艾滋病感染者中创伤后应激障碍的发病率及症状结构

目的:本研究考察我国艾滋病感染者中创伤后应激障碍的发病率及其症状结构。方法:样本1为云南省HIV感染者91名,样本2为该省和北京HIV感染者366名,施测自编创伤事件问卷及创伤后应激障碍检查表(PCLC),用DSM-Ⅳ轴Ⅰ障碍定式临床检查病人版(SCID-I)访谈对样本1被试进行诊断评估,确定PCL-C区分PTSD的分界点;用验证性因素分析比较PTSD症状结构的3个竞争模型。结果:1再体验-回避-麻木-警觉一阶四因子模型拟合最优;2PCL-C区分HIV感染者罹患PTSD的最佳分界点为44分,对应敏感度0.842,特异度0.906,诊断效能0.94,样本1中PTSD发病率为41.80%。结论:PTSD在HIV感染者人群中发病率高,PCL-C在该人群中呈一阶四因子一阶相关结构,提示该种症状分类具有跨样本一致性。     

Reconsidering the autohypnotic model of the dissociative disorders

The dissociative disorders field and the hypnosis field currently reject the autohypnotic model of the dissociative disorders, largely because many correlational studies have shown hypnotizability and dissociation to be minimally related (r = .12). Curiously, it is also widely accepted that dissociative patients are highly hypnotizable. If dissociative patients are highly hypnotizable because only highly hypnotizable individuals can develop a dissociative disorder – as the author proposes – then the methodology of correlational studies of hypnotizability and dissociation in random clinical and community samples would necessarily be constitutively unable to detect, and statistically unable to reflect, that fact. That is, the autohypnotic, dissociative distancing of that small subset of highly hypnotizable individuals who repeatedly encountered intolerable circumstances is statistically lost among the data of (1) the highly hypnotizable subjects who do not dissociate and (2) subjects (of all levels of hypnotizability) who manifest other kinds of dissociation. The author proposes that, when highly hypnotizable individuals repeatedly engage in autohypnotic distancing from intolerable circumstances, they develop an overlearned, highly-motivated, automatized pattern of dissociative self-protection (i.e., a dissociative disorder). The author urges that theorists of hypnosis and the dissociative disorders explicitly include in their theories (a) the trait of high hypnotizability, (b) the phenomena of autohypnosis, and (c) the manifestations of systematized, autohypnotic pathology. Said differently, the author is suggesting that autohypnosis and autohypnotic pathology are unacknowledged nodes in the nomothetic networks of both hypnosis and dissociation.     

Comparing the symptoms and mechanisms of “dissociation” in dissociative identity disorder and borderline personality disorder

A total of 75 patients were diagnosed with the Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised as having dissociative identity disorder (DID), and 100 patients were diagnosed with the Structured Interview for DSM–IV Personality as having borderline personality disorder (BPD). Both groups were administered the Multidimensional Inventory of Dissociation (MID). DID patients had significantly higher MID scores than BPD patients, different distributions of MID scores, and different MID subscale profiles in 3 ranges of MID scores (0–15, 15–30, 30–45). The core MID symptoms—exhibited at all ranges of MID scores—for DID patients (the presence of alters, identity confusion, and memory problems) and BPD patients (flashbacks, identity confusion, and memory problems) were ostensibly similar but were considered to be mostly produced by different underlying processes. Multiple regression analyses showed that the core MID symptoms of DID patients had different predictors than did the core MID symptoms of BPD patients. Alter identities seemed to generate most—but not all—dissociative phenomena in DID patients, whereas only the 24% highest scoring BPD patients (MID ≥45) seemed to manifest alter-driven dissociative experiences. Most BPD dissociative experiences appeared to be due to 5 other mechanisms: (a) BPD-specific, stress-driven, rapid shifts of self-state; (b and c) nondefensive disruptions of the framework of perceptual organization with or without an accompanying BPD-specific, dissociation-like disintegration of affective/neurocognitive functioning; (d) a defensive distancing or detachment from distress (i.e., simple depersonalization); and (e) Allen, Console, and Lewis’s (1999) severe absorptive detachment.     

PTSD and its dissociative subtype through the lens of the insula: Anterior and posterior insula resting-state functional connectivity and its predictive validity using machine learning

Individuals with post-traumatic stress disorder (PTSD) typically experience states of reliving and hypervigilance; however, the dissociative subtype of PTSD (PTSD+DS) presents with additional symptoms of depersonalization and derealization. Although the insula is critical to emotion processing, its association with these contrasting symptom profiles is yet to be fully delineated. Accordingly, we investigated insula subregion resting-state functional connectivity patterns among individuals with PTSD, PTSD+DS, and healthy controls. Using SPM12 and PRONTO software, we implemented a seed-based resting-state functional connectivity approach, along with multiclass Gaussian process classification machine learning, respectively, in order to evaluate unique patterns and the predictive validity of insula subregion connectivity among individuals with PTSD (n = 84), PTSD+DS (n = 49), and age-matched healthy controls (n = 51). As compared to PTSD and PTSD+DS, healthy controls showed increased right anterior and posterior insula connectivity with frontal lobe structures. By contrast, PTSD showed increased bilateral posterior insula connectivity with subcortical structures, including the periaqueductal gray. Strikingly, as compared to PTSD and controls, PTSD+DS showed increased bilateral anterior and posterior insula connectivity with posterior cortices, including the left lingual gyrus and the left precuneus. Moreover, machine learning analyses were able to classify PTSD, PTSD+DS, and controls using insula subregion connectivity patterns with 80.4% balanced accuracy (p < .01). These findings suggest a neurobiological distinction between PTSD and its dissociative subtype with regard to insula subregion functional connectivity patterns. Furthermore, machine learning algorithms were able to utilize insula resting-state connectivity patterns to discriminate between participant groups with high predictive accuracy.     

汶川地震孤儿的创伤后应激障碍和自我意识

目的:了解震后6个月地震孤儿创伤后应激障碍(PTSD)和自我意识的相互关系。方法:利用Piers-Harris儿童自我意识量表和儿童事件影响量表修订版对111名震后孤儿进行评定。结果:震后孤儿PTSD检出率为39.6%;除智力与学校情况、躯体外貌与属性两个维度之外,自我意识其它维度与PTSD症状成显著负相关,其中焦虑维度可显著预测PTSD。结论:低自我意识中的低焦虑得分可显著预测PTSD,震后及时的自我意识水平筛查可在一定程度指导孤儿心理援助工作。     

烟台海难援救军人PTSD发生的影响因素分析

目的：了解影响海难援救军人的创伤后应激障碍（PTSD）发生的相关因素,探讨影响其发生的危险因素及其作用。方法：采用PTSD自评量表,症状自评量表（SCL－90）,生活事件理表（LES）,艾森克问卷（EPQ）和自行编制的涉及应激事件强度和人口学等因素的调查表,在海难事件后1个月对参与善后援救军人进行调查,并分析统计其影响PTSD发生的相关因素。结果：PTSD的得分高低与能否获取经济帮助,对上级领导工作方法和善后处理的满意程度,善后处理中打捞和目睹的尸体量呈显著负相关;与生活事件评分,善后处理中抢救幸存者的数量和EPQ的N得分呈显著正相关;PTSD得分与SCL－90总分,总均分,阳性项目数,阳性症状均分,身体化,强迫症状,人际敏感,抑郁,焦虑,敌对,恐怖,偏执,精神病性和附加因子量表分均呈显著正相关,而与阴性症状项目数呈负相关。结论：该海难事件是一强烈的应激事件,PTSD发生率高,LES量表分和EPQ的N量表得分与PTSD严重程度密切相关,可望通过改善上级领导工作方法和善后处理方法,积极争取支持,以降低其发生或减轻其严重程度。     

Information processing and PTSD: a review of the empirical literature

This article reviews a series of studies that have utilized information-processing paradigms with posttraumatic stress disorder (PTSD) populations. The review suggests that pretrauma measures of intelligence (IQ) are predictive of the development of PTSD symptoms following trauma. There is also evidence of impaired performance on standardized tests of memory (independent of IQ) in PTSD populations. PTSD populations are found to exhibit deficits in memory function that may be due to hippocampus damage secondary to excessive neuroendocrine responses to conditioned stimuli. In addition, individuals with PTSD evince an attentional bias towards trauma-related stimuli at postrecognition stages of information processing. The review also includes that there is insufficient evidence to either support, or reject, the theoretical proposition that PTSD patients are sensitive to global valence effects at the earliest stages of information processing relative to traumatized non-PTSD populations. Finally, there is some evidence to suggest that the processes associated with autobiographical memory in PTSD populations are similar to those seen in depression. The implications of these findings for the behavioral and cognitive treatment of PTSD are discussed. Directions for future research with such paradigms are also discussed in light of contemporary information processing theories of PTSD.     

汶川地震幸存者的创伤后应激障碍及其影响因素

目的:评估汶川大地震对幸存者所带来的心理影响,以便为进行心理援助和治疗的临床工作者提供更有价值的诊断信息。方法:对安置在绵竹体育中心灾民安置点的956名地震幸存者施测了创伤暴露水平问卷,事件冲击量表(IES-R)和D型人格量表(DS-14)。结果:在地震发生之后不久,有82.6%的被试表现出创伤后应激障碍;在地震中创伤暴露水平高的被试更有可能表现出创伤后应激障碍;女性被试、中年被试、已婚被试以及拥有D型人格的被试更可能产生创伤后应激障碍;回归分析的结果表明性别、年龄、婚姻状态、创伤暴露水平以及D型人格中的负性情绪是影响被试是否表现出创伤性应激障碍的关键因素。结论:有较高比例的地震幸存者表现出创伤后应激障碍,高创伤暴露水平、女性、中年、已婚和负性情绪是幸存者表现出创伤后应激障碍的主要影响因素。     

The role of clinical experience,diagnosis, and theoretical orientation in the treatment of posttraumatic and dissociative disorders: A vignette and survey investigation

Controversy exists regarding the merits of exposure-based treatments for posttraumatic stress disorder (PTSD) versus a phased approach when prominent dissociative symptoms are present. The first aim of this study was to examine the degree to which diagnosing dissociation in two traumatized patients’ vignettes influenced clinicians’ preference for phase-oriented treatment and whether clinicians’ treatment experience contributed to their treatment preference. The second aim was to assess the extent to which participants had observed traumatized patients worsen when treated with exposure therapy or phase-oriented therapy and whether the theoretical orientation and treatment experience of the clinician were related to the observed deterioration. In the tradition of expert and practitioner surveys, 263 clinicians completed a survey of their diagnoses and treatment preferences for two vignettes and their treatment experience, theoretical orientation, and observations of patients’ deterioration. When a marked degree of dissociation was noted in the PTSD vignette, respondents favored phased approaches regardless of the diagnosis given. Reports of having observed patient deterioration during both exposure and phased therapy were predicted by years of experience. Psychodynamic therapists reported more observations of worsening during exposure therapy than cognitive behavior therapy therapists. Clinical experience treating PTSD may heighten awareness of negative therapeutic effects, potentially because experienced clinicians have a lower threshold for detecting such effects and because they are referred more challenging cases.     

A consideration of select pre-trauma factors as key vulnerabilities in PTSD

Posttraumatic stress disorder (PTSD) is a pathological response to a traumatic event. A number of risk and vulnerability factors predicting PTSD development have been identified in the literature. Many of these variables are specific factors occurring during and after exposure to a traumatic event or are not measured prospectively to assess temporal sequence. Recent research, however, has begun to focus on pre-trauma individual differences that could contribute to risk for developing PTSD. The present review proposes that a number of biological and cognitive vulnerability factors place individuals at risk for PTSD development prior to the actual experience of trauma. Accordingly, this review provides a summary of evidence for a select number of these factors as pre-trauma vulnerabilities to PTSD. Included is a discussion of biological factors, including molecular genetic studies of systems regulating serotonin, catecholamines, and glucocorticoids as well as aspects of the neuroendocrine system. Specific cognitive factors are also considered, including intelligence, neuropsychological functioning and cognitive biases such as negative attributional style and appraisals. For each factor, the present review summarizes evidence to date regarding PTSD vulnerability and highlights directions for future research in this area.     

Women with PTSD have lower basal salivary cortisol levels later in the day than do men with PTSD: A preliminary study

Acute stress responses of women are typically more reactive than that of men. Women, compared to men, may be more vulnerable to posttraumatic stress disorder (PTSD). Whether there are differences between women and men with PTSD in levels of the stress hormone, cortisol, was investigated in a pilot study. Methods: women (n = 6) and men (n = 3) motor vehicle accident (MVA) survivors, with PTSD, had saliva collected at 1400 h, 1800 h, and 2200 h. Cortisol levels in saliva were measured by radioimmunoassay. An interaction between gender and time of sample collection was observed due to women's cortisol levels being lower and decreasing over time, whereas men's levels were higher and increased across time of day of collection. Results of this pilot study suggest a difference in the pattern of disruption of glucocorticoid secretion among women and men with PTSD. Women had greater suppression of their basal cortisol levels than did men; however, the diurnal pattern for cortisol levels to decline throughout the day was observed among the women but not the men.     

Etiology of depression comorbidity in combat-related PTSD: A review of the literature

Posttraumatic stress disorder is often diagnosed with other mental health problems, particularly depression. Although PTSD comorbidity has been associated with more severe and chronic symptomology, relationships among commonly co-occurring disorders are not well understood. The purpose of this study was to review the literature regarding the development of depression comorbid with combat-related PTSD among military personnel. We summarize results of commonly tested hypotheses about the etiology of PTSD and depression comorbidity, including (1) causal hypotheses, (2) common factor hypotheses, and (3) potential confounds. Evidence suggests that PTSD may be a causal risk factor for subsequent depression; however, associations are likely complex, involving bidirectional causality, common risk factors, and common vulnerabilities. The unique nature of PTSD–depression comorbidity in the context of military deployment and combat exposure is emphasized. Implications of our results for clinical practice and future research are discussed.     

葡萄糖调节蛋白78和内质网调节蛋白57在PTSD大鼠前额皮质的表达

目的观察创伤后应激障碍(PTSD)大鼠前额皮质(mPFC)神经元未折叠蛋白反应(unfolded protein response,UPR)标志物葡萄糖调节蛋白78(GRP78)和内质网调节蛋白57(ERP57)的表达变化,探讨内质网分子伴侣在PTSD发病机制中的作用。方法采用国际认定的PTSD动物模型-SPS大鼠模型,取80只成年雄性健康Wistar大鼠,随机分为正常组和SPS模型组(SPS1d,SPS4d,SPS7d),采用逆转录-聚合酶链式反应、免疫组织化学法和免疫印记检测PTSD-SPS大鼠m PFC神经元中GRP78和ERP57的表达变化。结果 SPS刺激后大鼠m PFC神经元细胞内GRP78和ERP57蛋白表达于1d开始逐渐升高,7d时表达最多;GRP78和ERP57的m RNA水平的变化与其蛋白表达变化相一致。结论 GRP78和ERP57在PTSD大鼠mPFC过表达可能参与SPS刺激诱导的UPR反应。     

Gender differences in the prevalence of childhood sexual abuse and in the development of pediatric PTSD

Summary Despite an extensive literature on the links between childhood sexual abuse (CSA) and posttraumatic stress disorder (PTSD), our knowledge on the effects of gender in relation to the risks for sexual victimization and subsequent PTSD is limited. We review current knowledge of gender differences in prevalence of CSA and the role of gender in subsequent development of child and adolescent PTSD with specific attention to rates, phenomenology, biological correlates, and risk factors. Despite the heavy bias toward female representation in studies, the literature supports increased rates of CSA and heightened vulnerability to PTSD in girls, as well as possible gender differences in the biological correlates and psychiatric sequelae of CSA. Further work is needed to explore the mechanisms that underlie these differences.     

洪灾区成人PTSD及其危险因素的研究

目的：了解洪灾区成人PTSD的发生率及其影响因素。方法：用美国《精神障碍的诊断统计手册》第四版(MSD-Ⅳ)中对于PTSD的诊断标准对洪灾区成人进行PTSD评定。结果：洪灾后PTSD检出率为33．8％，其主要的影响因素为洪灾类型(OR=4．07)、曾被水围困等待救援(OR=2．65)，曾亲眼看见别人被洪水淹死(OR=2．77)，有和水中死人呆在一起的经历(OR=3．14)，对支持的满意度(OR=0．72)等。结论：我国洪灾区成年人中PTSD的发生并非罕见．应采取针对性的干预措施。     

PTSD symptoms associated with the experiences of psychosis and hospitalisation: A review of the literature

There is evidence of high rates of PTSD in people with psychosis, but the influence that symptoms or hospitalisation have on PTSD in individuals with psychosis is less clear. This paper reviewed studies investigating the prevalence of PTSD induced as a result of the experience of psychosis and hospitalisation and factors that might influence its development. The review included 24 studies, published between 1980 and 2011. Studies showed high levels of PTSD resulting from the trauma of symptoms and/or hospitalisation, with prevalence rates for actual PTSD resulting from these traumas varying from 11% to 67%. In line with studies of PTSD related to other traumatic events, there were inconsistent associations between PTSD and severity of positive and negative symptoms, but there were consistent associations between affective symptoms and PTSD. There were also inconsistent associations between hospital experiences and PTSD. Consistent with the general PTSD literature, there was some evidence that psychosis-related PTSD was associated with trauma history. There was also some emerging evidence that psychological variables, such as appraisals and coping style may influence psychosis-related PTSD. The review highlights the need for further research into psychological mechanisms that could increase vulnerability to psychosis-related PTSD and treatment approaches.     

江西省万载县芳林小学爆炸案幸存小学生心理创伤后应激障碍调查

目的 了解爆炸案幸存者PTSD的患病率和临床特征.方法 根据DSM-Ⅳ有关PTDS的诊断标准,自编《一般情况调查表》等,于2003年5月12日调查爆炸幸存者100人.结果 受伤害重的学生比未受伤害的学生发生PTSD的比率高,总的发生率是17.2%.结论 重大灾难事件的心理危机干预,应涉及所有的相关人群.对PTDS患者应加强心理健康教育,并尽量减少外界不良应激源干扰.