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.     

对汶川大地震62例伤残患者的心理健康状况调查

目的调查5．12汶川大地震6个月后62例伤残患者的心理健康状况。方法采用焦虑自评量表（SAS）、抑郁自评量表（SDS）及创伤后应激障碍检查量表平民版（PCL—C）对伤残患者进行评定。结果抑郁症状的阳性率为67．7％（42／62）、焦虑症状为37．1％（23／62）,创伤后应激障碍症状为30．6％（19／62）;24．2％（15／62）的患者共患抑郁、焦虑及PTSD;心理健康状况与性别、民族差异无统计学意义（P〉0．05）。结论地震后6个月伤残患者中存在较严重的焦虑、抑郁症状及创伤后应激障碍,应予重点关注。     

认知暴露疗法治疗创伤后应激障碍的5年随访

目的:探讨5年随访时认知暴露治疗对创伤后应激障碍(PTSD)患者的效果. 方法:63例PTSD患者随机分为两组,分别进行药物治疗和心理治疗,并且在治疗前、治疗后、治疗后3个月、治疗后5年进行心理状况评定. 结果:重复测量的方差分析表明,在创伤后应激障碍症状清单量表(PCLS)、症状自评量表、贝克抑郁问卷、汉米尔顿抑郁量表、状态-特质焦虑问卷及汉米尔顿焦虑量表上,总体上组间(药物和心理治疗)效应不显著(F=3.111,P＞0.05),时间(重复变量)效应显著(F=9.011,P＜0.01).治疗后心理治疗组PCLS再经历和回避分比药物治疗组下降更显著. 结论:认知暴露治疗和药物治疗对PTSD患者疗效相近,认知暴露治疗对再经历症状和回避症状疗效更好.     

创伤后应激障碍患者的脑干诱发电位分析

目的：探讨创伤后应激障碍（PTSD）患者的脑干听觉诱发电位（BAEP）变异特点及其与心身症状的关系。方法：对54例PTSD患者进行BAEP检测和心身症状评定，分析BAEP与心身症状的相关性，并与健康人作比较。结果：PTSD患者Pz脑区Ⅲ、Ⅴ波绝对潜伏期和Ⅰ～Ⅲ波间期均延迟，Ⅲ～Ⅴ波间期缩短，Ⅴ／Ⅰ波波幅比下降；症状自评量表（SCL-90）的总分及其躯体化、强迫、抑郁、焦虑因子分，事件影响量表（IES）的总分及其回避、闯入因子分显著高于对照组；Pz脑区BAEP各波的观察指标与大部分心身症状的相关有显著性意义。结论：BAEP检测为PTSD患者的临床辅助诊断提供了一种敏感、客观的电生理学手段。     

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....     

矿难受害者及家属创伤后应激障碍研究

目的：研究创伤后应激障碍(PTSD)对人体产生的神经生理心理学影响。方法：采用对照研究的方法，定期随访死亡矿工家属、获救矿工及其家属的神经生理心理学变化，并与周围人群作对照。结果：PTSD患者在焦虑自评量表(SAS)、抑郁自评量表(SDS)、PTSD评分及海马体积等方面均发生持久改变。结论：PTSD对人体造成神经生理心理等多方面损害，应采取积极有效措施，早期干预治疗。     

高频重复经颅磁刺激联合帕罗西汀治疗创伤后应激障碍的疗效

目的 观察高频重复经颅磁刺激（rTMS）对创伤后应激障碍（PTSD）的辅助疗效.方法 将60例创伤后应激障碍患者随机分为联合组及对照组,联合组采用帕罗西汀治疗,配合右侧前额叶背外侧部、10Hz高频rTMS.对照组采用帕罗西汀治疗及假性重复经颅磁刺激治疗.两组患者均治疗4周,并进行基线、治疗后创伤后应激障碍检查表（PCL）及汉密尔顿抑郁测评量表（HAMD）、汉密尔顿焦虑测评量表（HAMA）评定.结果 57例患者完成研究,两组患者治疗后PCL总分及重现、回避、警觉性增高因子分、HAMD、HAMA评分均较治疗前降低,差异有统计学意义（P＜0.05）;联合组治疗4周末PCL测评总分、重现、警觉性增高因子、HAMA治疗前后评分差均较对照组高,差异有统计学意义（P＜0.05）.结论 帕罗西汀能够改善PTSD的核心症状及抑郁、焦虑症状;在帕罗西汀治疗基础上,10 Hz重复经颅磁刺激能够增加对PTSD的重现、警觉性增高等核心症状及焦虑症状的疗效.     

创伤后应激障碍与血同型半胱氨酸、叶酸及维生素 B12的相关性

目的 探讨创伤后应激障碍（PTSD）患者应激症状与血同型半胱氨酸、叶酸、维生素B12 代 谢的相关性。方法 2016 年11 月—2017 年11 月对驻疆某部官兵经历创伤性事件后，按照创伤后应激 障碍筛查量表（PCL-C）评分阳性和美国精神疾病诊断统计手册第五版（DSM-5）的诊断标准，根据是否为 PTSD分为PTSD组（n=27）和在相同暴露条件下的未患PTSD的对照组（n=39）。对两组空腹血浆同型半胱 氨酸、叶酸、维生素B12 及部分其他血液学指标进行分析。结果 PTSD组血同型半胱氨酸水平高于对照 组，叶酸、维生素B12 水平、T3、T4低于对照组，差异均有统计学有意义，而TSH、LDL、HDL-C 组间比较， 差异均无统计学意义。结论 PTSD患者其血同型半胱氨酸较高，叶酸及维生素B12 水平较低。     

唐山大地震所致孤儿心理创伤后应激障碍的调查

目的 调查唐山大地震所致孤儿的心理创伤后应激障碍的发生情况。方法 应用中国精神疾病分类方案与诊断标准第２版修订本中的急性应激反应（ＡＳＲ）和心理创伤后应激障碍（ＰＩＳＤ）诊断标准,于１９９８年３月对５７例地震所致孤儿进行诊断,按有无ＰＩＳＤ分为患者和正常组,采用焦虑自评量表（ＳＡＳ）、症状自评量表（ＳＣＬ－９０）、明尼苏达多相个性测查表（ＭＭＰＩ）等进行测评和比较。结果 ５７例中有２７例（４７％）     

玉树地震后罹患创伤后应激障碍、焦虑症和抑郁症调查

目的:调查玉树地震后不同人群创伤后应激障碍(PTSD)、焦虑症、抑郁症的发生情况。方法:抽取震后灾区人群、其非灾区的亲属人群、灾区救援人群及非灾区人群为对象,每一人群进行随机分成两组,第1组每周进行1次集体心理干预;第2组每周进行3次集体心理干预。采用PTSD检查量表平民版(PCL-C)、焦虑自评量表(SAS)、抑郁自评量表(SDS)对不同人群在3个月、6个月进行问卷调查。结果:各人群在干预3个月和6个月均检出PTSD、焦虑症、抑郁症。各人群中第2组干预6个月时PTSD、焦虑症、抑郁症检出率明显低于干预3个月时(P均0.05)。结论:震后不同人群均存有PTSD、焦虑症、抑郁症发生;随着时间推移及积极干预可明显降低其发生。     

小学生焦虑抑郁障碍共病调查

目的：探讨小学生焦虑抑郁障碍共病情况。方法：用儿童焦虑障碍筛查量表（SCRED）对县城2900名及农村1800名8～14岁小学生进行筛查,对筛查出的焦虑障碍儿童进行抑郁障碍诊断,对焦虑与抑郁障碍共病儿童实施相关量表及问卷测量。结果：儿童焦虑抑郁障碍共病率为12.7%,其中县城12.9%,农村12.3%,两地差异无统计学意义（χ2=0.011,P=0.915）。焦虑抑郁障碍共病儿童与仅有焦虑障碍儿童在焦虑量表及家庭功能评定量表上得分差异均无显著性（P均〉0.05）,抑郁量表分与焦虑量表的躯体焦虑、广泛焦虑及焦虑总分呈显著相关（P〈0.001）。结论：小学生焦虑与抑郁障碍共病率较高。     

心理社会干预对中学生自杀高危人群的影响

目的:探讨心理社会干预对有自杀意念和自杀行为的中学生的影响。方法:通过流行病学调查,筛选出有自杀风险的高危中学生65人。除接受学校常规心理健康课程外,还参加团体认知行为实践辅导;对学生家长进行自杀预防宣教。并在干预前行青少年生活事件量表(ASLEC)、社会支持评定量表(SSRS)、简易应对方式问卷(SCSQ)、家庭环境问卷(FES)、Beck抑郁量表(BDI)、自杀意念自评量表(SIOSS)、和自尊量表(SES)问卷基线评估、干预后6个月及18个月后问卷随访评估效果。结果:干预后,青少年生活事件总应激量差异无统计学意义(F=1.350,P=0.264,P0.05);其他问卷在干预后6个月及18个月后随访与基线比较差异均存在统计学意义(P0.05),而干预后6个月随访与12个月后随访上述指标无统计学差异(P0.05)。结论:心理社会干预对改善中学生自杀意念及自杀行为短期内有一定的效果。     

Treating acute stress disorder: an evaluation of cognitive behavior therapy and supportive counseling techniques.

OBJECTIVE: Acute stress disorder permits an early identification of trauma survivors who are at risk of developing chronic posttraumatic stress disorder (PTSD). This study aimed to prevent PTSD by an early provision of cognitive behavior therapy. Specifically, this study indexed the relative efficacy of prolonged exposure and anxiety management in the treatment of acute stress disorder. METHOD: Forty-five civilian trauma survivors with acute stress disorder were given five sessions of 1) prolonged exposure (N = 14), 2) a combination of prolonged exposure and anxiety management (N = 15), or 3) supportive counseling (N = 16) within 2 weeks of their trauma. Forty-one trauma survivors were assessed at the 6-month follow-up. RESULTS: Fewer patients with prolonged exposure (14%, N = 2 of 14) and prolonged exposure plus anxiety management (20%, N = 3 of 15) than supportive counseling (56%, N = 9 of 16) met the criteria for PTSD after treatment. There were also fewer cases of PTSD in the prolonged exposure group (15%, N = 2 of 13) and the prolonged exposure plus anxiety management group (23%, N = 3 of 13) than in the supportive counseling group (67%, N = 10 of 15) 6 months after the trauma. Chronic PTSD in the supportive counseling condition was characterized by greater avoidance behaviors than in the prolonged exposure condition or the prolonged exposure plus anxiety management condition. CONCLUSIONS: These findings suggest that PTSD can be effectively prevented with an early provision of cognitive behavior therapy and that prolonged exposure may be the most critical component in the treatment of acute stress disorder.     

The Role of Traumatic Experiences and Posttraumatic Stress on Social Anxiety in a Youth Sample in Lithuania

Emerging adulthood is a developmental stage with an increased vulnerability to mental disorders. Social anxiety disorder (SAD) is highly prevalent anxiety disorder especially among adolescents and young adults. Furthermore, SAD is highly comorbid with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the prevalence of SAD, life-time traumatic experiences and PTSD among Lithuanian young adults studying at the Universities. We also aimed to search for associations between social anxiety, traumatic experiences, and posttraumatic stress in our sample. In total 590 young adults (67.7% female), aged 20 years on average and studying at the Universities in Lithuania were recruited for this study. Self-report measures were used to measure SAD and PTSD. SAD was measured using the Social Phobia Inventory (SPIN), and PTSD was measured using the Impact of Event Scale – Revised (IES-R). SAD prevalence based on SPIN cut-off >26 in our sample was 15.3%, life-time trauma exposure was 67.5%. No association between accumulative trauma exposure and SAD was found. SAD symptoms were highly correlated with PTSD symptoms. Comorbidity between SAD and PTSD was high, with 32.2% cases of PTSD in SAD group. We found high comorbidity between SAD and PTSD in our study among young adults. Further studies are needed to explore development of SAD and PTSD in longitudinal studies.

     

癫患者焦虑抑郁情绪研究

目的：探讨癫癎患者焦虑抑郁情绪的有关因素。方法：80例成年癫癎患者，前期诊疗不规范，采用焦虑自评量表（SAS）和抑郁自评量表（SDS）评估。结果：癫癎合并焦虑情绪者25％，合并抑郁情绪者45％。多因素回归分析结果显示，病程越长，发作程度越严重，男性患者更易产生焦虑情绪，而居住在农村的癫癎患者更易产生抑郁情绪。结论：癫癎患者焦虑抑郁情绪明显高于正常人群，性别、病程、发作严重程度和生活居住地是影响癫癎患者焦虑抑郁情绪的独立危险因素。     

An Evidence-Based Review of Early Intervention and Prevention of Posttraumatic Stress Disorder

We present an evidence-based review of post-trauma interventions used to prevent posttraumatic stress disorder (PTSD). Literature search of PubMed from 1988 to March 2016 using keywords “Early Intervention AND Prevention of PTSD” yielded 142 articles, of which 52 intervention studies and 6 meta-analyses were included in our review. Trauma-focused cognitive behavioral therapy and modified prolonged exposure delivered within weeks of a potentially traumatic event for people showing signs of distress have the most evidence in the treatment of acute stress and early PTSD symptoms, and the prevention of PTSD. Even though several pharmacological agents have been tried, only hydrocortisone prior to high-risk surgery, severe traumatic injury, or during acute sepsis has adequate evidence for effectiveness in the reduction of acute stress symptoms and prevention of PTSD. There is an urgent need to determine the best targets for interventions after trauma to accelerate recovery and prevent PTSD.     

A twin registry study of familial and individual risk factors for trauma exposure and posttraumatic stress disorder

This study examines the association of individual and familial risk factors with exposure to trauma and posttraumatic stress disorder (PTSD) in male twins (N = 6744) from the Vietnam Era Twin Registry. Independent reports of familial psychopathology from co-twins were used to avoid the potential biases of the family history method. Risk for exposure to traumatic events was increased by service in Southeast Asia, preexisting conduct disorder, preexisting substance dependence, and a family history of mood disorders whose effects appear to be partly genetic. Preexisting mood disorders in the individual were associated with decreased odds of traumatic exposure. Risk of developing PTSD following exposure was increased by an earlier age at first trauma, exposure to multiple traumas, paternal depression, less than high school education at entry into the military, service in Southeast Asia, and preexisting conduct disorder, panic disorder or generalized anxiety disorder, and major depression. Results suggest the association of familial psychopathology and PTSD may be mediated by increased risk of traumatic exposure and by preexisting psychopathology.