean of 5.8 years), 32 (65%) are either seizure free or have had a significant reduction in seizure frequency that has unambiguously improved their quality of life. The results are analyzed further by relating the surgical outcome to each of the pathologic entities that caused the seizures. This analysis reveals the variety of neurological conditions that commonly cause intractable focal seizure disorder in children and distinguishes those pathologic entities in which the seizure disorder is apt to respond to surgical intervention from those that will not.