玉树地震伤员急性应激期睡眠问题分析

目的 了解和分析玉树地震伤员急性应激期睡眠问题.方法 2010年4月,对90例玉树地震伤员的急性应激反应采用创伤后应激障碍症状清单平民版(PCL-C)17项量表进行筛查评估,并应用SPSS 17.0软件进行统计学分析.结果 在PCL-C 17个条目中,提示睡眠障碍的条目2和条目13发生率分别为61.10%、63.30%...     

208例芦山地震伤员康复需求分析

目的调查并分析芦山地震伤员的创伤类型、功能受限情况,以及伤员的康复需求。方法采用地震伤员康复需求调查表调查四川大学华西医院收治的208例芦山地震伤员的康复需求。结果208例被调查伤员的创伤类型以骨折居首（138例）,其次为复合伤、软组织损伤、肺挫伤和截肢。绝大部分伤员的运动功能、平衡功能、日常生活活动能力出现障碍,80％以上患者出现疼痛,少部分人出现感觉异常、呼吸障碍。大量患者需要康复辅具及住院治疗。结论芦山地震伤员的创伤类型及功能受限情况决定了患者所需康复辅具,结合伤员对康复的要求,可为伤员“量身定制”康复治疗方案。康复医学的早期介入极有益于地震伤员的康复。     

地震伤员心理状况及康复护理心理干预措施效果评价

目的探讨不同年龄段的地震伤员恢复期和康复期心理护理。方法90例地震伤员按年龄分为4组分别进行心理护理,震后1年评估伤员是否存在创伤后应激障碍（PTSD）。结果震后1年伤员未发生PTSD。结论心理护理能改善地震伤员心理应激能力。     

5·12汶川大地震127例伤员心理健康状况分析

目的 了解地震伤员急性期应激心理状况,加强伤员的心理康复治疗.方法 对2008年6月13～20日收治的127例5·12大地震伤员采用90症状清单(SCL-90)进行心理评定.结果 52例伤员SCL-90总分>160分,最高分达298分,均存在不同程度的心理问题,主要表现为焦虑、抑郁、恐惧及其他症状.结论 震后灾民存在不同程度的心理健康问题,应高度重视急性期创伤应激障碍.     

玉树地震31例伤残藏民创伤后应激障碍分析

目的了解玉树地震后50天住院地震伤残人员创伤后应激障碍（posttraumatic stress disorder,PTSD）的患病情况。方法采用创伤后应激障碍检查量表平民版（PTSD Checklist-Civilian Version,PCL-C）调查玉树地震发生后50天地震伤残人员与同期骨科普通患者PTSD的发生情况,并进行比较。结果地震伤残人员PTSD发生率为48.4%,同期骨科普通住院患者PTSD发生率为0,差异有统计学意义（P〈0.01）。结论地震伤残人员PTSD发生率明显高于同期骨科普通住院患者。在对地震患者进行手术等物理治疗、康复时应同时加强对其进行心理康复治疗。     

5·12汶川大地震127例伤员心理健康状况分析

目的 了解地震伤员急性期应激心理状况,加强伤员的心理康复治疗。方法 对2008年6月13—20日收治的127例5·12大地震伤员采用90症状清单（SCL-90）进行心理评定。结果 52例伤员SCL-90总分〉160分,最高分达298分,均存在不同程度的心理问题,主要表现为焦虑、抑郁、恐惧及其他症状。结论 震后灾民存在不同程度的心理健康问题,应高度重视急性期创伤应激障碍。     

地震创伤后应激障碍症状观察及其危机干预

[目的]观察地震后创伤应激障碍(PTSD)的临床特征,及时给予护理干预。[方法]咨询由四川转运到我院的26例伤员及其家属,查阅病历,了解其受伤过程及症状表现。[结果]病人都出现不同程度的PTSD症状,其中睡眠障碍、不由自主回想地震经历、烦躁焦虑、难以集中注意力及惊吓反应为主要临床特征。[结论]地震灾区伤员有不同程度的PTSD症状和体征,护士发现问题应积极给予危机干预处理,可以避免PTSD的发生和加重。     

地震伤员创伤后应激障碍的护理干预

报告了对21例地震后创伤性应激障碍(PTSD)伤员的护理干预.运用心理创伤后应激障碍自评量表对伤员进行心理测评与创伤后应激障碍筛查,发病率为61.76%.根据结果给予不同的护理支持,包括评价病情并制定康复计划,密切观察举止行为、保证伤员的安全,提供温馨的治疗环境,争取社会支持与关心,并给予恰当的药物治疗和心理护理.本组大部分伤员PTSD症状部分或完全纠正,临床效果满意.     

110例四川汶川地震灾区伤员心理状况调查研究

目的调查四川汶川地震灾区伤员的心理状况,探讨重大自然灾害事件对灾区伤员心理状况的影响情况。方法采用90项症状自评量表(SCL-90)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、自制的灾区伤员一般情况调查表、睡眠情况调查表以及心理应激调查表,对110例四川汶川灾区伤员的心理状况进行调查。结果灾区伤员SCL-90各因子分均高于正常人群,差异有显著性(P<0.05),其中,躯体化、抑郁、焦虑和恐怖性因子分与常模相比较,差异十分显著(P<0.01)。HAMA总分>14分的有16例(14.5%);HAMD总分>20分的有21例(19.1%);睡眠量表总分>7分的有65例(59.1%);应激量表总分>10分的有51例(46.4%);具有明显的创伤后综合症并且符合中国精神障碍分类与诊断标准第3版(CCMD-3)中创伤后应激障碍(PTSD)症状学标准的有9例(8.2%);符合CCMD-3脑器质性精神障碍诊断标准的1例。结论地震对灾区伤员心理的影响是普遍而严重的,为灾区伤员提供早期的确当的心理治疗和干预是十分必要的。     

地震创伤后应激障碍症状观察及其危机干预

[目的]观察地震后创伤应激障碍（PTSD）的临床特征，及时给予护理干预。[方法]咨询由四川转运到我院的26例伤员及其家属，查阅病历，了解其受伤过程及症状表现。[结果]病人都出现不同程度的PTSD症状，其中睡眠障碍、不由自主回想地震经历、烦躁焦虑、难以集中注意力及惊吓反应为主要临床特征。[结论]地震灾区伤员有不同程度的PTSD症状和体征，护士发现问题应积极给予危机干预处理，可以避免PTSD的发生和加重。     

汶川大地震受灾者创伤后应激症状及危险因素

目的:探讨大地震受灾者的心理健康状况、创伤后应激障碍(PTSD)症状及其影响因素,为心理救助及康复提供依据。方法:2008年四川汶川大地震1个月后,采用事件影响量表(IES)、症状自评量表(SCL-90)和受灾情况表对57例受灾者进行创伤后应激障碍症状、情绪障碍及人口学资料调查,根据诊断分为PTSD组与非PTSD组进行对照比较,并与60例医院健康体检人群进行对照比较。结果:①地震受灾组的IES总分、闯入因子、回避因子、警觉性因子、躯体化、抑郁、焦虑和其他项目因子分均高于正常对照组,差异有显著性意义(P<0.01),地震受灾组的SCL-90总分和抑郁因子分高于正常对照组,差异有显著性意义(P<0.05);②PTSD组的教育程度在小学及以下的比例、被困比例和伤残比例均高于非PTSD组,差异有显著性意义(P<0.05),PTSD组的一级亲属死亡比例、无家人支持比例均高于非PTSD组,差异有显著性意义(P<0.01)。结论:地震受灾者灾后1个月存在明显创伤后应激症状、躯体化、抑郁、焦虑、眠差等表现,心理救助和康复较为必要,应重点关注导致伤残、教育程度低、有被困经历、丧失亲人、缺少家庭支持的地震受灾个体。     

Correlations between psychosocial factors and psychological trauma symptoms among rescue personnel

During large-scale, sudden-onset disasters, rescue personnel experience severe stress due to the brief window of opportunity for saving lives. Following the earthquake in Haiti, rescue personnel worked in Port-au-Prince under harsh conditions in order to save lives and extricate bodies. Reactions to this disaster among rescue personnel were examined using self-report questionnaires. Correlations between psychosocial factors and psychological trauma (dissociation and post-traumatic stress disorder (PTSD) symptoms) were examined in a sample of 20 rescue personnel who worked in Haiti. The study indicated that negative affect and crisis of meaning were associated with higher levels of dissociative and PTSD symptoms. The results suggest that rescue personnel who are overwhelmed by the destruction and number of bodies being extricated may exhibit negative affect and loss of meaning along with dissociative and PTSD symptoms.     

Risk factors for adolescent alcohol use following a natural disaster

AbINTRODUCTION: On 29 March 1998, a series of category F-3 and F-4 tornadoes caused wide-spread destruction in four rural southern Minnesota counties in the United States. Extensive research has examined the impact of disaster exposure on adults' psychological functioning, including alcohol use. However, there has been little research on potential risk factors for adolescents' alcohol use following disaster exposure. HYPOTHESIS: It was hypothesized that demographic variables such as age and gender, prior drinking involvement, extent of prior trauma history, level of disaster exposure, and current disaster-related, post-traumatic stress disorder (PTSD) symptomatology would predict alcohol use among adolescents. METHODS: Six months following a natural disaster, survey data were collected from 256 adolescents assessing these factors. Risk factors for adolescents' alcohol use were identified using hierarchical, multiple regression and logistic regression analyses. RESULTS: Greater age, prior drinking involvement, and the extent of prior trauma history were significantly associated with higher levels of binge drinking. Prior trauma history and current levels of disaster-related PTSD symptomatology were significant risk factors for adolescents' report of increases in their alcohol consumption since the tornado. CONCLUSION: In general, the extent of trauma exposure was associated with greater binge drinking among adolescents. Similar to adults, post-traumatic stress symptoms experienced in the aftermath of a disaster can lead to increased alcohol consumption among adolescents.     

Diagnosis and management of post-traumatic stress disorder

Although post-traumatic stress disorder (PTSD) is a debilitating anxiety disorder that may cause significant distress and increased use of health resources, the condition often goes undiagnosed. The lifetime prevalence of PTSD in the United States is 8 to 9 percent, and approximately 25 to 30 percent of victims of significant trauma develop PTSD. The emotional and physical symptoms of PTSD occur in three clusters: re-experiencing the trauma, marked avoidance of usual activities, and increased symptoms of arousal. Before a diagnosis of PTSD can be made, the patient's symptoms must significantly disrupt normal activities and last for more than one month. Approximately 80 percent of patients with PTSD have at least one comorbid psychiatric disorder. The most common comorbid disorders include depression, alcohol and drug abuse, and other anxiety disorders. Treatment relies on a multidimensional approach, including supportive patient education, cognitive behavior therapy, and psychopharmacology. Selective serotonin reuptake inhibitors are the mainstay of pharmacologic treatment.     

Punishing the Self: Post-Traumatic Guilt Mediates the Link Between Trauma and Deficient Pain Modulation

Trauma survivors may suffer from post-traumatic stress disorder (PTSD), elevated post-traumatic guilt (PG), and alterations in the pain system. However, the association between PG and alterations in pain perception and modulation among trauma survivors has not been established, nor has the possible underlying role of PG. This longitudinal study investigated: 1) the unique contribution of PG in predicting pain perception and modulation, while controlling for PTSD symptoms; and 2) the mediating role of PG in explaining pain perception and modulation among torture survivors, above and beyond PTSD symptoms. Participants were 59 torture survivors and 44 age-matched controls. PG and PTSD symptoms were assessed in 2003 (T1). Heat-pain threshold, heat-pain tolerance, temporal summation of pain (TSP), and conditioned pain modulation (CPM) were measured 5 years later (T2). Torture survivors had elevated PG and PTSD symptoms, enhanced TSP, and reduced CPM, compared to controls. While PTSD predicted reduced pain tolerance and CPM, PG predicted increased pain tolerance. Moreover, PG mediated the associations between torture and (increased) pain threshold, pain tolerance, and TSP. It appears that PTSD and PG induce opposite effects on the pain modulation capacity of torture survivors, a dichotomy that may explain paradoxical pain responses among trauma survivors, as discussed.PerspectiveThis longitudinal study sheds light on the possible mechanisms underlying variations in pain perception and modulation among trauma survivors. PTSD and PG each mediated opposing pain modulation profiles, suggesting that individual responses to trauma, rather than the trauma itself, influence pain responses.     

创伤后应激障碍和创伤后成长的负相关性

目的:研究创伤后应激障碍(PTSD)与创伤后成长(PTG)的关系。方法:对汶川地震灾区5所学校共12个班的560位学生进行问卷调查。结果:灾区学生PTSD与PTG显著负相关;以班为单位,PTSD均值与PTG均值显著负相关。回归分析结果显示,在PTSD均值的变异中,有72.6%的变异由PTG均值引起。结论:PTG的产生能够有效降低PTSD症状,预防PTSD发生。     

Family-centered care and post-traumatic stress disorder

A year has passed since a major earthquake and tsunami hit northeastern Honshu, Japan in March 2011. Amidst mourning for the tens of thousands of victims, survivors have just begun the difficult and urgent tasks of rebuilding. Many survivors suffer from post-traumatic stress disorder (PTSD). PTSD causes chronic, long-term suffering for patients and their families and inevitably burdens social and medical care systems. This article tries to integrate PTSD evidence-based treatment experiences into a practical and detailed nursing intervention protocol for PTSD. We also elicit the function and effect of "family-centered care." We hope that nursing professionals apply family-centered care principles to PTSD treatment and care approaches in order to promote PTSD patient resilience. Nurses can thus enhance PTSD care efficacy and improve the opportunity for PTSD patients to overcome their symptoms and recover their life.