灾后吸烟与创伤暴露及创伤后应激障碍的关系研究

目的 了解吸烟与创伤暴露及创伤后应激障碍(Post-traumatic stress disorders,PTSD)之间的关系.方法 对1056名参加汶川抗震救灾的一线救援军人PTSD的患病率及吸烟情况进行调查.结果 创伤暴露后,吸烟人数和吸烟量未有明显改变.PTSD组中吸烟率为76.8%,显著高于非PTSD组(60%).多元Logistic回归分析显示,服役满意度低、创伤暴露后患PTSD、军龄长是地震现场救援军人创伤暴露后吸烟行为增加的危险因素.结论 创伤暴露对吸烟无明显影响,吸烟主要与PTSD有关,吸烟会增加创伤暴露后患PTSD的危险,而患PTSD后又会增加吸烟的危险.     

住院地震伤残人员创伤后应激障碍及相关因素分析

目的 了解地震后100天住院地震伤残人员创伤后应激障碍(posttraumatic stress disorder,PTSD)的患病情况及相关因素.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5·12汶川大地震发生后100天仍在我院住院治疗的70例地震伤残人员,并对相关因素进行分析.结果 地震后100天住院地震伤残人员PTSD的患病率为26%;PTSD的发生与患者年龄、目前伤残程度、前期是否进行心理危机干预、家庭成员伤亡情况密切相关(P<0.01),与性别、文化程度等无关(P>0.05).结论 目前仍住院治疗的地震伤、残人员有较高的PTSD发生率,躯体残疾程度、亲人遇难和是否得到及时的心理干预是导致PTSD主要因素.在进行物理康复治疗的同时,应加强心理康复治疗.     

“5.12”两年后地震亲历者睡眠障碍与创伤后应激障碍的关联性探讨

目的 了解“5.12”地震2年后江油、北川安置点地震亲历者的睡眠质量、心理应激水平及两者关系,为创伤后应激障碍的进一步预测与治疗提供依据.方法 以匹茨堡睡眠质量指数量表(PSQI)、创伤后应激障碍筛查量表平民版(PCL-C)为调查工具,采用系统抽样方法,评估地震亲历者的睡眠质量和心理应激水平及二者的关联性.结果 PSQI测评结果显示地震2年后560例安置点亲历者中有33.8％发生睡眠障碍,7.5％发生创伤后应激障碍(PTSD);睡眠良好组中,PTSD阴性358例占96.5％,PTSD阳性13例占3.5％;睡眠障碍组中,PTSD阴性160例占84.7％,PTSD阳性29例占15.3％.PTSD阴性组中,睡眠良好358例占69.1％,睡眠障碍160例占30.9％;PTSD阳性组中,睡眠良好13例占31.0％,睡眠障碍29例占69.0％.PSQI总分与PCL-C总分呈显著正相关;睡眠障碍影响因素的Logistic分析显示:受灾程度重、年龄大、心理应激状况差是发生睡眠障碍的相关因素.结论 地震2年后板房灾民的睡眠质量、心理应激水平不容乐观.PTSD可引起睡眠障碍,同时睡眠障碍又会增加患PTSD的风险.     

急性心肌梗死患者创伤后应激障碍发生率及其影响因素分析

[目的]探讨急性心肌梗死（AMI）患者创伤后应激障碍（PTSD）的发生率及影响因素,为开展AMI患者心理干预提供依据.[方法]采用分层抽样的方法,使用创伤后应激障碍检查量表平民版（PCL-C）对240例AMI患者进行评估,并依据美国精神障碍诊断与统计手册上版（DSM-Ⅳ）中PTSD的诊断标准确诊PTSD患者,Logistic回归分析其影响因素.[结果]240例AMI患者中共检出PTSD阳性患者68例,PTSD检出率为28.3％.女性患者和高Killip分级患者的PTSD发生率高于男性患者和低Killip分级患者（P＜0.01）,PTSD阳性组（32.18±3.35）的SSRS得分显著低于PTSD阴性组患者（39.71±3.14）（P＜0.01）.女性（OR=3.015,95％CI：1.687～5.391）、高Killip分级（OR=3.614,95％CI：2.437～5.360）和SSRS评分低（OR=0.960,95％CI：0.941～0.979）是PTSD发生的危险因素.[结论]AMI患者PTSD症状发生率较高,女性、高Killip分级及低社会支持水平是PTSD发生的危险因素.     

汶川地震两年后重灾区护士创伤后应激障碍症状分析及干预对策

目的 调查分析“5.12”汶川地震2年后重灾区护士创伤后应激障碍(PTSD)的发生情况、症状特点和相关因素,并探讨有效的心理干预对策.方法 采用便利抽样,以绵竹重灾区5家医院233名参与过救援的护士为调查对象,采用自制的震后基本状况调查表、PTSD检查量表平民版(PTSD checklist-civilian version,PCL-C)进行调查.结果 震后2年护士PTSD筛查阳性率为1.7％,另有8.2％的人表现出不同程度的创伤后应激障碍症状;PTSD的特征性症状群中,最突出的为高警觉性症状;年龄36～57岁(中年)、职称为主管护师、离异或丧偶者、健康状况差、地震中受过伤的护士群体,其PTSD检出率较高;健康状况差、离异或丧偶为2年后护士PTSD症状的主要相关危险因素.结论 震后2年护理人员仍存在一定程度的PTSD,且具有其自身的特点,需引起关注,采取针对性的心理干预.     

创伤后应激障碍的基因学研究进展

创伤后应激障碍(PTSD)是一种特有的精神障碍疾病,需要潜在的创伤性生活事件,同时具有一定的遗传特征.创伤后应激障碍的遗传学研究方面已取得许多新进展.本文将对影响PTSD的5-HTTLPR、DRD2及其他相关的基因给予综述.     

住院癌症患者创伤后应激障碍发病率及影响因素

目的:调查住院癌症患者创伤后应激障碍(PTSD)的发病率及影响因素.方法:采用整群随机抽样,使用埃森创伤问卷(ETI)、临床用PTSD诊断量表(CAPS)对住院癌症患者进行评估,发放250份问卷并依据DSM-IV中PTSD的诊断标准确诊PTSD患者.结果:收回有效问卷211份,PTSD的临床检出率为11.0%(21/1...     

肋骨骨折术后患者并发创伤后应激障碍的相关危险因素分析

目的 探讨肋骨骨折术后患者并发创伤后应激障碍(PTSD)的相关危险因素。方法 选取2021年7月至2022年9月该院收治的80例肋骨骨折术后患者作为研究对象,按照是否发生PTSD将其分为PTSD组和非PTSD组。收集并比较两组的一般资料及问卷调查结果。采用Logistic回归分析肋骨骨折患者并发PTSD的危险因素。结果 80例患者中有23例发生PTSD,发生率为28.75%(PTSD组);剩余57例为非PTSD组。PTSD组女性比例高于非PTSD组,VAS评分高于非PTSD组,心理弹性评分低于非PTSD组,内向患者比例高于非PTSD组,中重度的自我感受负担患者比例高于非PTSD组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示女性、VAS评分≥4分、性格内向、中重度的自我感受负担是肋骨骨折患者并发PTSD的危险因素(P<0.05),心理弹性评分>60分是肋骨骨折患者并发PTSD的保护因素(P<0.05)。结论 肋骨骨折患者并发PTSD与患者为女性、疼痛较严重、心理弹性较差、内向、自我感受负担较重等因素有关,临床可据此采取措施来降低PTSD的...     

急诊科护士创伤后应激障碍流行病学特点及危险因素

创伤后应激障碍(Post traumatic stress disorder,PTSD)是对创伤等严重应激因素的一种重度精神反应,它发生在经历过灾难性事件的人群或特殊职业人群,对PTSD的研究利于结合医学、护理学与社会心理学知识来提高疗效.综述了国内外文献中急诊科护士PTSD的流行病学特点及危险因素,认为急诊科护士PTSD发生率高于一般人群,其危险因素包括创伤性事件、与工作相关的压力源、个体易感因素、社会支持及社会历史文化因素.指出护士是护理事业的主体,其身心健康直接关系到护理服务质量,呼吁社会各界高度重视急诊科护士PTSD问题,关注护士的身心健康,促进急救护理事业的发展.     

急性创伤后早期中性粒细胞/淋巴细胞与创伤后应激障碍发病的关系研究

目的:探讨急性创伤后早期炎症水平变化与创伤后应激障碍（posttraumatic stress disorder, PTSD）发病的关系。方法:选2018年1月至2020年6月因急性创伤至徐州医科大学附属医院就诊患者为研究对象。于入院当天及伤后第3天、第7天采集患者外周静脉血检测血常规、C-反应蛋白（C-reaction protein, CRP）及降钙素原（procalcitonin, PCT）等检验指标,计算中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）,1个月后使用PCL-5量表评估患者PTSD症状,以38分为界将患者分为PTSD组与非PTSD组。分析PTSD组和非PTSD组的NLR变化规律。结果:纳入创伤患者91例,其中PTSD组23例,非PTSD组68例。与健康对照组相比,91例创伤患者入院当天、第3天、第7天的NLR水平均升高（均 P< 0.01）,PTSD组在创伤后第7天的NLR值明显高于非PTSD组（ P= 0.025）;而非PTSD组则呈下降趋势,在创伤后第7天非PTSD组NLR值已明显低于入院当天（ P= 0.001）。此外,伤后7 d的NLR高水平（β= 0.206, P= 0.01）是影响PTSD发病的危险因素。 结论:动态监测急性创伤后的NLR值变化,对创伤后PTSD的早期预警具有重要的临床价值。     

PTSD and substance use: unrecognized sequelae of bioterrorism in primary care providers

BACKGROUND: Psychological casualties following public health emergencies are likely to significantly outnumber physical casualties. However, postevent psychological disorders may be underrecognized by primary care providers (PCPs). METHODS: Rural PCPs in northern and central Florida were interviewed using a series of open-ended questions to assess knowledge of likely mental disorders, their risk factors, and preferred treatment options following such events (n=21). RESULTS: PTSD was identified by 14% and substance abuse by 10% of the sample. Physicians were significantly more likely to identify posttraumatic stress disorder (PTSD) as an expected postevent psychological disorder than nonphysician providers. PCPs were significantly more likely to endorse counseling (86%) than medications (43%) as a preferred treatment option. CONCLUSIONS: Our findings support the need for increased education and training regarding the mental health consequences of bioterrorism in rural PCPs, particularly for nursing-level and other nonphysician providers. Improvements in knowledge may enhance preparedness for such emergencies.     

'It is still so deep-seated, the fear': psychological stress reactions as consequences of intimate partner violence

The negative mental health consequences of intimate partner violence have been well documented in recent years. One aim of the present study was to examine psychological distress and mental problems in assaulted women who have left their relationships. Another aim was to explore these women's sense of coherence (SOC). A combination of qualitative in-depth interviews and quantitative measurement instruments was used. Data were collected from 14 assaulted women with a mean age of 38, living in different places in Sweden. Impact of event scale-revised and symptom checklist-90-R show that the violence creates long-term psychological stress reactions and confirm previous research on the subject. Twelve of the 14 women have symptoms of post-traumatic stress disorder (PTSD). The result of the interviews confirmed complex PTSD and disorders of extreme stress not otherwise specified. On the other hand we found a surprisingly high SOC level among several of the respondents, a fact which could explain why these women finally managed to leave mainly by their own efforts. We call for more both qualitative and quantitative studies on this serious public health issue.     

PTSD in the Combat Veteran: Using Roy's Adaptation Model to Examine the Combat Veteran as a Human Adaptive System

Posttraumatic stress disorder (PTSD) is the most prevalent mental disorder arising from combat and is poised to be a considerable health risk for our military veterans. To date, there is a paucity of nursing research that examines PTSD in this vulnerable population. The purpose of this article is to demonstrate how Roy's Adaptation Model can be an effective framework for nurses to understand the phenomenon of posttraumatic stress disorder in the combat veteran population. Current research conducted on PTSD across other disciplines is highlighted within the context of Roy's model to elucidate the idea of the combat veteran as a human adaptive system and to identify gaps for future nursing research.     

Psychiatric Comorbidity of Chronic Daily Headache: Focus on Traumatic Experiences in Childhood,Post-Traumatic Stress Disorder and Suicidality

The fifth edition of the Diagnostic and Statistic Manual (DSM-5) reclassified some mental disorders recently. Post-traumatic stress disorder (PTSD) is in a new section termed “trauma- and stressor-related disorder”. Community-based studies have shown that PTSD is associated with a notably high suicidal risk. In addition to previous findings of comorbidity between chronic daily headache (CDH) and both depressive disorders and anxiety disorders, recent data suggest that frequency of childhood maltreatment, PTSD, and suicidality are also increased in CDH. CDH patients with migraine aura are especially at risk of suicidal ideation. Research suggests that migraine attack, aura, frequency, and chronicity may all be related to serotonergic dysfunction. Vulnerability to PTSD and suicidality are also linked to brain serotonin function, including polymorphisms in the serotonin transporter gene (5-HTTLPR). In the present review, we focus on recent advances in knowledge of traumatic experiences in childhood, PTSD, and suicidality in relation to migraine and CDH. We hypothesize that vulnerability to PTSD is associated with migraine attack, migraine aura, and CDH. We further postulate that these associations may explain some of the elevated suicidal risks among patients with migraine, migraine aura, and/or CDH. Field studies are required to support these hypotheses.     

Intimate partner violence and mental health symptoms in African American female ED patients

BackgroundIntimate partner violence (IPV) victims often seek care in the ED, whether for an injury from abuse or other sequelae such as mental health symptoms.ObjectivesThe objective of the study was to assess whether depressive symptoms, posttraumatic stress disorder (PTSD), and suicidality were associated with physical, sexual, or emotional IPV in African American female ED patients and to determine if experiencing multiple types of abuse was associated with increased mental health symptoms.MethodsAll eligible African American female patients were approached in the ED waiting room during study periods. Patients participated in the screening process via a computer kiosk. Questions regarding IPV and mental health symptoms were asked using validated tools.ResultsIn this prospective cohort, 569 participated and 36% of those in a relationship in the past year (n = 461) disclosed that there were victims of IPV in the past year. In the past year, 22% experienced recent physical abuse, 9% recent sexual abuse, and 32% recent emotional abuse. A Pearson correlation was conducted and showed that all mental health symptoms were positively correlated with each type of IPV and each type of mental health symptom category. Mental health symptoms increased significantly with amount of abuse: depression (odds ratio [OR], 5.9 for 3 types of abuse), PTSD (OR, 9.4 for 3), and suicidality (OR, 17.5 for 3).ConclusionsEmotional, sexual, and physical IPV were significantly associated with mental health symptoms. Each type of abuse was independently associated with depression, suicidality, and PTSD. Experiencing more than 1 type of abuse was also correlated with increased mental health symptoms.     

Psychological trauma in chronic pain: Implications of PTSD for fibromyalgia and headache disorders

The association of traumatic exposures with posttraumatic stress disorder (PTSD) and other mental health conditions is well known. Patients with chronic pain, particularly headache disorders and fibromyalgia (FM), associated with psychological traumas need a special management strategy. Diagnosis of headache disorders and FM in traumatized patients and collecting the clinical history of a traumatic event or diagnosing PTSD in chronic pain patients is of great importance. Psychotherapy and pharmacotherapeutic options should be started on patients with comorbid PTSD and headache disorders and/or FM.     

Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression. Part II--clinical applications and guidelines

Yogic breathing is a unique method for balancing the autonomic nervous system and influencing psychologic and stress-related disorders. Part I of this series presented a neurophysiologic theory of the effects of Sudarshan Kriya Yoga (SKY). Part II will review clinical studies, our own clinical observations, and guidelines for the safe and effective use of yoga breath techniques in a wide range of clinical conditions. Although more clinical studies are needed to document the benefits of programs that combine pranayama (yogic breathing) asanas (yoga postures), and meditation, there is sufficient evidence to consider Sudarshan Kriya Yoga to be a beneficial, low-risk, low-cost adjunct to the treatment of stress, anxiety, post-traumatic stress disorder (PTSD), depression, stress-related medical illnesses, substance abuse, and rehabilitation of criminal offenders. SKY has been used as a public health intervention to alleviate PTSD in survivors of mass disasters. Yoga techniques enhance well-being, mood, attention, mental focus, and stress tolerance. Proper training by a skilled teacher and a 30-minute practice every day will maximize the benefits. Health care providers play a crucial role in encouraging patients to maintain their yoga practices.     

Common data elements for posttraumatic stress disorder research

Kaloupek DG, Chard KM, Freed MC, Peterson AL, Riggs DS, Stein MB, Tuma F. Common data elements for posttraumatic stress disorder research.An expert work group with 7 members was formed under the cosponsorship of 5 U.S. federal agencies to identify common data elements for research related to posttraumatic stress disorder (PTSD). The work group reviewed both previous and contemporary measurement standardization efforts for PTSD research and engaged in a series of electronic and live discussions to address a set of predefined aims. Eight construct domains relevant to PTSD were identified: (1) traditional demographics, (2) exposure to stressors and trauma, (3) potential stress moderators, (4) trauma assessment, (5) PTSD screening, (6) PTSD symptoms and diagnosis, (7) PTSD-related functioning and disability, and (8) mental health history. Measures assigned to the core data elements category have relatively low time-and-effort costs in order to make them potentially applicable across a wide range of studies for which PTSD is a relevant condition. Measures assigned to the supplemental data elements category have greater costs but generally demonstrate stronger psychometric performance and provide more extensive information. Accordingly, measures designated as supplemental are recommended instead of or in addition to corresponding core measures whenever resources and study design allow. The work group offered 4 caveats that highlight potential limitations and emphasize the voluntary nature of standardization for PTSD-related measurement.     

Post-traumatic stress disorder: evidence-based research for the third millennium

The stress that results from traumatic events precipitates a spectrum of psycho-emotional and physiopathological outcomes. Post-traumatic stress disorder (PTSD) is a psychiatric disorder that results from the experience or witnessing of traumatic or life-threatening events. PTSD has profound psychobiological correlates, which can impair the person's daily life and be life threatening. In light of current events (e.g. extended combat, terrorism, exposure to certain environmental toxins), a sharp rise in patients with PTSD diagnosis is expected in the next decade. PTSD is a serious public health concern, which compels the search for novel paradigms and theoretical models to deepen the understanding of the condition and to develop new and improved modes of treatment intervention. We review the current knowledge of PTSD and introduce the role of allostasis as a new perspective in fundamental PTSD research. We discuss the domain of evidence-based research in medicine, particularly in the context of complementary medical intervention for patients with PTSD. We present arguments in support of the notion that the future of clinical and translational research in PTSD lies in the systematic evaluation of the research evidence in treatment intervention in order to insure the most effective and efficacious treatment for the benefit of the patient.     

Development of a Brief Mental Health Screen for Intimate Partner Violence Victims in the Emergency Department

Background: Emergency physicians routinely treat victims of intimate partner violence (IPV) and patients with mental health symptoms, although these issues may be missed without routine screening. In addition, research has demonstrated a strong association between IPV victimization and mental health symptoms.
Objectives: To develop a brief mental health screen that could be used feasibly in an emergency department to screen IPV victims for depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and suicidal ideation.
Methods: The authors conducted a pretest/posttest validation study of female IPV victims to determine what questions from the Beck Depression Inventory II, Posttraumatic Stress Diagnostic Scale, and Beck Scale for Suicide Ideation would predict moderate to severe levels of depressive symptoms, PTSD symptoms, and suicidal ideation. A principal components factor analysis was conducted to determine which questions would be used in the brief mental health screen. Scatter plots were then created to determine a cut point.
Results: Scores on the brief mental health screen ranged from 0 to 8. A cutoff score of 4 was used, which resulted in positive predictive values of 96% for the brief mental health screen for depression, 84% for PTSD symptoms, and 54% for suicidal ideation. In particular, four questions about sadness, experiencing a traumatic event, the desire to live, and the desire to commit suicide were associated with moderate to severe mental health symptoms in IPV victims.
Conclusions: The brief mental health screen provides a tool that could be used in an emergency department setting and predicted those IPV victims with moderate to severe mental health symptoms. Using this tool can assist emergency physicians in recognizing at-risk patients and referring these IPV victims to mental health services.