新型冠状病毒肺炎疫情心理危机干预步骤——Response模式

本文目的是为服务于本次新型冠状病毒肺炎(COVID-19)的广大心理援助者提供专业的指导和建议。根据临床工作和既往危机干预经验,本文详细介绍了进行危机干预的Response模型。Response模式包括8个步骤:建立治疗关系、评估、制定解决方案、优先排序、实证方法、价值中立、主观判断和退出。该模式在强调建立良好治疗关系的前提下,也强调心理援助者需要具备和疫情相关的基础知识,并进行准确评估、运用循证的心理治疗方法对求助者的核心诉求进行干预。本文将逐一讨论Response模型的干预步骤,供专业同行参考。     

创伤后应激障碍相关神经递质和神经肽的研究

与精神创伤有比较明显因果关系的精神障碍有急性应激障碍、创伤后应激障碍（PTSD）和适应障碍,其中,PTSD是应激相关障碍中临床症状最严重、预后最不好、最可能导致脑损害的一类精神障碍。目前,PTSD发病机制尚未阐明,本文对其相关神经递质和神经肽的生化研究进行了综述。     

瓦斯爆炸事件致创伤后应激障碍调查分析

创伤后应激障碍(posttraumatic stress disorder,PTSD)是由于受到威胁性、灾难性心理创伤,导致延长出现和长期持续的精神障碍[1].主要表现为再体验症状、回避症状、过度唤起症状、内疚、愤怒和失落感[2].我们对瓦斯爆炸事件中的相关人员进行调查,结果表明,这次爆炸事故是一次强烈的创伤性应激事件,受伤人员与其他相关人员均有符合第3版<中国精神障碍分类与诊断标准>中PTSD诊断标准[3]的病例,导致受伤者及相关人员广泛普遍的心理痛苦,PTSD发生率较高.     

PTSD相关睡眠障碍的概述

创伤后应激障碍（PTSD）是突发威胁性或灾难性事件所致的延迟出现且长期存在的一组精神障碍，以再度体验创伤、回避行为和警觉性增高等为表现。创伤应激后常出现睡眠障碍，尤其那些发展为PTSD者。睡眠障碍是PTSD标志性症状之一，以梦魇和失眠最常见，不仅出现早，严重影响生活质量、健康和well—being，且预示PTSD的发生、程度和转归（Maher等，CNSDrugs，2006）。本文简述了PTSD相关睡眠障碍，现报道于后。     

论创伤后应激障碍的司法精神病学鉴定

目的探讨创伤后应激障碍的本质特征及司法精神病学鉴定实践中争议较大的问题。方法对PTSD诊断标准和流行病学、应激源、发病机制及共病特征进行研究,对PTSD鉴定中存在的诊断扩大化倾向、人格特征关系、心理创伤界定、创伤性事件与精神障碍的关系、精神损伤程度的评定以及鉴别诊断进行分析论证。结果应激源的强烈程度并非导致PTSD发生的唯一因素,患者在创伤性事件前的人格特征、幼年经历、生活处境、遗传易感性以及事件后的社会支持系统启动程度等均可成为PTSD潜在致病因素。结论PTSD司法精神病学鉴定应采取多元化诊查措施做出评定,谨慎处置伪现象干扰。     

精神创伤后应激障碍的神经精神病学

关于精神创伤后应激障碍(PTSD)的研究很多,涉及到社会、心理和生物学的各个领域。本文从生物学的角度出发,在介绍了PTSD的诊断标准之后。综述了行为理论对PTSD的解释、PTSD的神经化学、特别强调了脑啡肽、内啡肽及大脑半球偏侧性与PTSD的关系。     

PTSD大鼠模型的实验研究

创伤后应激障碍(posttraumatic stress disorder,PTSD)是指受到亲身经历或目睹的异乎寻常的威胁性、灾难性事件所致的心理创伤,导致出现长期持续性精神障碍[1]。在竞争日益激烈的现代社会,应激事件日趋增多,PTSD的发生呈明显上升趋势,对PTSD的研究,可有效降低应激人群PTSD的发生,促进应激人群的身心健康。反复发生的闯入性体验的病     

糖皮质激素受体对创伤后记忆障碍的研究进展

创伤后应激障碍（posttraumatic stress disorder,PTSD）是指由于异常威胁或灾难性心理创伤导致延迟出现和长期持续的精神障碍。PTSD明显的特点之一是创伤后记忆障碍,表现为记忆失常,如记忆减退、恐惧记忆、高唤醒状态等。近年来,创伤后记忆障碍的机理受到广泛重视,其中糖皮质激素及其受体在创伤后记忆障碍发生中的作用和机制研究颇多,但观点存在较大分歧。本文对此项研究的现状和进展综述如下：     

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.     

创伤后应激障碍影像遗传学研究进展

正创伤后应激障碍(posttraumatic stress disorder,PTSD)是指经历严重威胁性、灾难性事件后,个体延迟出现并持久存在的一种精神障碍,该疾病具有高患病率、高自杀风险的特征,易造成患者强烈的心理痛苦和社会功能严重损伤,甚至影响患者一生。研究表明,约70%的人在一生中会经历创伤性事件,其中10%～20%的人会发展为PTSD,PTSD是环境因素与个体因素共同作用的结果~([1])。一项针对     

Methodology of a randomized double-blind clinical trial for comorbid posttraumatic stress disorder and alcohol dependence

INTRODUCTION: Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are each associated with profound disruptions in psychological, social, and physical functioning, and these disruptions are compounded in individuals with both disorders. Comorbidity between the two disorders is high, with the risk for AD increasing substantially among individuals with PTSD and, conversely, PTSD is highly prevalent among people experiencing AD. AIMS: Given the increased impairment associated with this comorbidity, it is imperative to develop effective treatments for individuals who experience both disorders. METHODS: This paper describes the methodology of a study that examines the efficacy of prolonged exposure therapy alone, naltrexone alone, and their combination compared to pill placebo in reducing the severity of PTSD and alcohol use in individuals with comorbid AD and PTSD. DISCUSSION: Issues related to design, assessment, treatment choice, and challenges posed by the study population are discussed.     

Assault characteristics and posttraumatic stress disorder in rape victims

A diagnosis of posttraumatic stress disorder (PTSD) encompasses several of the symptoms associated with the response to rape. The object of this study was to determine the incidence of PTSD among 51 rape victims and to compare the groups with and without PTSD with respect to the characteristics of the assaults. The results showed that 70% of the victims had PTSD and further suggested that PTSD was likely to be a long-term problem for these women. The results supported the view that psychological treatment approaches to rape victims should take into account the posttraumatic nature of the response. The incidence of rapes by strangers, of physical force being used, of weapons being displayed and of injuries being sustained by the victim were all higher in the group of women who had PTSD. These are all features that can be readily identified in the initial assessment of the rape victim and may help to identify the victims at risk of developing long-term psychological sequelae after rape. Appropriate therapeutic action taken early may influence the prognosis for a significant proportion of rape victims.     

Psychobiology of posttraumatic stress disorder in pediatric injury patients: a review of the literature

Research suggests that about a quarter to a third of children with traffic-related injuries develop posttraumatic stress disorder (PTSD). Early symptoms of PTSD have been found to predict poor mental and physical outcome in studies of medically injured children. However, these symptoms are rarely recognized by physicians who provide emergency care for these children. In addition, there is insufficient knowledge about predictors of posttraumatic stress symptoms in this specific pediatric population. Early identification of those children at particular risk is needed to target preventive interventions appropriately. After some introducing remarks on the classification and the nature of posttraumatic stress reactions, current research findings on psychological and biological correlates of PTSD in pediatric injury patients are presented. The particular focus in this paper is on the neurobiological mechanisms that influence psychological responses to extreme stress and the development of PTSD. Continued study of the psychobiology of trauma and PTSD in pediatric injury patients, both in terms of neurobiology and treatment is needed.     

Posttraumatic Stress Disorder in Adults: Impact,Comorbidity, Risk Factors,and Treatment

During the last 30 years, there has been a substantial increase in the study of posttraumatic stress disorder (PTSD). Several high-profile traumatic events, such as the wars in Afghanistan and Iraq, and the terrorist attacks of September 11 on the World Trade Center, have led to a greater public interest in the risk and protective factors for PTSD. In this In Review paper, I discuss some of the important advances in PTSD. The paper provides a concise review of the evolution of PTSD diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, impact of PTSD in the community, an overview of the established risk factors for developing PTSD, and assessment and treatment. Throughout the paper, controversies and clinical implications are discussed.     

Treating PTSD Within the Context of Heightened Suicide Risk

Because posttraumatic stress disorder (PTSD) is one of the few psychological conditions that predict suicidal behavior among those who think about suicide, many patients with PTSD present clinically with elevated suicide risk. Expert consensus and practice guidelines recommend against trauma-focused treatments for patients with elevated suicide risk, however. Research aimed at understanding the common mechanisms that underlie the association of PTSD and suicide risk has led to several advances in the effective care of suicidal patients diagnosed with PTSD. Based on these results, various combinations and sequences of suicide-focused treatments, risk management procedures, and trauma-focused treatments are implicated.     

Prediction of posttraumatic stress disorder by immediate reactions to trauma: a prospective study in road traffic accident victims

Road traffic accidents often cause serious physical and psychological sequelae. Specialists of various medical faculties are involved in the treatment of accident victims. Little is known about the factors which might predict psychiatric disorders, e.g. Posttraumatic Stress Disorder (PTSD) after accidents and how psychological problems influence physical treatment. In a prospective study 179 unselected, consecutively admitted road traffic accident victims were assessed a few days after the accident for psychiatric diagnoses, severity of injury and psychopathology. All were inpatients and had to be treated for bone fractures. At 6-months follow-up assessment 152 (85%) of the patients were interviewed again. Of the patients, 18.4% fulfilled the criteria for Posttraumatic Stress Disorder (DSM-III-R) within 6 months after the accident. Patients who developed PTSD were injured more severely and showed more symptoms of anxiety, depression and PTSD a few days after the accident than patients with no psychiatric diagnosis. Patients with PTSD stayed significantly longer in the hospital than the other patients. Multiple regression analysis revealed that the length of hospitalization was due mainly to a diversity of factors such as severity of injury, severity of accident, premorbid personality and psychopathology. Posttraumatic stress disorder is common after road traffic accidents. Patients with PTSD at follow-up can be identified by findings from early assessment. Untreated psychological sequelae such as PTSD cause longer hospitalization and therefore more costs than in non-PTSD patients. Received: 20 April 1998 / Accepted: 9 October 1998     

Posttraumatic stress disorder among Israeli ex-prisoners of war 18 and 30 years after release

BACKGROUND: The psychological responses to captivity were measured in a sample of former prisoners of war (POWs) 18 and 30 years after release from captivity. METHOD: 209 Israeli veterans of the 1973 Yom Kippur War (103 ex-POWs and 106 controls) who had taken part in a previous study conducted in 1991 participated in the current study conducted in 2003. The study assessed current rates of posttraumatic stress disorder (PTSD), changes in PTSD over time, and the contribution of captivity severity (objective and subjective), sociode-mographic variables, and psychological appraisal and coping with captivity to predicting PTSD using standardized self-report questionnaires. RESULTS: Twenty-three percent of the ex-POWs met PTSD criteria and were 10 times more likely than controls to experience deterioration in their psychological condition in the 12-year interval between the 2 assessments. Almost 20% of ex-POWs who did not meet PTSD criteria in 1991 met criteria in the current assessment, in comparison to almost 1% of the controls. Current PTSD was predicted by younger age at the time of captivity, by loss of emotional control and higher subjective appraisal of suffering in captivity, and by a greater number of PTSD symptoms in the 1991 assessment. CONCLUSION: It is important to follow up and offer treatment to former POWs. Special attention should be paid to those who lost emotional control in captivity and to those who felt that the conditions of their captivity were severe.     

Post-traumatic stress disorder and traumatic brain injury: A review of causal mechanisms,assessment,and treatment

In this paper we explore the evidence for post-traumatic stress disorder (PTSD) after traumatic brain injury (TBI). We examine its possible mediating mechanisms after brain injury, the evidence for its occurrence, risk, and protective factors, and the implications for intervention and service demands. In the first section we review the current literature relevant to cause, maintenance, and treatment of PTSD in general, before addressing issues associated with the assessment and management of PTSD after TBI. It is argued that PTSD may occur after a brain injury, and can be, relatively, a common disorder. However, explanatory mechanisms for its occurrence may be speculative. In this context, we argue, assessment and treatment need to be carefully considered, and comprehensive.     

Post-traumatic stress disorder and traumatic brain injury: A review of causal mechanisms, assessment,and treatment

In this paper we explore the evidence for post-traumatic stress disorder (PTSD) after traumatic brain injury (TBI). We examine its possible mediating mechanisms after brain injury, the evidence for its occurrence, risk, and protective factors, and the implications for intervention and service demands. In the first section we review the current literature relevant to cause, maintenance, and treatment of PTSD in general, before addressing issues associated with the assessment and management of PTSD after TBI. It is argued that PTSD may occur after a brain injury, and can be, relatively, a common disorder. However, explanatory mechanisms for its occurrence may be speculative. In this context, we argue, assessment and treatment need to be carefully considered, and comprehensive.     

Coroners and PTSD: Treatment Implications

Experimental studies have documented the development of posttraumatic stress disorder (PTSD) in first responders. These studies have routinely included police, firefighters, and paramedics. However, there is another group of first responders that are at risk for PTSD but that has received less research attention. This group is comprised of coroners. This paper reviewed the published data concerning coroners and PTSD and outlined various treatments for addressing coronial PTSD. The findings, the differing treatments, and a detailed methodological inquiry are presented. The need for a conceptual framework for the various other professional groups responding to critical incidents and a crisis intervention approach to address the psychological needs of both family survivors and coronial personnel are noted.